Adults with depression or anxiety disorders have significantly more medical debt than adults without these mental illnesses, according to a new study led by researchers at the Johns Hopkins Bloomberg School of Public Health. Adults with depression or anxiety disorders who have medical debt are twice as likely to report having delayed or missed mental health care in the past 12 months compared to those without medical debt.
The researchers analyzed data from the 2022 National Health Interview Survey conducted by the Centers for Disease Control and Prevention among 27,651 U.S. adults. They measured the prevalence of medical debt (current and past, across lifetimes) among people with depression and anxiety disorders and assessed the relationship between medical debt and delays and abandonment of mental health care in the past 12 months.
Among adults who currently suffer from depression and have medical debt, 36.9% delayed mental health care in the past 12 months and 38% did not seek treatment in the past 12 months. In contrast, among those who reported currently suffering from depression but no medical debt, 17.4% delayed mental health care in the past 12 months and 17.2% did not seek any mental health care in the past 12 months.
Among adults who are currently anxious and have medical debt, 38.4% delayed medical treatment in the past 12 months and 40.8% forgot treatment. Among adults who reported currently anxious and no medical debt, 16.9% delayed medical treatment in the past 12 months and 17.1% forgot treatment.
The results were published online on July 17th. JAMA Psychiatry.
“The prevalence of medical debt in the United States is already sizable, especially among adults with depression and anxiety disorders. Yet, even among adults without medical debt, medical debt appears to exacerbate the problem, as more people delay or don’t seek mental health care.”
Kyle Moon, PhD Student, Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
The survey found that 27.3% of adults with current depression and 26.2% with current anxiety disorders reported having medical debt dating back to the past 12 months, compared with 9.4% of adults without current depression and 9.6% of adults without current anxiety disorders.
Researchers captured medical debt and delayed or discontinued mental health care from responses to the following CDC survey questions:
- In the past 12 months, have you had trouble paying or been unable to pay a medical bill?
- In the past 12 months, have you put off seeking counseling or therapy from a mental health professional because of cost?
- During the past 12 months, have you needed counseling or therapy from a mental health professional but were unable to get it because of cost?
To ascertain current depression or anxiety, the researchers used the Patient Health Questionnaire8 and Generalized Anxiety Disorder7 scales, respectively. A score of 10 or higher corresponds to moderate or severe symptoms on both scales. Both were administered as part of the CDC’s 2022 National Health Interview Survey.
According to data from the Consumer Credit Report, medical debt is the leading cause of personal debt and impacts access to medical care. Inability to pay medical debt has been shown to delay needed treatment, especially when seeking treatment for mental illness. Fewer than half of U.S. adults with a mental illness receive treatment.
Medical debt remains common despite insurance coverage: More than 90% of people in the survey had insurance, but between 19.4% and 27.3% reported having medical debt in the past 12 months.
The researchers also looked at adults who reported having a lifetime diagnosis of depression or anxiety. Among adults with a lifetime diagnosis of depression and medical debt, 29% delayed treatment due to cost, and 29.4% never sought mental health care at all. Among adults with a lifetime diagnosis of anxiety disorder and medical debt, 28% delayed treatment, and 28.2% never sought treatment at all.
“Health systems have an important role to play,” Moon said, “and could potentially expand services for patients by improving the process for determining whether patients qualify for financial assistance.”
The authors note that economic stress and financial burden are risk factors for both depression and anxiety. Thus, while medical debt may be a risk factor for poor mental health, illness and disability are also risk factors for medical debt. The authors suggest further research to evaluate state policies that can prevent medical debt and break down barriers to receiving mental health care for those who need it.
“Medical Debt and Mental Health Treatment Disparities Among U.S. Adults” was written by Kyle Moon, Sabriya L. Linton, and Ramin Mojtabai.
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Johns Hopkins Bloomberg School of Public Health
