Feeling Stressed? It's More Likely in Some U.S. States Than Others


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By Denise Mann
TUESDAY, April 14, 2009 (Health.com) — The state you live in may affect your state of mind, according to new report that shows that rates of stress, depression, and emotional problems vary by geographic region. That's good news if you live in Hawaii, where only 6.6% of people report frequent mental distress. Not-so-good news for those in Kentucky: In the Bluegrass State, 14.4% of people said they frequently experienced mental distress—the highest prevalence in the country. Frequent mental distress is defined as having 14 or more mentally unhealthy days during the previous 30-day period.

The researchers were surprised that the study, which will be published in the June 2009 issue of the American Journal of Preventive Medicine, showed such a broad range in mental distress depending on geographic location. "The occurrence of frequent mental distress in adults differs much more than expected among the residents of U.S. states and counties," says lead researcher Matthew M. Zack, MD, of the Centers for Disease Control and Prevention (CDC) in Atlanta.

People who have frequent mental distress may have treatable and preventable mental illnesses or problems, and social programs or interventions may help, Dr. Zack says. In the study, the researchers looked at rates of mental distress by state among 2.4 million adults across two time periods—1993 through 2001 and 2003 through 2006—as part of the ongoing Behavioral Risk Factor Surveillance System study. Overall, the prevalence for frequent mental distress across both time periods was 9.4%, with the lowest rate in Hawaii and the highest rate in Kentucky.

Why the difference? It may be because residents in some areas of the country are more likely than others to have health conditions such as disability or diabetes, untreated mental conditions like anxiety or depression, high unemployment rates, risky behaviors including cigarette smoking and alcohol abuse, and/or social circumstances such as lower incomes.

Next page: In many areas, mental distress is on the rise

An area centered on Kentucky showed high levels of frequent mental distress that remained elevated over time, while in other parts of the country (such as the upper Midwest) low levels of frequent mental distress remained low over time, the study showed.

Overall, though, frequent mental distress seems to be on the rise. The rate of frequent mental distress increased by at least one percentage point in 27 states, and by more than four percentage points in Mississippi, Oklahoma, and West Virginia from the earlier time period to the later time period. "In some areas, normal or low frequent-mental-distress levels increased over time, implying the introduction of influences that increased levels of frequent mental distress," Dr. Zack says.

The new state-by-state breakdown of rates of mental distress should have ramifications as the Obama Administration takes on health care reform, points out Chuck Holzer, PhD, a professor of psychiatry and behavioral science at the University of Texas Medical Branch in Galveston.

"From a public health standpoint, it's great to be aware of places with high rates of frequent mental distress so we can help make sure that access to care is increasing in those areas," he says.

Many of the states with high rates of frequent mental distress are struggling economically, as are their residents. As a result, they may not be able to afford health insurance that includes mental health services. "The big message is that you need to monitor the health and mental health of the country because it will lead to greater equity in mental health services," Holzer says.

And Dr. Zack says, "Community mental health agencies, social service agencies, and public health agencies in counties where frequent mental distress is increased should recognize that such increases may indicate unmet health and social service needs."