Date of Award
Spring 2025
Document Type
Open Access Dissertation
Department
Health Services and Policy Management
First Advisor
Christina Andrews
Abstract
Introduction: Unmet need for mental health services—when an individual experiences mental health symptoms and perceives a need for treatment but does not receive services—is a growing problem in the U.S. Nearly half (49%) of 59.3 million adults aged 18 or older with a mental health disorder do not receive needed mental health treatment (Substance Abuse and Mental Health Services Administration, 2023). Unmet need has been linked to several access barriers including accessibility of services, affordability, and acceptability or the stigma associated with mental health treatment. Experiencing these barriers to treatment can lead some individuals to seek alternative forms of treatment. Recently, as the media has reported positive effects of psychedelics to treat mental health conditions, illicit use of these substances has increased. Although research of psychedelics use outside of the clinical setting remains understudied, there is evidence to suggest that psychedelics are being used for self-medication, sometimes referred to as ‘microdosing’ or ‘macrodosing’. However, these studies are often smaller survey studies conducted via online recruitment, and lacking a representative sample. The purpose of this study is to provide nationally representative information on psychedelic use trends and their relationship to unmet need, as well as factors that may affect their use like access barriers and mental health diagnoses. Methods: This is a quantitative, cross-sectional study using secondary data from the 2015-2019 National Survey on Drug Use and Health (NSDUH). Multivariable logistic regressions were used to examine the relationship between past-year psychedelic use and unmet need, receipt of mental health treatment, access barriers, and Major Depressive Disorder (MDD) and psychedelic use. Interaction terms and marginal effects were used to assess the moderating effect of unmet need on the relationship between past-year MDD and psychedelic use. Demographic information collected in the NSDUH was used as covariates for the adjusted logistic regressions. Results: In both the unadjusted and adjusted results, those with unmet need for mental health services in the past year are more likely to have use psychedelics in the past year compared to those who did not report unmet need (OR 3.17; 95% CI 2.98-3.37 and aOR 2.41; 95% CI 2.25-2.57, respectively). Additionally, marginal effects were calculated and determined receipt of formal treatment weakened the association between perceived unmet need for mental health treatment and past-year psychedelic use. When examining access barriers, only the affordability barrier had significant findings. For both the unadjusted and adjusted models, individuals who indicated they could not afford the cost of mental health treatment as their reason for not receiving services were more likely to have used psychedelics in the past year (OR 1.28: 95% CI 1.14-1.43 and aOR 1.26: 95% CI 1.11-1.41, respectively). Similar positive associations were discovered between past-year MDE and past-year psychedelic use. The unadjusted odds of having used psychedelics in the past year if an individual also experienced past-year depression is 2.89 (95% CI 1.73-3.07). The association persisted after adjusting for sociodemographic covariates (aOR 1.66; 95% CI 1.55-1.79). After calculating marginal effects for the moderating effect of past-year depression, results suggest its presence was associated with higher odds of psychedelic use only when there was no unmet need (0.021 versus 0.012). On the other hand, depression did not add much to the odds of psychedelic use if the participant had unmet need (0.0256 versus 0.0259). Conclusion: This is the first nationally representative study to examine the relationship between unmet need and related factors to the illicit use of psychedelic substances. Across all studies, a significant, positive association was found between past-year psychedelic use and unmet need, affordability barriers, and depression. The implications of this research are important as the legalization of these substances, for either medical use or, in some states’ case, recreational use nears. While this study cannot determine causal links, it has important preliminary findings towards answer whether individuals with unmet mental health care needs may be substituting evidence-based care with psychedelic use outside of a clinical setting. Understanding these relationships and related factors are an imperative step to further research. Details of unmet need and psychedelic use can better inform policymakers as they decide how psychedelics might be made available to the public and how to direct the development of safety regulations. Further research should focus on prospective longitudinal studies that utilize repeated standardized measures with the intention of informing public policy surrounding the safe and effective implementation of these substances at mental health treatment.
Rights
© 2025, Sophia Nancy Dennett Negaro
Recommended Citation
Negaro, S. N.(2025). Utilization of Psychedelic Substances and Unmet Need for Mental Health Services in the United States: A Nationally Representative Study. (Doctoral dissertation). Retrieved from https://scholarcommons.sc.edu/etd/8296