Disparities in mental health service utilization among adolescents with depression: Results from a 2022 U.S. National Survey

The prevalence of adolescent depression has increased following the COVID-19 pandemic, and adolescent depression is often under-treated. The emergence of new barriers resulting from the COVID-19 pandemic limited existing efforts to address pre-existing inequalities in appropriate mental health treatment utilization. We analyzed data from adolescents with major depressive episode (MDE) in the 2022 U.S. National Survey on Drug Use and Health to examine mental health service utilization by rurality, race/ethnicity, gender, age, health insurance coverage, and poverty level. We applied analytic weights to estimate nationally representative estimates and account for survey nonresponse. Multivariate logistic regression identified significant disparities in the use of mental health services. The 2022 NSDUH assessed adolescent MDE based on past-year self-reported depressive symptoms based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. Among the 19.2% of adolescents aged 12-17 who experienced MDE, only 47.5% received treatment within the past year. Adolescents in rural areas had significantly lower odds of receiving specialist treatment compared to their urban counterparts [adjusted odds ratio (AOR) 0.64 (95% confidence interval (CI) 0.47-0.87)]. Odds of receiving telehealth services were significantly lower for rural adolescents [AOR 0.64 (95% CI 0.44-0.93)] but were significantly higher for adolescents with insurance (public insurance [AOR 2.99 (95% CI 1.10-8.14)] and private insurance [AOR 3.82 (95% CI 1.39-10.49)]). Older adolescents had lower odds of utilizing school-based services than younger adolescents [AOR 0.52 (95% CI 0.38-0.71)]. Females had greater odds and Black adolescents significantly lower odds of utilizing any mental health treatment relative to males and non-Hispanic White adolescents, respectively [Females: AOR 1.59 (95% CI 1.11-2.28); Black: AOR 0.36 (95% CI 0.22-0.59)]. Our findings continue to illustrate the persisting inequity in mental health treatment among adolescents from marginalized groups amidst the COVID-19 pandemic. Tailored strategies to address these inequities are needed.