(116) Impact of the Affordable Care Act on Mental Health in Dysphonia, Dysphagia, and Dysarthria Patients

Introduction: To identify changes post- Affordable Care Act (ACA) in mental health and treatment patterns among adults with self-reported dysphonia, dysphagia, and dysarthria.

Methods: A cross-sectional analysis was conducted comparing weighted responses from adults who self-reported dysphagia, dysphonia, or dysarthria from the National Health Interview Survey (NHIS). Survey data was re-coded for interpretability. Changes in anxiety and depression symptoms, medication use, and mental health professional utilization between 2012 and 2022 were estimated using multivariate logistic regression.

Results: Analysis included 6313 dysphonia, 3417 dysphagia, and 2607 dysarthria patients. Compared to 2012, the odds of worrying more frequently was higher across dysphonia (aOR 2.30; 95% CI 1.82–2.91; p< 0.001), dysphagia (aOR 1.69; 95% CI 1.26–2.26; p< 0.001), and dysarthria patients (aOR 1.96; 95% CI 1.36–2.85; p< 0.001) in 2022. The level of worry was also higher across dysphonia (aOR 1.44; 95% CI 1.08-1.94; p=0.014), dysphagia (aOR 1.58; 95% CI 1.19-2.28; p=0.015), and dysarthria (aOR 2.07; 95% CI 1.32-3.27; p=0.002). Dysphonia patients were also more frequently depressed (aOR 1.43; 95% CI 1.14-1.79; p=0.002). The odds of seeing a mental health professional increased across dysphonia (aOR 1.63; 95% CI 1.35-1.98; p< 0.001), dysphagia (aOR 1.33; 95% CI 1.06-1.68; p=0.016), and dysarthria patients (aOR 1.52; 95% CI 1.15-2.00; p< 0.001). Dysarthria patients were more likely to take medications for anxiety (aOR 2.10; 95% CI 1.42-3.10; p< 0.001) and depression (aOR 1.80; 95% CI 1.17-2.77; p=0.008).

Conclusions: Although patients in 2022 were more likely to receive medication and seek mental health care compared to 2012, mental health symptom frequency and intensity increased. While increased resource utilization may reflect the ACA's increase in mental health care access, worsening symptoms may be confounded by stressors related to the COVID-19 pandemic. Further research should explore longer-term effects of the ACA on mental health in these populations.