Study: Medical debt linked to mental health care delays among adults with depression and anxiety

Medical debt leads to mental health care delays: ©Zimmytws - stock.adobe.com

A study led by researchers at the Johns Hopkins Bloomberg School of Public Health has found a correlation between medical debt and the prevalence of mental health care delays among adults suffering from depression and anxiety. The study, which analyzed data from the Centers for Disease Control and Prevention’s 2022 National Health Interview Survey, found that adults with these mental disorders are significantly more likely to carry medical debt compared to those without such conditions.

The research team evaluated responses from 27,651 U.S. adults to measure the prevalence of medical debt and its impact on accessing mental health care. Their findings were published online in JAMA Psychiatry.

Among adults currently experiencing depression and holding medical debt, 36.9% reported delaying mental health care, and 38% did not seek care at all within the past 12 months. Conversely, among those with depression but no medical debt, only 17.4% delayed care and 17.2% skipped it altogether.

The situation is similarly dire for those with anxiety. The study found that 38.4% of adults with current anxiety and medical debt delayed seeking mental health care, while 40.8% did not seek care at all in the past year. For those with anxiety but no medical debt, 16.9% delayed care and 17.1% skipped it.

“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,” said lead researcher Kyle Moon in a statement. “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 highlights that 27.3% of adults with current depression and 26.2% with current anxiety reported having medical debt in the previous 12 months, compared to 9.4% of adults without current depression and 9.6% without current anxiety.

Medical debt remains a substantial issue despite insurance coverage, with over 90% of the individuals in the study being insured. Nevertheless, 19.4 to 27.3% of them reported having medical debt in the last 12 months. This financial strain often leads to delays in seeking necessary mental health care, exacerbating the existing treatment gap.

The study pointed out that consumer credit report data underscores that medical debt is the leading contributor to personal debt in the U.S., significantly impacting access to health care treatment. The inability to pay medical bills has been shown to delay needed care, particularly for mental health disorders. Less than half of U.S. adults with mental disorders currently receive treatment.

The researchers also examined adults with lifetime diagnoses of depression or anxiety. Among those with a lifetime depression diagnosis and medical debt, 29% delayed care due to cost, while 29.4% did not seek care at all. Among those 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 said. “They could expand services for patients by improving the processes to determine patient eligibility for financial assistance.”

The study's authors also note that economic stressors and financial strain are risk factors for both depression and anxiety, suggesting a cyclical relationship where medical debt exacerbates mental health conditions, which in turn can lead to more medical debt. They call for further studies to evaluate state policies that can protect against medical debt and reduce barriers to mental health care access.