Intersectional Disparities in Mental Healthcare Utilization by Sex and Race/Ethnicity among US Adults: An NHANES Study

IntroductionMental healthcare utilization in the US remains low, with sociodemographic factors like sex and race/ethnicity influencing access across different population groups. However, how these factors interact to shape service utilization remains understudied. MethodsUsing data from the 2009-2018 cycles of the National Health and Nutrition Examination Survey (NHANES), we employed design-based log-binomial models to estimate the relative differences (prevalence ratios) of mental healthcare utilization across intersecting sex and race/ethnic groups. To assess the absolute differences, we used linear probability regression models to estimate the prevalence differences across these intersectional groups. We also conducted stratified analyses by education, income, health insurance, and depression status, to examine whether disparities persisted across socioeconomic and health-related subgroups. ResultsOverall, 9.1% of adults reported accessing mental health services in the past year. Hispanic males had the lowest utilization rates compared to Non-Hispanic (NH) White males, with an adjusted prevalence ratio (aPR) of 0.59 [95% CI: 0.47-0.73]. Among females, significant disparities were observed across all race/ethnic minority groups with NH Black and Hispanic females having significantly lower utilization rates compared to NH White females. Absolute prevalence differences mirrored the relative measures. Stratified analysis were largely consistent with primary results but revealed some variation across education, income and health insurance strata. DiscussionThese findings reflect how intersecting sociodemographic characteristics, specifically sex and race/ethnicity, influence utilization of mental health services. Stratified results suggest that socio-economic status may modify these disparities, pointing to the role played by systemic inequities. Hence, culturally informed strategies and wider structural interventions are needed to address these disparities. Future research should consider additional intersecting identities (e.g., sexual orientation and disability) and investigate socio-structural approaches to reducing these gaps.