Mental health care utilization among middle-aged and older U.S. adults: Findings from the National Health Interview Survey

Mental health care (MHC) utilization remains uneven among middle-aged and older adults in the United States, yet the role of comorbidity burden and other sociodemographic, socioeconomic, behavioral, and clinical domain predictors remains incompletely characterized. We analyzed pooled data from six waves (2019–2024) of the National Health Interview Survey (NHIS), comprising 128,261 adults aged ≥40 years. Comorbidity burden was the primary predictor, categorized as none, one, or ≥2 chronic conditions, while together with additional predictors was organized according to the predisposing, enabling, and need domains of Andersen’s Behavioral Model of Health Services Use. MHC utilization, the outcome, was defined as counseling or psychotherapy, mental health medication use, or visits to a mental health specialist within the previous 12 months. Survey-weighted multivariable logistic regression accounted for the complex survey design and sampling weights. Overall, approximately one in five adults utilized MHC services. Utilization was higher among females, non-Hispanic White adults, unmarried adults, smokers, overweight or obese adults, those with lower income, those with health insurance coverage, or residence in the Midwest, and those with one or ≥2 comorbidities, depression, or anxiety. In contrast, utilization was lower among adults aged 50–64, 65–74, and ≥75 years, non-Hispanic Black and Asian adults, and those with higher educational attainment. Taken together, these findings indicate that MHC utilization is shaped by comorbidity burden alongside predisposing, enabling, and need-related factors, underscoring the need for targeted and culturally responsive strategies to improve equitable access to MHC among this ageing population.Author summary: Many middle-aged and older adults in the U.S. live with chronic health conditions, yet some do not use mental health care (MHC) even when they may have mental health needs. We analyzed data from 128,261 adults aged 40 years and older who participated in the National Health Interview Survey from 2019 to 2024. About one in five adults used MHC, including counseling, mental health medicines, or visits to mental health professionals. We examined comorbidity burden as the main predictor of MHC use, while also considering other factors based on Andersen’s model, including personal characteristics, access to care, and health needs. MHC use was higher among women, White adults, unmarried adults, smokers, people who were overweight or obese, those with lower incomes, those with health insurance, and those living in the Midwest. Use was also higher among people with one or more chronic conditions, depression, or anxiety. In contrast, MHC use was lower among adults aged 50 years and older, Black and Asian adults, and those with higher levels of education. These findings show that both chronic health conditions and social and personal factors may influence whether middle-aged and older adults receive MHC or not. Hence, expanding affordable, accessible, and culturally appropriate services may help reduce gaps in care and connect aging adults with the mental health support they need to promote healthy ageing and mental well-being.