Predictors of Unmet Mental Health Needs Among Young Adults with Mental Illness in a U.S. Nationally Representative Sample

Background

High prevalence of mental illness among young adults is highlighted in recent studies. Young adults’ unmet needs for mental health treatment might result in disabling chronic mental illnesses and therefore cause negative long-term developmental outcomes to full adulthoods. However, limited research has focused on the extent and predictors of perceived unmet need for mental health treatment among young adults with mental illness in U.S. This study utilizes the Andersen’s Behavioral Model of Health Services Use to answer the two overarching research questions: (1) What are the predictors associated with perceived unmet needs for mental health treatment among young adults with mental illness? (2) Among those reporting unmet needs, what are the barriers and the predictors to these barriers?

Methods

Using data from the 2012-2013 National Survey on Drug Use and Health, the sample is from an independent multistage probability sample of the 50 states and the District of Columbia. The study focuses on non-institutionalized young adults age 18 to 25 with mental illness. Independent variables were organized as predisposing factors (gender, race-ethnicity, educational attainment, employment status), enabling factors (household income, health insurance) and need factors (mental illness severity, substance abuse/dependence and self-rated health status). Four binary logistic regression models were performed. The first dependent variable for the study is a dichotomous variable representing past year perceived unmet needs for mental health treatment. Individuals reporting having unmet needs were then followed by asking reasons for unmet needs; these barriers were grouped into three categories and served as three dichotomous dependent variables for the study: financial and access barriers, stigma avoidance, and negative attitudes toward mental health treatment. Geographic region is the covariate for the study.

Results

A total of 3,623 young adults with mental illness were included in the study, and 1,005 (28%) of them reported unmet needs for mental health treatment past year. The multivariate analysis indicated that female gender, White ethnicity, higher level of education, self-rated poorer health status, having moderate and serious mental illness and having substance abuse/dependence issues are positively related to unmet needs for mental health treatment. The most common identified barriers for not seeking needed treatment was a concern about cost and access (70%), followed by stigma avoidance (39%) and negative attitude towards mental health treatment (34%). Three separate binary logistic regressions indicated that financial and access barriers are positively related to lack of health insurance, higher level of education and female gender; stigma avoidance is positively related to having health insurance and higher mental illness severity; finally, negative attitudes towards treatment is positively related to having health insurance.

Conclusions and Implications

Unmet mental health needs are widespread, especially for those young adults who are experiencing more severe mental illness and adverse health conditions. Findings imply a need to reconsider the roles of gender and health insurance in predicting barriers for unmet needs. Future research should examine the relationships among psychosocial variables or help-seeking behaviors that might also affect young adults’ perceived unmet needs.