National Institute of Mental Health announced that the prevalence of depressive disorder among adults in the U.S. was 7.1% (17.3 million) in 2017. People living with depression have a shorter lifespan and greater co-morbid health problems than the general population in the U.S. Therefore, elevated mortality rates in people with depressive disorders are well known for over two decades. Recent meta-analysis reported that people with depression have 50% increased risk of mortality.
Inequality in health care for people with serious mental illness were found in the U.S. as well as in countries with national health insurance. Previous research indicated that unhealthy lifestyle behaviors, such as physical inactivity, poor diet, smoking, and excessive alcohol intake, contribute to premature mortality and excessive morbidity of individuals with depression. This extraordinary elevated mortality rates may reflect a combination of 1) poorer health care access, 2) a greater risk of chronic diseases, and 3) increased health-risk behaviors.
Our research sought to investigate the difference between the high impact health-related factors amongst people with depression and the general population. This research is critical as it seeks to illuminate the health disparities within healthcare provisions and economic hardships for people with depression.
A secondary data analysis was conducted using the 2013 Behavioral Risk Factor Surveillance System (BRFSS), including four states (Minnesota, Nevada, Tennessee, and Washington). A total of 32,621 individuals without depression and 3,797 people with depression were selected. Since the 2013 BRFSS data used a post-stratification method to weigh survey data, a complex survey analysis was applied. Chi-square analyses were conducted comparing the difference in chronic diseases, healthcare access and health behaviors between these groups.
As previous research found people with depression were more likely to have chronic diseases including heart attacks, coronary heart disease, stroke, asthma, skin cancer, any cancer, COPD, arthritis, kidney disease and diabetes, and obesity. Higher rates of binge drinking, smoking, physical inactivity in people with depression than in the general population were also found. According to healthy eating habits, people with depression and the general population showed significant differences in daily vegetable and fruit consumption. Our finding highlights that despite a high rate (92.6%) of having health insurance in people with depression, approximately 18% of them were not able to see a doctor or to take a medication due to its cost. However, only less than 11% of the general population reported not being able to see a doctor or to take a medication because of cost.
This study confirmed disparities in health care access between people with depression and the general population. Also, preventive health behaviors were worse in people with depression. These results highlight why 70 % of people with depression have at least one co-occurring chronic physical illness. Higher rates of not being able to see a doctor and take a medication due to cost in people with depression reflect economic inequality between these groups. Efforts are urgently needed to remove barriers to health care access and economic inequality for people with depression.