This population-based research investigated how intersecting social identities influence help-seeking for issues related to emotions, nerves, or mental health among New York City adults. The study framed help-seeking broadly, encompassing both formal care from health professionals and informal support from family, friends, or community networks. The authors emphasized that social determinants—race and ethnicity, gender, socioeconomic status, and immigration-related characteristics—shape help-seeking behavior and create disparities in access to and use of mental health services.
The analysis used a citywide representative sample of 43,606 non-institutionalized adults drawn from the 2023 Neighborhood Wellness Survey. Data collection occurred between May and September 2023. The study employed a cross-sectional design to assess past 12-month help-seeking for emotions, nerves, or mental health.
Help-seeking was classified into two broad categories: informal support (for example, family and friends) and formal support (for example, therapists or counselors). The authors also identified the most frequently reported specific sources. Sociodemographic variables included race and ethnicity, gender, and socioeconomic indicators (education, employment status, and poverty). Immigration-related characteristics comprised place of birth, English proficiency, and duration of U.S. residence. Psychological distress over the past 30 days was used for sensitivity analyses.
The primary analytic approach used log-linear regression models to evaluate both main effects and conditional effects (interactions) between race and ethnicity and other social identifiers (gender, socioeconomic status, and immigration-related characteristics) on help-seeking during the prior 12 months. Where interaction terms were statistically significant, predicted probabilities were calculated and presented to illustrate the intersectional impacts. The authors conducted sensitivity analyses restricted to respondents with moderate-to-high psychological distress in the prior 30 days to test the robustness of observed patterns.
In the full sample, 46.6% of adults reported any help-seeking for emotions, nerves, or mental health in the past 12 months. Breakdown by support type showed 36.2% used informal supports and 24.2% used formal supports. These prevalence estimates describe help-seeking across the NYC adult population sampled in 2023.
Among specific sources, the single most commonly reported informal resource was family or friends, cited by 33.1% of respondents. The most commonly reported formal source was a therapist or counselor, cited by 16.8% of respondents. The paper presents these items to characterize where adults most often turn for mental health-related concerns in NYC.
Testing conditional effects revealed significant interactions between race and ethnicity and several other social identifiers for any help-seeking. Specifically, interactions with race and ethnicity were statistically significant for gender (p = 0.003), employment status (p < 0.001), place of birth (p < 0.001), and English proficiency (p < 0.001). These interaction effects indicate that the relationship between race and ethnicity and help-seeking varied depending on an individual’s gender, employment, nativity, and language proficiency.
When models examined formal and informal support separately, the interaction patterns largely persisted, with two exceptions documented in the source: there was no significant interaction between race and ethnicity and gender for informal help-seeking, and there was no significant interaction between race and ethnicity and English proficiency for formal help-seeking. The article reports predicted probabilities from models with significant interaction terms to illustrate how intersecting identities shape help-seeking, although specific probability estimates by subgroup are presented in the original tables and figures.
To assess robustness, the authors repeated analyses among participants who reported past 30-day moderate-to-high psychological distress. The sensitivity analyses produced similar patterns of findings compared to the full adult sample, suggesting that the intersectional relationships observed were not solely attributable to differences in recent distress levels.
The study concludes that patterns of mental health help-seeking in NYC vary markedly across intersecting social identities. Disparities are linked to race and ethnicity in combination with gender, employment, nativity, and language proficiency. Based on these findings, the authors recommend improving the accessibility and cultural relevance of formal mental health services while recognizing and strengthening trusted informal support systems. The results underscore the need for approaches that account for intersectional identities when designing outreach, service delivery, and policy interventions.
The data derive from the 2023 Neighborhood Wellness Survey conducted by the NYC Department of Health and CUNY Graduate School of Public Health and Health Policy. The dataset is under embargo and not publicly available; researchers may contact the corresponding author or the research team at info@nycnws.org to inquire about potential access, subject to review and applicable data use agreements. The study was funded by the NYC Department of Health, which provided support in the form of salaries for all authors but did not influence study design, data collection and analysis, decision to publish, or manuscript preparation. The authors declared no competing interests. Specific limitations beyond those intrinsic to cross-sectional survey designs are discussed in the original manuscript.
In this representative New York City sample of 43,606 adults, nearly half reported seeking some form of help for emotions, nerves, or mental health in the prior year. Use of informal supports exceeded use of formal services, and the most common sources were family or friends and therapists or counselors. Patterns of help-seeking differed across intersecting identities: race and ethnicity interacted with gender, employment status, place of birth, and English proficiency to shape both formal and informal help-seeking in most analyses. These findings point to the importance of intersectional strategies to reduce disparities, improve cultural relevance and accessibility of formal services, and support informal networks that people rely on for mental health concerns.