Medical Debt and the Mental Health Treatment Gap Among US Adults

Kyle J. Moon; Sabriya L. Linton; Ramin Mojtabai

doi:10.1001/jamapsychiatry.2024.1861

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Original Investigation

July 17, 2024

Medical Debt and the Mental Health Treatment Gap Among US Adults

Kyle J.听Moon,听BS¹; Sabriya L.听Linton,听PhD, MPH¹; Ramin听Mojtabai,听MD, PhD, MPH^1,2

Author Affiliations Article Information

¹Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
²Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland

JAMA Psychiatry. 2024;81(10):985-992. doi:10.1001/jamapsychiatry.2024.1861

Key Points

Question听 Is medical debt associated with delayed or forgone mental health care?

Findings听 This cross-sectional study of 27鈥�651 US adults estimated that between 1 in 4 and 1 in 5 US adults with depression and anxiety carry medical debt. Medical debt was associated with more than a 2-fold increase in delayed or forgone treatment for mental disorders.

Meaning听 Medical debt is prevalent among US adults with common mental disorders, and this may contribute to the mental health treatment gap.

Abstract

Importance听 Medical debt is common in the US and may hinder timely access to care for mental disorders.

Objective听 To estimate the prevalence of medical debt among US adults with depression and anxiety and its association with delayed and forgone mental health care.

Design, Setting, and Participants听 Cross-sectional, nationally representative survey study of US adult participants in the 2022 National Health Interview Survey who had current or lifetime diagnoses of depression or anxiety.

Exposures听 Self-reported lifetime clinical diagnoses of depression and anxiety; moderate to severe symptoms of current depression (Patient Health Questionnaire鈥�8 score 鈮�10) and anxiety (Generalized Anxiety Disorder鈥�7 score 鈮�10) irrespective of lifetime diagnoses; and past-year medical debt.

Main Outcomes and Measures听 Self-reported delaying and forgoing mental health care because of cost in the past year.

Results听 Among 27鈥�651 adults (15鈥�050 [54.4%] female; mean [SD] age, 52.9 [18.4] years), 5186 (18.2%) reported lifetime depression, 1948 (7.3%) reported current depression, 4834 (17.7%) reported lifetime anxiety, and 1689 (6.6%) reported current anxiety. Medical debt was more common among adults with lifetime depression (19.9% vs 8.6%; adjusted prevalence ratio [aPR], 1.97; 95% 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) compared with adults without the respective mental disorders. Medical debt was associated with delayed health 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 those without these diagnoses. Medical debt was associated with forgone health care 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) compared with those without the diagnoses.

Conclusions and Relevance听 Medical debt is prevalent among adults with depression and anxiety and may contribute to the mental health treatment gap. In the absence of structural reform, new policies are warranted to protect against this financial barrier to mental health care.

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Medical Debt and the Mental Health Treatment Gap Among US Adults