Associations of COVID-19 history, substance use, and mental illness with mental health treatment utilization in the United States: age and gender differences

This study examined the associations of COVID-19 history, substance use, and mental health problems with mental health treatment (MHT) utilization among U.S. adults in 2022 and explored age- and gender-related differences in these relationships. Data were drawn from 27 147 adults participating in the 2022 National Health Interview Survey. Multiple logistic regression (MLR) models were used to estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for past-year MHT utilization. Analyses were conducted for the overall sample and stratified by gender and age groups (18–25, 26–45, 46–64, and ≥65 years). Overall, 23.5% of adults reported using MHT (17.3% of males; 29.1% of females). In MLR, female, prior COVID-19 infection, alcohol use, and e-cigarette use, anxiety, depression, and long sleep duration were independently associated with higher MHT odds (all p < 0.05). Gender-stratified analyses indicated that COVID-19 history, alcohol use, and physical activity were significant predictors of MHT utilization among females only, whereas former cigarette smoking was associated with MHT utilization among males. Age-stratified analyses showed that female, health insurance coverage, and the presence of anxiety or depression were consistently associated with higher MHT use across all age groups. Higher educational attainment was associated with increased MHT utilization among adults aged 26–45 years. Among middle-aged (46–64 years) and older adults (≥65 years), COVID-19 history, current e-cigarette use, former cigarette smoking, and long sleep duration were linked to greater MHT utilization. Former e-cigarette use and current alcohol consumption were associated with MHT use among adults aged 26–45 years and ≥65 years, while moderate physical activity was positively associated with MHT utilization among older adults. These findings underscore the need for integrated post-COVID mental health and substance-use screening and for age- and gender-responsive strategies to improve equitable access to mental health care.