Cited by 333Mental Health Treatment and AccessHealth disparities and outcomesHealthcare Policy and Management

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Barriers to healthcare access among U.S. adults with mental health challenges: A population-based study

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Coombs, Nicholas C., Meriwether, Wyatt E., Caringi, James, Newcomer, Sophia R.·2021·SSM - Population Health

DOI 10.1016/j.ssmph.2021.100847PMC PMC8214217

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Abstract

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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Screening for serious mental illness in the general population
Kessler, R. C., Barker, P. R., Colpe, L. J., Epstein, J. F., Gfroerer, J. C., Hiripi, E., Howes, M. J., Normand, S.-L. T., Manderscheid, R. W., Walters, E. E., et al. (2003) · Archives of General Psychiatry · doi:10.1001/archpsyc.60.2.184 · Cited by 5,692
Patient-centred access to health care: conceptualising access at the interface of health systems and populations
Levesque, J.-F., Harris, M. F., & Russell, G. (2013) · International Journal for Equity in Health · doi:10.1186/1475-9276-12-18 · Cited by 3,484
The chi-square test of independence
McHugh, M. L. (2013) · Biochemia Medica · doi:10.11613/bm.2013.018 · Cited by 2,828
Mental illness-related stigma in healthcare: Barriers to access and care and evidence-based solutions
Knaak, S., Mantler, E., & Szeto, A. (2017) · Healthcare Management Forum · doi:10.1177/0840470416679413 · Cited by 1,031
Validity study of the K6 scale as a measure of moderate mental distress based on mental health treatment need and utilization
Prochaska, J. J., Sung, H., Max, W., Shi, Y., & Ong, M. (2012) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.1349 · Cited by 942
Health Spending Projections to 2030
Lorenzoni, L., Marino, A., Morgan, D. J., & James, C. (2019) · OECD health working papers · doi:10.1787/5667f23d-en · Cited by 793
Changes in Utilization and Health Among Low-Income Adults After Medicaid Expansion or Expanded Private Insurance
Sommers, B. D., Blendon, R. J., Orav, E. J., & Epstein, A. M. (2016) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2016.4419 · Cited by 528
Equity of access to health care: outlining the foundations for action
Oliver, A., & Mossialos, E. A. (2004) · Journal of Epidemiology & Community Health · doi:10.1136/jech.2003.017731 · Cited by 507
Discrimination in health care against people with mental illness
Thornicroft, G., Rose, D. S., & Kassam, A. (2007) · International Review of Psychiatry · doi:10.1080/09540260701278937 · Cited by 493
Health and Access to Care during the First 2 Years of the ACA Medicaid Expansions
Miller, S., & Wherry, L. (2017) · New England Journal of Medicine · doi:10.1056/nejmsa1612890 · Cited by 479

