{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T14:35:56Z","timestamp":1792852556555,"version":"4.5.0"},"reference-count":59,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T00:00:00Z","timestamp":1755648000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosmentalhealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Ment Health"],"abstract":"<jats:p>The prevalence of adolescent depression has increased following the COVID-19 pandemic, and adolescent depression is often under-treated. The emergence of new barriers resulting from the COVID-19 pandemic limited existing efforts to address pre-existing inequalities in appropriate mental health treatment utilization. We analyzed data from adolescents with major depressive episode (MDE) in the 2022 U.S. National Survey on Drug Use and Health to examine mental health service utilization by rurality, race\/ethnicity, gender, age, health insurance coverage, and poverty level. We applied analytic weights to estimate nationally representative estimates and account for survey nonresponse. Multivariate logistic regression identified significant disparities in the use of mental health services. The 2022 NSDUH assessed adolescent MDE based on past-year self-reported depressive symptoms based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. Among the 19.2% of adolescents aged 12\u201317 who experienced MDE, only 47.5% received treatment within the past year. Adolescents in rural areas had significantly lower odds of receiving specialist treatment compared to their urban counterparts [adjusted odds ratio (AOR) 0.64 (95% confidence interval (CI) 0.47-0.87)]. Odds of receiving telehealth services were significantly lower for rural adolescents [AOR 0.64 (95% CI 0.44-0.93)] but were significantly higher for adolescents with insurance (public insurance [AOR 2.99 (95% CI 1.10-8.14)] and private insurance [AOR 3.82 (95% CI 1.39-10.49)]). Older adolescents had lower odds of utilizing school-based services than younger adolescents [AOR 0.52 (95% CI 0.38-0.71)]. Females had greater odds and Black adolescents significantly lower odds of utilizing any mental health treatment relative to males and non-Hispanic White adolescents, respectively [Females: AOR 1.59 (95% CI 1.11-2.28); Black: AOR 0.36 (95% CI 0.22-0.59)]. Our findings continue to illustrate the persisting inequity in mental health treatment among adolescents from marginalized groups amidst the COVID-19 pandemic. Tailored strategies to address these inequities are needed.<\/jats:p>","DOI":"10.1371\/journal.pmen.0000388","type":"journal-article","created":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T17:25:40Z","timestamp":1755710740000},"page":"e0000388","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmen.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Disparities in mental health service utilization among adolescents with depression: Results from a 2022 U.S. National Survey"],"prefix":"10.1371","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-8772-3706","authenticated-orcid":true,"given":"Su Chen","family":"Tan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaylynn","family":"Hunt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brittany","family":"Shelton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,8,20]]},"reference":[{"issue":"3","key":"pmen.0000388.ref001","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1016\/j.jadohealth.2021.12.003","article-title":"Rising rates of adolescent depression in the United States: challenges and opportunities in the 2020s","volume":"70","author":"S Wilson","year":"2022","journal-title":"J Adolesc Health"},{"key":"pmen.0000388.ref002","volume-title":"National survey on drug use and health","author":"Substance Abuse and Mental Health Services Administration","year":"2022"},{"issue":"1","key":"pmen.0000388.ref003","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1002\/cbl.30759","article-title":"NSDUH finds substance use, depression, suicidality high among youth","volume":"40","author":"A Knopf","year":"2023","journal-title":"Child Adolesc Behav"},{"key":"pmen.0000388.ref004","doi-asserted-by":"crossref","first-page":"104169","DOI":"10.1016\/j.brat.2022.104169","article-title":"The