Marital Disruption and Mental Health–Related Care Access Barriers Among US Adults

Abstract Background Social determinants of health influence healthcare access and engagement. Marital and partnership relationships may shape care-seeking through household organization, care-related labor, and social support. Less is known about how marital status relates to mental health–related access barriers. Objective To examine the association between marital status and discordant care among US adults and assess whether associations differ by sex and age. Design Cross-sectional analysis of 2024 Behavioral Risk Factor Surveillance System (BRFSS) data. Participants The analytic sample included 346,330 respondents, representing 192.7 million noninstitutionalized US adults after application of survey weights. Main Measures Discordant care was defined as frequent mental distress, measured as 14 or more poor mental health days in the past 30 days, combined with two or more access barriers: no routine checkup in the past year, no personal doctor, no current health insurance, or inability to see a doctor because of cost. Marital status was categorized as partnered, previously partnered, or never partnered. Survey-weighted logistic regression models adjusted for age, sex, income, education, race and ethnicity, and the marital status by sex interaction. Key Results The weighted prevalence of discordant care was 3.43% (95% CI, 3.29–3.58). In sex-specific contrasts from the race- and ethnicity-adjusted interaction model, previously partnered men had higher odds of discordant care than partnered men (aOR, 2.53; 95% CI, 2.09–3.05; P < .001). Previously partnered women had higher odds, though the association was smaller (aOR, 1.40; 95% CI, 1.18–1.65; P < .001). Never partnered status was not significantly associated with discordant care among men or women after adjustment. Older age, higher income, and education were associated with lower odds. Conclusions Previously partnered adults, especially men, had higher adjusted odds of discordant care. Marital status may mark care-access vulnerability but should not be interpreted as a measure of relationship quality, caregiving labor, or social support.