Factors Associated with Professional Mental Health Counseling Among Korean Adults: An Age-Stratified Analysis Using the Andersen Behavioral Model

Abstract

Background/Objectives: Mental health service utilization remains considerably lower than the level of mental health need, and the factors related to utilization may differ across the life cycle. Applications of the Andersen Behavioral Model often underrepresent service availability and responsiveness. Based on the Andersen Behavioral Model, this study aimed to identify factors related to professional mental health counseling among Korean adults within three age strata. Methods: Using nationally representative, cross-sectional data from the 2021 National Mental Health Survey of Korea, this secondary analysis included 5511 participants: 1135 young adults aged 18–34 years, 3339 middle-aged adults aged 35–64 years, and 1037 older adults aged 65–79 years. Rao-Scott chi-square tests and survey-weighted logistic regression were used. The outcome was counseling for a mental health problem by a physician, nurse, clinical psychologist, or doctor of Korean medicine during the previous five years. Results: Female sex was associated with higher odds of counseling among young adults (odds ratio [OR] = 1.99, 95% confidence interval [CI] 1.01–3.95) and middle-aged adults (OR = 1.75, 95% CI 1.06–2.87), as was greater satisfaction with health status (OR = 2.67, 95% CI 1.46–4.91 and OR = 1.93, 95% CI 1.28–2.91, respectively). Higher loneliness was inversely associated with counseling in all three strata (OR = 0.70, 95% CI 0.55–0.89; OR = 0.69, 95% CI 0.58–0.83; OR = 0.64, 95% CI 0.52–0.80). Conclusions: Loneliness was the only factor associated with counseling in every stratum. These within-stratum estimates are not formal tests of between-group differences, and temporal order is uncertain. Loneliness may reflect a disruption in the pathway from need to help-seeking, change following prior care, or residual confounding; longitudinal evaluation is required.