Date of Conferral

6-23-2025

Degree

Ph.D.

School

Health Services

Advisor

Sheryl Richard

Abstract

Disparities in service use of mental health care persist in the United States, and African Americans have been disproportionately affected. The COVID-19 pandemic worsened these disparities, increasing barriers such as stigma, lack of culturally appropriate care, distance, and affordability. The purpose of this quantitative, nonexperimental, and correlational study was to examine the relationships between sociodemographic factors and the use of mental health counseling or therapy services. Bronfenbrenner’s ecological systems theory was applied to examine how the systemic factors in the mesosystem, exosystem, and macrosystem work together to influence care availability. Specifically, the study examined the relationship between race, income, education, geographic region, and the receipt of mental health services, as well as the relationship between these factors and the need for services but not their utilization. Logistic regression analyses were used to assess data from the U.S. Census Bureau 2020 Household Pulse Survey (COVID-19). Results showed considerable variations: Blacks (OR = 0.85; p = .001; 95% CI [0.78, 0.92]) and those in the South and Midwest (OR = 0.75, 0.76; p = .001; 95% CI [0.703, 0.804 & 0.712, 0.823]) had more difficulties accessing care. However, higher levels of education were found to be a better predictor of service use. The study’s findings reveal the intersectionality of sociodemographic factors and systemic barriers, suggesting possible ways for healthcare providers, community organizations, and policymakers to design specific, culturally compatible, and regionally tailored efforts to address these issues. Removing such gaps may help achieve positive social changes in mental health access, enhance health quality, and eliminate other healthcare service inequalities.

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