Mental Health Distress Associated with Lack of Health Care Insurance and Resources in Four Cities in the U.S

Background:  Chronic stress among Hispanics and Latinos has been associated with diminished physical and psychological health, including diabetes, cardiovascular disease, hypertension, and depression.  While risk for depression in this patient population increases significantly in the presence of cardiovascular disease, treatment for those without insurance is sorely lacking.  Access to health care plays a vital role in mediating both physical and psychological health, particularly in patients who are uninsured or underinsured.        

Methods:  Data were collected from 1808 Hispanic/Latino/as from Los Angeles, California; Miami, Florida; El Paso, Texas; and Lawrence, Massachusetts.  Participants completed the Patient Health Questionnaire 9 (PHQ-9) an assessment of mental distress; the WHO-QoL which measures quality of life in four domains:  physical, psychological, social and environmental; and the Hispanic Stress Inventory 2.0.  Items from an item pool of stressors associated with health—related stress were used as predictors for total PHQ-9 scores.  Data were analyzed using multivariate regression in SAS 9.4.  Beta weights and uniqueness scores were examined for each independent variable.

Results:  The majority were women (57%) with a mean age of 42 years (SD=19); 47% were employed full/part-time.  Nine variables were significantly associated with total PHQ-9 score and overall the model accounted for 27 percent of the variance in PHQ-9 scores.  Except for the WHO-QoL, variables were worded so that the respondent either endorsed or did not endorse the statement as a source of stress.  Variables positively and significantly associated with higher PHQ-9 scores and their contribution to the overall variance were:  “I had to use home remedies to take care of myself” (b=.12, R²=8%; p<.0001); “I had to go to an ER for general health care” (b=.12, R²=8%; p<.0001);  “family health problems forced me to leave work) (b=.10, R²=5.7%; p<.0001);  “my doctor did not spend enough time with me” (b=.06, R²=5.7%; p=.01); “I could not take off work to see doctor” (b=.06, R²=4.7%; p<.01); “I did not trust the medical staff” (b=.05, R²=4.4%; p=.02); “my spouse and I disagreed on contraception” (b=.07, R²=2.9%; p<.01); “I could not go to the doctor because no interpreter” (b=-.06, R²=2.1%; p<.05); and WHO-QoL total scores (b=-.31, R²=16.5%; p<.0001).

Discussion:  Lack of access to health care may result in greater depressive symptoms and lower quality of life, particularly among Hispanics/Latinos living in the U.S.  Policy changes, such as Medicaid expansion and the Patient Protection and Affordable Care Act (PPACA), are vital to alleviate the negative impact on mental health associated with being uninsured or underinsured.