Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
JAMA Psychiatry. 2024 Oct 1;81(10):985-992. doi: 10.1001/jamapsychiatry.2024.1861.
Medical debt is common in the US and may hinder timely access to care for mental disorders.
To estimate the prevalence of medical debt among US adults with depression and anxiety and its association with delayed and forgone mental health care.
DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional, nationally representative survey study of US adult participants in the 2022 National Health Interview Survey who had current or lifetime diagnoses of depression or anxiety.
Self-reported lifetime 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) irrespective of lifetime diagnoses; and past-year medical debt.
Self-reported delaying and forgoing mental health care because of cost in the past year.
Among 27 651 adults (15 050 [54.4%] female; mean [SD] age, 52.9 [18.4] years), 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. Medical debt was more common among adults with lifetime depression (19.9% vs 8.6%; adjusted prevalence ratio [aPR], 1.97; 95% 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) compared with adults without the respective mental disorders. Medical debt was associated with 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 with those without these diagnoses. Medical debt was associated with forgone 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) compared with those without the diagnoses.
Medical debt is prevalent among adults with depression and anxiety and may contribute to the mental health treatment gap. In the absence of structural reform, new policies are warranted to protect against this financial barrier to mental health care.
在美国，医疗债务很常见，可能会阻碍精神障碍患者及时获得治疗。
评估美国患有抑郁症和焦虑症的成年人的医疗债务的流行程度，以及其与延迟和放弃心理健康护理之间的关联。
设计、地点和参与者：这是一项针对 2022 年全国健康访谈调查中患有抑郁或焦虑症的美国成年参与者的横断面、全国代表性调查研究。
终生临床诊断的抑郁和焦虑；目前的抑郁（患者健康问卷-8 得分≥10）和焦虑（广泛性焦虑障碍-7 得分≥10）的中度至重度症状，无论是否有终生诊断；以及过去一年的医疗债务。
过去一年因费用而延迟和放弃心理健康护理的自我报告。
在 27651 名成年人中（女性 15050 名[54.4%]；平均[标准差]年龄为 52.9[18.4]岁），5186 名（18.2%）报告有终生抑郁症，1948 名（7.3%）报告有当前抑郁症，4834 名（17.7%）报告有终生焦虑症，1689 名（6.6%）报告有当前焦虑症。与没有相应精神疾病的成年人相比，有终生抑郁症（19.9%比 8.6%；调整后的患病率比[aPR]，1.97；95%CI，1.96-1.98）、终生焦虑症（19.4%比 8.8%；aPR，1.91；95%CI，1.91-1.92）、当前抑郁症（27.3%比 9.4%；aPR，2.34；95%CI，2.34-2.36）和当前焦虑症（26.2%比 9.6%；aPR，2.24；95%CI，2.24-2.26）的成年人中，医疗债务更为常见。与没有这些诊断的成年人相比，有终生抑郁症（29.0%比 11.6%；aPR，2.68；95%CI，2.62-2.74）、终生焦虑症（28.0%比 11.5%；aPR，2.45；95%CI，2.40-2.50）、当前抑郁症（36.9%比 17.4%；aPR，2.25；95%CI，2.13-2.38）和当前焦虑症（38.4%比 16.9%；aPR，2.48；95%CI，2.35-2.66）的成年人中，医疗债务与医疗保健的延迟有关。与没有这些诊断的成年人相比，有终生抑郁症（29.4%比 10.6%；aPR，2.66；95%CI，2.61-2.71）、终生焦虑症（28.2%比 10.7%；aPR，2.63；95%CI，2.57-2.68）、当前抑郁症（38.0%比 17.2%；aPR，2.35；95%CI，2.23-2.48）和当前焦虑症（40.8%比 17.1%；aPR，2.57；95%CI，2.43-2.75）的成年人中，医疗债务与放弃医疗保健有关。
患有抑郁症和焦虑症的成年人中普遍存在医疗债务，这可能导致心理健康治疗差距。在没有结构性改革的情况下，需要制定新的政策来防范这一心理健康护理的经济障碍。
