Intersectional disparities in mental healthcare utilization by sex and race/ethnicity among US adults: An NHANES study

Mental healthcare utilization in the US remains low, with persistent disparities observed across population groups. However, little is known about how sex and race/ethnicity jointly shape access to care. Intersectionality theory highlights the need to examine these dimensions together, as their combined influence may produce unique disadvantages not captured in single-axis analyses. This study utilized data from the 2009-2018 cycles of the National Health and Nutrition Examination Survey (NHANES). The relative differences (prevalence ratios) of mental healthcare utilization across intersecting sex and racial/ethnic groups were estimated using design-based log-binomial models. The absolute measure (prevalence differences) across these intersectional groups were obtained using linear probability regression models. Stratified analyses were conducted to examine how socioeconomic and need-related factors modified disparities. Overall, 9.1% of adults reported accessing mental health services in the preceding year. Marked disparities were observed across the intersectional groups. Hispanic males had the lowest utilization rates compared to Non-Hispanic (NH) White males, with an adjusted prevalence ratio (aPR) of 0.59 [95% CI: 0.47-0.73]. Among females, all minority racial/ethnic groups reported lower utilization compared with NH White females with aPRs ranging from 0.73 to 0.81. Within racial/ethnic groups, women generally accessed care more than men, though the magnitude of sex differences varied. Stratified analyses showed that disparities were magnified among those without insurance and attenuated at higher income levels. These results show that sex and race/ethnicity jointly shape patterns of mental healthcare utilization in the United States, producing compounded disadvantages for specific groups such as Hispanic men. Stratified analyses suggest that socio-economic status may modify these disparities, pointing to the role played by systemic inequities. These findings underscore the importance of intersectional approaches in population mental health research and policy. Future research should consider additional intersecting identities including sexual orientation and disability.