Over 8.3 million American adults suffer from severe psychological distress

By Kathleen Martin
22 April 2017

According to a report released Monday by the Psychiatrics Journal, 3.4 percent, or a staggering 8.3 million American adults, suffer from “severe psychological distress” (SPD).

The study examined the results of a study, the National Health Interview Survey, conducted by the Center for Disease Control and Prevention from 2006-2014. It focused on the data of 207,853 participants from over 35,000 households, aged 18-64, on 11 indicators: health insurance coverage, insufficient money for medications, delay in health care, insufficient money for health care, visiting a doctor 10 or more times in a year, change in place of health care, change of place in health care due to insurance, limitations in ability to work, limitations in activities of daily living, insufficient money for mental health care, and having seen a mental health care provider.

About 38 percent of the study’s participants’ family incomes were 400 percent or higher than the federal poverty line, currently at $11,880 per person.

The purpose of the study was to gather data on health care utilization after the implementation of the Affordable Care Act (ACA), popularly known as Obamacare. The conclusions reached based on the study indicate that adults with SPD “had an increased risk of forgoing health care and prescription medications because of cost and were more likely to be uninsured. Adults with SPD were also more likely to exhibit greater nonadherence to mental care.”

“Yet earlier reports also showed that despite being more likely to lack health insurance coverage, adults with SPD visited doctors more frequently than adults without SPD,” the authors noted. “Our hypothesis was that SPD represents a risk factor for experiencing health care barriers independent of risk associated with other chronic health conditions.”

Over one-third of the study’s participants had no health care coverage whatsoever. Over another third had “private coverage,” meaning health care was either provided by the individual’s place of work—usually taken out of the individual’s paycheck—or that it was purchased separately by the participant. A larger portion of adults with SPD were also found to be more likely to have limitations on activities of daily living (ADL), meaning that the participant felt that they needed assistance in personal care needs—such as getting dressed, eating, and getting around the house—due to a physical, mental, or emotional problem.

“What’s been most surprising isn’t necessarily that the overall numbers [of those with SPD] have increased but that the cohort that is most impacted has changed,” Judith Weissman, who headed the study at the Langone Medical Center at New York University, told CNN.

“There’s a newfound high-risk group: middle-aged adults; that’s adults from about the age of 45 to 59 in the US, who previously had not been thought to be at high risk for mental illness or suicide, and now we’re finding that they are.”

The severe and deepening economic crisis paired with an increased lack of access to decent health care overall has resulted in tragedy for a large section of the population who can find no way out.

The suicide rate has increased drastically in the wake of the economic crash of 2008 for nearly every demographic but most notably for the Baby Boomer generation, whose suicide rates in previous years had stabilized or fallen. “The Great Recession of 2008 had a tremendous impact on adults with serious psychological distress,” Weissman said. From 1999-2014 the suicide rate increased by 24 percent, with the US seeing on average more than 43,000 suicides a year.

The study reveals that utilization of health care for the non-mentally ill has increased since 2006, the inverse of the mentally ill. In other words, those who fared the worst during the Great Recession have simultaneously had much more difficulty attaining proper medical care for mental health issues that were likely a result of the economic crisis to begin with.

While those suffering from SPD tend to have less money for medications and poor access to health care, they also visit a doctor much more than those who do not have SPD.

“It is paradoxical that although SPD is associated with several indicators of poor utilization and access, as well as relatively poor general medical health, it is also associated with high utilization of expensive outpatient care,” the authors note. “One possible explanation is that primary care physicians are providing mental health care and prescription refills to adults with SPD in lieu of general medical care.”

The researchers stressed that although these findings are significant, it is based on “noninstitutionalized civilians,” meaning that it excludes a large section of the population which has a higher tendency to suffer from chronic mental health issues: the homeless.

Over half a million people in the US are homeless on any given night, and data reports that anywhere from 20 to 25 percent of the homeless population suffers from some form of severe mental illness, compared to 6 percent of the rest of the population. “Our study must be viewed in light of these exclusions, which may underestimate associations between SPD and indicators of poor health care use and access,” the authors state.

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