Barriers to healthcare access among U.S. adults with mental health challenges: A population-based study
Open accessAbstract
BACKGROUND: Having sufficient healthcare access helps individuals proactively manage their health challenges, leading to positive long-term health outcomes. In the U.S., healthcare access is a public health issue as many Americans lack the physical or financial resources to receive the healthcare services they need. Mental healthcare is especially difficult due to lingering social stigmas and scarcity of services. Subsequently, those with mental health impairment tend to be complex patients, which may convolute delivery of services. OBJECTIVE: To quantify the prevalence of barriers to healthcare access among U.S. adults with and without mental health challenges (MHC) and evaluate the relationship between MHC and no usual source of care (NUSC). METHODS: A cross-sectional study was conducted with data from the 2017-2018 National Health Interview Survey. MHC was categorized into three levels: no (NPD), moderate (MPD) and severe (SPD) psychological distress. Eight barriers were quantified; one was used as the primary outcome: NUSC. Multivariable logistic regression was used to quantify associations between these characteristics. RESULTS: The sample included 50,103 adults. Most reported at least one barrier to healthcare access (95.6%) while 13.3% reported NUSC. For each barrier, rates were highest among those with SPD and lowest for those with NPD. However, in the multivariable model, SPD and MPD were not associated with NUSC (OR, 0.92; 95% CI, 0.83-1.01; 0.88; 0.73-1.07). Male sex (1.92; 1.78-2.06), Hispanic race/ethnicity (1.59; 1.42-1.77), and worry to afford emergent (1.38; 1.26-150) or normal (1.60; 1.46-1.76) healthcare were associated with NUSC. Having a current partner (0.88; 0.80-0.96), dependent(s) (0.77; 0.70-0.85) and paid sick leave (0.60; 0.56-0.65) were protective. CONCLUSIONS: The most prevalent barriers to healthcare access link to issues with affordability, and MHC exist more often when any barrier is reported. More work is needed to understand the acuity of burden as other social and environmental factors may hold effect.
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College students are typically too embarrassed to seek treatment or want to work through their issues.
“College students are not immune to these barriers, typically being too embarrassed to seek treatment or wanting to work through their issues [7].”
From Analysis of Mobile App-Based Mental Health Solutions for College Students: A Rapid Review (2023) · cites this paper as [7]
The Introduction discusses stigma and healthcare-access barriers among U.S. adults with mental health challenges, but does not address college students’ reasons for avoiding treatment. Searches for embarrassment, self-reliance, and wanting to work through issues found no passage supporting those specific reasons. (LLM, conf=0.76)
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Naik, H., Tran, K. C., Staples, J. A., Perlis, R. H., & Levin, A. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.8481 · Cited by 16 · see citing works
Heinz, M. V., Mackin, D., Trudeau, B., Bhattacharya, S., Wang, Y., Banta, H. A., Jewett, A. D., Salzhauer, A., Griffin, T., & Jacobson, N. C. (2024) · doi:10.31234/osf.io/pjqmr · Cited by 14 · see citing works
Hirten, R. P., Suprun, M., Danieletto, M., Zweig, M., Golden, E., Pyzik, R., Kaur, S., Helmus, D. S., Biello, A., Landell, K., et al. (2023) · JAMIA Open · doi:10.1093/jamiaopen/ooad029 · Cited by 15 · see citing works
“However, mental health resources are limited with wide disparities in access across geography and socioeconomic status.(3) Access is further limited by the need for in-person assessment or the completion of validated mental health surveys.”
BackgroundEmotion AI Use in U.S. Mental Healthcare: Potentially Unjust and Techno-Solutionist
Roemmich, K., Corvite, S., Pyle, C., Karizat, N., & Andalibi, N. (2024) · Proceedings of the ACM on Human-Computer Interaction · doi:10.1145/3637324 · Cited by 15 · see citing works
Ayo‐Ajibola, O., Julien, C., Lin, M. E., Riddell, J., Duan, N., & Kravitz, R. L. (2025) · Journal of General Internal Medicine · doi:10.1007/s11606-025-09406-9 · Cited by 14 · see citing works
Chronic Illnesses: Varied Health Patterns and Mental Health Challenges
Leite, Â. M. T. (2025) · Healthcare · doi:10.3390/healthcare13121396 · Cited by 14 · see citing works
“Despite the high prevalence of conditions like depression and anxiety in this population, access to care is often limited by stigma, a shortage of geriatric mental health providers, and the common under-recognition of mental illness by both patients and professionals [31,32].”
