Medical Financial Burdens and Later Risks of Adult Psychological Distress (2014-2023)

Research suggests that medical debt and difficulty paying medical bills are associated with worse mental health. However, limited research examines the longitudinal association between medical spending as a proportion of income and later mental health.

Using a series of two-year panels from the US Medical Expenditure Panel Survey-Household Components (2014-2023) (N=60,391 adults), this study employed longitudinal logistic regression models to examine the relationship between out-of-pocket and premium burdens in Year 1 and mental health outcomes in Year 2. Symptoms of severe psychological distress and probable major depression were measured using the Kessler-6 Severe Psychological Distress Scale and the Patient Health Questionnaire-2, respectively.

Among the study population, 63% of adults identified as non-Hispanic White, 16% as Hispanic, 12% as non-Hispanic Black, 6% as non-Hispanic Asian and Pacific Islander, 2% as non-Hispanic Multiracial and 1% as non-Hispanic American Indian or Alaska Native. The sample was 52% female. After controlling for covariates, adults with out-of-pocket burdens in Year 1 faced increased odds of both severe psychological distress [OR 1.405; 95% CI=1.182, 1.670] and probable major depression [OR 1.293, 95% CI 1.114, 1.500] at Year 2 compared to their peers a year later. Premium burdens were not associated with either outcome in Year 2.

Out-of-pocket medical financial burdens in Year 1 were associated with worse mental health outcomes in Year 2. No association existed between premium burdens and mental health outcomes. Policymakers should consider how to address the nation's healthcare affordability crisis.