Association between poverty and mental health impairment

Background: Mental health access changed significantly with the enactment of the Mental Health Parity Act in 1996. This legislation fostered varying parity laws throughout the United States. Ohio adopted its own legislation in 2006, prohibiting discrimination in the coverage of diagnosis, care, and treatment of biologically based mental illnesses. However, it is unclear whether mental health status is improved by increased coverage. This study examines the relationship between mental health impairment and poverty, controlling for insurance coverage. Methods: Data used are from the 2008 Ohio Family Health Survey, a complex designed survey of 50,944 households, excluding institutions. Survey domains include insurance coverage, access to and utilization of health services, health status, employment, and family violence. Results: Logistic regression examining mental health impairment (defined as 14 or more days within the past 30 days in which mental health problems prevented usual activity) and poverty (less than 201% FPL), controlling for employment status, insurance status, age, gender, race, and region of Ohio found that impoverished Ohioans are significantly more likely to be impaired by mental health conditions, even after controlling for the factors listed above (Odds Ratio: 3.6 (3.1, 4.1)). Conclusions: While mental health parity laws have been successful in expanding access to mental health care (Harris et al., 2006), the findings of the current study indicate that despite coverage, those below 201% FPL remain at increased likelihood to be impaired by mental health problems. Therefore, future interventions should target poverty as a determinant, in order to reach those in greatest need.