Pain mechanisms in the transgender individual: a review
Anger, J. T., Case, L. K., Baranowski, A. P., Berger, A. S., Craft, R. M., Damitz, L., Gabriel, R. A., Harrison, T. E., Kaptein, K., Lee, S., et al. (2024) · Frontiers in Pain Research · doi:10.3389/fpain.2024.1241015 · Cited by 15 · see citing works
“…societal stressors have been shown to have a direct impact on a number of measured variables, including: psychological processing, concern over fi nancial well-being such as access to affordable housing (274), general concern over health (275), access to health care (276), and food insecurity (277).”
Armoon, B., LESAGE, A. D., Mohammadi, R., Khoshnazar, Z., Varnousfaderani, M. R., Hosseini, A., Fotovvati, F., Mohammadjani, F., Khosravi, L., Beigzadeh, M., et al. (2025) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-025-01446-x · Cited by 15 · see citing works
“In Western countries, studies have indicated that 35%–55% of individuals with mental health disorders and substance use disorders do not seek the necessary services to address their health issues (Apsley et al., 2023; Coombs et al., 2021 ; Szlyk et al., 2023).”
McGuire, F. H., Beccia, A. L., Peoples, J. E., Williams, M. R., Schuler, M. S., & Duncan, A. E. (2024) · American Journal of Epidemiology · doi:10.1093/aje/kwae121 · Cited by 13 · see citing works
RetractedCommunity Mental Health Workers: Their Workplaces, Roles, and Impact
Heetderks-Fong, E., & Bobb, A. (2024) · Community Mental Health Journal · doi:10.1007/s10597-024-01306-2 · Cited by 13 · see citing works
“Stigma in seeking treatment and stigma from PCPs, lack of trust, discrimination, and poor health literacy, combined with a dearth of culturally competent providers all form barriers to care (Aguirre Velasco et al. 2020; Allen et al. 2017; Coombs et al. 2021; Fox & Heitkamp, 2022).”
James, D., & Horne, L. (2024) · Social Science & Medicine · doi:10.1016/j.socscimed.2024.117193 · Cited by 14 · see citing works
Fang, A., Chhabria, H., Maram, A., & Zhu, H. (2025) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/3706598.3713115 · Cited by 12 · see citing works
“Indeed, limited access to mental health care and resources remains a major barrier to receiving necessary support, even for individuals facing severe conditions [27].”
Flavin, K., Paulson, D. R., VanDeWiele, M. D., Evans, M., & Stull, C. L. (2025) · BMC Oral Health · doi:10.1186/s12903-025-06499-w · Cited by 12 · see citing works
Bisby, M. A., Barrett, V., Staples, L., Nielssen, O. B., Dear, B. F., & Titov, N. (2024) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2024.102882 · Cited by 11 · see citing works
Nowels, M., McDarby, M., Brody, L. A., Kleiman, E. M., Henson, S. J. S., Castro, C. M., & Kozlov, E. (2024) · Journal of Medical Internet Research · doi:10.2196/48696 · Cited by 11 · see citing works
“…of mental health service use is largely attributed to barriers to health care access, such as not being able to schedule an appointment in a timely manner [4] and persistent shortages in the mental health workforce—especially in rural communities and for people with serious mental illness [5,6].”
