Impact of ACA implementation on health related quality of life among those with depressive disorders in the United States: A secondary data analysis of the 2011-2017 BRFSS

PURPOSE: The passage of the Affordable Care Act in the US resulted in more Americans with health insurance coverage as well as expanded health benefits. However, barriers in accessing health care still exist in the US especially as it relates to some of the most vulnerable Americans including those with depressive disorders. The purpose of this cross-sectional secondary data analysis was to examine the differences in health-related quality of life for individuals with depressive disorders in early years of the implementation of the Affordable Care Act as compared to later years of implementation. METHODS: This study used a repeated cross-sectional design that pooled data from the 2011–2017 Behavioral Risk Factor Surveillance System which is a nationally representative survey of the non-institutionalized U.S. population. Logistic regression models were used to evaluate the before and after impact of the Affordable Care Act on health related quality of life for those with depressive disorders. RESULTS: Those with depressive disorders in early years of implementation of the Affordable Care Act were less likely to report 14 or more days of poor physical health (AOR = 0.96; 95% CI: 0.95, 0.98), were less likely to report 14 or more days of poor mental health (AOR = 0.93; 95% CI: 0.92, 0.94), and less likely to report 14 or more days of overall poor physical and mental health (AOR = 0.93; 95% CI: 0.90, 0.96) as opposed to later years of implementation. CONCLUSIONS: Our results indicate poorer health related quality of life for those with depressive disorders in later years of implementation of the Affordable Care Act. Despite expanded mental health benefits under the Affordable Care Act, those benefits do not always translate into improved access or improved patient-reported outcomes. The federal government needs to comprehensively address mental health services in order to improve patient-reported outcomes and mental health treatment for those with depression.