Disparities in mental health service utilization among immigrants during the COVID-19 Pandemic in the United States

Keywords: immigrants, mental health service utilization, COVID-19, disparities
Abstract Type: Virtual Paper Abstract

Abstract

Immigrants (foreign-born individuals) are an essential part of United States (US) society, accounting for more than 10 percent of the population. Immigrants utilize mental health services differently than the US-born, and previous studies could not fully explain the differences using individual-level data. Using mobile phone-based mental health service utilization data, we estimated the average mental health visit in contiguous US census tracts from 2019 (pre-COVID-19-outbreak) to 2021 (after-COVID-19-outbreak). We then investigated the tract-level association between population proportions of major immigrants (i.e., Asian immigrants, European immigrants, and Latino immigrants) and mental health service utilization (MHSU) per new depression diagnosis (MHSU-to-need ratio [MnR]) using a mixed-effects linear regression model that accounted for spatial lag effects, adjusted for time, demographic, socioeconomic, and accessibility factors. Census tracts with a higher percentage of Latino immigrants were associated with lower MnR. Conversely, positive associations were observed when the immigrant's country of origin was in Europe or Asia. These relationships evolved over time and space. A higher proportion of Latino immigrants was associated with much lower MnR in 2020 (serious COVID-19-outbreak period) and in rural areas. Our findings suggest disparities in MHSU by immigrant status, and these disparities are spatiotemporally heterogeneous. Using emerging mobile phone-based MHSU data, immigrant-dominated neighborhoods in the US with disproportionately low mental health visits can be monitored in real-time to precisely provide additional resources to address MHSU disparities.