Racial and Ethnic Differences in Mental Health Service Use Among Adolescents.

Importance: The delivery of mental health services to US adolescents has changed significantly in recent years, especially with the increased use of telemental health. More data are needed to understand the implications for racial and ethnic differences in adolescent mental health care use. Objective: To examine racial and ethnic differences in mental health service use among US adolescents in the most recent national survey data. Design, Setting, and Participants: This cross-sectional study used 2022 to 2023 US national survey data to estimate racial and ethnic differences in mental health service use through weighted logistic regressions, controlling for sociodemographic characteristics and health status. Adolescents participating in the National Survey on Drug Use and Health in 2022 to 2023 were included. Exposure: Racial and ethnic group. Main Outcomes and Measures: Dichotomous indicators of mental health treatment type included receipt of any mental health visit (medical setting), prescription medication, support group, or peer support specialist or recovery coach service. Treatment settings were assessed with indicators of mental health services received in outpatient, telehealth, school, inpatient, and emergency department settings. Results: The overall sample included a total of 23 541 adolescents aged 12 to 17 years (8351 aged 14-15 years [weighted percentage = 35.1%]; 12 167 male [weighted percentage = 51.1%]; 6057 Hispanic [weighted percentage = 26.0%], 1202 non-Hispanic Asian, Hawaiian, or Other Pacific Islander [weighted percentage = 6.2%], 3239 non-Hispanic Black [weighted percentage = 13.8%], 10 756 non-Hispanic White [weighted percentage = 49.7%], and 2287 other non-Hispanic race or ethnicity [weighted percentage = 4.3%]), of whom 5994 individuals had experienced a major depressive episode. The model-adjusted percentage of adolescents receiving any mental health visit was 31.7% (95% CI, 30.4%-33.1%) among non-Hispanic White adolescents and was significantly lower among members of racial and ethnic minority groups, ranging from 21.9% (95% CI, 19.5%-24.3%) among non-Hispanic Black adolescents to 25.6% (95% CI, 23.6%-27.6%) among Hispanic adolescents (all P < .001). Significant differences were also seen in prescription medication use and receipt of care in outpatient, school, and telemental health settings. For example, 17.0% (95% CI, 16.0%-18.0%) of non-Hispanic White adolescents received a telemental health visit after adjustment, but this percentage ranged from 8.1% (95% CI, 5.4%-10.8%) among non-Hispanic Asian, Hawaiian, or Other Pacific Islander adolescents to 12.0% (95% CI, 10.4%-13.6%) among Hispanic adolescents (all P < .001). Few to no racial or ethnic differences were observed in receipt of mental health services from support groups, peer support specialists or recovery coaches, inpatient or residential settings, or emergency departments. Similar patterns were observed among adolescents with past major depressive episodes. Conclusions and Relevance: In this study, substantial racial and ethnic differences were observed in US adolescent mental health service use after the COVID-19 pandemic, particularly in psychotropic medication use and clinical outpatient, school, and telemental health settings. These findings highlight the need to improve mental health access for adolescent members of racial and ethnic minority groups.