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

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.