Abstract
BACKGROUND: Health insurance access is a critical determinant of mental health, yet racial/ethnic disparities in coverage persist. Examining the relationship between health insurance access and depressive symptoms at early midlife can inform interventions addressing mental health inequities. METHODS: To examine the association between health insurance coverage type (private, public, or uninsured) and depressive symptoms (CES-D-5 scale) at early midlife and variation across racial and ethnic groups. We used data from Waves I, IV, and V of the National Longitudinal Study of Adolescent to Adult Health (Add Health), a nationally representative cohort study conducted from 1994 to 2018 in the U.S. The analytic sample included 7,302 respondents who completed Waves I, IV, and V, had valid sample weights, and were not missing key independent or dependent variables. We used ordinary least squares regression to evaluate the association between health insurance type and depressive symptoms. RESULTS: The analytic sample was 49% women, 4% Asian, 14% Black, 9% Hispanic, and 73% White, and were 38 years old (n = 7,302). Among respondents, 75% had private insurance, 16% had public insurance, and 9% were uninsured. Relative to those with private insurance, adults with public insurance (B = 0.82; 95% CI = 0.53, 1.10; P = < 0.001) and those uninsured (B = 0.95; 95% CI = 0.60, 1.29; P = < 0.001) had significantly greater depressive symptoms. Racial and ethnic differences emerged: Hispanic and White adults with public insurance had greater depressive symptoms, while uninsured White adults reported significantly greater depressive symptoms. CONCLUSIONS: Disparities in health insurance access were associated with differences in depressive symptoms at early midlife, with variation across race and ethnicity. Addressing disparities in access to private health insurance may help improve mental health outcomes.