Trends in Extreme Distress in the United States, 1993-2019

Abstract

Objectives. To investigate changes from 1993 to 2019 in the percentage of US citizens suffering extreme distress.Methods. Using data on 8.1 million randomly sampled US citizens, we created a new proxy measure for exceptional distress (the percentage who reported major mental and emotional problems in all 30 of the last 30 days). We examined time trends for different groups and predictors of distress.Results. The proportion of the US population in extreme distress rose from 3.6% in 1993 to 6.4% in 2019. Among low-education midlife White persons, the percentage more than doubled, from 4.8% to 11.5%. Regression analysis revealed that (1) at the personal level, the strongest statistical predictor of extreme distress was "I am unable to work," and (2) at the state level, a decline in the share of manufacturing jobs was a predictor of greater distress.Conclusions. Increasing numbers of US citizens report extreme levels of mental distress. This links to poor labor-market prospects. Inequality of distress has also widened.Public Health Implications. Policymakers need to recognize the crisis of an ever-growing group of US citizens in extreme distress.

FIGURE 1—

The Rising Percentage of US Adults Reporting Extreme Levels of Distress by Gender: 1993–2019 Note. The sample size was approximately 8.1 million adults. The study’s proxy measure of “extreme distress” is depicted on the vertical axis. It is the percentage of people who gave the maximum answer of 30 days in response to the Behavioral Risk Factor Surveillance System question: “Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?”

FIGURE 2—

Rising Inequality of Extreme Distress Among Middle-Aged (35–54 Years) US Citizens by College vs Noncollege Subsamples: 1993–2019 Note. The study’s proxy measure of “extreme distress” is depicted on the vertical axis. It is the percentage of people who gave the maximum answer of 30 days in response to the Behavioral Risk Factor Surveillance System question: “Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?”