Mental Health in U.S. Is Worsening, Survey Shows


CHICAGO — A barometer of the nation's mental health shows psychopathology-related symptoms have worsened overall in the past decade, with intriguing geographic variations.

Rates of frequent mental distress are highest in the Appalachian and Mississippi valley regions, and lowest and declining in the upper Midwest and Hawaii. The explanation for the geographic disparity is unknown, psychiatric epidemiologist Daniel P. Chapman, Ph.D., said at the American Psychiatric Association's Institute on Psychiatric Services.

He does, however, have a theory about the phenomenon. “These high frequent-mental-distress states fall mainly within the so-called Stroke Belt. We suspect the high mental distress rates there could have something to do with the increased stroke rate and the burden that creates,” he said in an interview. He added that for now, this theory is speculative and subject to further investigation.

Dr. Chapman of the Centers for Disease Control and Prevention presented data on roughly 2.5 million randomly selected community-dwelling U.S. adults who participated in the agency's Behavioral Risk Factor Surveillance System interviews from 1993 to 2001 or 2003 to 2006.

The survey included a question asking respondents how many days over the previous month their mental health—including aspects such as stress, depression, and problems with emotions—had not been good.

Frequent mental distress was defined by investigators as 14 or more mentally unhealthy days during the prior 30 days.

Frequent mental distress is certainly not a specific psychiatric diagnosis. However, it's a useful construct that encompasses a diverse range of psychopathology and helps in identifying regional unmet mental health needs and the impact of interventions over time, Dr. Chapman continued.

The mean prevalence of frequent mental distress nationwide from 1993 to 2001 was 9.0%. By 2003–2006, it had climbed to 10.2%. The five states with the highest rates were Kentucky, West Virginia, Nevada, and Alabama and Mississippi. The four least mentally distressed were Hawaii, South Dakota, and Kansas and Nebraska. The District of Columbia came in at 7.4%. The frequent mental distress gap between the five highest and five lowest prevalence states grew from 4% to 5.9% between the two periods.

The prevalence of frequent mental distress increased over time by at least 1% in 27 states and the District of Columbia. In Oklahoma, West Virginia, and Mississippi, it jumped by more than 4%.

When the survey data were analyzed on a county-by-county basis, most states showed intrastate variations in frequent mental distress prevalence.

'These high frequent-mental-distress states fall mainly within the so-called Stroke Belt.' DR. CHAPMAN


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