---
title: "Mental health help-seeking in New York City: Intersectional influences on formal and informal supp"
id: "plos-one-6-mental-health-help-seeking-in-new-york-city-how-intersecting-identities-shape"
canonical_url: "https://medichelpline.com/clinical-feed/plos-one-6-mental-health-help-seeking-in-new-york-city-how-intersecting-identities-shape"
content_type: "clinical_feed_article"
specialty: "General"
source_name: "PLOS ONE (Medicine)"
source_url: "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292"
published_at: "2026-08-14T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Mental health help-seeking in New York City: Intersectional influences on formal and informal supp
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/plos-one-6-mental-health-help-seeking-in-new-york-city-how-intersecting-identities-shape
- **Specialty:** [General](https://medichelpline.com/clinical-feed/general.md)
- **Primary Source:** PLOS ONE (Medicine)
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292)
- **Published At:** 2026-08-14T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- This population-based study examined how intersecting social identities affect **mental health help-seeking** among New York City adults, using a representative sample of 43,606 non-institutionalized residents surveyed between May and September 2023. - Overall, 46.6% of adults reported any help-seeking for emotions, nerves, or mental health in the prior 12 months; 36.2% used **informal** support and 24.2% used **formal** support. - The most common sources were **family or friends** (33.1%) among informal supports and **therapist or counselor** (16.8%) among formal supports. - Log-linear regression models tested main effects and interaction (conditional) effects of race and ethnicity with gender, socioeconomic indicators (education, employment, poverty), and immigration-related characteristics (place of birth, English proficiency, U.S. residence duration). - Significant interactions for any help-seeking were found between race and ethnicity and: gender (p = 0.003), employment status (p < 0.001), place of birth (p < 0.001), and English proficiency (p < 0.001). - Interaction patterns largely persisted when models examined **formal** and **informal** support separately, though gender did not significantly interact with race and ethnicity for informal help-seeking, and English proficiency did not significantly interact with race and ethnicity for formal help-seeking. - Sensitivity analyses restricted to participants with past 30-day moderate-to-high psychological distress produced similar findings, supporting robustness of results. - The authors conclude that help-seeking varies across intersecting identities, underscoring the need to improve accessibility and cultural relevance of formal mental health services while recognizing and supporting trusted informal networks. - Data come from the 2023 Neighborhood Wellness Survey; the dataset is under embargo and not publicly available, but researchers may inquire about access subject to review and data use agreements. - Study funding was provided by the NYC Department of Health; authors reported no competing interests.
## Clinical Analysis & Structured Key Points
[ Skip to main content ](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292#main-content) Advertisement * [plos.org](https://plos.org/) * [Create account](https://community.plos.org/registration/new) * [Sign in](https://journals.plos.org/user/secure/login?page=%2Fplosone%2Farticle%3Fid%3D10.1371%2Fjournal.pone.0356292) * * About * Browse * Publish * [](https://journals.plos.org/plosone/ "PLOS One") * Search [advanced search](https://journals.plos.org/plosone/search) * [Browse Topics](https://journals.plos.org/plosone/subjectAreaBrowse) Browse Subject Areas ? Click through the PLOS taxonomy to find articles in your field. For more information about PLOS Subject Areas, click [here](https://github.com/PLOS/plos-thesaurus/blob/master/README.md "Link opens in new window"). [](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292) [](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292) * 0 [Save](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0356292#savedHeader) [Total Mendeley and Citeulike bookmarks.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0356292#savedHeader) * 0 [Citation](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0356292#citedHeader) [Paper's citation count computed by Dimensions.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0356292#citedHeader) * 15 [View](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0356292#viewedHeader) [PLOS views and downloads.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0356292#viewedHeader) * 0 [Share](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0356292#discussedHeader) [Sum of Facebook, Twitter, Reddit and Wikipedia activity.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0356292#discussedHeader) Open Access Peer-reviewed Research Article # Mental health help-seeking in New York City: How intersecting identities shape informal and formal support use * Thinh Toan Vu , Roles Conceptualization, Formal analysis, Investigation, Methodology, Resources, Software, Visualization, Writing – original draft, Writing – review & editing * E-mail: tvu@health.nyc.gov, vutoanthinhph@gmail.com Affiliation Bureau of Mental Health, New York City Department of Health and Mental Hygiene, New York, United States of America [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0002-1304-4059 ](https://orcid.org/0000-0002-1304-4059 "ORCID Registry") ⨯ * Jo-Anne Caton, Roles Validation, Writing – review & editing Affiliation Bureau of Mental Health, New York City Department of Health and Mental Hygiene, New York, United States of America ⨯ * Christina Norman Roles Conceptualization, Writing – review & editing Affiliation Bureau of Mental Health, New York City Department of Health and Mental Hygiene, New York, United States of America ⨯ # Mental health help-seeking in New York City: How intersecting identities shape informal and formal support use * Thinh Toan Vu, * Jo-Anne Caton, * Christina Norman ![PLOS](https://journals.plos.org/resource/img/logo-plos-full-color.svg) x * Published: August 14, 2026 * * [Article](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292) * [Authors](https://journals.plos.org/plosone/article/authors?id=10.1371/journal.pone.0356292) * [Metrics](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0356292) * [Comments](https://journals.plos.org/plosone/article/comments?id=10.1371/journal.pone.0356292) * [Media Coverage](http://plos.altmetric.com/details/doi/10.1371/journal.pone.0356292) * [Abstract](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292#abstract0) * [Introduction](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292#sec005) * [Materials and