{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T14:23:35Z","timestamp":1792160615766,"version":"4.4.0"},"reference-count":44,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Psychiatry"],"published-print":{"date-parts":[[2024,10,1]]},"abstract":"Importance<\/jats:title>Medical debt is common in the US and may hinder timely access to care for mental disorders.<\/jats:p><\/jats:sec>Objective<\/jats:title>To estimate the prevalence of medical debt among US adults with depression and anxiety and its association with delayed and forgone mental health care.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>Cross-sectional, nationally representative survey study of US adult participants in the 2022 National Health Interview Survey who had current or lifetime diagnoses of depression or anxiety.<\/jats:p><\/jats:sec>Exposures<\/jats:title>Self-reported lifetime clinical diagnoses of depression and anxiety; moderate to severe symptoms of current depression (Patient Health Questionnaire\u20138 score \u226510) and anxiety (Generalized Anxiety Disorder\u20137 score \u226510) irrespective of lifetime diagnoses; and past-year medical debt.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Self-reported delaying and forgoing mental health care because of cost in the past year.<\/jats:p><\/jats:sec>Results<\/jats:title>Among 27\u202f651 adults (15\u202f050 [54.4%] female; mean [SD] age, 52.9 [18.4] years), 5186 (18.2%) reported lifetime depression, 1948 (7.3%) reported current depression, 4834 (17.7%) reported lifetime anxiety, and 1689 (6.6%) reported current anxiety. Medical debt was more common among adults with lifetime depression (19.9% vs 8.6%; adjusted prevalence ratio [aPR], 1.97; 95% CI, 1.96-1.98), lifetime anxiety (19.4% vs 8.8%; aPR, 1.91; 95% CI, 1.91-1.92), current depression (27.3% vs 9.4%; aPR, 2.34; 95% CI, 2.34-2.36), and current anxiety (26.2% vs 9.6%; aPR, 2.24; 95% CI, 2.24-2.26) compared with adults without the respective mental disorders. Medical debt was associated with delayed health care among adults with lifetime depression (29.0% vs 11.6%; aPR, 2.68; 95% CI, 2.62-2.74), lifetime anxiety (28.0% vs 11.5%; aPR, 2.45; 95% CI, 2.40-2.50), current depression (36.9% vs 17.4%; aPR, 2.25; 95% CI, 2.13-2.38), and current anxiety (38.4% vs 16.9%; aPR, 2.48; 95% CI, 2.35-2.66) compared with those without these diagnoses. Medical debt was associated with forgone health care among adults with lifetime depression (29.4% vs 10.6%; aPR, 2.66; 95% CI, 2.61-2.71), lifetime anxiety (28.2% vs 10.7%; aPR, 2.63; 95% CI, 2.57-2.68), current depression (38.0% vs 17.2%; aPR, 2.35; 95% CI, 2.23-2.48), and current anxiety (40.8% vs 17.1%; aPR, 2.57; 95% CI, 2.43-2.75) compared with those without the diagnoses.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>Medical debt is prevalent among adults with depression and anxiety and may contribute to the mental health treatment gap. 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