Demographic, socioeconomic, and health correlates of unmet need for mental health treatment in the United States, 2002–16: evidence from the national surveys on drug use and health

Abstract

Background Unmet need for mental health services remains high in the United States and is disproportionately concentrated in some groups. The scale and nature of these disparities have not been fully elucidated and bear further scrutiny. As such, in this study, we examine the demographic, socioeconomic, and health correlates of unmet need for mental health treatment as well as the reasons for unmet need. Methods We draw upon the National Survey for Drug Use and Health (NSDUH) from 2002 to 16 for adults aged 18 and over in the United States ( n = 579,017). Using multivariable logistic regression, we simultaneously model the demographic, socioeconomic, and health correlates of unmet need for mental health treatment from 2002 to 16. We also analyse the reasons for unmet need expressed by these populations, reasons which include cost, perceived stigma, minimisation of symptoms, low perceived effectiveness of treatment, and structural barriers. Results Major characteristics associated with increased odds of unmet need include past year substance abuse or dependence (other than hallucinogens and sedatives), fair, poor, or very poor health, being female, and an educational attainment of college or higher. With respect to reasons for unmet need, cost was most often cited, followed by perceived stigma, structural barriers, and minimisation. Characteristics associated with increased odds of indicating cost as a reason for unmet need include: being uninsured or aged 26–35. Minimisation and low perceived effectiveness are mentioned by high-income persons as reasons for unmet need. College-educated persons and women had higher odds of citing structural barriers as a reason for unmet need. Conclusions The correlates and causes of unmet need highlight the intersectionality of individual health needs with implications on addressing inequities in mental health policy and practice.

Unmet mental health needs in the general population: perspectives of Belgian health and social care professionals

“…Despite these limitations and contextual remarks, we can conclude that our ndings are in line with those of epidemiological studies. According to our participants, UMHNs are most prevalent in vulnerable groups such as people living in poverty, ethnic minorities, and in the young and old age groups (11,21,22).…”

“…Our study con rms that attitudinal barriers and not recognizing a need for care play a major role in the development of UMHNs. Interventions focusing on mental health literacy and de-stigmatization of mental health problems may help to recognize needs and to overcome attitudinal barriers (6,11,35). 'Worrisome care avoiders' were particularly mentioned in this context as a group with high UMHNs for which specialized outreach interventions are needed.…”

“…Vulnerable groups are generally more likely to underuse or experience access barriers to health care, resulting in high levels of UMHNs (20). Groups with a high level of UMHNs include the young and the elderly, ethnic or cultural minorities, people with poorer health and people with lower income (11,(21)(22)(23).…”

“…Also patients with more complex needs are less likely to receive appropriate care, such as those with a longer disease course, comorbidities and substance abuse (10,11,21,22).…”

“…The more severe the disorder, the more likely one is to face structural barriers to mental health care (27,29). Cost of services was the most often cited reason for UMHNs in a recent large-scale study in the United States (11). In addition to increasing service provision, existing services should therefore also be optimized in terms of access, use, effectiveness and e ciency (10).…”