Mental Health and Access to Medical Care in Patients with Chronic Cardiovascular Conditions: An Analysis of the Behavior Risk Factor Surveillance System


  • Riyad Y. Kherallah, M.D. Baylor College of Medicine
  • Mahmoud Al Rifai, M.D., MPH
  • Jing Liu, M.D.
  • Sina Kianoush, M.D., MPH
  • Arunima Misra, M.D.
  • Salim S. Virani, M.D., Ph.D.



Introduction. Poor mental health is associated with worse outcomes for chronic diseases. It is unclear whether mental illness predisposes to difficulties with healthcare access.

Methods. Using a combined dataset of the 2016-2019 behavioral risk factor surveillance system, we included individuals who reported a chronic cardiovascular condition. Weighted multivariable logistic regression analyses were used to explore the association between domains of mental health and measures of healthcare access including delaying medical care, > 1 year since last routine checkup, lack of a primary care physician (PCP), and cost-related medication nonadherence (CRMNA).

Results. Among 1,747, 397 participants, 27% had a chronic cardiovascular condition, 12% had clinical depression, and 12% had poor mental health. Those with poor mental health (OR 3.20 [3.08 – 3.33]) and clinical depression (OR 2.43 [2.35 – 2.52]) were more likely to report delays in medical care.  Those with greater stress frequency (OR 8.47 [6.84 -10.49] stressed all of the time), lower levels of emotional support received (OR 3.07 [2.21 – 4.26] rarely get needed emotional support), and greater life dissatisfaction (6.66 [4.14 – 10.70] very dissatisfied) reported greater delays in medical care.

Conclusions. Individuals with poor mental health have greater difficulty accessing medical care independent of socioeconomic variables.






Original Research