Previously submitted to: JMIR Mental Health (no longer under consideration since Jan 30, 2026)
Date Submitted: Jan 24, 2026
Open Peer Review Period: Jan 30, 2026 - Jan 30, 2026
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Sociodemographic Determinants of Mental Health Burden and Healthcare Affordability Among U.S. Adults: A Regression Analysis of the 2023 Behavioral Risk Factor Surveillance System
ABSTRACT
Background:
Mental health disorders and financial barriers to healthcare remain significant public health challenges in the United States. Disparities in mental health burden and access to care persist across socioeconomic and demographic groups, underscoring the need for population-level evidence to inform equitable interventions.
Objective:
This study aimed to examine the association between sociodemographic factors and (1) mental health burden, (2) inability to afford medical care, and (3) lifetime diagnosis of depression among U.S. adults.
Methods:
A cross-sectional analysis was conducted using data from the 2023 Behavioral Risk Factor Surveillance System (BRFSS). A random subset of 10,000 adults was analyzed. Survey-weighted linear regression was used to assess predictors of the number of mentally unhealthy days reported in the past 30 days. Survey-weighted logistic regression models were used to evaluate associations with inability to afford medical care in the past 12 months and lifetime diagnosis of depression. Independent variables included age, sex, income, employment status, and marital status. All analyses accounted for the complex survey design and weighting.
Results:
Lower income and unemployment were consistently associated with poorer mental health outcomes and reduced healthcare affordability. Older age was associated with fewer depression diagnoses but a higher number of mentally unhealthy days. Female respondents had higher odds of reporting a depression diagnosis (odds ratio [OR] 1.89, 95% CI 1.69–2.10) and cost-related barriers to care but reported fewer mentally unhealthy days compared with males. Unmarried individuals had higher odds of depression and inability to afford care. All key associations remained statistically significant after adjustment for covariates.
Conclusions:
Sociodemographic characteristics—particularly income, employment status, age, sex, and marital status—are important predictors of mental health burden and healthcare affordability among U.S. adults. These findings highlight persistent socioeconomic disparities and support the need for public health strategies that address social determinants of health to improve mental health outcomes and equitable access to care.
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