methods](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292#sec006) * [Results](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292#sec011) * [Discussion](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292#sec016) * [Conclusion](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292#sec017) * [Acknowledgments](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292#ack) * [References](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292#references) * [Reader Comments](https://journals.plos.org/plosone/article/comments?id=10.1371/journal.pone.0356292) * [Figures](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292) ## Abstract ### Introduction This study investigated how intersecting identities, including race and ethnicity, gender, socioeconomic status, and immigration-related characteristics, impact help-seeking for emotions, nerves, or mental health among New York City (NYC) adults. It also identified primary sources of informal and formal support. ### Methods Using a citywide representative sample of 43,606 non-institutionalized adults, data were collected between May and September 2023. Log-linear regression models assessed main effects and conditional effects (i.e., interactions) of sociodemographic and immigration-related characteristics on mental health help-seeking in the past 12 months. Predicted probabilities from models with significant interaction terms illustrated intersectional impacts. Sensitivity analyses among participants with past 30-day moderate-to-high psychological distress tested robustness of these findings. ### Results Approximately 46.6% of adults sought any mental health support, with 36.2% seeking informal support and 24.2% seeking formal support. Family/friend (33.1%) and therapist/counselor (16.8%) were the most common informal and formal sources, respectively. Significant interactions for any help-seeking emerged between race and ethnicity with gender (p = 0.003), employment status (p < 0.001), place of birth (p < 0.001), and English proficiency (p < 0.001). These interactions held for both formal and informal support, except there was no significant interaction with gender for informal support nor with English proficiency for formal support. Sensitivity analysis among those with past 30-day moderate-to-high psychological distress produced similar findings compared to all adults. ### Conclusions Mental health help-seeking in NYC varies significantly across intersecting social identities, highlighting disparities linked to race and ethnicity, gender, immigration status, and language proficiency. Addressing these disparities requires improving accessibility and cultural relevance of formal mental health services while recognizing and strengthening trusted informal support systems. ## Figures ![Table 3](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0356292.t003) ![Table 4](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0356292.t004) ![Table 5](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0356292.t005) ![Table 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0356292.t001) ![Fig 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0356292.g001) ![Table 2](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0356292.t002) ![Table 3](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0356292.t003) ![Table 4](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0356292.t004) ![Table 5](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0356292.t005) ![Table 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0356292.t001) ![Fig 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0356292.g001) ![Table 2](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0356292.t002) **Citation:** Vu TT, Caton J-A, Norman C (2026) Mental health help-seeking in New York City: How intersecting identities shape informal and formal support use. PLoS One 21(8): e0356292. https://doi.org/10.1371/journal.pone.0356292 **Editor:** Aline Siteneski, Universidad Técnica de Manabí: Universidad Tecnica de Manabi, ECUADOR **Received:** May 19, 2026; **Accepted:** July 31, 2026; **Published:** August 14, 2026 **Copyright:** © 2026 Vu et al. This is an open access article distributed under the terms of the [Creative Commons Attribution License](http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. **Data Availability:** The data used in this study are from the 2023 Neighborhood Wellness Survey, a population-based cross-sectional survey conducted by the NYC Department of Health and CUNY Graduate School of Public Health and Health Policy. The dataset is not publicly available due to embargo and data access restrictions. Researchers interested in access may contact the corresponding author or research team at info@nycnws.org to inquire about potential data access options, which are subject to review, approval, and applicable data use agreements. **Funding:** This study was funded by the NYC Department of Health. The funder provided support in the form of salaries for all authors, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. **Competing interests:** The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. ## Introduction Mental health continues to be a pressing public health concern in the U.S., including in New York City (NYC), where 22.9% of adults reported experiencing any mental illness in the past year. Despite this high burden, more than half of adults with any mental illness did not receive treatment, and over a fifth perceived an unmet need for mental health treatment [[1](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292#pone.0356292.ref001)]. Left unaddressed, such unmet treatment needs are projected to contribute to an estimated US$14 trillion in excess costs nationally by 2040 [[2](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292#pone.0356292.ref002)]. Although experiences with mental health challenges vary, the process of seeking help, whether formal (from health professionals) or informal (from family, friends, or community networks), is a beneficial coping strategy. Help-seeking is not limited to those with a clinical diagnosis; it also encompasses the everyday reasons people seek support, advice, or relief in response to emotional distress, life stressors, or uncertainty (e.g., job changes, relationship strain, or unwanted habits) [[3](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292#pone.0356292.ref003)]. In this broader context, mental health help-seeking serves as an adaptive coping mechanism [[4](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292#pone.0356292.ref004)] that can alleviate illness burden, lower treatment costs, and enhance overall functioning [[5](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292#pone.0356292.ref005)]. Mental health help-seeking is not solely an individual decision [[6](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292#pone.0356292.ref006)], it is deeply shaped by social and structural conditions. Specifically, help-seeking is significantly influenced by social determinants of mental health [[7](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292#pone.0356292.ref007)], the conditions into which people are born and in which they grow, live, work, and age. Adults from minoritized racial and ethnic groups may be less likely to seek help for