Disparities in Health Care Utilization and Functional Limitations Among Adults With Serious Psychological Distress, 2006-2014

Psychiatr Serv. 2017 Jul 1;68(7):653-659. doi: 10.1176/appi.ps.201600260. Epub 2017 Apr 17.


Objective: This study compared health care access, utilization, and functional indicators among adults with and without serious psychological distress (SPD) in the years surrounding implementation of the Patient Protection and Affordable Care Act (ACA).

Methods: Adults ages 18 to 64 from the 2006-2014 National Health Interview Survey (N=207, 853) were examined on 11 access, utilization, and functional indicators: health insurance coverage (health coverage), insufficient money for medications, delay in health care (delay in care), insufficient money for health care, visiting a doctor ten or more times in the past 12 months, change in place of health care, change in place of health care due to insurance, limitations in ability to work, limitations in activities of daily living (ADLs), insufficient money for mental health care, and having seen a mental health care provider.

Results: Multivariate models that were adjusted for health coverage and sociodemographic characteristics indicated that compared with adults without SPD, adults with SPD had greater odds of lacking money for medications (AOR=10.0) and health care (AOR=3.1), experiencing delays in care (AOR=2.7), visiting a doctor ten or more times in the past 12 months (AOR=3.2), changing usual place of health care (AOR=1.5), changing usual place of health care because of insurance (AOR=1.5), and experiencing limitations in ADLs (AOR=3.6) and ability to work (AOR=1.8). The proportions of adults with SPD who lacked health coverage and money to buy prescriptions increased during the study period. Although this trend reversed in 2014, the proportion with SPD experiencing barriers remained above 2006 levels.

Conclusions: Health care patterns among adults with SPD require greater attention.

Keywords: Community mental health services; Depression; Health Care Access; Mental health systems/hospitals.

MeSH terms

  • Adolescent
  • Adult
  • Anxiety / therapy*
  • Depression / therapy*
  • Female
  • Health Services Accessibility / statistics & numerical data*
  • Healthcare Disparities / statistics & numerical data*
  • Humans
  • Insurance, Health / statistics & numerical data*
  • Male
  • Middle Aged
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Stress, Psychological / therapy*
  • United States
  • Young Adult