Kyle Moon
Credit: Johns Hopkins Bloomsburg School of Public Health
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A new study observes a high prevalence of medical debt among adults with depression and anxiety, which may be a factor preventing people from seeking mental health care.1
“The prevalence of medical debt in the United States is already sizable, and the prevalence is significantly higher among adults with depression and anxiety disorders,” Kyle Moon, a doctoral student in the Bloomberg School’s Department of Mental Health and lead author of the paper, said in a press release.2 “Meanwhile, even among adults without medical debt, a relatively large proportion delay or forgo mental health care, and medical debt appears to exacerbate the problem.”
Over the past decade, the government has tried to reduce medical debt through new laws and policies, including expanding private and public insurance through the Affordable Care Act.1 However, many low-income adults in the United States still face barriers to receiving mental health care.
Moon and his colleagues sought to determine how many people delayed or missed mental health care in the past year because of medical debt, and to estimate the prevalence of medical debt among U.S. adults with depression and anxiety.
The research team conducted a cross-sectional, nationally representative study of U.S. adults who participated in the National Health Interview Survey 2022 and had a diagnosis of depression or anxiety disorder. The researchers collected data on self-reported clinical diagnoses of depression and anxiety disorders, current moderate-to-severe symptoms of depression (Patient Health Questionnaire score 8, 10 or higher) and anxiety disorders (generalized anxiety disorder score 7, 10 or higher), and past-year medical debt.
The study included 27,651 adults, of whom 54.4% were women and had a mean age of 52.9 years. A total of 5186 (18.2%) reported lifetime depression, 1948 (7.3%) current depression, 4834 (17.7%) lifetime anxiety, and 1689 (6.6%) current anxiety. Compared with individuals without each mental disorder, adults with lifetime depression had more medical debt (19.4% vs. 8.8%, adjusted prevalence ratios 0–100). [aPR]1.97; 95% CI [CI]1.96 – 1.98), lifetime anxiety (19.4% vs 8.8%; aPR, 1.91; 95% CI, 1.91 – 1.92), current depression (27.3% vs 9.4%; aPR, 2.34; 95% CI, 2.34 – 2.36), and current anxiety (26.2% vs 9.6%; aPR, 2.24; 95% CI, 2.24 – 2.26).
Furthermore, medical debt was associated with delayed medical care among adults with lifetime depression (29.0% vs. 11.6%; aPR, 2.68; 95% CI, 2.62–2.74), lifetime anxiety (28.0% vs. 11.5%; aPR, 2.45; 95% CI, 2.40–2.50), current depression (36.9% vs. 17.4%; aPR, 2.25; 95% CI, 2.13–2.38), and current anxiety (38.4% vs. 16.9%; aPR, 2.48; 95% CI, 2.35–2.66) compared with participants without a mental disorder. Medical debt was also associated with medical neglect among adults with lifetime depression (29.4% vs. 10.6%; aPR, 2.66; 95% CI, 2.61-2.71), lifetime anxiety (28.2% vs. 10.7%; aPR, 2.63; 95% CI, 2.57-2.68), current depression (38.0% vs. 17.2%; aPR, 2.35; 95% CI, 2.23-2.48), and current anxiety (40.8% vs. 17.1%; aPR, 2.57; 95% CI, 2.43-2.75).
The researchers noted that medical debt is a risk factor for depression and anxiety, but poor mental health also puts people at risk of medical debt.
“Medical debt appears to contribute to disparities in mental health treatment, suggesting that aggressive debt collection practices have a negative impact on the population’s mental health,” the researchers concluded. “In the absence of health care reform, many states have enacted laws to protect patients from medical debt, but regulations vary across states. Further research is needed to evaluate policies to create protections against medical debt at the federal level.”
References
- Moon KJ, Linton SL, Mojtabai R. Medical debt and mental health treatment gaps among U.S. adults. JAMA Psychiatry. Published online July 17, 2024. doi:10.1001/jamapsychiatry.2024.1861
- More than one-third of adults with medical debt and depression or anxiety delayed seeking mental health care in the past 12 months. EurekAlert! July 18, 2024. https://www.eurekalert.org/news-releases/1051846. Accessed July 19, 2024.