Medical Debt Causes Many People to Delay or Forgo Mental Health Care

Kyle Moon

Credit: Johns Hopkins Bloomsberg School of Public Health

A new study observed the high prevalence of medical debt among adults with depression and anxiety, a factor that may prevent people from receiving mental health care.¹

“The prevalence of medical debt in the US is already quite high, and the prevalence was significantly higher among adults with depression and anxiety,” said lead author Kyle Moon, a PhD student in the Bloomberg School’s Department of Mental Health, in a press release.² “On the flip side, a relatively high number of adults with no medical debt also report delaying or forgoing mental health care, and medical debt appears to compound the problem.”

The government has strived to reduce medical debt with new legislation and policies in the last decade, such as extending private and public insurance through the Affordable Care Act.¹ However, many low-income adults still face barriers to receiving mental health care in the US.

Moon and colleagues sought to examine how many people delayed or forgone mental health care in the past year due to medical debt. They also wanted to estimate the prevalence of medical debt among US adults with depression and anxiety.

The team conducted a cross-sectional, nationally representative study of US adult participants in the 2022 National Health Interview Survey who had diagnoses of depression or anxiety. Investigators collected data on self-reported clinical diagnoses of depression and anxiety, moderate to severe symptoms of current depression (Patient Health Questionnaire–8 score ≥10) and anxiety (Generalized Anxiety Disorder–7 score ≥10), and past-year medical debt.

The study included 27,651 adults with 54.4% female and a mean age of 52.9 years. In total, 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. Compared to individuals without the respective mental disorders, medical debt was more prevalent among adults with lifetime depression (19.4% vs 8.8%; adjusted prevalence ratio [aPR], 1.97; 95% confidence interval [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 linked to 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 to participants without mental disorders. Medical debt was also linked to forgoing 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).

Investigators pointed out medical debt is a risk factor for depression and anxiety, but poor mental health is also putting people at risk of medical debt.

“Medical debt appears to contribute to the mental health treatment gap, suggesting that aggressive debt collection practices have negative consequences for population mental health,” investigators concluded. “In the absence of structural health care reform, many states have enacted laws to protect patients from medical debt, but regulations have been heterogeneous across states. Further studies are needed to evaluate policies to inform protections against medical debt at the federal level.”

References

1. ^{Moon KJ, Linton SL, Mojtabai R. Medical Debt and the Mental Health Treatment Gap Among US Adults. JAMA Psychiatry. Published online July 17, 2024. doi:10.1001/jamapsychiatry.2024.1861}
2. ^{More Than One-Third of Adults With Medical Debt And Depression or Anxiety Delayed Mental Health Care In Previous 12 Months. EurekAlert! July 18, 2024. https://www.eurekalert.org/news-releases/1051846. Accessed July 19, 2024.}