ImportanceMedical debt is common in the US and may hinder timely access to care for mental disorders.ObjectiveTo 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 ParticipantsCross-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.ExposuresSelf-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.Main Outcomes and MeasuresSelf-reported delaying and forgoing mental health care because of cost in the past year.ResultsAmong 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.Conclusions and RelevanceMedical 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.

中文翻译：

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美国成年人的医疗债务和心理健康治疗差距


重要性医疗债务在美国很常见，可能会阻碍及时获得精神障碍的护理。目的估计美国成人抑郁症和焦虑症患者医疗债务的患病率及其与延迟和放弃心理健康护理的相关性。设计、设置和参与者对 2022 年全国健康访谈调查中当前或终生被诊断为抑郁症或焦虑症的美国成年参与者进行的横断面、全国代表性调查研究。暴露自我报告的抑郁和焦虑的终生临床诊断;当前抑郁（患者健康问卷 8 分 ≥10） 和焦虑（广泛性焦虑症 7 分 ≥10） 的中度至重度症状，无论终生诊断如何;以及过去一年的医疗债务。主要结局和措施自我报告在过去一年中因费用而延迟和放弃心理健康护理。结果在 27 651 名成年人 （15 050 [54.4%] 女性;平均 [SD] 年龄，52.9 [18.4] 岁）中，5186 名 （18.2%） 报告了终生抑郁症，1948 名 （7.3%） 报告了目前的抑郁症，4834 名 （17.7%） 报告了终生焦虑，1689 名 （6.6%） 报告了当前的焦虑。与没有相应精神障碍的成年人相比，终生抑郁（19.9% 对 8.6%;调整患病率 [aPR]，1.97;95% CI，1.96-1.98）、终生焦虑（19.4% 对 8.8%;aPR，1.91;95% CI，1.91-1.92）、当前抑郁（27.3% 对 9.4%;aPR，2.34;95% CI，2.34-2.36）和当前焦虑（26.2% 对 9.6%;aPR，2.24;95% CI，2.24-2.26）的成年人中医疗债务更为常见。在患有终生抑郁症（29.0% 对 11.6%;aPR，2.68;95% CI，2.62-2.74）、终生焦虑（28.0% 对 11.5%;aPR，2.45;95% CI，2.40-2.50）、当前抑郁症（36.9% 对 17.4%;aPR，2.25;95% CI，2.13-2.38）和当前焦虑 （38.4% 对 16.9%;aPR，2.48;95% CI，2.35-2.66） 与未诊断的人相比。与未诊断的人相比，患有终生抑郁（29.4% 对 10.6%;aPR，2.66;95% CI，2.61-2.71）、终生焦虑（28.2% 对 10.7%;aPR，2.63;95% CI，2.57-2.68）、当前抑郁（38.0% 对 17.2%;aPR，2.35;95% CI，2.23-2.48）和当前焦虑（40.8% 对 17.1%;aPR，2.57;95% CI，2.43-2.75）的成年人的医疗债务与放弃医疗保健有关。结论和相关性医疗债务在患有抑郁症和焦虑症的成年人中普遍存在，并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止精神卫生保健的这一经济障碍。