Ranking America's Mental Health: An Analysis of Depression Across the States
Depression is a chronic illness that exacts a significant toll on America's health and productivity. It affects more than 21 million American children and adults annually and is the leading cause of disability in the United States for individuals ages 15 to 44.
Lost productive time among U.S. workers due to depression is estimated to be in excess of $31 billion per year. Depression frequently co-occurs with a variety of medical illnesses such as heart disease, cancer, and chronic pain and is associated with poorer health status and prognosis. It is also the principal cause of the 30,000 suicides in the U.S. each year. In 2004, suicide was the 11th leading cause of death in the United States, third among individuals 15-24.
Despite significant gains in the availability of effective depression treatment over the past decade, the level of unmet need for treatment remains high. On average, people living with depression go for nearly a decade before receiving treatment, and less than one-third of people who seek help receive minimally adequate care.
"Ranking the States: An Analysis of Depression Across the States" was researched and written by Mental Health America and Thomson Healthcare. It looks at data from 2002-2006 and was conducted from July to November 2007. The report compares depression levels and suicide rates in all 50 states and the District of Columbia and uses the information to highlight solutions to improve states' mental health status.
Mental Health America has two goals for the report: (1) spur the development of a public health surveillance system to monitor the mental health of Americans and the specific impact of depression, and (2) to stimulate action by communities, public health professionals, federal and state policy makers, and others to address depression in their populations.
The Ranking of the States
Using data from nationally representative surveys conducted by the United States government, Mental Health America created two different rankings of the states: one showing the state rankings of depression and one showing the state rank in terms of suicide rates.
Four different measures of depression and mental health status were used to develop one composite measure of the level of depression in a given state. The four measures were: (1) the percentage of the adult population experiencing at least one major depressive episode in the past year, (2) the percentage of the adolescent population (ages 12 to 17) experiencing at least one major depressive episode in the past year, (3) the percentage of the adult population experiencing serious psychological distress, and (4) the average number of days in the past 30 days in which the population reported that their mental health was not good.
Age-adjusted suicide rates were also examined since suicide is the most significant negative outcome of depression.
State Ranking on Depression Status
State Ranking on Suicide Rates
The Top and Bottom 10 States
South Dakota was the healthiest state with respect to depression status. Among adults in South Dakota, 7.31 percent had a major depressive episode in the past year and 11.16 percent experienced serious psychological distress. Among adolescents in South Dakota, 7.4 percent had a major depressive episode in the past year. On average, individuals in South Dakota reported having 2.41 poor mental health days in the past 30 days.
Utah was the most depressed state. Among adults in Utah, 10.14 percent experienced a depressive episode in the past year and 14.58 percent experienced serious psychological distress. Among adolescents in Utah, 10.14 experienced a major depressive episode in the past year. Individuals in Utah reported having on average 3.27 poor mental health days in the past 30 days.
In terms of 2004 suicide rates, the District of Columbia was the lowest, followed by New York and Massachusetts. Alaska had the highest suicide rate, followed by Nevada and New Mexico.
The Five Factors Affecting Depression Status
While many factors likely contribute to these differences which are not represented in the state summary data employed in these analyses, a clear and compelling theme emerges from the data included. The availability of and access to mental health services improves mental health outcomes. This is particularly true for suicide, where less difficulty in obtaining needed care, actual utilization of services, and the availability of a professional workforce are all related to decreased rates of death. Similarly, access to health insurance - a key variable in obtaining care - is also related to decreased rates of suicide.
In "Ranking America's Mental Health," Mental Health America found statistically significant associations between the following factors and better depression status and lower suicide rates:
- Mental health resources - On average, the higher the number of psychiatrists, psychologists and social workers per capita in a state, the lower the suicide rate.
- Barriers to treatment - The lower the percentage of the population reporting that they could not obtain healthcare because of costs, the lower the suicide rate and the better the state's depression status. In addition, the lower the percentage of the population that reported unmet mental healthcare needs, the better the state's depression status.
- Mental health treatment utilization - Holding the baseline level of depression in the state constant, the higher the number of antidepressant prescriptions per capita in the state, the lower the suicide rate.
- Socioeconomic characteristics - The more educated the population and the greater the percentage with health insurance, the lower the suicide rate. The more educated the population, the better the state's depression status.
In addition, the report found the following factor to be significantly associated with the level of mental health service utilization in a state:
Mental health parity - The more generous a state's mental health parity coverage, the greater the number of people in the population that receive mental health services.
Factors That Influence State Mental Health Status and Suicide Rates
The Five Suggested Public Policy Solutions
The report provides a snapshot of the level of mental health of each state's population, particularly depression - from the "healthiest" state in terms of depression status to the least. Importantly, it links that data to a number of factors that are significantly associated with better depression status and lower suicide rates, and thus provides for the first time a statistical foundation for pathways to reduce depression and its profound consequences. Specifically, the analyses suggest that the following factors reduce depression and suicide:
- Improving the availability of mental health professionals
- Reducing cost and other barriers to mental health treatment
- Encouraging appropriate utilization of mental health therapies
- Providing a richer socioeconomic environment by improving education levels, economic status and health insurance coverage
- Legislating mental health benefits that are equivalent to that for physical health
Additional Charts
Having At Least One Major Depressive Episode in Past Year among Persons Aged 18 or Older, by State: Percentages, Annual Averages Based on 2004 and 2005 NSDUH
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2004 and 2005.
Having At Least One Major Depressive Episode in Past Year among Youths Aged 12 to 17, by State: Percentages, Annual Averages Based on 2004 and 2005 NSDUH
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2004 and 2005.
Serious Psychological Distress in Past Year among Persons Aged 18 or Older, by State: Percentages, Annual Averages Based on 2004 and 2005 NSDUH
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2004 and 2005.
Average Number of Poor Mental Health Days in Past 30 Days among Persons Aged 18 or Older, by State
Source: 2006 Behavioral Risk Factor Surveillance System.
Age-Adjusted Suicide Rate in Each State per 100,000, 2004
Source: Centers for Disease Control and Prevention, National Injury Mortality Data.
For More Information:
For more information, contact your local Mental Health America affiliate or the national Mental Health America office.
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