Mental Health Status and Disparities In Health Care Access Among California Adults, 2020-2024

Background and Purpose: Health care access is crucial for the prevention, early diagnosis, and treatment of mental health problems. In the United States (US), approximately 1 in 5 adults experience mental illness annually, with 1 in 20 facing severe conditions that interfere with major life activities. Despite this, about 1 in 4 adults lack access to adequate mental health care, and an estimated two-thirds of individuals with mental disorders do not receive treatment. Mental health problems are a significant public health concern associated with adverse health outcomes, making it essential to understand barriers to care. The current study examines barriers to health care by mental health status in a representative sample of California adults.

Methods: We analyzed data from nonelderly adults aged 18-64 (N=78,179) in the publicly available 2020-2024 California Health Interview Survey (CHIS), one of the largest ongoing state health surveys, which covers a broad range of health topics and has included at least 20,000 participants annually since 2001. Mental health status was assessed using the Kessler-6 (K6) scale, which measures the frequency of nonspecific psychological distress over the past 30 days (0 = none of the time to 4 = all of the time). K6 scores were categorized as no psychological distress (NPD: 0-4), moderate psychological distress (MPD: 5-12), and serious psychological distress (SPD: 13-24). Two barriers to health care were assessed: lack of a usual source of medical care and health insurance coverage. Weighted descriptive analyses summarized sociodemographic and health characteristics by mental health status. Logistic regression with replicate weights estimated associations between distress and barriers, adjusting for age, sex, race, education, marital status, family income relative to the US Census Bureau’s poverty guidelines, general health conditions, chronic health conditions, and survey year. Adjusted odds ratios (ORs), 95% confidence intervals (CIs), and p-values are reported.

Results: Weighted prevalence was 53.6% NPD, 36.6% MPD, and 9.8% SPD. SPD was more prevalent among younger adults (18–34 years: 62%), those with lower income (<100% FPL: 22.2%), women, and widowed, separated, or divorced adults. Compared with NPD, MPD was associated with lower odds of reporting better self-rated health (OR=0.900; 95% CI: 0.837–0.968; p=0.005), and SPD was associated with substantially lower odds (OR=0.644; 95% CI: 0.579–0.715; p < 0.001). Older age, female sex, higher education, and having ≥1 chronic condition were positively associated with better self-rated health. Mental health status was not independently associated with insurance coverage (MPD: OR=1.076; 95% CI: 0.957–1.211; p=0.220; SPD: OR=0.957; 95% CI: 0.810–1.130; p=0.600), whereas older age, female sex, higher education, and chronic conditions were associated with higher odds of being insured.

Conclusions and Implications: These findings suggest that mental health status is associated with poorer self-rated health but not with insurance coverage, likely due to high baseline insurance (>90%). SPD disproportionately affects younger, lower-income, and unmarried adults, highlighting vulnerable populations. Understanding patterns of health care access is critical for targeting interventions, reducing disparities in mental health care, and improving outcomes, particularly among socioeconomically disadvantaged subpopulations.