<p>Anxiety and depression are among the most common mental health disorders in the United States. Yet, Hispanic and Latino adults remain significantly underserved in the mental health care system. Using nationally representative data from the 2023 National Health Interview Survey, this study examined how immigration status, acculturation, and socioeconomic disadvantage shape mental health service utilization among Hispanic/Latino adults. The analytic sample included 4,417 respondents, of whom 12.9% reported an anxiety diagnosis and 13.9% reported a depression diagnosis. Despite this burden, fewer than 10% received counseling in the past year, and 5% reported an unmet need for therapy due to cost. Logistic regression analyses revealed that prior diagnosis, higher education, US citizenship, and health insurance coverage were strongly associated with treatment utilization, while women reported greater unmet need than men. Fairlie decomposition analyses showed that disparities in counseling and medication use between citizens and non-citizens were largely explained by differences in diagnosis, English language use for socializing and media, and socioeconomic resources. Findings underscore how immigration-related barriers, limited English proficiency, and structural inequities intersect to restrict access to effective treatments. Expanding insurance coverage, improving culturally and linguistically responsive services, and fostering trust within immigrant communities are important steps to closing the mental health treatment gap and advancing equity for Hispanic and Latino populations.</p>