Poster #97 - Disparities in Unmet Mental Health Care Need by Race, Ethnicity, and Limited English Proficiency: National Analysis

• In Event: Friday Poster Reception

Abstract

Background:
Racial/ethnic minority populations in the United States are less likely to receive mental health services and more likely to experience lower quality care. In 2022, 28% of White adults report receiving counseling or prescription medication for mental health conditions in the past year, compared to16% of Hispanic and Black adults and 9% of Asian adults. Prior studies often rely on non-nationally representative data or aggregated racial/ethnic categories, potentially masking important within group disparities. This includes differences by English proficiency, a barrier to care that remains underexplored. This study examined disparities in unmet mental health care need across racial/ethnic groups and by English proficiency using the National Survey on Drug Use and Health (NSDUH).

Methods:
We analyzed pooled 2022-2023 data from NSDUH, a nationally representative survey of U.S. adults.  Mental health service use was defined as receipt of inpatient, outpatient, or prescription treatment in the past year. Unmet need was defined as having any mental health illness (AMI) without receiving any services. Survey-weighted descriptive analyses and multivariable logistic regression models were conducted to examine disparities in unmet mental health needs by racial/ethnic groups and English proficiency.

Results:
From January 2022 to December 2023, 60.2% (95% CI: 59.1–61.3) reported unmet mental health care need among adults with AMI (unweighted n = 22,469). Compared to NH White adults, higher odds of unmet need were observed among NH Asian (OR=2.94, 95% CI: 2.08–4.17), NH Black (OR=2.40, 95% CI: 1.98–2.92), Hispanic (OR=1.90, 95% CI: 1.63–2.21), NH American Indians and Alaska Natives (AI/AN) (OR=1.84, 95% CI: 1.28–2.64), NH Multiracial (OR=1.39, 95% CI: 1.10–1.76), and NH Native Hawaiian or Other Pacific Islander (NHPI) (OR=10.76, 95% CI: 3.80–30.47) individuals. Approximately 13% of respondents reported limited English proficiency, with little variation within some groups (e.g., >90% of NH White and NH Black adults were proficient). Adults with limited English proficiency had higher unmet need than proficient peers (72.4% vs. 58.6%). These disparities persisted after adjusting for insurance, socioeconomic, and geographic factors. Limited English proficiency was also independently associated with higher odds of unmet need (OR=1.34, 95% CI: 1.06–1.68).

Discussion:
This study provides nationally representative evidence of persistent disparities in unmet mental health care need across racial/ethnic groups in the U.S. Using disaggregated categories, we find disproportionate burden among nearly all non-White populations, patterns that aggregated analyses would obscure. The persistence of disparities after adjusting for insurance, socioeconomic status, and geography may suggest that financial and structural barriers alone do not fully explain gaps in mental health utilization; cultural factors, discrimination, and system mistrust may also contribute. Limited English proficiency represents an additional, distinct dimension of inequity, reinforcing the need for language-concordant care and multilingual mental health resources. Progress requires culturally and linguistically appropriate service delivery, mental health workforce diversification, and targeted outreach for underserved groups, particularly NH NHPI and NH AI/AN adults who remain underrepresented in health data and policy.

Author

• PhiYen Yasmin Nguyen, New York University
  Presenting Author