Private Insurance and Mental Health among Older Adults with Multiple Chronic Conditions: A Longitudinal Analysis by Race and Ethnicity.

Hankyung Jun,Emma Aguila

doi:10.3390/ijerph18052615

Abstract

Older adults with multiple chronic conditions have a higher risk than those without multiple conditions of developing a mental health condition. Individuals with both physical and mental conditions face many substantial burdens. Many such individuals also belong to racial and ethnic minority groups. Private insurance coverage can reduce the risks of developing mental illnesses by increasing healthcare utilization and reducing psychological stress related to financial hardship. This study examines the association between private insurance and mental health (i.e., depressive symptoms and cognitive impairment) among older adults in the United States with multiple chronic conditions by race and ethnicity. We apply a multivariate logistic model with individual fixed-effects to 12 waves of the Health and Retirement Study. Among adults with multiple chronic conditions in late middle age nearing entry to Medicare and of all racial and ethnic groups, those without private insurance have a stronger probability of having depressive symptoms. Private insurance and Medicare can mediate the risk of cognitive impairment among non-Hispanic Whites with multiple chronic conditions and among Blacks regardless of the number of chronic conditions. Our study has implications for policies aiming to reduce disparities among individuals coping with multiple chronic conditions.

Highlights

This paper examines the association between private health insurance coverage and mental health among those with multiple chronic conditions (MCC) in the United States by race and ethnicity
Our study shows private insurance coverage is significantly associated with reduced risks of developing depressive symptoms for Whites, Blacks, and Hispanics 50 to 64 years of age with multiple chronic conditions
The effects we found from private insurance in reducing mental health risks for Whites with MCC, even if not as extensive as those for Blacks, indicate that the benefits of such insurance may be applicable to individuals of all racial/ethnic groups with multiple health conditions

Summary

Introduction

One in four U.S adults have multiple chronic conditions (MCC) [1,2]. Older adults with MCC have higher risks of developing a mental health condition. Patients with more health conditions tend to experience higher levels of depression [3,4,5]. Dementia and cognitive impairment are associated with cardiovascular disease [6], hypertension [7], obesity [8,9], diabetes [10], and stroke [11]. Previous research shows that cognitive impairment manifests more among individuals older than 78 years of age [12]. This suggests that those at older ages with MCC are more likely to experience cognitive impairment

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Discussion

Conclusion