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April 15, 2009

More Americans Report Frequent Mental Distress

State of mind may have a lot to do with state of residence — people who live in Hawaii have the lowest “frequency of mental distress” (6.6%), while Kentucky residents have the highest (14.4%), according to the CDC.
Action Points

* Explain to interested patients that this report is an analysis of self-reported survey data, which need to be cautiously interpreted because the findings are subject to a number of limitations.

But overall, more Americans have been experiencing more bad days in recent years — 10.2% of adults reported frequent mental distress in the period from 2003-2006, up from 9% in 1993-2001, wrote Matthew M. Zack, M.D., M.P.H., of the division of adult and community health at the National Center for Chronic Disease Prevention and Health Promotion at the CDC in Atlanta, and colleagues.

Those findings, published online today by the American Journal of Preventive Medicine,emerged from an analysis of responses from 2.4 million adults collected by the ongoing, random-digit-dialed telephone surveys conducted by the Behavioral Risk Factor Surveillance System. The analysis was performed in 2007 and 2008.

Dr. Zack and colleagues used 14 mentally unhealthy days as the threshold to define frequent mental distress.

The final analysis included results from 3,112 counties representing all 50 states and Washington, D.C.

“For the 1993-2001 period, the smoothed [frequent mental distress] prevalence was less than 8% in 989 (31.8%) of the 3,112 counties analyzed and was ≥12.0% in 148 (4.8%) of counties,” they wrote.

By comparison, in 2003-2006, “the smoothed [frequent mental distress] prevalence was <8% in 494 counties (15.9%) and ≥12.0% in 502 (16.1%) of the counties.”

The researchers excluded counties in which there were fewer than 30 responses to this question: “Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the previous 30 days was your mental health not good?”

Among the findings:

* During 1993-2001, 15 states had at least one county where the prevalence of frequent mental distress was ≥12.0% and by 2003-206 that number had doubled to 30 states.
* The prevalence of frequent mental distress tended to decrease in contiguous parts of the upper Midwest (Minnesota, Wisconsin, and Michigan), and to increase in the Four Corners area (Utah, Arizona, Colorado, and New Mexico), the Mississippi Valley (Missouri, Arkansas, Tennessee, Mississippi, and Alabama), and the central Appalachian region (Pennsylvania, Maryland, West Virginia, Ohio, Kentucky, and Virginia).
* Alabama and Kentucky were the only states that remained in the top five for frequent mental distress prevalence in both time periods — 9.8% and 12.7% for Alabama in 1993-2001 and 2003-2006 and 14.4% in both time periods for Kentucky.
* In addition to Hawaii, other states with low rates of mental distress were South Dakota, Iowa, Nebraska, and North Dakota.

The authors pointed out that the survey has a number of limitations, including the fact that “risk factors do not respect state boundaries.” Moreover, states that have large urban populations “tend to reflect the [frequent mental distress] prevalence in those areas due to their sheer numbers, potentially obscuring the detection of high or low [frequent mental distress] prevalence in less-populated areas of the state.”

Additionally, they said, because the Behavioral Risk Factor Surveillance System excludes homeless persons, people who reside in institutions, households without landlines, and those who are unable to complete the survey because of language problems, the survey might underrepresent people with frequent mental distress.

Moreover, the prevalence rates might reflect factors such as age, gender, race/ethnicity, employment status, occupation, educational background, natural disasters and a number of other factors that were not controlled for in the study.

Nonetheless, the authors concluded that because the data do indicate “potentially unmet health and social service needs, programs for public health, community mental health, and social services whose jurisdictions include areas with high [frequent mental distress] levels should collaborate to identify and eliminate the specific preventable sources of this distress.”

No financial disclosures were reported by the authors.

Primary source: American Journal of Preventive Medicine
Source reference:
Moriarty DG, et al “Geographic patterns of frequent mental distress U.S. adults, 1993-2001 and 2003-2006” Am J Prev Med 2009;

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