Frequent Mental Distress

Frequent Mental Distress in United States

United States

A healthy mental state is essential to overall positive health and well-being. In some cases, poor mental health may lead to suicide. Frequent mental distress aims to capture the population experiencing persistent, and likely severe, mental health issues, defined by 14 or more days of self-reported poor mental health in the past month. There is a strong relationship between the 14-day period and clinically diagnosed mental disorders, such as depression and anxiety. Frequent mental distress is associated with smoking, physical inactivity, housing insecurity, food insecurity and insufficient sleep. 

Direct medical spending associated with mental health disorders (including anxiety, depression and dementia) in the United States reached $201 billion in 2013, surpassing costs for heart disease ($147 billion) and traumatic injury ($143 billion).

The prevalence of frequent mental distress is higher among:

• Women compared with men.
• Adults ages 18-44 compared with those ages 45 and older.
• Multiracial and American Indian/Alaska Native adults compared with Hawaiian/Pacific Islander and Asian adults.
• Adults with less than a high school education compared with those with a high school diploma or GED degree and college graduates.
• Adults with an annual household income of $25,000 or less compared with those with higher income levels.
• Adults who have a disability compared with those who do not have a disability. 
• Adults who are unemployed or unable to work compared with employed adults.
• Adults who are divorced, widowed or separated compared with those who are married or who never married.

Although occasional short periods of mental distress may be unavoidable, more prolonged and serious episodes are treatable and may be prevented through early interventions. Effective early interventions for mental distress include: 

• School-based cognitive behavioral therapy has been found to be effective in reducing depression and anxiety symptoms among adolescents. 
• Home-based depression care management for older adults has been shown to improve short-term depression symptoms. This intervention includes active screening for depression, measurement-based outcomes, trained depression care managers, case management, patient education and a supervising psychiatrist. 
• Collaborative care, a team-based approach to depressive disorders care, provides multicomponent intervention to patients. A health care manager and primary care provider work with the patient to develop a treatment plan.

Continued surveillance of frequent mental distress may help identify unmet social and mental health needs and guide prevention and treatment interventions. The Centers for Disease Control and Prevention (CDC) has a resources page for mental health, including a mental health services locator.

Healthy People 2030 has numerous objectives related to mental health, including increasing the proportion of primary care visits where adolescents and adults are screened for depression.

Arango, Celso, Covadonga M. Díaz-Caneja, Patrick D. McGorry, Judith Rapoport, Iris E. Sommer, Jacob A. Vorstman, David McDaid, et al. 2018. “Preventive Strategies for Mental Health.” The Lancet Psychiatry 5 (7): 591–604. https://doi.org/10.1016/S2215-0366(18)30057-9.

Bruning, John, Ahmed A. Arif, and James E. Rohrer. 2014. “Medical Cost and Frequent Mental Distress among the Non-Elderly US Adult Population.” Journal of Public Health 36 (1): 134–39. https://doi.org/10.1093/pubmed/fdt029.

Cree, Robyn A., Catherine A. Okoro, Matthew M. Zack, and Eric Carbone. 2020. “Frequent Mental Distress Among Adults, by Disability Status, Disability Type, and Selected Characteristics — United States, 2018.” MMWR. Morbidity and Mortality Weekly Report 69 (36): 1238–43. https://doi.org/10.15585/mmwr.mm6936a2.

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

Moriarty, David G., Matthew M. Zack, James B. Holt, Daniel P. Chapman, and Marc A. Safran. 2009. “Geographic Patterns of Frequent Mental Distress: U.S. Adults, 1993–2001 and 2003–2006.” American Journal of Preventive Medicine 36 (6): 497–505. https://doi.org/10.1016/j.amepre.2009.01.038.

Roehrig, Charles. 2016. “Mental Disorders Top The List Of The Most Costly Conditions In The United States: $201 Billion.” Health Affairs 35 (6): 1130–35. https://doi.org/10.1377/hlthaff.2015.1659.

Shih, Margaret, and Paul A. Simon. 2008. “Health-Related Quality of Life among Adults with Serious Psychological Distress and Chronic Medical Conditions.” Quality of Life Research 17 (4): 521–28. https://doi.org/10.1007/s11136-008-9330-9.

Slabaugh, S. Lane, Mona Shah, Matthew Zack, Laura Happe, Tristan Cordier, Eric Havens, Evan Davidson, Michael Miao, Todd Prewitt, and Haomiao Jia. 2016. “Leveraging Health-Related Quality of Life in Population Health Management: The Case for Healthy Days.” Population Health Management 20 (1): 13–22. https://doi.org/10.1089/pop.2015.0162.