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J Womens Health (Larchmt). 2019 Jun 7. doi: 10.1089/jwh.2018.7551. [Epub ahead of print]

Health Care Disparities Among U.S. Women of Reproductive Age by Level of Psychological Distress.

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1 School of Public Health, University of Minnesota, Minneapolis, Minnesota.
2 Health Science Department, California State University-Long Beach, Long Beach, California.
3 Department of Community Health Sciences, Fielding School of Public Health, UCLA, Los Angeles, California.


Purpose: Reproductive-age women have a high rate of contact with the health care system for reproductive health care. Yet, beyond pregnancy, little is known about psychological distress and unmet health care needs among these women. We examined reasons for delayed medical care and types of foregone care by level of psychological distress. Methods: We used a nationally representative sample of U.S. women aged 18-49, from the 2015-2016 National Health Interview Survey. Using the K6 screening tool for nonspecific psychological distress, we examined differences in reasons for delayed care and types of care foregone due to cost by level of psychological distress (none, moderate psychological distress [MPD], and severe psychological distress [SPD]). Results: Overall, 20% of U.S. women aged 18-49 had MPD (16%) or SPD (4%), equating to nearly 13 million women of reproductive age living with psychological distress. Women with SPD or MPD are more likely to have delayed and foregone care. Notably, women with SPD have higher odds of needing but not receiving mental health care (adjusted odds ratios [AOR] = 12.4, 95% confidence interval [CI] 8.4-18.4), specialist care (AOR = 3.6, 95% CI 2.6-5.1), and follow-up care (AOR = 3.5, 95% CI 2.4-5.1) due to cost than women with no psychological distress. Cost is the greatest barrier to timely medical care for women with MPD and SPD. Conclusions: Women of reproductive age with psychological distress face considerable structural and cost-related barriers to accessing health care, which may be exacerbated by their psychological state. Despite recent policy advances such as the Affordable Care Act, additional efforts by policymakers and providers are crucial to address the needs of this population.


access to care; health disparities; mental health; reproductive-age women


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