impact of COVID-19 on child and adolescent mental health and treatment considerations","volume":"157","author":"DA Chavira","year":"2022","journal-title":"Behav Res Ther"},{"issue":"1","key":"pmen.0000388.ref005","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1017\/S2045796011000746","article-title":"Age of onset of mental disorders and use of mental health services: needs, opportunities and obstacles","volume":"21","author":"G de Girolamo","year":"2012","journal-title":"Epidemiol Psychiatr Sci"},{"issue":"7","key":"pmen.0000388.ref006","doi-asserted-by":"crossref","first-page":"3432","DOI":"10.3390\/ijerph18073432","article-title":"Mental health of children and adolescents amidst COVID-19 and past pandemics: a rapid systematic review","volume":"18","author":"S Meherali","year":"2021","journal-title":"Int J Environ Res Public Health"},{"issue":"5","key":"pmen.0000388.ref007","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1016\/j.pcl.2021.05.003","article-title":"Mental health effects of the COVID-19 pandemic on children and adolescents: a review of the current research","volume":"68","author":"J Meade","year":"2021","journal-title":"Pediatr Clin North Am"},{"issue":"2","key":"pmen.0000388.ref008","first-page":"256","article-title":"Can less be more? The promise (and perils) of single-session youth mental health interventions","volume":"40","author":"JL Schleider","year":"2017","journal-title":"Behav Therapist"},{"issue":"4","key":"pmen.0000388.ref009","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1136\/ebmental-2018-300060","article-title":"Early intervention in youth mental health: progress and future directions","volume":"21","author":"PD McGorry","year":"2018","journal-title":"Evid Based Ment Health"},{"issue":"5","key":"pmen.0000388.ref010","doi-asserted-by":"crossref","first-page":"972","DOI":"10.1007\/s10597-022-01081-y","article-title":"Mental health service utilization and disparities in the U.S: observation of the first year into the COVID pandemic","volume":"59","author":"C Lin","year":"2023","journal-title":"Community Ment Health J"},{"issue":"4","key":"pmen.0000388.ref011","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1016\/j.jadohealth.2023.01.018","article-title":"Family structure and adolescent mental health service utilization during the COVID-19 pandemic","volume":"73","author":"TD Burrell","year":"2023","journal-title":"J Adolesc Health"},{"issue":"6","key":"pmen.0000388.ref012","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2016-1878","article-title":"National trends in the prevalence and treatment of depression in adolescents and young adults","volume":"138","author":"R Mojtabai","year":"2016","journal-title":"Pediatrics"},{"issue":"1","key":"pmen.0000388.ref013","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1037\/rmh0000183","article-title":"Adolescent depression and anxiety treatment in rural schools: a systematic review","volume":"46","author":"B Berryhill","year":"2022","journal-title":"Rural Ment Health"},{"issue":"8","key":"pmen.0000388.ref014","doi-asserted-by":"crossref","first-page":"2442","DOI":"10.3390\/jcm9082442","article-title":"Racial disparities-associated COVID-19 mortality among minority populations in the US","volume":"9","author":"DJ Alcendor","year":"2020","journal-title":"J Clin Med"},{"key":"pmen.0000388.ref015","doi-asserted-by":"crossref","first-page":"05015","DOI":"10.7189\/jogh.11.05015","article-title":"Racial disparities in COVID-19 pandemic cases, hospitalisations, and deaths: a systematic review and meta-analysis","volume":"11","author":"W Mude","year":"2021","journal-title":"J Glob Health"},{"key":"pmen.0000388.ref016","doi-asserted-by":"crossref","first-page":"101012","DOI":"10.1016\/j.ssmph.2021.101012","article-title":"The unequal burden of the Covid-19 pandemic: Capturing racial\/ethnic disparities in US cause-specific mortality","volume":"17","author":"AN Luck","year":"2022","journal-title":"SSM Popul Health"},{"key":"pmen.0000388.ref017","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.annepidem.2020.05.003","article-title":"Assessing differential impacts of COVID-19 on black communities","volume":"47","author":"GA