Sociodemographic disparities, healthcare system trust, and social support in mental health treatment among U.S. adults with depressive or anxiety symptoms

Large and persistent sociodemographic disparities in rates of mental health treatment in the United States have been reported, but whether these differences reflect institutional mistrust or limited social support remains unclear. This study described current treatment use among American adults with moderate-to-severe depressive or anxiety symptoms and examined whether trust in health care institutions and availability of emotional support were associated with lack of treatment. A cross-sectional analysis was conducted using data from a nationally distributed, web-based opinion survey of 9733 American adults with moderate-to-severe depressive or anxiety symptoms (Patient Health Questionnaire-9 score ≥10 and/or Generalized Anxiety Disorder-2 score ≥3). The survey was fielded April 10th-28th, 2025, using quota sampling for age, gender, race, ethnicity, education, U.S. census region, and urbanicity; post-stratification weights approximated the U.S. adult population. The primary outcome was no current mental health treatment (neither antidepressant nor psychotherapy use). Weighted logistic regression estimated odds ratios for treatment absence by sociodemographic characteristics, trust in physicians and hospitals, scientists and researchers, the Centers for Disease Control and Prevention, pharmaceutical companies, and emotional support. Among 9733 adults with elevated symptoms, 66.3 % reported no current treatment. Racial and ethnic minority groups, men, and those born outside the United States had higher odds of being untreated, while public insurance predicted lower odds. Lower trust in doctors and hospitals, lower trust in science, and lack of emotional support each independently predicted treatment absence, but inclusion of these variables did not meaningfully attenuate sociodemographic disparities.