July 19,2024

Study Links Medical Debt to Delayed and Forgone Mental Health Care Among Adults with Depression and Anxiety

Medical debt is significantly more common among adults with depression or anxiety compared to those without these mental health conditions, according to a new study led by researchers at the Johns Hopkins Bloomberg School of Public Health. The study found that adults with depression or anxiety who have medical debt are twice as likely to report having delayed or skipped mental health care in the past year compared to those without medical debt.

The researchers analyzed data from the Centers for Disease Control and Prevention's (CDC) 2022 National Health Interview Survey, which included responses from 27,651 U.S. adults. They assessed the prevalence of medical debt among individuals with current and past depression or anxiety and examined the relationship between medical debt and delayed or forgone mental health care in the previous 12 months.

Among adults with current depression and medical debt, 36.9% delayed mental health care, and 38% did not seek care in the past year. In contrast, for those with current depression but no medical debt, only 17.4% delayed care and 17.2% skipped it altogether.

Similarly, among adults with current anxiety and medical debt, 38.4% delayed care, and 40.8% did not seek care in the past year. For those with current anxiety but no medical debt, 16.9% delayed care, and 17.1% skipped it.

These findings were published online on July 17 in JAMA Psychiatry.

The study highlights that the prevalence of medical debt is significantly higher among adults with depression and anxiety. Conversely, a substantial number of adults without medical debt also report delaying or skipping mental health care, indicating that medical debt exacerbates an existing issue.

Kyle Moon, a PhD student in the Department of Mental Health at Johns Hopkins Bloomberg School of Public Health, stated, "The prevalence of medical debt in the U.S. is already quite high, and the prevalence was significantly higher among adults with depression and anxiety. 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 study found that 27.3% of adults with current depression and 26.2% with current anxiety reported having medical debt in the past 12 months, compared to 9.4% of adults without current depression and 9.6% without current anxiety.

The researchers gathered information on medical debt and delays or avoidance of mental health care through CDC survey questions, including whether respondents had problems paying medical bills or delayed/avoided mental health care due to cost. Depression and anxiety were assessed using the Patient Health Questionnaire-8 and Generalized Anxiety Disorder-7 scales, respectively, with a score of 10 or greater indicating moderate or severe symptoms.

Consumer credit report data shows that medical debt is a major contributor to personal debt, which impacts access to healthcare treatment. Inability to pay medical debt has been shown to delay necessary care, particularly for mental health disorders: less than half of U.S. adults with mental disorders receive treatment. Medical debt remains common despite insurance coverage, with over 90% of individuals in this study being insured, yet 19.4% to 27.3% reported having medical debt in the past 12 months.

The study also examined adults with a lifetime diagnosis of depression or anxiety. Among those with a lifetime depression diagnosis and medical debt, 29% delayed care due to cost, and 29.4% did not seek mental health care at all. Among adults with a lifetime anxiety diagnosis and medical debt, 28% delayed care, and 28.2% forwent care altogether.

"Health systems have a critical role to play," Moon noted. "They could expand services for patients by improving the processes to determine patient eligibility for financial assistance."

The study authors suggest that economic stressors and financial strain are risk factors for both depression and anxiety. Therefore, while medical debt may increase the risk of poor mental health, illness and disability are also risk factors for medical debt. The authors recommend further studies to evaluate state policies that can protect against medical debt and reduce barriers to mental health care for those in need.