Private Insurance and Mental Health among Older Adults with Multiple Chronic Conditions: A Longitudinal Analysis by Race and Ethnicity

Older adults with multiple chronic conditions have a higher risk than those without
multiple conditions of developing a mental health condition. Individuals with both physical and
mental conditions face many substantial burdens. Many such individuals also belong to racial and
ethnic minority groups. Private insurance coverage can reduce the risks of developing mental illnesses
by increasing healthcare utilization and reducing psychological stress related to financial hardship.
This study examines the association between private insurance and mental health (i.e., depressive
symptoms and cognitive impairment) among older adults in the United States with multiple chronic
conditions by race and ethnicity. We apply a multivariate logistic model with individual fixed-effects
to 12 waves of the Health and Retirement Study. Among adults with multiple chronic conditions
in late middle age nearing entry to Medicare and of all racial and ethnic groups, those without
private insurance have a stronger probability of having depressive symptoms. Private insurance and
Medicare can mediate the risk of cognitive impairment among non-Hispanic Whites with multiple
chronic conditions and among Blacks regardless of the number of chronic conditions. Our study
has implications for policies aiming to reduce disparities among individuals coping with multiple
chronic conditions.