Folorunsho, S. A. (2025) · Journal of Aging & Social Policy · doi:10.1080/08959420.2025.2528584 · Cited by 11 · see citing works
Llaneza, D. H., Llaneza, A. J., & Kozlov, E. (2022) · Clinical Gerontologist · doi:10.1080/07317115.2022.2154728 · Cited by 11 · see citing works
“Given the mental health workforce shortage that impacts access to high quality mental health treatments (Coombs et al., 2021; Health Resources & Services Administration, 2022) and that some caregivers may find mHealth mindfulness therapy helpful, it is important to continue to consider mHealth…”
BackgroundAbdellatif, H. M. (2022) · BMC Oral Health · doi:10.1186/s12903-022-02543-1 · Cited by 10 · see citing works
Ngo, V. K., Vu, T. T., Punter, M. A., Levine, D. A., Borrell, L. N., & Mateu‐Gelabert, P. (2023) · Journal of Community Health · doi:10.1007/s10900-023-01301-w · Cited by 10 · see citing works
Gupta, A., Pajai, S., Gupta, A., Thakur, A. S., Muneeba, S., Batra, N., & Patel, D. J. (2024) · Cureus · doi:10.7759/cureus.54245 · Cited by 10 · see citing works
“These hurdles are particularly acute for individuals grappling with mental health challenges, who frequently confront social stigmas and encounter a scarcity of available services [47].”
BackgroundBisby, M. A., Jones, M., Staples, L., Dear, B. F., & Titov, N. (2024) · JMIR Formative Research · doi:10.2196/57804 · Cited by 10 · see citing works
Bezabih, A., Nourriz, S., Snider, A.-M., Rauenzahn, R., Handzo, G., & Smith, C. E. (2025) · Proc. ACM Hum. Comput. Interact. · doi:10.1145/3757492 · Cited by 12 · see citing works
“Individuals may encounter problems like internalized stigma [8], linguistic discrepancies [4], and healthcare accessibility, affordability, and medical debt [32, 37, 73] that prevent them from seeking formal institution-based care or continuing care.”
Availability and Accessibility of Mental Health Services in New York City
Breslau, J. A., Barnes‐Proby, D., Bhandarkar, M., Cantor, J., Hanson, R. W., Kofner, A., Li, R., Malika, N. M., Mendoza-Graf, A., & Pincus, H. A. (2022) · Rand health quarterly · doi:10.7249/rhq-10-01-06 · Cited by 10 · see citing works
Titov, N., Dear, B. F., Nielssen, O. B., Barrett, V., Kayrouz, R., & Staples, L. (2024) · Behaviour Research and Therapy · doi:10.1016/j.brat.2024.104536 · Cited by 9 · see citing works
Maternal Psychological Well-Being as a Protector in Infantile Colic
Garnacho‐Garnacho, V. E., Rodríguez‐López, E. S., Oliva‐Pascual‐Vaca, Á., Goenaga, L., & Otero-Campos, Á. (2024) · Nutrients · doi:10.3390/nu16142342 · Cited by 9 · see citing works
Wang, M. L., Narcisse, M., Rodriguez, K., & McElfish, P. A. (2025) · SSM - Population Health · doi:10.1016/j.ssmph.2025.101761 · Cited by 9 · see citing works
“Firstly, mental health care utilization is influenced by multifaceted factors beyond job characteristics alone, including socioeconomic status, health insurance coverage, access to mental health care services, and perceived stigma (Coombs et al., 2021).”
Al‐Johani, W. M., Almansour, A., Albakr, D. M., Alghirash, D. Y., Alfadhli, A. N., Almutairi, R., Mobarki, O. A., Alqasim, S., AlShammari, M. A., & Wahab, M. M. A. (2025) · Clinical Practice and Epidemiology in Mental Health · doi:10.2174/0117450179414477250905100917 · Cited by 10 · see citing works
"Doing The Work": Therapeutic Labor, Teletherapy, and the Platformization of Mental Health Care
Garofalo, L. (2024) · doi:10.2139/ssrn.4779005 · Cited by 11 · see citing works
Galadima, H. I., Dumadag, A., & Tonn, C. (2024) · Education Sciences · doi:10.3390/educsci14020125 · Cited by 9 · see citing works
Ni, Y., & Cao, Y. (2025) · Mental Health and Digital Technologies · doi:10.1108/mhdt-02-2025-0013 · Cited by 6 · see citing works
Held, P., Stade, E. C., Dondanville, K. A., & Stirman, S. W. (2025) · Journal of Traumatic Stress · doi:10.1002/jts.23188 · Cited by 8 · see citing works
“However, logistical barriers, financial constraints, and clinician shortages can limit access to these interventions (Coombs et al., 2021; Kantor et al., 2017).”
