Racial Differences in Mental Healthcare Service Use Outcomes during the Coronavirus-2019 Pandemic

Background and Purpose

The 2019 coronavirus outbreak impacted mental health needs and service delivery. The social work Grand Challenges highlight the need to address access and inequitable health outcomes. To increase mental healthcare access across racial groups, social workers should understand factors related to accessibility during the pandemic to direct policy changes and implementation research. This paper describes and compares differential predictors of mental healthcare utilization during the pandemic across white, Black, and multiracial groups.

Methods

This paper uses the Household Pulse Survey (HPS) collected December 9-21, 2020 and examines the impact of COVID-19 on social determinants of health and personal wellbeing. The current analysis used Anderson’s Health Behavior Model to examine mental healthcare access with variables of service utilization, inaccessibility of desired mental health services, and mental health prescription use (MHPU). Predisposing characteristics include generation, gender, education, and self-rated health status. Frequency measures of depression and anxiety symptoms are categorized as perceived needs. Enabling resources encompass income, perceived difficulty paying expenses, and whether individuals hold either private or public insurance

Results

11.84% of whites received mental health service (n=4,781) compared to 11.90% of Blacks (n=373) and 14.55% of multiracial (n=337). 12.05% of white individuals (n=4,865) reported being unable to access needed mental health services compared to 14.51% of Black respondents (n=455) and 17.62% of multiracial respondents (n=408). 25.76% (n= 10,402) of white individuals accessed mental health medication compared to 17.29% of Black (n=542) and 23.96% of multiracial (n=555).

Income was not associated with service use, inaccessibility or MHPU for Black and multiracial groups. Among whites, females were more likely to use services (OR=1.53, p<0.001), increased depression frequency was most associated with service inaccessibility (OR=1.81, p<0.001), and females were more likely to use mental health prescriptions (OR=2.02, p<0.001). Among Blacks, those with public insurance had the largest effect size for service use (OR=2.09, p<0.001), frequency of anxiety symptoms was most associated with service inaccessibility (OR=1.64, p<0.001), and insurance status was most associated with MHPU (OR=1.54, p<0.001). For multiracial individuals, public insurance status was most associated with service use (OR=1.86, p<0.001), females (OR=1.67, p<0.001) and those with frequent anxiety symptoms (OR=1.64, p<0.001) were most likely to experience service inaccessibility, and insurance status was most associated with MHPU (OR= 1.89, p<0.001).

Discussion and Conclusion

The results indicate differential association in mental health accessibility and medication use based on gender, insurance status, and experience of mental health symptoms. Social workers should use implementation science, or the study of how an evidence-based practice is put into use, to build on the current study and provide additional insights to improve access. As mental healthcare providers and advocates for marginalized groups, social work practitioners and scholars should use dissemination and implementation strategies to address these different racial factors and improve mental healthcare access.