Mental health help-seeking in New York City: How intersecting identities shape informal and formal support use

INTRODUCTION: This study investigated how intersecting identities, including race and ethnicity, gender, socioeconomic status, and immigration-related characteristics, impact help-seeking for emotions, nerves, or mental health among New York City (NYC) adults. It also identified primary sources of informal and formal support. METHODS: Using a citywide representative sample of 43,606 non-institutionalized adults, data were collected between May and September 2023. Log-linear regression models assessed main effects and conditional effects (i.e., interactions) of sociodemographic and immigration-related characteristics on mental health help-seeking in the past 12 months. Predicted probabilities from models with significant interaction terms illustrated intersectional impacts. Sensitivity analyses among participants with past 30-day moderate-to-high psychological distress tested robustness of these findings. RESULTS: Approximately 46.6% of adults sought any mental health support, with 36.2% seeking informal support and 24.2% seeking formal support. Family/friend (33.1%) and therapist/counselor (16.8%) were the most common informal and formal sources, respectively. Significant interactions for any help-seeking emerged between race and ethnicity with gender (p = 0.003), employment status (p < 0.001), place of birth (p < 0.001), and English proficiency (p < 0.001). These interactions held for both formal and informal support, except there was no significant interaction with gender for informal support nor with English proficiency for formal support. Sensitivity analysis among those with past 30-day moderate-to-high psychological distress produced similar findings compared to all adults. CONCLUSIONS: Mental health help-seeking in NYC varies significantly across intersecting social identities, highlighting disparities linked to race and ethnicity, gender, immigration status, and language proficiency. Addressing these disparities requires improving accessibility and cultural relevance of formal mental health services while recognizing and strengthening trusted informal support systems.