Background: Limited attention has focused on midlife health. Yet, this is a time of great change, including onset of chronic conditions and changes in mental health.
Objective: To examine unmet healthcare needs among midlife adults (50-64 years) in the US with severe psychological distress (SPD) and/or multiple chronic conditions (MCC).
Methods: Nationally representative data for midlife adults (50-64 years) from NHIS 2014-2018 were examined (n = 39,329). Multimorbidity status: no MCC/SPD, MCC alone, SPD alone, or both. We used logistic regression to estimate adjusted odds ratios (AOR) of delayed or foregone care by multimorbidity status.
Results: Nearly 40% of midlife adults had MCC, SPD, or SPD/MCC. SPD with or without MCC had higher prevalence of social disadvantage, fair/poor health, activity limitations, and delayed/foregone healthcare. Compared to those with neither, adults with SPD/MCC were more likely to delay care due to limited office hours (AOR = 4.2, 95% CI 3.1-5.5) and had nearly three to four times higher odds of delays for all other reasons. Those with SPD/MCC had higher odds of needing but not getting mental healthcare (AOR = 6.4, 95% CI 4.5-9.1), prescriptions (AOR = 4.8, 95% CI 3.9-5.9), or follow-up care (AOR = 5.0, 95% CI 3.7-6.6), and three to four times higher odds of all other types of foregone care.
Conclusions: Midlife adults with SPD/MCC have substantial unmet healthcare needs. Midlife is a critical time to manage both chronic conditions and mental illness. Coordinated efforts by policymakers and healthcare systems are crucial to address complex healthcare needs of this population at a critical stage of the life-course.
Keywords: Access to care; chronic conditions; healthcare utilization; mental illness; midlife; psychological distress.