Mental Distress on the Rise in the United States
By Amanda Gardner, HealthDay Reporter
THURSDAY, Oct. 21 (HealthDayNews) -- Ten percent of American adults say they suffer from stress, depression and other forms of mental distress that affect them at least 14 days a month.
From 1993 to 2001, the prevalence of U.S. adults with "frequent mental distress" increased from 8.4 percent to 10.1 percent of the population. There were substantial differences among racial and ethnic groups, as well as men and women, and household incomes, said a review in the Oct. 22 issue of Morbidity and Mortality Weekly Report, published by the U.S. Centers for Disease Control and Prevention.
The overall increase was "significant," said Rosemarie Kobau, co-author of the report and a public health advisor in the CDC's division of adult and community health.
"This should raise alarms across the board," said Bob Carolla, a spokesman for the National Alliance for the Mentally Ill. "Among other things, Congress needs to pass mental health insurance parity and take other steps to ensure access to treatments."
The study authors said the findings point to the need for programs to reduce the stigma associated with mental disorders and to reduce disparities between groups of people.
According to the report, as many as one in five American adults has a mental disorder in any given year. Frequent mental distress is a category defined as 14 or more days in the past 30 days during which mental health, as reported by the individual, was "not good." Fourteen days a month is a marker for doctors to look for clinical depression and anxiety disorders in people.
The authors of this study looked at a representative sample of almost 1.3 million adults throughout the 50 states and the District of Columbia. Participants were asked to respond to the 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?"
Frequent mental distress (FMD) was most common among American Indians/Alaska Natives (14.4 percent) and non-Hispanic whites and blacks (12.9 percent). It was least common among Asian/Pacific Islanders (6.2 percent). Among non-Hispanic whites, FMD increased from 8.1 to 9.7 percent and, for non-Hispanic blacks, from 9.5 to 11.3 percent.
Regardless of the racial/ethnic group, those with higher socioeconomic status were less likely to have FMD.
Frequent mental distress was also more prevalent among women than men in all racial/ethnic groups except Asian/Pacific Islanders and American Indians/Alaska Natives. The prevalence of FMD was highest among women who identified themselves as non-Hispanic (14.3 percent) and American Indians/Alaska Natives (12.5 percent). Next came non-Hispanic white women (11.1 percent), Hispanic women (9.5 percent), non-Hispanic black women (9.2 percent), and Asian/Pacific Islanders (7.7 percent).
In all racial/ethnic groups, FMD rates were higher among respondents who were younger, female, separated, divorced, widowed, had less than a high school education, carried no health insurance, were unemployed or unable to work, or who earned less than $15,000 a year.
"The findings are important from a public-health perspective because they identify disparities across population groups," Kobau said. "We've identified some vulnerable populations, young people, women, those with low socioeconomic status, so we can intervene in those groups and help reduce the level of frequent mental distress."
The disparities are also important because they may indicate other, unhealthy behaviors. "Mood can influence beliefs and attitudes towards health [and] coping styles and can impair self-management or adherence to treatment regimens," Kobau said.
It's not clear why the overall figures increased, although the study did include the period immediately following the terrorist attacks of Sept. 11, 2001. "I would think that it might have an effect, but we did not look at that specifically," Kobau said.
"It's hard to attribute any one factor to the increase," she added. Although socioeconomic status played a role, it did not account for the whole picture.
Higher rates of frequent mental distress among women might be explained by higher disclosure rates.
Indeed, less stigma surrounding mental disorders may have increased reporting among various groups.
"People are willing to self-disclose or seek help more than they did," Carolla said. "Keep in mind that from 1993 to 2001, you had the Surgeon General's report [on Americans' mental health] and you had Tipper Gore speaking out. The other part of it is that our medical knowledge is becoming better. Practitioners are spotting and identifying and diagnosing the problem sooner than they did before."
More information
The National Alliance for the Mentally Ill (www.nami.org ) has more information on mental illness. 
SOURCES: Bob Carolla, spokesman, National Alliance for the Mentally Ill, Arlington, Va.; Rosemarie Kobau, M.P.H., public health advisor, division of adult and community health, U.S. Centers for Disease Control and Prevention, Atlanta; Oct. 22, 2004, Morbidity and Mortality Weekly Report
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