Rethinking Mental Healthcare Disparities: The Role of Social Drivers Beyond Poverty

Importance: Understanding which social drivers of mental health (SDoMH) influence disparities in mental healthcare access can inform inequity reducing policies. Objective: The objective was to assess how age, sex, race and ethnicity, education, employment, citizenship, income, marital status, sexual orientation, and residential setting affect mental healthcare receipt while controlling for healthcare access, health status, insurance, and mental illness severity. Results: We analyzed a total of 117,938 (62,865 [53.3%] women; 39,785 [33.7%] non‐white; mean [SD] age, 53.0 (18.4) years) individuals, representing 254,161,543 adults through weighted sampling. For those reporting yearly depression/anxiety, being female (depression (D)‐OR 0.58, p < 0.001 and anxiety (A)‐OR 0.57, p < 0.001); non‐Hispanic White (D‐OR 0.49, p < 0.001 and A‐OR 0.45, p < 0.001); employed (D‐OR 1.46, p < 0.001 and A‐OR 1.35, p < 0.001); a US citizen (D‐OR 0.55, p < 0.001 and A‐OR 0.54, p < 0.001); and nonheterosexual (D‐OR 0.65, p < 0.001 and A‐OR 0.61, p < 0.001) influenced the odds of going without antidepressant or anxiolytic medication. Income did not affect these odds (D‐OR 1.00, p = 0.401 and A‐OR 1.00, p = 0.936). When switching the population to those with monthly or daily depression/anxiety and when swapping outcomes with mental health counseling or either medication or mental health counseling, income still exerted no substantial effects on receiving mental healthcare. Conclusions and Relevance: We demonstrate that after controlling for numerous previously established SDoMH, income did not influence mental healthcare access. Our findings suggest a reconsideration of traditional frameworks that uphold poverty as the primary factor contributing to mental illness and the largest barrier to mental healthcare, suggesting that the socioeconomic factors that drive income disparities in the United States may be what truly shape mental healthcare access.