Sociodemographic Determinants of Mental Health Burden and Healthcare Affordability Among U.S. Adults: A Regression Analysis of the 2023 Behavioral Risk Factor Surveillance System

Mental health disorders and barriers to healthcare access remain major public health challenges in the United States, with substantial disparities across socioeconomic and demographic groups. Population-level evidence on how sociodemographic factors influence mental health burden and healthcare affordability is essential for informing equitable public health interventions and policy. This cross-sectional study analyzed data from the 2023 Behavioral Risk Factor Surveillance System (BRFSS), a nationally representative survey of U.S. adults. Survey-weighted linear regression models were used to examine predictors of the number of mentally unhealthy days reported in the past 30 days. Survey-weighted logistic regression models assessed associations with inability to afford medical care in the past 12 months and lifetime diagnosis of depression. Explanatory variables included age, sex, income, employment status, and marital status. All analyses accounted for the complex survey design. Lower income and unemployment were consistently associated with poorer mental health outcomes and reduced healthcare access. Respondents in lower income categories reported significantly more mentally unhealthy days and had higher odds of being unable to afford medical care compared with higher-income respondents. Unemployed individuals exhibited increased odds of both depression diagnoses and cost-related barriers to care. Unmarried respondents also demonstrated higher odds of depression and inability to afford healthcare. Female respondents had higher odds of reporting a depression diagnosis, while younger adults experienced a greater mental health burden compared with older adults. All associations remained statistically significant after adjustment for covariates. Sociodemographic characteristics, particularly income, employment status, age, sex, and marital status, are important predictors of mental health burden and healthcare affordability among U.S. adults. These findings highlight persistent socioeconomic disparities and support the need for population-level public health strategies that address social determinants of health to improve mental health outcomes and equitable access to care.