Millett","year":"2020","journal-title":"Ann Epidemiol"},{"issue":"25","key":"pmen.0000388.ref018","doi-asserted-by":"crossref","first-page":"7433","DOI":"10.12998\/wjcc.v9.i25.7433","article-title":"Association between COVID-19 and anxiety during social isolation: a systematic review","volume":"9","author":"ERR Dos Santos","year":"2021","journal-title":"World J Clin Cases"},{"key":"pmen.0000388.ref019","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.bbi.2012.12.008","article-title":"The inflammasome: pathways linking psychological stress, depression, and systemic illnesses","volume":"31","author":"M Iwata","year":"2013","journal-title":"Brain Behav Immun"},{"key":"pmen.0000388.ref020","doi-asserted-by":"crossref","first-page":"24705470221118574","DOI":"10.1177\/24705470221118574","article-title":"Racial stress and trauma and the development of adolescent depression: a review of the role of vigilance evoked by racism-related threat","volume":"6","author":"ML Woody","year":"2022","journal-title":"Chronic Stress (Thousand Oaks)"},{"issue":"6","key":"pmen.0000388.ref021","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1016\/j.jadohealth.2021.05.005","article-title":"Family stress and rural african-american adolescents\u2019 depressive symptoms","volume":"69","author":"AJ Reck","year":"2021","journal-title":"J Adolesc Health"},{"key":"pmen.0000388.ref022","article-title":"Geographic variation in the supply of selected behavioral health providers","volume":"54","author":"CHA Andrilla","year":"2018","journal-title":"Am J Prev Med"},{"key":"pmen.0000388.ref023","article-title":"Rural-urban mental health disparities in the United States during COVID-19","volume":"12","author":"NM Summers-Gabr","year":"2020","journal-title":"Psychol Trauma"},{"issue":"9","key":"pmen.0000388.ref024","doi-asserted-by":"crossref","first-page":"1548","DOI":"10.1176\/appi.ajp.159.9.1548","article-title":"Unmet need for mental health care among U.S. children: variation by ethnicity and insurance status","volume":"159","author":"SH Kataoka","year":"2002","journal-title":"Am J Psychiatry"},{"issue":"11","key":"pmen.0000388.ref025","doi-asserted-by":"crossref","first-page":"1215","DOI":"10.1001\/jamapediatrics.2023.3996","article-title":"Estimates of major depressive disorder and treatment among adolescents by race and ethnicity","volume":"177","author":"MW Flores","year":"2023","journal-title":"JAMA Pediatr"},{"issue":"4","key":"pmen.0000388.ref026","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1007\/s40615-021-01049-w","article-title":"Black adolescent experiences with COVID-19 and mental health services utilization","volume":"9","author":"A Banks","year":"2022","journal-title":"J Racial Ethn Health Disparities"},{"issue":"1","key":"pmen.0000388.ref027","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.acap.2023.05.016","article-title":"COVID-19 and adolescent outpatient mental health service utilization","volume":"24","author":"TD Burrell","year":"2024","journal-title":"Acad Pediatr"},{"issue":"4","key":"pmen.0000388.ref028","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1176\/appi.ps.201800428","article-title":"Differences in utilization of mental health treatment among children and adolescents with medicaid or private insurance","volume":"70","author":"MM Ali","year":"2019","journal-title":"Psychiatr Serv"},{"issue":"1","key":"pmen.0000388.ref029","doi-asserted-by":"crossref","first-page":"181","DOI":"10.5993\/AJHB.43.1.15","article-title":"Adolescent depression: national trends, risk factors, and healthcare disparities","volume":"43","author":"W Lu","year":"2019","journal-title":"Am J Health Behav"},{"issue":"4","key":"pmen.0000388.ref030","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1097\/CHI.0b013e31819996f1","article-title":"National comorbidity survey replication adolescent supplement (NCS-A): I. Background and measures","volume":"48","author":"KR Merikangas","year":"2009","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"key":"pmen.0000388.ref031","volume-title":"Rural-urban continuum codes","author":"United States Department of Agriculture Economic Research