Associations of COVID-19 history, substance use, and mental illness with mental health treatment utilization in the United States: age and gender differences

< 0.05). Gender-stratified analyses indicated that COVID-19 history, alcohol use, and physical activity were significant predictors of MHT utilization among females only, whereas former cigarette smoking was associated with MHT utilization among males. Age-stratified analyses showed that female, health insurance coverage, and the presence of anxiety or depression were consistently associated with higher MHT use across all age groups. Higher educational attainment was associated with increased MHT utilization among adults aged 26-45 years. Among middle-aged (46-64 years) and older adults (≥65 years), COVID-19 history, current e-cigarette use, former cigarette smoking, and long sleep duration were linked to greater MHT utilization. Former e-cigarette use and current alcohol consumption were associated with MHT use among adults aged 26-45 years and ≥65 years, while moderate physical activity was positively associated with MHT utilization among older adults. These findings underscore the need for integrated post-COVID mental health and substance-use screening and for age- and gender-responsive strategies to improve equitable access to mental health care.