A recent cross-sectional study found that medical debt is prevalent among U.S. adults with depression and anxiety and may be associated with delayed and forgone mental health care. 

"Medical debt appears to contribute to the mental health treatment gap, suggesting that aggressive debt collection practices have negative consequences for population mental health," noted researchers.

Methods

The study, published in JAMA Psychiatry, included 27,651 U.S. adults (54.4% female; mean age, 52.9 years). Johns Hopkins Bloomberg School of Public Health researchers analyzed data from the 2022 National Health Interview Survey. The Patient Health Questionnaire-8 and Generalized Anxiety Disorder-7 scales assessed mental health status using self-reported lifetime diagnoses and current symptoms. Researchers used weighted multivariable Poisson regression models with robust variance to assess associations between mental health status, medical debt, and delayed or forgone mental health care. Models were adjusted for sociodemographic characteristics, physical comorbidities, and health insurance status. Medical debt was defined as reporting problems with paying or an inability to pay medical bills in the past 12 months.

Key Findings

Just under 20% of adults with lifetime depression and 19.4% with lifetime anxiety reported medical debt, compared to 8.6% and 8.8% of adults without these diagnoses, respectively. Just over 27% of adults with current depression and 26.2% with current anxiety reported medical debt, compared to 9.4% and 9.6% of adults without these current symptoms, respectively. Medical debt was associated with a more than two-fold increase in delayed and forgone mental health care across all groups studied.

The association between medical debt and forgone mental health care was more pronounced among insured adults compared to uninsured adults for those with lifetime depression and lifetime anxiety.

More detailed comparisons:

Prevalence of Medical Debt

• Medical debt was more prevalent among those with lifetime depression than those without the diagnosis (19.9% versus 8.6%), among those with lifetime anxiety versus those without this diagnosis (19.4% versus 8.8%), among those with current depression (27.3% versus 9.4%), and among those with current anxiety (26.2% versus 9.6%).

Delayed Mental Health Care

• Those with lifetime depression were more likely to delay receiving mental health care than those without the diagnosis at 29% versus 11.6%.

Forgone Mental Health Care

• Those with lifetime depression were more likely to forgo mental health care (29.4% versus 10.6%), as were those with lifetime anxiety versus those without the diagnosis (28.2% versus 10.7%).

The cross-sectional nature of the study prevents establishing causality between mental disorders and medical debt. The measure of lifetime diagnosis depends on access to health care professionals, which may introduce bias. The study was limited to depression and anxiety and did not assess other psychiatric disorders.

Full disclosures can be found in the published study article.