Barriers to healthcare access among U.S. adults with mental health challenges: A population-based study

Background: Having sufficient healthcare access helps individuals proactively manage their health challenges, leading to positive long-term health outcomes. In the U.S., healthcare access is a public health issue as many Americans lack the physical or financial resources to receive the healthcare services they need. Mental healthcare is especially difficult due to lingering social stigmas and scarcity of services. Subsequently, those with mental health impairment tend to be complex patients, which may convolute delivery of services. Objective: To quantify the prevalence of barriers to healthcare access among U.S. adults with and without mental health challenges (MHC) and evaluate the relationship between MHC and no usual source of care (NUSC). Methods: A cross-sectional study was conducted with data from the 2017–2018 National Health Interview Survey. MHC was categorized into three levels: no (NPD), moderate (MPD) and severe (SPD) psychological distress. Eight barriers were quantified; one was used as the primary outcome: NUSC. Multivariable logistic regression was used to quantify associations between these characteristics. Results: The sample included 50,103 adults. Most reported at least one barrier to healthcare access (95.6%) while 13.3% reported NUSC. For each barrier, rates were highest among those with SPD and lowest for those with NPD. However, in the multivariable model, SPD and MPD were not associated with NUSC (OR, 0.92; 95% CI, 0.83–1.01; 0.88; 0.73–1.07). Male sex (1.92; 1.78–2.06), Hispanic race/ethnicity (1.59; 1.42–1.77), and worry to afford emergent (1.38; 1.26–150) or normal (1.60; 1.46–1.76) healthcare were associated with NUSC. Having a current partner (0.88; 0.80–0.96), dependent(s) (0.77; 0.70–0.85) and paid sick leave (0.60; 0.56–0.65) were protective. Conclusions: The most prevalent barriers to healthcare access link to issues with affordability, and MHC exist more often when any barrier is reported. More work is needed to understand the acuity of burden as other social and environmental factors may hold effect.