Frequent Mental Distress in United States

United States

A healthy mental state is key to overall health and well-being and is influenced by individual, community, family and societal factors. Frequent mental distress, defined by 14 or more days of poor mental health a month, aims to capture the population experiencing persistent and likely severe mental health issues. There is a strong link between the 14-day period and clinically diagnosed mental disorders, such as depression and anxiety.

Populations suffering from severe mental illness and frequent mental distress have a higher prevalence of risky health behaviors, including smoking, alcohol use, unhealthy diet and lack of physical activity. These health behaviors increase the likelihood of developing chronic diseases like diabetes, cancer and cardiovascular disease. Chronic stressors such as housing insecurity, food insecurity and insufficient sleep are also related to frequent mental distress. In severe cases, poor mental health can lead to suicide, one of the leading causes of death in the United States. 

Poor mental health can impact financial health with costly treatments and missed economic opportunities. In 2019, the direct costs for treatment of mental health disorders among women in the U.S. totaled $61.5 billion. Among pregnant women and their children, untreated perinatal mood and anxiety disorders cost the U.S. roughly $14 billion.

According to America’s Health Rankings data, the prevalence of frequent mental distress is higher among:

• Women compared with men.
• Adults ages 18-44 compared with those age 45 and older.
• Multiracial, American Indian/Alaska Native and Hawaiian/Pacific Islander adults compared with Asian adults.
• Adults with less than a high school education compared with college graduates.
• Adults with an annual household income of $25,000 or less than those with higher income levels.
• Adults who have difficulty with cognition compared with adults without a disability.
• Lesbian, gay, bisexual and queer (LGBQ+) adults compared with straight adults.
• Adults who have not served compared with adults who have served in the U.S. armed forces. 

Additionally, one study found that the prevalence of frequent mental distress was higher among adults without health insurance, adults who are unemployed or unable to work, and adults who are divorced, widowed or separated.

Although occasional short periods of mental distress and a few bad mental health days may be unavoidable, more prolonged and severe episodes are treatable and potentially preventable through early intervention. Parity laws that expand and protect insurance coverage for mental health care are associated with lower out-of-pocket costs, lower suicide rates and increased use of health care services. Collaborative care models, which connect primary care providers and mental health specialists, are also effective in managing depressive disorders. 

The Community Guide lists several strategies that are effective at improving mental health, including:

• School-based cognitive behavioral therapy. 
• Home-based depression care management. 
• Collaborative care.

The RAND Corporation has recommendations to transform the mental health system centered around three main goals: promoting pathways to care, improving access to care and establishing a continuum of evidence-based care.

Surveillance systems for mental health issues — including frequent mental distress — help prioritize and tailor mental health promotion, mental illness prevention and treatment programs. The Centers for Disease Control and Prevention has a resources page for mental health.

Healthy People 2030 has several objectives related to mental health, including: 

• Increasing the proportion of primary care visits where adolescents and adults are screened for depression.
• Increasing the proportion of adults with depression who get treatment.
• Increasing the proportion of adults with serious mental illness who get treatment.
• Increasing the proportion of homeless adults with mental health problems who get mental health services.

Arango, Celso, Covadonga M. Díaz-Caneja, Patrick D. McGorry, Judith Rapoport, Iris E. Sommer, Jacob A. Vorstman, David McDaid, et al. “Preventive Strategies for Mental Health.” The Lancet Psychiatry 5, no. 7 (July 2018): 591–604. https://doi.org/10.1016/S2215-0366(18)30057-9.

Bruning, John, Ahmed A. Arif, and James E. Rohrer. “Medical Cost and Frequent Mental Distress Among the Non-Elderly US Adult Population.” Journal of Public Health 36, no. 1 (March 1, 2014): 134–39. https://doi.org/10.1093/pubmed/fdt029.

Caceres, Billy A., Abraham A. Brody, Perry N. Halkitis, Caroline Dorsen, Gary Yu, and Deborah A. Chyun. “Cardiovascular Disease Risk in Sexual Minority Women (18-59 Years Old): Findings from the National Health and Nutrition Examination Survey (2001-2012).” Women’s Health Issues 28, no. 4 (July 1, 2018): 333–41. https://doi.org/10.1016/j.whi.2018.03.004.

Hydes, Theresa J., Robyn Burton, Hazel Inskip, Mark A. Bellis, and Nick Sheron. “A Comparison of Gender-Linked Population Cancer Risks between Alcohol and Tobacco: How Many Cigarettes Are There in a Bottle of Wine?” BMC Public Health 19, no. 316 (March 28, 2019). https://doi.org/10.1186/s12889-019-6576-9.

Liu, Yong, Rashid Njai, and Kurt J. Greenlund. “Relationships Between Housing and Food Insecurity, Frequent Mental Distress, and Insufficient Sleep Among Adults in 12 US States, 2009.” Preventing Chronic Disease 11 (March 13, 2014). https://doi.org/10.5888/pcd11.130334.

Luca, Dara Lee, Caroline Margiotta, Colleen Staatz, Eleanor Garlow, Anna Christensen, and Kara Zivin. “Financial Toll of Untreated Perinatal Mood and Anxiety Disorders Among 2017 Births in the United States.” American Journal of Public Health 110, no. 6 (June 1, 2020): 888–96. https://doi.org/10.2105/AJPH.2020.305619.

Massetti, Greta M., Cheryll C. Thomas, Jessica King, Kathleen Ragan, and Natasha Buchanan Lunsford. “Mental Health Problems and Cancer Risk Factors Among Young Adults.” American Journal of Preventive Medicine 53, no. 3 Suppl 1 (September 1, 2017): S30–39. https://doi.org/10.1016/j.amepre.2017.04.023.

McBain, Ryan K., Nicole K. Eberhart, Joshua Breslau, Lori Frank, M. Audrey Burnam, Vishnupriya Kareddy, and Molly M. Simmons. “Transforming Mental Health Care in the United States.” RAND Corporation, 2021. https://doi.org/10.7249/RBA889-1.

Rashid, Mamunur, M. Mazharul Islam, Aiping Li, and Naima Shifa. “Frequent Mental Distress among Adults in the United States and Its Association with Socio-Demographic Characteristics, Lifestyle, and Chronic Health Condition.” Journal of Public Health and Development 20, no. 1 (January 30, 2022): 146–62. https://doi.org/10.55131/jphd/2022/200112.

Slabaugh, S. Lane, Mona Shah, Matthew Zack, Laura Happe, Tristan Cordier, Eric Havens, Evan Davidson, Michael Miao, Todd Prewitt, and Haomiao Jia. “Leveraging Health-Related Quality of Life in Population Health Management: The Case for Healthy Days.” Population Health Management 20, no. 1 (2017): 13–22. https://doi.org/10.1089/pop.2015.0162.

Soni, Anita. “Healthcare Expenditures for Treatment of Mental Disorders: Estimates for Adults Ages 18 and Older, U.S. Civilian Noninstitutionalized Population, 2019.” Agency for Healthcare Research and Quality, February 2022. https://meps.ahrq.gov/data_files/publications/st539/stat539.pdf.