The COVID-19 pandemic strained and highlighted the fragility of the U.S. mental health care system, during a co-occurring period of increased societal attention to racism. Existing disparities in MH access and utilization worsened. This three-study dissertation explores and describes mental health utilization rates and experiences of individuals with multiple marginalized identities and applies Intersectionality Theory as a critical lens of analysis.
Study 1 describes, maps and analyzes trends in mental health utilization during the COVID-19 pandemic with data from the COVID-19 Research Database, utilizing a 1- year pre-COVID-19 comparison group. On average U.S. adults utilized more mental health visits per person per month during the first year of the pandemic compared to 1-year prior. However, Native Americans, Pacific Islanders, and adults aged 65 and older saw a statistically significant decrease in mental health visits during the first year of COVID-19. Findings of disparities in access and utilization emphasize the need for more structural solutions to address mental health equity.
Study 2 explores and describes the experiences of eight women of color navigating mental health services during COVID-19 and a concurrent period of increased societal attention to racism, through qualitative interviews analyzed using a narrative approach. Key findings from these interviews were as follows: 1) these women sought mental health services due to increased fears of racial violence and being burdened at work to teach others about racism, 2) changes due to COVID-19 like telehealth, made accessing therapy easier for most of these women during this period, but 3) they had to put in additional work to find culturally responsive therapists, and 4) they experienced racism perpetuated by mental health professionals within the therapeutic dyad.
Study 3 applies Intersectionality Theory and Intersectional Quantitative methods to identify and describe potential disparities in mental health utilization for individuals at the intersection of gender and race. Propensity Score Matching (PSM) was utilized to address the variability of serious mental illness, education level, income level, and age category on overall mean mental health utilization per person per month, and the mean change in visits during COVID-19 compared to pre-COVID-19 among U.S. adults with a mental health diagnosis. Disparities in mean mental health visits by the intersection of race and gender and independent variables, such as education and income, demonstrate key intersectional findings that not all quantifiable measures such as income level, impact all women of color similarly because of the intersecting systems of power and oppression.
These findings demonstrate the need for Intersectional methods informed by racial and social justice in the identification of disparities in mental health utilization to inform training and policy interventions to increase access to culturally responsive mental health care services. / 2026-08-19T00:00:00Z
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/49155 |
| Date | 19 August 2024 |
| Creators | Do, Daniel |
| Contributors | Muroff, Jordana |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
| Rights | Attribution-NonCommercial-NoDerivatives 4.0 International, http://creativecommons.org/licenses/by-nc-nd/4.0/ |
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