A triple play: psychological distress, physical comorbidities, and access and use of health services among U.S. adults with disabilities

Abstract

Purpose: Among adults with disabilities, we examined whether increasing levels of psychological distress were associated with higher estimated prevalences of chronic conditions, obesity, health care access, and use of preventive services.

Methods: We analyzed data from the 2007 Behavioral Risk Factor Surveillance System. The Kessler-6 scale was used to assess psychological distress.

Results: Increasing levels of psychological distress were associated with an increased prevalence of chronic diseases and conditions, and decreased access to health care and utilization of preventive services in keeping with what has been established for non-disabled populations. Among adults with disabilities, aged 18-64 years and 65 years or older, increasing levels of distress were also associated with increased receipt of mental health treatment. However, compared to adults aged 18-64 years, larger proportions of older adults reported non-receipt of mental health treatment (mild to moderate psychological distress: 58.0% versus 70.6%; serious psychological distress: 40.5% versus 54.5%).

Conclusions: While adults with disabilities who had increased levels of psychological distress were more likely to receive mental health services, they also had higher estimated prevalences of chronic conditions, barriers to health care, and non-receipt of preventive cancer screenings.

Figure 1.

Adjusted estimates (and 95% CIs) of total number of chronic diseases and conditions among adults with disabilities by mild to moderate and serious psychological distress, 35 States, DC, and Puerto Rico, BRFSS, 2007.^{ab a}Adjusted for age, sex, race/ethnicity, educational attainment, marital status, and employment status. ^bEstimates based upon adults responding “yes” or “no” to each of the assessed chronic diseases and conditions (i.e., arthritis, asthma, coronary heart disease, diabetes, high cholesterol, hypertension, and stroke).