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A new study reveals 8 million Americans have serious psychological distress, and many don't have health insurance or access to effective treatment. 

April 18, 2017

More Americans than ever before are suffering from mental and emotional distress, according to a new study. What's more, many lack access to adequate treatment, despite legislation implemented over the last 10 years designed to reduce these gaps in health coverage.

The study, published in the journal Psychiatric Services, used data from census interviews to estimate that 3.4% of the U.S. population, or more than 8 million Americans, suffer from serious psychological distress (SPD)—a term to describe feelings of sadness, worthlessness, and restlessness that are hazardous enough to impair physical well being. Previous census surveys have estimated SPD to affect 3% of people or less.

SPD isn’t a medical diagnosis, but it’s a good measure of community mental health that overlaps substantially with conditions like depression and anxiety, says lead study author Judith Weissman, PhD, a research manager at NYU Langone Medical Center. It’s calculated with the use of six questions, administered during an annual health survey conducted by the Centers for Disease Control and Prevention (CDC).

More than 35,000 households across the country, involving more than 200,000 American adults of all socioeconomic backgrounds, participate in the CDC yearly survey. For their new analysis, Weissman and her coauthors used data from 2006 to 2014.

They found that over that time, access to healthcare services deteriorated for people with high levels of psychological distress. This was somewhat surprising, says Weissman, since legislation like the 2008 Mental Health Parity and Addiction Equity Act and the 2010 Affordable Care Act included provisions designed to help close insurance gaps for people with mental-health issues.

The study estimates that 9.5% of distressed Americans in 2014 did not have health insurance that would allow them to see a psychiatrist or counselor—a slight rise from 9% in 2006. Americans with SPD were also more likely to report delays in getting professional help and trouble paying for psychiatric medications in 2014 than they were in 2006.

Meanwhile, healthcare access and affordability for people without psychological distress—even people with two or more physical chronic health problems, like cancer or diabetes—improved. “These people are beginning to see the benefits of the Affordable Care Act and they’re doing better than in 2006,” says Weissman. “But the people with mental illness are falling behind.”

Weissman says the recession of 2008 appears to have played a role in the increased prevalence of SPD, but that it was surprising that so many people had not recovered by 2014. “I think they’re trying to get better, but they don’t have the access to treatment options that can help them,” she says. She says the findings may help explain why the U.S. suicide rate has risen to 43,000 people a year.

The age group that’s most affected by psychological distress has also changed, Weissman says. Middle-age adults were not previously considered at high risk for mental illness and suicide, but this and other research has shown that now they are. In this analysis, SPD prevalence was highest among women versus men, ages 45 to 64 versus younger adults, and people with lower incomes and less education. (Adults over 65 were not included in the study.)

Part of the problem is that people with mental illness have a harder time navigating the complex healthcare industry to begin with, says Weissman; they also have a harder time holding a job and keeping a steady income.

But there’s also a lack of available and experienced physicians and therapists who can help them. “The trends seem to be diverging," she says. "Poor mental health is increasing, and the number of mental-health providers cannot keep up."

Solving these problems won’t be easy, says Weissman. It will require more mental-health screening and education at the primary-care level, providing more assistance to distressed people who can’t manage health care on their own, and exploring ways to make more mental-health professionals available to those who need them most.

The authors do note that since 2014 was the first year the Affordable Care Act was fully implemented (and because many states still had not accepted the plan’s Medicaid expansion), the true impact of the legislation—now facing an uncertain future under the Trump administration—may not yet be seen.

But Weissman encourages people who are struggling to not give up hope. “There are treatments out there that work, but you just have to find the right provider for you,” she says. “It’s not as though you have an illness that’s untreatable; you just have a society that’s not willing to make it easy for you.”

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