ASSOCIATION BETWEEN SELF-REPORTED DEPRESSION AND MISSED MEDICATION DUE TO COST AMONG U.S. ADULTS: A 2024 BRFSS ANALYSIS
Author(s)
Oluwapelumi I. Odubunmi, MPH1, Ibukunoluwa Folarin, MD2, Adedapo Ogunlewe, MD3, Ibrahim Idris, MD₍c₎2, Abdullah Adeniji-Bello, MD₍c₎2;
1University of Nevada, Reno, School of Public Health, Reno, NV, USA, 2Lagos State University College of Medicine, Ikeja, Nigeria, 3College of Medicine, University of Lagos, Idi-Araba, Nigeria
1University of Nevada, Reno, School of Public Health, Reno, NV, USA, 2Lagos State University College of Medicine, Ikeja, Nigeria, 3College of Medicine, University of Lagos, Idi-Araba, Nigeria
OBJECTIVES: Cost-related medication nonadherence remains a persistent public-health concern in the United States and may be particularly common among people living with depression. This study examined whether adults who reported ever being told they had a depressive disorder were more likely to miss prescribed medication because of cost, using data from the 2024 Behavioral Risk Factor Surveillance System (BRFSS).
METHODS: Data from 453,453 adults in the 2024 BRFSS were analyzed using SAS 9.4 with survey weights to account for the complex sampling design. The exposure was a self-reported lifetime diagnosis of depression, and the outcome was cost-related medication nonadherence. Weighted prevalence estimates and 95% confidence intervals (CIs) were calculated using survey procedures. Adjusted odds ratios (aORs) were estimated using multivariable logistic regression controlling for age, sex, race, education, income, health insurance, and employment.
RESULTS: Weighted prevalence of cost-related medication nonadherence was 21.1% (95% CI 20.6-21.7) among adults with depression and 9.9% (95% CI 9.7-10.2) among those without depression. In adjusted models, depression remained strongly associated with missed medication due to cost (aOR = 2.39, 95% CI 2.25-2.50). Income and insurance status showed the largest effects: adults earning < $15,000 had nearly eight-fold higher odds of cost-related nonadherence, and uninsured adults had more than four-fold higher odds compared with high-income and insured adults. Higher odds were also observed among women, racial and ethnic minority groups, and adults aged 55-64 years.
CONCLUSIONS: Adults with depression were significantly more likely to forgo prescribed medication because of cost, even after accounting for income, insurance, and other socioeconomic factors. These findings underscore the intertwined impact of mental health and financial barriers on medication adherence and support policies that expand coverage, improve parity for mental-health benefits, and reduce out-of-pocket medication costs for lower-income populations.
METHODS: Data from 453,453 adults in the 2024 BRFSS were analyzed using SAS 9.4 with survey weights to account for the complex sampling design. The exposure was a self-reported lifetime diagnosis of depression, and the outcome was cost-related medication nonadherence. Weighted prevalence estimates and 95% confidence intervals (CIs) were calculated using survey procedures. Adjusted odds ratios (aORs) were estimated using multivariable logistic regression controlling for age, sex, race, education, income, health insurance, and employment.
RESULTS: Weighted prevalence of cost-related medication nonadherence was 21.1% (95% CI 20.6-21.7) among adults with depression and 9.9% (95% CI 9.7-10.2) among those without depression. In adjusted models, depression remained strongly associated with missed medication due to cost (aOR = 2.39, 95% CI 2.25-2.50). Income and insurance status showed the largest effects: adults earning < $15,000 had nearly eight-fold higher odds of cost-related nonadherence, and uninsured adults had more than four-fold higher odds compared with high-income and insured adults. Higher odds were also observed among women, racial and ethnic minority groups, and adults aged 55-64 years.
CONCLUSIONS: Adults with depression were significantly more likely to forgo prescribed medication because of cost, even after accounting for income, insurance, and other socioeconomic factors. These findings underscore the intertwined impact of mental health and financial barriers on medication adherence and support policies that expand coverage, improve parity for mental-health benefits, and reduce out-of-pocket medication costs for lower-income populations.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EPH61
Topic
Epidemiology & Public Health
Topic Subcategory
Safety & Pharmacoepidemiology
Disease
No Additional Disease & Conditions/Specialized Treatment Areas