Barriers to Mental Health Service Use Among People With Disabilities During the COVID-19 Pandemic

• Published in: Rehabilitation psychology 2023-11, Vol.68 (4), p.351-361
• Main Authors: Manning, Robert B., Cipollina, Rebecca, Lowe, Sarah R., Bogart, Kathleen R., Ostrove, Joan M., Adler, Jonathan M., Nario-Redmond, Michelle R., Wang, Katie
• Format: Article
• Language: English
• Subjects: Adult; COVID-19; Disabilities; Disabled Persons; Female; Health Care Utilization; Human; Humans; Inpatient; Male; Mental Health Services; Pandemics; Prospective Studies; Treatment Barriers
• ISSN: 0090-5550; 1939-1544; 1939-1544
• DOI: 10.1037/rep0000512

Purpose/Objective: The COVID-19 pandemic has exacerbated existing health inequities for people with disabilities (PWD), including disparities in mental health needs and service use. The present study investigated prospective predisposing, enabling, and illness-related correlates of mental health service need and use among PWD during the COVID-19 pandemic. Research Method/Design: Data were collected online at two time points: October-December 2020 and October-December 2021. U.S. adults with disabilities completed self-report measures on demographic and disability characteristics, pandemic-related stressors (e.g., worries about COVID-19), depression, anxiety, barriers to service use, and perceived mental health needs and service use. Two logistic regressions were used to examine the effect of predisposing, enabling, psychosocial barriers, and illness-related factors on perceived mental health service need and service use. Results: Perceptions of mental health service needs were significantly predicted by gender (female-identified, transgender and gender diverse [TGD]), younger age, increased depressive symptoms, and presence of a prepandemic mental health condition. Among those who reported a perceived need, mental health service use was predicted by gender (female-identified and TGD), greater income, lower frequency of anticipated provider disability bias, and presence of a prepandemic mental health condition. Conclusions/Implications: This study provides vital descriptive data on the pattern of mental health service utilization among PWD during the COVID-19 pandemic, a uniquely disruptive, challenging time. Findings further underscore the necessity of providing disability competency training and bias reduction interventions to mental health professionals, as anticipated provider disability bias was a key factor in nonservice use of PWD. Impact and Implications In a two-wave study of adults with a wide range of visible and invisible disabilities during the COVID-19 pandemic, we found that perceived disability bias from providers significantly predicted a lower likelihood of mental health service use. These findings point to the urgent need for disability competency training and stigma reduction interventions geared toward mental health professionals. Additionally, we found that specific subpopulations of the disability community (e.g., female and transgender/gender diverse, more depressed, and younger individuals) have higher mental health needs and that lo