The Association Between History of Depression and Access to Care Among Medicare Beneficiaries During the COVID-19 Pandemic

Abstract

Background Depression is associated with a higher risk for experiencing barriers to care, unmet social needs, and poorer economic and mental health outcomes. Objective To determine the impact of COVID-19 on ability to access care, social and economic needs, and mental health among Medicare beneficiaries with and without depression. Design and Participants Cross-sectional study using data from the 2020 Medicare Current Beneficiary Survey COVID-19 Summer Supplement Public Use File. Main Measures Access to medical care, inability to access food, medications, household supplies, pay rent or mortgage, feelings of economic security, and mental health effects since COVID-19, risk-adjusted for sociodemographic and clinical characteristics. Key Results Participants were 11,080 Medicare beneficiaries (nationally representative of 55,960,783 beneficiaries), 27.0% with and 73.0% without a self-reported history of depression. As compared to those without a history of depression, Medicare beneficiaries with a self-reported history of depression were more likely to report inability to get care because of COVID-19 (aOR = 1.28, 95% CI, 1.09, 1.51; P = 0.003), to get household supplies such as toilet paper (aOR = 1.32, 95% CI, 1.10, 1.58; P = 0.003), and to pay rent or mortgage (aOR = 1.64, 95% CI, 1.07, 2.52; P = 0.02). Medicare beneficiaries with a self-reported history of depression were more likely to report feeling less financially secure (aOR = 1.43, 95% CI, 1.22, 1.68; P < 0.001), more stressed or anxious (aOR = 1.68, 95% CI, 1.49, 1.90; P < 0.001), more lonely or sad (aOR = 1.97, 95% CI, 1.68, 2.31; P < 0.001), and less socially connected (aOR = 1.27, 95% CI, 1.10, 1.47; P = 0.001). Conclusion A self-reported history of depression was associated with greater inability to access care, more unmet social needs, and poorer economic and mental health outcomes, suggesting greater risk for adverse health outcomes during COVID-19. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-021-06990-4.

Forgone Health Care for Non–COVID-19–Related Needs Among Medicare Beneficiaries During the COVID-19 Pandemic, Summer 2020–Winter 2021

“…These conditions may have limited the type of care and risk of accessing care. Mental health status is also associated with disparities in health care access ( 16 , 23 , 24 ) and may be related to gaps in Medicare coverage for mental health disorders ( 24 ).…”

Utilization of patient-reported outcomes in joint replacement care design

“…[24][25][26] Depression has been associated with greater inability to access care, more unmet social needs, and poorer economic and mental health outcomes, suggesting greater risk for adverse health outcomes. 27…”

Association Between Social Support and Depression Help-Seeking Behaviors Among U.S. Chinese Older Adults

“…Literature has shown that older adults with depression are at greater risk for suicide and increased morbidity and mortality (Balasuriya et al, 2021; Conwell et al, 2011), and vulnerable to the decline in daily functioning, independence, and quality of life (Polacsek et al, 2019). Additionally, late life depression also poses challenges to the caregivers (e.g., stress, financial burden) and the society (e.g., increased healthcare costs) (Pocklington, 2017).…”