Walker, V. G., & Harrison, T. C. (2023) · The Gerontologist · doi:10.1093/geront/gnad149 · Cited by 8 · see citing works
Unmet need for mental health care is common across insurance market segments in the United States
Meiselbach, M. K., Ettman, C. K., Shen, K., Castrucci, B. C., & Galea, S. (2024) · Health Affairs Scholar · doi:10.1093/haschl/qxae032 · Cited by 8 · see citing works
AI-Facilitated Cognitive Reappraisal via Socrates 2.0: Mixed Methods Feasibility Study.
Held, P., Pridgen, S. A., Szoke, D. R., Chen, Y., Akhtar, Z., & Amin, D. (2025) · JMIR Mental Health · doi:10.2196/80461 · Cited by 7 · see citing works
“In line with other digital mental health tools, it appears that the 24/7 access can be a key factor for high user engagement, particularly among those who avoid traditional in-person therapy due to logistical constraints or concerns about stigma [4,29,30].”
Mesbah, H., Rafique, Z., Moukaddam, N. J., & Peacock, W. F. (2024) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2024.02.040 · Cited by 7 · see citing works
Rosen, S., Cassidy, J., Liang, H.-W., Wasser, L. M., Huh, D., & Williams, A. M. (2025) · Biomedicine Hub · doi:10.1159/000545307 · Cited by 7 · see citing works
“A prior study examining appointment attendance in chronic eye disease demonstrated that mental illness was the only medical characteristic to predict NS [12], and mental health challenges have previously been identi fi ed as a barrier to healthcare [13].”
Characterization of online support group resources for patients with dermatologic conditions
Kaundinya, T., El-Behaedi, S., Bilimoria, S. N., & Choi, J. N. (2023) · Archives of Dermatological Research · doi:10.1007/s00403-023-02528-2 · Cited by 7 · see citing works
“Furthermore, the psychiatric population in medicine is one that faces several unique barriers to healthcare access [29], yet none of the databases contained information on primary psychocutaneous conditions.”
BackgroundMENTAL HEALTH POLICIES: A COMPARATIVE REVIEW BETWEEN THE USA AND AFRICAN NATIONS
Odilibe, I. P., Akomolafe, O. O., Arowoogun, J. O., Anyanwu, E. C., Onwumere, C., & Ogugua, J. O. (2024) · International Medical Science Research Journal · doi:10.51594/imsrj.v4i2.766 · Cited by 7 · see citing works
Lee, Y., Kumwiang, K., Chiang, T. C., Shelley, M., & Chang, Y. (2024) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-024-01362-5 · Cited by 7 · see citing works
“These determinants may be associated with increased depression, anxiety, and other mental health problems (Coombs et al., 2021; Sareen et al., 2011; Zare et al., 2022).”
Graham, A. J., Robinson, M. T., Kahler, J., Azadi, J. R., & Maleki, Z. (2023) · Cancer Cytopathology · doi:10.1002/cncy.22764 · Cited by 6 · see citing works
“33,34 Although this problem is multifactorial, clinical trials centering un-derrepresented ethnic groups may be helpful in analyzing quality”
BackgroundSun, Y., Song, J., Li, X., Wang, X., Wu, Y., Huang, J.-J., Wang, S., & Teng, Y. (2024) · BMC Public Health · doi:10.1186/s12889-024-19289-w · Cited by 6 · see citing works
“Furthermore, the stigma surrounding these disorders could additionally impede their quest for knowledge about Alzheimer’s Disease [50].”
BackgroundRouvere, J., Fillipo, I. G., Romanelli, M., Sharma, A., Mosser, B. A., Nguyen, T., Rushton, K., Marion, J., Althoff, T., & Pullmann, M. D. (2025) · JMIR Mental Health · doi:10.2196/73188 · Cited by 7 · see citing works
“Self-guided mental health websites may be especially helpful for those who face structural barriers (eg, time, geographic constraints, and cost) and individual barriers (eg, stigma, low perceived need, and lack of readiness) to treatment [1-3].”