Show all 47 references

Research works printed but not linked: 1

Lorenzoni, 2019, Vol. 110

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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
In the Shadows of Motherhood: A Comprehensive Review of Postpartum Depression Screening and Intervention Practices
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
“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].”
Background
Measurement of Daily Actions Associated With Mental Health Using the Things You Do Questionnaire–15-Item: Questionnaire Development and Validation Study
Bisby, M. A., Jones, M., Staples, L., Dear, B. F., & Titov, N. (2024) · JMIR Formative Research · doi:10.2196/57804 · Cited by 10
Meeting Patients Where They're At: Toward the Expansion of Chaplaincy Care into Online Spiritual Care Communities
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
“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
A pilot study examining whether restricting and resuming specific actions systematically changes symptoms of depression and anxiety. A series of N-of-1 trials.
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
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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
Gender disparities in job flexibility, job security, psychological distress, work absenteeism, and work presenteeism among U.S. adults
Wang, M. L., Narcisse, M., Rodriguez, K., & McElfish, P. A. (2025) · SSM - Population Health · doi:10.1016/j.ssmph.2025.101761 · Cited by 10
“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).”
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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
"Doing The Work": Therapeutic Labor, Teletherapy, and the Platformization of Mental Health Care
Garofalo, L. (2024) · doi:10.2139/ssrn.4779005 · Cited by 11
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Ni, Y., & Cao, Y. (2025) · Mental Health and Digital Technologies · doi:10.1108/mhdt-02-2025-0013 · Cited by 12
Generative artificial intelligence in posttraumatic stress disorder treatment: Exploring five different use cases
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“However, logistical barriers, financial constraints, and clinician shortages can limit access to these interventions (Coombs et al., 2021; Kantor et al., 2017).”
Life Course Perspectives of Aging With Schizophrenia Spectrum Disorders in Psychiatric and Long-Term Care Facilities
Walker, V. G., & Harrison, T. C. (2023) · The Gerontologist · doi:10.1093/geront/gnad149 · Cited by 10
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
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
“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].”
Predicting aggressive behavior in psychiatric patients in emergency department: A systematic literature review
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
Patient Characteristics Are Associated with Appointment “No-Show” at a Tertiary Academic Glaucoma Service: A Cross-Sectional Study
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“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
“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.”
Background
MENTAL 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 10
Twenty-Year Trends and Urban–Rural Disparities in Smoking, Alcohol Consumption, and Dual Consumption Among Chinese Older Adults
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
“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).”
Rapid on‐site evaluation (ROSE) of image‐guided FNA specimens improves subsequent core biopsy adequacy in clinical trial patients: The impact of preanalytical factors and its correlation with survival
Graham, A. J., Robinson, M. T., Kahler, J., Azadi, J. R., & Maleki, Z. (2023) · Cancer Cytopathology · doi:10.1002/cncy.22764 · Cited by 6
“33,34 Although this problem is multifactorial, clinical trials centering un-derrepresented ethnic groups may be helpful in analyzing quality”
Background
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Sun, 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
“Furthermore, the stigma surrounding these disorders could additionally impede their quest for knowledge about Alzheimer’s Disease [50].”
Background
Personalization Strategies for Increasing Engagement With Digital Mental Health Resources: Sequential Multiple Assignment Randomized Trial
Rouvere, J., Fillipo, I. G., Romanelli, M., Sharma, A., Mosser, B., Nguyen, T., Rushton, K., Marion, J., Althoff, T., & Pullmann, M. D. (2025) · JMIR Mental Health · doi:10.2196/73188 · Cited by 9
“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
“These barriers were critically addressed, aligning with previous findings that created shameful feelings when visiting psychiatric hospitals (Coombs et al., 2021).”
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Yeager, K. R., Gregoire, T. K., & Daron, C. A. (2025) · doi:10.1093/oso/9780197687833.003.0015 · Cited by 6
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“Mental health-related stigma is a multidimensional problem, which imposes a great burden on those affected [42].”
Background
A survey of special education teachers and specialists in Saudi Arabia on the use of collaborative practices to support the mental health of students with disabilities
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“…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).”
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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
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“However, barriers such as cost, lack of providers and stigma make in-person psychological interventions difficult to access for most 4,5 .”
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Effects of online brain training on self‐reported mental health symptoms for generally healthy adults during the Covid‐19 pandemic
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
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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
Does access to medicines differ from access to healthcare? Experiences of barriers to medicines access by people facing social disadvantage
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
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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
“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].”
Self-Management Interventions for Black Women at Risk for Cardiovascular Disease: A Systematic Literature Review
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“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.”
Sick and tired: A quantitative analysis of paid sick leave access and psychological distress by race and gender
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“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., Lam, A., Shanahan, M., Beck, V. C., Baxi, E., Pham, D. L., Altimus, C., Frye, M., et al. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.05.036 · Cited by 4

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.
ORCID: Coombs, Nicholas C.
Meriwether, Wyatt E.
Caringi, James
Newcomer, Sophia R.
Venue: SSM - Population Health
Publisher: Elsevier BV
Published: 2021-09
Volume: 15
Pages: 100847
ISSN: 2352-8273 (ISSN-L)
DOI: 10.1016/j.ssmph.2021.100847
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: cc-by-nc-nd
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
creativecommons.org/licenses/by-nc-nd/4.0/ (vor)
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: Health Sciences › Medicine › Psychiatry and Mental health › 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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Barriers to healthcare access among U.S. adults with mental health challenges: A population-based study

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