A Retrospective Study of Demographic, Socio-Economic and Healthcare Access Disparities Among Patients With Depression in the USA

TL;DR

This study finds that depression in the US is linked to factors like poor health, insurance type, and access to care, highlighting the need for better mental health policies.

Contribution

The study provides new empirical evidence on disparities in depression linked to healthcare access and socioeconomic factors in the US.

Findings

Poor mental health for 14+ days strongly increases depression risk.

Medicaid and military insurance are strongly associated with higher depression odds.

Better medication affordability is linked to lower depression likelihood.

Abstract

Introduction

Depression is a multifactorial psychological condition influenced by a complex interplay of demographic, socioeconomic, and healthcare access factors. Understanding these associations is essential to develop effective, inclusive, and targeted mental health interventions. Globally, and particularly in the United States, disparities in mental healthcare organization and access contribute to unequal outcomes.

Methodology

This cross-sectional observational study utilized the 2021 Behavioral Risk Factor Surveillance System (BRFSS) dataset comprising 438,693 respondents across the United States. After applying exclusion criteria, 85,398 participants were included in the final analysis. Depression was the dependent variable, and independent variables included age, gender, race, education, employment, income, mental/physical health status, insurance type, and access to healthcare providers. Binomial logistic regression was used to calculate odds ratios (ORs), 95% confidence intervals (CIs), and p-values.

Results

Participants reporting 14 or more days of poor mental health had a significantly higher likelihood of depression (OR = 12.41; 95% CI: 11.77-13.08; p < 0.0001). Those with multiple physical health issues (OR = 1.56; 95% CI: 1.49-1.64; p < 0.0001) and more than one healthcare provider (OR = 1.21; 95% CI: 1.16-1.26; p < 0.0001) also had higher odds. Insurance types like Medicaid (OR = 1.83; 95% CI: 1.71-1.95; p < 0.0001) and military-related coverage (OR = 1.68; 95% CI: 1.54-1.85; p < 0.0001) were strongly associated with depression. Conversely, those who did not face medication cost-related issues had a lower likelihood of depression (OR = 0.62; 95% CI: 0.58-0.66; p < 0.0001).

Conclusion

Significant associations exist between depression and various demographic, socioeconomic, health, and healthcare access factors. These findings underscore the need for systemic reforms in mental healthcare delivery and support the development of targeted policies to reduce disparities and improve mental health outcomes across diverse populations.

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