mental health concerns in the first place, due to stigma, lack of culturally competent care, and mistrust of medical institutions [[8](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292#pone.0356292.ref008)]. Among those who do seek help, these groups remain consistently less likely than white counterparts to receive mental health services [[9](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292#pone.0356292.ref009)–[11](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292#pone.0356292.ref011)]. In NYC, non-Hispanic white adults with serious psychological distress (58%) are more likely to have received past-year mental health treatment compared to non-Hispanic Black (48%), and non-Hispanic Asian (39%) adults [[12](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292#pone.0356292.ref012)], which may highlight racial and ethnic disparities in mental health help-seeking. Gender disparities also persist, with men less likely than women to seek mental health support [[10](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292#pone.0356292.ref010),[13](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292#pone.0356292.ref013)–[15](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292#pone.0356292.ref015)]. Among NYC adults with any mental illness, approximately 47% of males and 53% of females received past-year mental health treatment [[12](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292#pone.0356292.ref012)], a pattern often attributed to traditional gender norms that discourage emotional expression and promote self-reliance, which may contribute to underutilization of services among men [[16](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292#pone.0356292.ref016)]. Socioeconomic status represents another important social determinant of mental health help-seeking [[17](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292#pone.0356292.ref017),[18](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292#pone.0356292.ref018)]. Individuals experiencing poverty or financial hardship often face significant barriers to seeking professional mental health services. During the COVID-19 pandemic, NYC adults living in low-income housing encountered twice the obstacles in seeking mental health services (e.g., obtaining health insurance, stigma, or low trust in providers) compared to their counterparts residing in market-rate housing [[19](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292#pone.0356292.ref019)]. Immigration-related factors add another layer of complexity. Immigrants often encounter unique barriers to care, including language difficulties, unfamiliarity with the healthcare system, and fears related to immigration status, which could discourage or delay help-seeking [[20](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292#pone.0356292.ref020)]. Place of birth, English proficiency, and residence duration in the U.S. have all been shown to influence mental health outcomes and help-seeking patterns. Particularly, individuals who are foreign-born [[20](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292#pone.0356292.ref020)] or have limited English proficiency [[15](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292#pone.0356292.ref015)] are less likely to seek professional mental health services. Intersectionality, a framework introduced over three decades ago [[21](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292#pone.0356292.ref021)] that takes into account intersecting identities such as one’s race and gender, offers a powerful lens for addressing these disparities [[7](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292#pone.0356292.ref007)]. It captures the complex, overlapping influences of social categories on individual and population health, rather than treating these factors as separate and additive [[7](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292#pone.0356292.ref007),[22](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292#pone.0356292.ref022)]. While extensively applied in various fields, its integration into public health research is relatively recent [[22](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292#pone.0356292.ref022)]. In the U.S., health research has traditionally focused on documenting disparities in outcomes between racial and ethnic groups, often without examining how intersecting social identities shape these disparities [[23](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292#pone.0356292.ref023)]. Although the application of intersectionality in public health is increasing, studies often limit their analyses to a narrow range of identity combinations [[22](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292#pone.0356292.ref022)]. For instance, one study found that younger Black women were more likely than older Black women to use mobile technology to manage anxiety [[24](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292#pone.0356292.ref024)], but the focus on a single racial and gender group limited the broader applicability of the findings. While such studies yield important within-group insights [[22](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292#pone.0356292.ref022)], they may offer limited perspective on how multiple social identities interact across diverse populations. Without broader intersectional comparisons, it remains challenging to understand whether and why mental health help-seeking behaviors differ between groups, such as between Black women and women of other racial or ethnic backgrounds. NYC offers a unique and timely context in which to explore these questions. As one of the most diverse urban cities in the world, NYC is home to a population that is 36.1% foreign-born, 50% racial or ethnic minority, and 17.9% living below the poverty line [[25](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292#pone.0356292.ref025)]. This exceptional demographic diversity presents a distinct opportunity to examine how intersecting social identities influence mental health help-seeking in a densely populated, highly heterogeneous, urban environment. To address the limitations of prior research, which has largely focused on formal mental health help-seeking and examined the individual effects of sociodemographic factors [[20](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356292#pone.0356292.ref020)], this study had two aims. First, it investigated how the intersections of race and ethnicity with gender, socioeconomic status (education, employment, and poverty), and immigration-related characteristics (place of birth, English proficiency, and residence duration in the U.S.) influence both formal and informal help-seeking for issues related to emotions, nerves, or mental health among NYC adults. Second, the study identified the primary sources of mental health support, offering a comprehensive overview of health-seeking patterns. ## Materials and methods ### Study design and sample size This population-based cross-sectional study utilized data from the 202
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