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Behavioral Health

Mental health worsened among women during the first year of the COVID-19 pandemic with disparities by race/ethnicity, income, education and age. Teen suicide, anxiety and depression among youth varied widely across states.

Women

Frequent Mental Distress Frequent mental distress represents the population experiencing persistent, and likely severe, mental health issues, defined by 14 or more days of poor mental health a month. A strong relationship exists between the 14-day period and clinically diagnosed mental disorders, such as depression and anxiety.
  • Changes over time. Nationally, the percentage of women ages 18-44 who reported their mental health was not good 14 or more days in the past 30 days significantly increased 14% from 17.0% to 19.4% between 2017-2018 and 2019-2020. During 2019-2020, roughly 10.9 million women in the U.S. were affected, an increase of more than 1.2 million women since 2017-2018. Frequent mental distress significantly increased in eight states and the District of Columbia, led by 46% in the District of Columbia (12.5% to 18.3%) and 41% in Montana (15.8% to 22.2%). Most racial/ethnic, education, income and age subpopulations experienced significant increases in frequent mental distress. By group, the largest increases were: 54% among American Indian/Alaska Native women (17.3% to 26.6%), 32% among college graduates (10.2% to 13.5%), 30% among women with an annual household income of $75,000 or more (9.2% to 12.0%) and 18% among women ages 25-34 (16.2% to 19.1%).
Graphic showing frequent mental distress data included on this page and in the full report PDF available for download from the report Overview page.
  • Disparities. Frequent mental distress among women was highest in Arkansas (27.8%) and lowest in Hawaii (14.9%) in 2019-2020. The prevalence varied the most by race/ethnicity, and also significantly varied by income, education and age. It was 2.4 times higher among multiracial (26.7%) compared with Asian (11.3%) women; 2.1 times higher among women with an annual household income less than $25,000 (24.8%) compared with those with an income of $75,000 or more (12.0%); and 1.5 times higher among women with some post-high school education (20.8%) compared with college graduates (13.5%).
Depression
  • Changes over time. Nationally, the percentage of women ages 18-44 who reported being told by a health professional that they have a depressive disorder — including depression, major depression, minor depression or dysthymia — significantly increased 5% from 24.8% to 26.1% between 2017-2018 and 2019-2020. During 2019-2020, nearly 14.9 million women in the U.S. were affected by depression, an increase of roughly 624,000 women since 2017-2018. Some age subpopulations and white women experienced significant increases in depression.
  • Disparities. Depression among women was highest in West Virginia (39.7%) and lowest in Hawaii (16.9%) in 2019-2020. The prevalence varied the most by race/ethnicity, and also significantly varied by income, education, metropolitan status and age. It was 3.8 times higher among multiracial (37.1%) compared with Asian (9.7%) women; 1.5 times higher among women with an annual household income less than $25,000 (31.8%) compared with those with an income of $75,000 or more (21.1%); and 1.4 times higher among women with some post-high school education (30.2%) compared with college graduates (20.9%).
Postpartum Depression Nationally, 13.6% of women with a recent live birth reported experiencing depressive symptoms in 2020, an increase of 14% (from 11.9%) since 2014. Out of the 41 states with data, postpartum depression was highest in Arkansas (23.2%) and lowest in Iowa (7.9%) in 2020.

Children

Graphic showing Teen suicide was highest in Alaska and lowest in Massachusetts in 2018-2020. Download the report PDF from the Overview page for full details.
Teen Suicide Suicide is a serious public health problem, especially among youth, as it exacts an enormous toll due to the years of potential life lost. In 2020, suicide was the second-leading cause of death among those ages 10-24 and 25-34.
  • Changes over time. Nationally, the teen suicide rate significantly increased 29% from 8.4 to 10.8 deaths per 100,000 adolescents ages 15-19 between 2012-2014 and 2018-2020. Teen suicide significantly increased in 10 states, led by 82% in Nevada (8.3 to 15.1), 67% in Colorado (12.9 to 21.5) and 55% in South Carolina (8.7 to 13.5). The rate significantly increased 28% among both females (4.0 to 5.1) and males (12.7 to 16.3).
  • Disparities. Teen suicide was highest in Alaska (40.4 deaths per 100,000 adolescents ages 15-19) and lowest in Massachusetts (5.0) in 2018-2020. The rate varied significantly by race/ethnicity and gender. It was 4.9 times higher among American Indian/Alaska Native teens (38.9) compared with Black teens (8.0), and 3.2 times higher among males (16.3) compared with females (5.1).
Graphic showing teen suicide data included on this page.
Anxiety and Depression - Children Occasional feelings of worry or sadness are normal from time to time. However, if children do not outgrow their fears and worries, or anxiety starts interfering with school and other activities, they might have an anxiety disorder. Or if they feel persistent sadness and hopelessness, they may have depression. If untreated, mental health disorders can interfere with a child’s development, causing problems in school and in forming friendships.
  • Changes over time. Nationally, among children ages 3-17, anxiety increased 23% from 7.5% to 9.2% (an increase of more than 1 million children), while depression increased 27% from 3.3% to 4.2% (an increase of 555,700) between 2017-2018 and 2020-2021. These conditions affected approximately 5.6 million children and 2.5 million children in 2020-2021, respectively.
  • Disparities. Anxiety was highest in Vermont (16.9%) and lowest in Hawaii (4.6%). Depression was highest in Kentucky (7.3%) and lowest in Hawaii (2.4%).
Graphic showing anxiety data included on this page.
Flourishing Flourishing measures children’s well-being and how well they function and thrive within their family and community. Flourishing in children is associated with higher levels of school engagement, and attributes of flourishing have been linked with fewer risky health behaviors during adolescence.
Graphic showing flourishing data contained on this page.
  • Changes over time. Nationally, flourishing among children significantly decreased 7% from 71.7% to 66.6% between 2018-2019 and 2020-2021, equaling roughly 4.7 million fewer children in 2020-2021. Flourishing is defined as the percentage of children ages 6 months to 5 years who show affection, resilience, interest and curiosity in learning, and smile and laugh a lot; and children ages 6-17 who show self-regulation, interest and curiosity in learning, and work to finish tasks, as reported by a caregiver. By age group, flourishing significantly decreased 3% (from 83.5% to 80.8%) among children ages 6 months to 5 years and 9% (66.5% to 60.4%) among children ages 6-17. Flourishing among children significantly decreased in 14 states, led by 14% in Maryland (75.1% to 64.5%) and South Carolina (76.6% to 66.0%).
  • Disparities. Flourishing among children was highest in Nebraska and Hawaii (both 71.6%) and lowest in Oregon (62.8%) in 2020-2021. The prevalence was significantly higher among children ages 6 months to 5 years (80.8%) compared with children ages 6-17 (60.4%).

