The potential mediating role of depression on medical mistrust and mental health service use in Black adults

Background Major depressive disorders are ranked third in the global burden of disease by the World Health Organization. The association between mistrust in Black adults and its effect on health service utilization is well established. However, research on mistrust and specific utilization of mental health services is limited. This study examines role of medical mistrust and depressive symptoms on mental health service utilization. Methods We conducted an online cross-sectional survey among Black adults (n = 1042) using the Group-Based Medical Mistrust Scale, the General Help-Seeking Questionnaire, and the Patient Health Questionaire-9. Gamma regression models were used to assess the relationship between medical mistrust and its association with willingness to use mental health services. We added depressive symptoms to the model to assess whether depressive symptoms may mediate the primary association Results Black adults with moderate levels of mistrust reported increasing levels of willingness to seek help (RR = 1.40; 95%CI 1.28, 1.53; p < 0.001 and RR = 1.50; 95%CI 1.38, 1.64; p < 0.001), whereas Black adults at the highest level of mistrust were less likely to seek help from a mental health professional (RR = 1.23; 95%CI = 1.13, 1.34; p < 0.001). The inclusion of depressive symptoms in the model resulted in a 9.5% average decrease in willingness to seek help from a mental health professional. Conclusion Depressive symptoms may have a mediating effect on medical mistrust and its association with willingness to seek mental health services for Black adults. Interventions designed to increase service utilization and engagement should consider the role of medical mistrust and the role of depressive symptoms.