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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“Access to psychotherapy is often limited by availability, cost, or long waiting times, particularly in publicly funded health systems (17).”
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Scofield, D., Weis, N. M., Meddis, A., Storgaard, M., Pedersen, G., Johansen, I. S., Katzenstein, T. L., Graugaard, C. L., Omland, L. H., Frisch, M., et al. (2025) · AIDS and Behavior · doi:10.1007/s10461-025-04806-8 · Cited by 2
“Despite this progress, marked health disparities persist in several areas, including sexual [ 3 , 4 ] and mental health [ 5 , 6 ], rendering people with HIV (PWH) susceptible to a diminished quality of life.”
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Woo, J., Shook, J. J., Tillman, H., Vang, H., & Goodkind, S. A. (2025) · Labor Studies Journal · doi:10.1177/0160449x251370759 · Cited by 2
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Influential
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“Affordability of health care is one of the most prominent barriers to access (Coombs et al., 2021).”
Background
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Compton, M. T., Frimpong, E. Y., Ehntholt, A., Zhu, H., Chaudhry, S., Ferdousi, W., Rowan‐Szal, G. A., Radigan, M., Smith, T. E., & Rotter, M. (2023) · Community Mental Health Journal · doi:10.1007/s10597-023-01165-3 · Cited by 2
“Chronic medical conditions are unlikely to be adequately screened for in mental health clinics (Compton et al., 2020), despite those sites often serving as the client’s sole source of care, and barriers to primary care have been thoroughly documented (Coombs et al., 2021; Kaufman et al., 2012).”
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“Further statistics demonstrate that as many as 8 million deaths a year are attributed to untreated mental health issues (Coombs et al., 2021; Walker et al., 2015).”
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“…to engage in the intervention within the comfort of their own environments via Zoom, we have overcome several common barriers (eg, travel times and lack of availability/opportunity to engage in treatment) that can be associated with seeking psychological support in diverse populations [41,42].”
Background
Improved Screening for Depression in Patients Initiating Fertility Treatment
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Socioeconomic Determinants of Household Access to HIV/AIDS Healthcare in Kibra Sub-County, Nairobi County, Kenya
Ating’ah, L. O., Odek, A. W., & Ochieng, D. (2024) · African Journal of Empirical Research · doi:10.51867/ajernet.5.4.20 · Cited by 1
“Research conducted in United States by Coombs et al. (2021 ) underscored disparities in HIV care outcomes, revealing that factors like race, gender, and contribute to varied effectiveness in medical care delivery, and with Americans experiencing suboptimal treatment compared other demographic…”
Background
Prevalence of reversible visual impairments and their association with the psychiatric illness severity among inpatients with psychotic disorders
Fradet, M., Nadeau, F., Suey, A., Choulakian, M. Y., & Grignon, S. (2024) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2024.11.005 · Cited by 1
“It’s a Circus”: Family Caregivers’ Perceptions on Accessing Mental Health Care for Individuals with Intellectual and Developmental Disabilities
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Le, C. M., & Bui, D. N. (2025) · Multidisciplinary Science Journal · doi:10.31893/multiscience.2025496 · Cited by 1
“…to mental health services, since the expenses associated with medicine and therapy can be excessively burdensome for many individuals with disabilities, especially those who are unemployed or underemployed owing to their physical or mental impairments (Coombs et al., 2021; Ziller et al., 2010).”
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Accessing mental health care: A population-level exploration of the impact of immigration duration in the United States 2019–2023
Fan, S., & Piret, E. M. (2025) · PLOS mental health. · doi:10.1371/journal.pmen.0000339 · Cited by 1
“However, socio-cultural barriers to mental health service use, such as experiences of discrimination, stigma, and lack of trust in the healthcare system, further define US immigrants’ engagement with formal services [8,33,53].”
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Milgram, L., Toranzo, T., Mathews, R. E., & Lewin, A. B. (2025) · Journal of Clinical Psychology · doi:10.1002/jclp.70025 · Cited by 1
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“This suggests that patients in the study were seen relatively quickly by a psychiatrist in contrast to patients seeking specialty care in the outpatient setting where long wait times are the norm (Coombs et al., 2021 ).”
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“Housing first initiatives, 54,55 basic income, 40 and healthcare access, including mental health, 15,35,46 are needed to manage the needs that substance use is meeting.”
Influential
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“Affordability, approachability, and access to mental health care services were noted barriers perceived by adults in the USA [6].”
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“25 Overall, participants did not ﬁ nd AI chatbots to be more accurate, private, or trustworthy than clinicians.”
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“48 These disparities highlight the influence of environmental and socioeconomic factors on treatment outcomes.”
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“In line with previous work (Coombs et al., 2021; Corscadden et al., 2018; Levesque et al., 2013), participants indicated that overall individuals have limited access to traditional mental health services (i.e., one-on-one in-person sessions with a mental health provider) due to several reasons.”
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“Accessing mental health care is also challenging due socioeconomic factors and cultural stigma [13].”
Identifying Factors Associated With Variation in Telemental Health Delivery at Federally Qualified Health Centers
Lombardi, B. M., Sullivan, C., Gaiser, M., Zerden, L. D. S., Galloway, E., & Wright, B. (2024) · Journal of Primary Care & Community Health · doi:10.1177/21501319241303605 · Cited by 1
“17 Telemental health is 1 way to potentially close treatment gaps and address the maldis-tribution of behavioral health workforce in the U.S. 18 Understanding the organizational factors of health centers that are associated with telemental health delivery could inform policies that support future…”

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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