Mortality

The mortality rate among women significantly increased during the first year of the pandemic. Maternal mortality continued to be a major challenge for the U.S., with wide disparities by race/ethnicity.

Women

Mortality Rate The mortality rate among women ages 20-44 held steady from 2016 to 2019 but increased significantly in 2020. The 10 leading causes of death among women ages 20-44 in 2020 were: unintentional injury, malignant neoplasm, heart disease, suicide, COVID-19, liver disease, homicide, diabetes mellitus, complicated pregnancy and cerebrovascular disease.
  • Changes over time. Nationally, the mortality rate among women significantly increased 21% from 97.2 to 117.3 deaths per 100,000 women ages 20-44 between 2019 and 2020. In 2020, 63,655 women in the U.S. died of any cause, an increase of 11,152 women since 2019. This increase was primarily driven by deaths from COVID-19, which became the fifth-leading cause of death nationwide among women. In addition to COVID-19, deaths from liver disease, unintentional injury, diabetes, homicide, pregnancy complications and heart disease all increased 14% or more in 2020. The mortality rate significantly increased in 32 states, led by 35% in Arizona (100.7 to 135.6 deaths per 100,000 women ages 20-44). Nearly all racial/ethnic subpopulations experienced significant increases in mortality.
Graphic representation of mortality information contained on this page. Download the full report PDF from the Overview page.
  • Disparities. Mortality among women was highest in West Virginia (214.6 deaths per 100,000 women ages 20-44) and lowest in Hawaii (73.8) in 2020. The mortality rate was 9.5 times higher among American Indian/Alaska Native women (357.6), the group with the highest rate, compared with Asian women (37.6), the group with the lowest rate.
Graphic representation of mortality among women information contained on this page. Download the full report PDF from the report Overview page for details.
Drug Deaths
  • Changes over time. Nationally, the drug death rate — deaths due to drug injury (unintentional, suicide, homicide or undetermined) — among women significantly increased 19% from 18.9 to 22.4 deaths per 100,000 women ages 20-44 between 2015-2017 and 2018-2020. During 2018-2020, 36,358 women in the U.S. died from a drug overdose, an increase of 6,031 women since 2015-2017. The drug death rate significantly increased in 23 states, led by: 63% in Vermont (20.3 to 33.1 deaths per 100,000 women ages 20-44), 59% in Nebraska (7.0 to 11.1) and 49% in Louisiana (22.3 to 33.3). During the same time period, drug deaths among women significantly decreased 19% in Utah (23.9 to 19.4).
  • Disparities. Drug deaths among women were 7.8 times higher in West Virginia (72.2 deaths per 100,000 women ages 20-44), the state with the highest rate in 2018-2020, compared with Hawaii (9.3), the state with the lowest rate. The rate varied significantly by race/ethnicity and age. It was 15.9 times higher among American Indian/Alaska Native women (42.9) compared with Asian women (2.7), and 2.2 times higher among women ages 35-44 (27.0) compared with those ages 20-24 (12.2).
Graphic representation of drug death information contained on this page. Download the full report PDF from the Overview page.
Maternal Mortality The maternal mortality rate in the U.S. has been rising since 1990 and is higher than those of many other developed countries. Between April and December 2020, a substantial increase in maternal deaths was reported, coinciding with the COVID-19 pandemic.
Graphic representation of maternal mortality information contained on this page. Download the full report PDF from the Overview page.
Severe Maternal Morbidity
  • Changes over time. Nationally, severe maternal morbidity — the number of significant life-threatening maternal complications during delivery — significantly increased 5% from 77.5 to 81.0 complications per 10,000 delivery hospitalizations between 2018 and 2019, and 12% (from 72.1) since 2016. In 2019, 28,155 women experienced significant life-threatening complications during delivery. Severe maternal morbidity significantly increased in four states between 2018 and 2019: 29% in Nevada (65.2 to 84.4), 14% in Pennsylvania (77.0 to 87.8), 11% in Florida (73.4 to 81.8) and 9% in Texas (66.2 to 72.4).
  • Disparities. Out of the 48 states with data, severe maternal morbidity was highest in Rhode Island (111.3 complications per 10,000 delivery hospitalizations) and lowest in South Dakota (52.5) in 2019. The rate varied the most by race/ethnicity — it was 1.9 times higher among Black mothers (126.1) compared with white mothers (66.2) — but also significantly varied by age, income and metropolitan status.
‡ Education and income subpopulations are among women ages 25-44.

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