Medical Debt Likely Contributes to the Mental Health Treatment Gap in the US

Medical debt likely contributes to the mental health treatment gap among adults with depression and anxiety in the United States, according to study results published in JAMA Psychiatry.

Medical debt has been on the rise in recent decades and evidence indicates that people who can’t afford to pay their medical bills often delay or skip necessary health care. To gauge the prevalence of medical debt among adults in the US who have depression or anxiety and to assess its effect on mental health care utilization, researchers examined data from the 2022 National Health Interview Survey (NHIS), a nationally representative survey of noninstitutionalized US adults.

From the NHIS data, the investigators used survey items and the Patient Health Questionnaire–8 (PHQ-8) and Generalized Anxiety Disorder-7 (GAD-7) scales to identify the current and/or lifetime status of depression and anxiety, respectively. Additionally, survey questions were used to evaluate medical debt and whether participants delayed or abandoned mental health care because of cost. Poisson regression models were used to evaluate the association between medical debt and mental health care utilization.

The researchers included a total of 27,651 participants in the present analysis. The participants had a mean (SD) age of 52.9 (18.4) years and 54.4% were women. When stratified by psychiatric disorder, 5186 individuals had a lifetime diagnosis of depression, 1948 had current depression, 4834 had a lifetime diagnosis of anxiety, and 1689 had current anxiety.

The investigators found that medical debt was more common among those with mood and anxiety disorders. Medical debt was reported by 19.9% of individuals with lifetime depression compared with 8.6% of adults without a lifetime diagnosis (adjusted prevalence ratio [aPR], 1.97; 95% CI, 1.96-1.98). Similarly, 27.3% of respondents with current depression had medical debt vs 9.4% of adults without current depression (aPR, 2.34; 95% CI, 2.34-2.36). Medical debt was also reported by 19.4% of individuals with lifetime anxiety, relative to 8.8% among adults without anxiety (aPR 1.91; 95% CI, 1.91-1.92) and among 26.2% of respondents with current anxiety vs 9.6% of adults without anxiety (aPR 2.24; 95% CI, 2.24-2.26).

Medical debt was also associated with delayed and forgone mental health care. Medical debt was significantly associated with delayed mental health care among individuals with lifetime depression (aPR 2.68; 95% CI, 2.62-2.74), current depression (aPR 2.25; 95% CI, 2.13-2.38), lifetime anxiety (aPR 2.45; 95% CI, 2.40-2.50), and current anxiety (aPR 2.48; 95% CI, 2.35-2.66). Similarly, medical debt was associated with abandoned mental health care among individuals with lifetime depression (aPR 2.66; 95% CI, 2.61-2.71), current depression (aPR 2.35; 95% CI, 2.23-2.48), lifetime anxiety (aPR 2.63; 95% CI, 2.57-2.68), and current anxiety (aPR 2.57; 95% CI, 2.43-2.75).

When adjusting for confounding factors, the investigators found that income did not modify the association between medical debt and forgone care. However, insurance

status modified the association for adults with lifetime depression and lifetime anxiety, as the association between medical debt and forgone mental health care was more prominent among insurance adults vs uninsured adults.

These findings indicate that medical debt is highly prevalent maong individuals with depression and anxiety and is associated with delayed or abandoned mental heatlh treatment. “Medical debt appears to contribute to the mental health treatment gap, suggesting that aggressive debt collection practices have negative consequences for population mental health,” the researchers concluded.

Study limitations include the inability to assess the temporal link between mental disorders and medical debt and the lack of study power to evaluate ethnic disparities in medical debt and mental health care.

Disclosure: One study author reported affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on Psychiatry Advisor