Service","year":"2023"},{"issue":"8","key":"pmen.0000388.ref032","doi-asserted-by":"crossref","first-page":"1532","DOI":"10.1007\/s10597-024-01305-3","article-title":"Disparities in access to mental health services among children diagnosed with anxiety and depression in the United States","volume":"60","author":"A Mahmood","year":"2024","journal-title":"Community Ment Health J"},{"issue":"4","key":"pmen.0000388.ref033","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2022-058227","article-title":"Disparities in pediatric mental and behavioral health conditions","volume":"150","author":"JA Hoffmann","year":"2022","journal-title":"Pediatrics"},{"issue":"1","key":"pmen.0000388.ref034","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1186\/s12913-023-09083-6","article-title":"Mental health professionals and telehealth in a rural setting: a cross sectional survey","volume":"23","author":"D Nelson","year":"2023","journal-title":"BMC Health Serv Res"},{"issue":"1","key":"pmen.0000388.ref035","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1007\/s10597-005-2598-0","article-title":"Unmet need for community-based mental health and substance use treatment among rural adolescents","volume":"41","author":"RL Anderson","year":"2005","journal-title":"Community Ment Health J"},{"issue":"5","key":"pmen.0000388.ref036","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1017\/cts.2020.42","article-title":"A call to action to address rural mental health disparities","volume":"4","author":"DA Morales","year":"2020","journal-title":"J Clin Transl Sci"},{"key":"pmen.0000388.ref037","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1016\/j.childyouth.2017.04.017","article-title":"A scoping literature review of service-level barriers for access and engagement with mental health services for children and young people","volume":"77","author":"JK Anderson","year":"2017","journal-title":"Chil Youth Serv Rev"},{"key":"pmen.0000388.ref038","author":"U.S. Census Bureau","year":"2018"},{"key":"pmen.0000388.ref039","author":"B Whitacre","year":"2023"},{"key":"pmen.0000388.ref040","author":"M Madden","year":"2013"},{"issue":"4","key":"pmen.0000388.ref041","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1097\/FCH.0000000000000306","article-title":"Disparities in technology and broadband internet access across rurality: implications for health and education","volume":"44","author":"JM Graves","year":"2021","journal-title":"Fam Community Health"},{"key":"pmen.0000388.ref042","doi-asserted-by":"crossref","first-page":"113848","DOI":"10.1016\/j.psychres.2021.113848","article-title":"Implementation lessons from the transition to telehealth during COVID-19: a survey of clinicians and young people from youth mental health services","volume":"299","author":"J Nicholas","year":"2021","journal-title":"Psychiatry Res"},{"issue":"2","key":"pmen.0000388.ref043","doi-asserted-by":"crossref","first-page":"169","DOI":"10.31887\/DCNS.2020.22.2\/lvalmaggia","article-title":"Virtual reality as a clinical tool in mental health research and practice","volume":"22","author":"IH Bell","year":"2020","journal-title":"Dialogues Clin Neurosci"},{"issue":"6","key":"pmen.0000388.ref044","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2021-053760","article-title":"COVID-19-associated orphanhood and caregiver death in the United States","volume":"148","author":"SD Hillis","year":"2021","journal-title":"Pediatrics"},{"issue":"2","key":"pmen.0000388.ref045","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1111\/1475-6773.13115","article-title":"Mental health care among blacks in America: confronting racism and constructing solutions","volume":"54","author":"SM Alang","year":"2019","journal-title":"Health Serv Res"},{"issue":"39","key":"pmen.0000388.ref046","doi-asserted-by":"crossref","DOI":"10.1073\/pnas.2109139118","article-title":"The emotional and mental health impact of the murder of George Floyd on the US population","volume":"118","author":"JC Eichstaedt","year":"2021","journal-title":"Proc Natl Acad Sci U S A"},{"issue":"5","key":"pmen.0000388.ref047","article-title":"Understanding and addressing mental health stigma across cultures for improving psychiatric care: a narrative review","volume":"15","author":"AA