Abstract
BACKGROUND: The 2007 to 2009 U.S. economic recession was associated with widespread job loss, housing instability, and rising mental health challenges. While previous studies have linked economic downturns to psychological distress, limited research has examined how health insurance status modifies this relationship during and after a recession. AIMS: This study investigated changes in psychological distress (PD) among U.S. adults before, during, and after the 2007 to 2009 recession and examined whether insurance status mediated the relationship between economic hardship and PD. METHODS: Using Behavioral Risk Factor Surveillance System (BRFSS) data from 2007, 2009, 2012, and 2013, the study applied an integrative data analysis (IDA) framework to construct composite demographic profiles and approximate longitudinal trends. Structural equation modeling (SEM), including exploratory and confirmatory factor analysis, panel modeling, and mediation analysis, was used to examine PD trends and the influence of insurance coverage and income. RESULTS: Exploratory and confirmatory factor analyses confirmed a two-factor structure of PD: depression and anxiety symptoms. From 2007 to 2009, PD remained stable, but levels improved between 2009 and 2012. Higher uninsured rates significantly increased PD, with a 1% increase in the uninsured population resulting in a 17.4% rise in PD. Mediation analysis showed that limited access to mental health treatment partially explained the relationship between being uninsured and increased distress. CONCLUSION: Health insurance status plays a critical role in moderating psychological distress during economic downturns. Expanding insurance coverage and integrating mental health services into economic recovery efforts may mitigate long-term mental health consequences of financial crises.