Feasibility of online psychosocial interventions to promote mental health recovery and well-being
Leah, P., Riewpaiboon, W., Sirirungruang, I., & Visuttipun, P. (2024) · International Journal of Social Psychiatry · doi:10.1177/00207640241264656 · Cited by 8 · see citing works
“These barriers were critically addressed, aligning with previous findings that created shameful feelings when visiting psychiatric hospitals (Coombs et al., 2021).”
Zoppé, H., Xavier, J.-L., Dupuis, A., Migeot, V., Bioulac, S., Hary, R., Bonnet-Brilhault, F., & Albouy, M. (2024) · Neuroscience and Biobehavioral Reviews · doi:10.1016/j.neubiorev.2024.105938 · Cited by 6 · see citing works
Crisis Intervention Application of Brief Solution-Focused Therapy in Addictions
Yeager, K. R., Gregoire, T. K., & Daron, C. A. (2025) · doi:10.1093/oso/9780197687833.003.0015 · Cited by 6 · see citing works
Szöllösi, G. J., Boruzs, K., Karcagi-Kováts, A., Kalas, N., Bányai, G., & Bíró, K. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.982716 · Cited by 6 · see citing works
Mugambwa, K. A., Lutchmun, W., Gach, J., Bader, C., & Froeschl, G. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-04727-7 · Cited by 5 · see citing works
“Mental health-related stigma is a multidimensional problem, which imposes a great burden on those affected [42].”
BackgroundAlbash, N. I. A. (2024) · Education and Information Technologies · doi:10.1007/s10639-024-12667-2 · Cited by 5 · see citing works
“…around the world have identified certain barriers to accessing mental healthcare for the general population, including financial and cultural issues that vary from country to country (Alamer et al., 2021; AlAteeq et al., 2018; Coombs et al., 2021; Modi et al., 2022; Salaheddin & Mason, 2016).”
Seah, S. J., Tan, C. C. M., Chew, M. S.-L., Lim, J. R. N., Mahirah, D., Ho, Y.-C. L., Lee, S. A., Lee, E.-L., Yoon, S., Marimuttu, V. J., et al. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1527521 · Cited by 5 · see citing works
A crowdsourced megastudy of 12 digital single-session interventions for depression in US adults
Kaveladze, B. T., Voelkel, J. G., Stagnaro, M. N., Huang, M., Smock, A., Sullivan, E., Xu, Y., McCall, M. P., Zapata, J. P., Ahmed, S. I., et al. (2026) · Nature Human Behaviour · doi:10.1038/s41562-026-02415-6 · Cited by 5 · see citing works
“However, barriers such as cost, lack of providers and stigma make in-person psychological interventions difficult to access for most 4,5 .”
