Content provided by the Faculty of the Harvard Medical School

In brief: Feeling bad in America

In brief

Feeling bad in America

Revealing information on the mental health of Americans appears in data from three random telephone surveys of the adult population by the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System.

One survey suggests that mental health may have declined during the 1990s.

Interviewers asked: “Thinking about your mental health, which includes stress, depression, and emotional problems, for how many days in the past month was your mental health not good?” A person who estimated more than 14 days was said to be suffering from frequent mental distress.

The overall rate of this distress rose from 8.4% in 1993 to 10.1% in 2001. Women had higher rates than men (10.6% versus 7.2% in 2001) and blacks had higher rates than whites, with Latinos intermediate. Mental distress was most common among Native Americans (14.4% in 2001) and least common (or perhaps least acknowledged, as the authors suggest) among Asian Americans (only 6.2%). Persons with incomes under $15,000 a year were twice as likely to suffer frequent mental distress as those with incomes above $50,000 a year.

In a second survey, conducted between 1995 and 2000, participants were asked how many days in the previous month they had felt depressed or sad. The average was three days. Again, women had more sad days than men (3.5 versus 2.4) and Latinos and blacks more than whites. People who did not graduate from high school had an average of nearly five sad days, college graduates only about two. Married people had fewer days of depression than the single, divorced, and widowed, who in turn had fewer than unmarried couples and separated partners. Underweight people were depressed on more days than the overweight and obese; those who smoked a pack a day or more had twice as many depressed days as those who had never smoked. The average number of depressed days was highest for people in their late teens and early 20s, declined steadily up to age 70, and then slowly rose to the average of three days at age 85.

A third survey, conducted in 2001–2002, identifies some of the consequences of mental distress for health and the quality of life. Interview subjects were asked whether they were limited in any way by physical or mental or emotional problems, and whether they had a health problem requiring special equipment. If they answered yes to either question, they were asked to describe the problem. Anyone who mentioned depression, anxiety, or emotional difficulties was described as having a primary mental health impairment.

About 5% of Americans who reported a primary health impairment of any kind said it involved mental health — all together, 1% of the people interviewed. Whites reported this kind of problem more often than blacks; the single, divorced, and widowed more than the married; and people under age 65 more than those over age 65. Compared to those with a primary physical impairment, people with a primary mental health impairment were more likely to smoke, drink heavily, and feel tired or lacking in energy. They also suffered more physical pain and distress than those with no health impairment.

Kobau R, et al. “Sad, Blue, or Depressed Days, Health Behaviors, and Health-Related Quality of Life, Behavioral Risk Factor Surveillance System, 1995–2000,” Health and Quality of Life Outcomes (July 30, 2004) Vol. 2, No. 40.

Strine TW, et al. “Depression, Anxiety, and Physical Impairments and Quality of Life in the U.S. Noninstitutionalized Population,” Psychiatric Services (Dec. 2004): Vol. 55, No. 12, pp. 1408–13.

Zahran HS, et al. “Self-Reported Frequent Mental Distress among Adults — United States, 1993–2001,” Morbidity and Mortality Weekly Report (Oct. 22, 2004): Vol. 53, No. 41, pp. 963–66.

Last updated:	August 21, 2006