Ahad","year":"2023","journal-title":"Cureus"},{"issue":"5","key":"pmen.0000388.ref048","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1016\/S0033-3549(04)50068-7","article-title":"Racial residential segregation: a fundamental cause of racial disparities in health","volume":"116","author":"DR Williams","year":"2001","journal-title":"Public Health Rep"},{"key":"pmen.0000388.ref049","doi-asserted-by":"crossref","first-page":"641605","DOI":"10.3389\/fpubh.2021.641605","article-title":"Barriers and facilitators for mental health service use among racial\/ethnic minority adolescents: a systematic review of literature","volume":"9","author":"W Lu","year":"2021","journal-title":"Front Public Health"},{"key":"pmen.0000388.ref050","doi-asserted-by":"crossref","first-page":"113965","DOI":"10.1016\/j.psychres.2021.113965","article-title":"Attitudes about mental illness and help seeking among adolescent males","volume":"301","author":"SK Liddle","year":"2021","journal-title":"Psychiatry Res"},{"issue":"4","key":"pmen.0000388.ref051","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1080\/02673843.2015.1106414","article-title":"Tough, sensitive and sincere: how adolescent boys manage masculinities and emotions","volume":"21","author":"E Randell","year":"2015","journal-title":"Int J Adolesc Youth"},{"key":"pmen.0000388.ref052","doi-asserted-by":"crossref","first-page":"1604072","DOI":"10.3389\/ijph.2021.1604072","article-title":"The long-term effectiveness of interventions addressing mental health literacy and stigma of mental illness in children and adolescents: systematic review and meta-analysis","volume":"66","author":"AM Fre\u0163ian","year":"2021","journal-title":"Int J Public Health"},{"issue":"1","key":"pmen.0000388.ref053","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1186\/s12913-019-4124-z","article-title":"Access to care among Medicaid and uninsured patients in community health centers after the Affordable Care Act","volume":"19","author":"V Seo","year":"2019","journal-title":"BMC Health Serv Res"},{"issue":"8","key":"pmen.0000388.ref054","first-page":"1167","article-title":"Pediatric primary care perspectives of mental health services delivery during the COVID-19 pandemic","volume":"9","author":"CM Lee","year":"2022","journal-title":"Children (Basel)"},{"issue":"12","key":"pmen.0000388.ref055","doi-asserted-by":"crossref","first-page":"1967","DOI":"10.1377\/hlthaff.2018.05125","article-title":"Telehealth in health centers: key adoption factors, barriers, and opportunities","volume":"37","author":"C-CC Lin","year":"2018","journal-title":"Health Aff (Millwood)"},{"key":"pmen.0000388.ref056","volume-title":"Institute of education sciences","year":"2022"},{"issue":"10","key":"pmen.0000388.ref057","doi-asserted-by":"crossref","first-page":"1330","DOI":"10.1176\/ps.2007.58.10.1330","article-title":"Transformation of children\u2019s mental health services: the role of school mental health","volume":"58","author":"SH Stephan","year":"2007","journal-title":"Psychiatr Serv"},{"key":"pmen.0000388.ref058","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1186\/2046-4053-1-49","article-title":"A systematic review of the role of school-based healthcare in adolescent sexual, reproductive, and mental health","volume":"1","author":"AJ Mason-Jones","year":"2012","journal-title":"Syst Rev"},{"issue":"3","key":"pmen.0000388.ref059","first-page":"268","article-title":"Mental health care for LGBT youths","volume":"18","author":"LE Lothwell","year":"2020","journal-title":"Focus (Am Psychiatr Publ)"}],"container-title":["PLOS Mental Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pmen.0000388","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T17:25:47Z","timestamp":1755710747000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pmen.0000388"}},"subtitle":[],"editor":[{"given":"Karli","family":"Montague-Cardoso","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,8,20]]},"references-count":59,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,8,20]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pmen.0000388","relation":{},"ISSN":["2837-8156"],"issn-type":[{"value":"2837-8156","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,20]]}}}