Social media, diversity, equity, and inclusion
Jones, T. R., & Johnson, S.-A. H. (2023) · Elsevier eBooks · doi:10.1016/b978-0-323-95630-7.00005-6 · Cited by 5 · see citing works
Warren, S. E., & Barron, A. L. (2024) · Frontiers in Rehabilitation Sciences · doi:10.3389/fresc.2023.1306485 · Cited by 5 · see citing works
Tolerance to uncertainty as a factor in the mental health of the population in conditions of war
Trofimov, A. Y., & Zabolotna, V. (2023) · Social & Legal Studios · doi:10.32518/sals3.2023.189 · Cited by 5 · see citing works
Hicks, P. M., Simmons, K., Newman-Casey, P. A., Woodward, M. A., & Elam, A. R. (2024) · Translational Vision Science & Technology · doi:10.1167/tvst.13.1.22 · Cited by 5 · see citing works
Adzrago, D., Thapa, K., Rajbhandari‐Thapa, J., Sulley, S., & Williams, F. (2024) · BMC Public Health · doi:10.1186/s12889-024-18336-w · Cited by 5 · see citing works
Exploring Support Preferences for Young Women Who Self-Harm: A Qualitative Study
Rheinberger, D., Ravindra, S., Slade, A., Calear, A. L., Wang, A., Bunyan, B., Christensen, H. M., Mahony, I. S., Gilbert, I., Boydell, K., et al. (2025) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph22040587 · Cited by 5 · see citing works
Laane, S. A., Cook, L. G., Spence, J. S., Harris, M. N., & Chapman, S. B. (2022) · Brain and Behavior · doi:10.1002/brb3.2853 · Cited by 5 · see citing works
Marini, M., Gutkind, S., Livne, O., Fink, D. S., Saxon, A. J., Simpson, T. L., Sherman, S. E., & Mannes, Z. L. (2025) · Journal of General Internal Medicine · doi:10.1007/s11606-024-09320-6 · Cited by 4 · see citing works
Norris, P., George, M., Symon, V., Keown, S., Bhawan, S., Richard, L., & Richards, R. (2025) · Research in Social and Administrative Pharmacy · doi:10.1016/j.sapharm.2025.02.010 · Cited by 4 · see citing works
Szoke, D. R., Hutzler, I., Liu, J., Addante, S., Akhtar, Z., Smith, D. L., Dickens, K., Small, C., Pridgen, S., & Held, P. (2026) · JMIR Mental Health · doi:10.2196/91367 · Cited by 4 · see citing works
“Systemic barriers to mental health care, including therapist shortages, cost, and stigma, are a significant public health challenge, leaving most individuals without effective treatment [1,2].”
Church, E., Kelley, E. L., Maniglia, T., Kohli, R., Sajatovic, M., & Levin, J. B. (2024) · Journal of Women s Health · doi:10.1089/jwh.2024.0600 · Cited by 4 · see citing works
“In the current review, mental health was considered in only one of these interventions, despite evidence that psychological distress negatively impacts self-care, 56 access to health care, 57 physical activity, 58 and cardiovascular health in marginalized groups.”
Swanson-Varner, R. T., & Nadon, M. L. (2024) · SSM - Mental Health · doi:10.1016/j.ssmmh.2024.100372 · Cited by 4 · see citing works
Screening Students for Stress Using Fitbit Data
Lopez, R., Shrestha, A., Hickey, K., Guo, X., Tlachac, M., Liu, S., & Rundensteiner, E. A. (2024) · IEEE International Conference on Big Data (BigData) · doi:10.1109/bigdata62323.2024.10825089 · Cited by 4 · see citing works
“The shortage of mental health professionals and rising costs of care further limit access to stress management resources [5], [6].”
BD2: A roadmap for learning health networks driving care improvement in bipolar disorder
Savitz, S. T., Lipschitz, J. M., Burdick, K. E., Lam, A., Shanahan, M. R., Beck, V. C., Baxi, E. G., Pham, D. L., Altimus, C. M., Frye, M. A., et al. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.05.036 · Cited by 4 · see citing works
- Authors
- Coombs, N. C., Meriwether, W. E., Caringi, J., & Newcomer, S. R.
- Affiliations
- University of Montana (US)
- Kansas City VA Medical Center (US)
- Corresponding author
- Coombs, Nicholas C.
- Venue
- SSM - Population Health
- Publisher
- Elsevier BV
- Published
- 2021-09
- Volume
- 15
- Pages
- 100847
- ISSN
- 2352-8273 (ISSN-L)
- PMC
- PMC8214217
- OpenAlex
- W3173909632
- Cited by
- 333
- References
- 47
- Citations by year
- 2026: 81 · 2025: 98 · 2024: 90 · 2023: 49 · 2022: 14 · 2021: 1
- FWCI
- 37.70
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- SSM - Population Health (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Institute of General Medical Sciences
- National Institutes of Health
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Health › Health disparities and outcomes
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Keywords
- barriers to care, mental illness, psychological distress, mental health stigma, health care affordability, financial barriers to care, social determinants of health, Hispanic adults, sex differences, paid sick leave, National Health Interview Survey, United States adults, access to mental health care, complex patients, employment status, social isolation
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