Sociodemographic, Behavioral, Health, and Health Care Access Factors Associated with Frequent Mental Distress Among Non-Hispanic Multiracial U.S. Adults: A 2023 BRFSS with Policy Implications

Background/Objectives: Frequent mental distress (FMD) is an important population mental health indicator, yet non-Hispanic multiracial adults remain understudied. This study estimated FMD prevalence and examined associated sociodemographic, health care access, behavioral, and health-related factors. Methods: Data from the 2023 Behavioral Risk Factor Surveillance System (BRFSS) were subjected to cross-sectional analysis, accounting for strata, survey weights, and primary sampling units. FMD was defined as ≥14 mentally unhealthy days during the past 30 days. Survey-weighted logistic regression estimated adjusted odds ratios (AORs) and 95% confidence intervals (CIs). Analyses used R version 4.6.1. Results: Among 9899 respondents with FMD data, weighted FMD prevalence was 24.49% (95% CI 22.64–26.34%). The complete-case analysis included 7444 of 10,125 eligible respondents (73.52%). Higher odds of FMD were associated with cost-related barriers to medical care (AOR 4.49, 95% CI 3.35–6.00, p < 0.001), inability to work (AOR 2.38, 95% CI 1.62–3.49, p < 0.001), current smoking (AOR 1.88, 95% CI 1.37–2.58, p < 0.001), unemployment, physical inactivity, former smoking, and underweight status. Adults aged ≥65 years had lower odds than those aged 18–34 years (AOR 0.15, 95% CI 0.09–0.26, p < 0.001). Sensitivity analyses using a larger sample without household income (N = 8609) and prevalence-ratio regression produced broadly consistent principal findings. Conclusions: Approximately one-quarter of non-Hispanic multiracial adults experienced FMD. Findings identify health care affordability, employment circumstances, smoking, physical inactivity, and health-related factors as important correlates and support further research addressing mental health needs among multiracial adults.