Perceived Need for Care and Mental Health Service Use: The Moderating Effect of Race/Ethnicity and Military Veteran Status among a Population-based Sample of U.S Adults

Abstract

Background: Black, Indigenous, and People of Color (BIPOC) adults and military veterans are susceptible to chronic and severe mental illness given their higher likelihood of exposure to risk factors compared to the general population. Despite the consequences of untreated mental illness and federal initiatives aimed at expanding healthcare access, treatment utilization among both groups remains low relative to treatment need. Research has found significant racial and ethnic differences in perceived need for care (PNC) and severity of psychological distress, important antecedents of treatment seeking. However, the extent to which these factors apply to veterans has not been widely examined. Using the Behavioral Model of Health Services Use (Andersen, 1995) and Behavioral Model for Vulnerable Populations (BMVP, Gelberg et al., 2000), this dissertation aimed to address these gaps in the existing literature given their significance to ongoing research, policy, and intervention efforts.

Methods: Data were drawn from the 2018 National Survey on Drug Use and Health (N = 43,026). Binary logistic regression was used to examine the associations of PNC and symptom severity with mental health service use among veterans and nonveterans of diverse racial and ethnic backgrounds with interaction terms for race/ethnicity and veteran status.

Results: PNC and symptom severity are associated with higher probabilities of mental health service use. However, there are differences in the adjusted probabilities in mental health service use favoring White nonveterans. Veteran status moderates these associations such that the probabilities of mental health service use were stronger for veterans than nonveterans who reported PNC, except for Asian veterans.

Conclusions: Veteran status moderates some longstanding racial and ethnic disparities in mental health service use. Further research is needed, particularly among Asian veterans, to identify factors that contribute to lower probability of mental health service use in comparison to White adults, and to identify ways to leverage the effectiveness of interventions employed among veterans in support of other vulnerable groups.