Mental Health
Unmet Need for Depression Treatment Before and After the Affordable Care Act Daniel Hagen* Daniel Hagen Emily Goldmann Rebecca M. Schwartz Jacqueline Moline
Background:
The 2010 Affordable Care Act (ACA) expanded access to depression screening and care. However, its effect on unmet need for depression treatment remains understudied.
Methods:
Data from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2020 were used to examine changes in unmet need for depression treatment (no current use of antidepressants or receipt of past-year psychotherapy despite current depressive symptoms [Patient Health Questionnaire (PHQ)-9 score ≥ 10]). Modified Poisson regression models were used to estimate the association between time period (post-ACA, 2013-2020 vs. pre-ACA, 2005-2010) and unmet need for depression treatment, both overall and stratified by socio-demographic and health care-related variables. Unadjusted models and models adjusted for socio-demographic characteristics and physical comorbidity yielded prevalence ratios (PRs) and 95% CIs.
Results:
Unmet need for depression treatment decreased from 56% in 2005-10 to 47% in 2013-20. After adjusting for covariates, this corresponded to a 14% reduction in unmet need post- vs. pre-ACA (PR=0.86; 95% CI: 0.79,0.95). In stratified models, the decline was statistically significant among men, Hispanic respondents, those 18-34 and 65+ years old, and participants with a Bachelor’s degree or more (at p<0.05). Only those reporting Medicare vs. another type of insurance coverage experienced a significant decrease in unmet need for depression treatment (PR=0.77; 95% CI: 0.60,0.99). A similar decrease in unmet need was observed regardless of having a regular point of care or not, but only detected among those who had used health care services in the prior year (PR=0.80; 95% CI: 0.70,0.92) vs. those who had not (PR=1.13; 95% CI: 0.92,1.37).
Conclusion:
Unmet need for depression treatment decreased after ACA implementation but remains common. Reductions in barriers to primary care visits and universal screening policies may further decrease unmet need for depression treatment.