Racial-Ethnic and Sex Disparities in Mental Health Service Use Before Self-Harm Among Young People Enrolled in Medicaid

Abstract

OBJECTIVE: This study examined racial-ethnic and sex differences (and their intersections) in mental health service use prior to deliberate self-harm among young people enrolled in Medicaid. METHODS: A retrospective cohort study was conducted by using Medicaid data from 25 states between January 1, 2011, and December 31, 2021. The cohort included 222,924 young people ages 9-25 years with a new self-harm diagnosis. Primary outcomes were any mental health service use 1, 6, and 12 months prior to self-harm, categorized as outpatient, inpatient, or emergency department visits. Logistic regression models with sex × race-ethnicity interaction terms estimated associations with service use, clustered by state and adjusted for covariates. RESULTS: Overall, 34.2% of the cohort had a mental health visit in the month prior to self-harm, and 54.5% had a visit in the preceding year. The highest probabilities of any mental health service use in the month prior to self-harm were among non-Hispanic White (NHW) male (adjusted predicted probability [APP]=58.14%) and NHW female (APP=54.72%) individuals. The probabilities and odds of service use were higher for NHW, non-Hispanic Black, and Hispanic male individuals compared with their respective female counterparts for all service types and periods. CONCLUSIONS: Among young people enrolled in Medicaid, patterns of mental health service use prior to self-harm varied by sex and race-ethnicity. Culturally tailored mental health promotion strategies that address structural racism, provider bias, and system fragmentation may help reduce disparities in care and mitigate risks for self-harm and suicide.