Adult Mental Health Conditions - More Prevalent and More Severe, But Among Different Populations

Now let’s turn from happiness to mental health – starting with adults.

Mental health is somewhat different from happiness. Mental health does not necessarily measure wellbeing. Mental health is more of a capacity to experience wellbeing. So good mental health doesn’t necessarily mean that you find your life meaningful or joyful, but that your psychological processes are developing in such a way that it makes it more likely. Although mental health is a spectrum that encompasses positive mental health, it is traditionally measured through deficits – i.e., presence of diagnosable mental health conditions.

Here we will focus on two ways of measuring mental health, based on classifications from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA): any mental illness (AMI) or serious mental illness (SMI). SAMHSA uses a combination of survey questions and clinical interviews to estimate the prevalence of any condition that meets DSM criteria (i.e., AMI) and those that cause serious functional impairments interfering with major life activities (i.e., SMI). Note that there is often confusion around SMI. Sometimes people think of certain diagnoses as SMI, such as schizophrenia, while others are AMI, such as anxiety. In reality, someone could have schizophrenia and have AMI or have anxiety and have SMI, depending on how much it is presently limiting them.

Overall, both AMI (inclusive of SMI) and SMI prevalence increased among adults in recent years. AMI increased by 16% between 2008 and 2019, and SMI increased by 41%.

First, let’s dig more into the AMI data:

• By age: Those ages 18-25 experienced the largest increase (59%), followed by those ages 26-59 (21%), with no increase among those aged 50 or older.
• By gender: Both men and women experienced increases, although men rose by 42% more, while women had much higher levels even in 2019 (16% v 25%).
• By race and ethnicity: All races and ethnicities experienced increases, although the greatest increases were among White (21%), multiracial (20%), or Hispanic (13%) adults.
• By geography: All regions experienced increases, but they were by far the largest in the West (28%) and the Midwest (20%). The increases were also 34% larger in less urbanized areas than large metro areas.
• By income: Mental health grew worse across income brackets, but those making 200% or more above the federal poverty line (FPL) experienced an increase that was more than 3 times larger. Those well above FPL still had better mental health on average though than those below FPL.
• By education: Although this was only collected starting in 2015, all groups faced worse mental health, but mental health among those college educated experienced almost 3 times higher growth.

For SMI, many of the trends are similar with two noticeable differences:

• SMI increased least amongst the White population, with by far the highest increases among American Indians and Alaskan Natives.
• SMI increased most among those with a high school education, rather than among those with college and graduate degrees.

What Does it All Mean?

Some of this is hard to interpret. Are highly educated White men in the less urban West driving the trend in mental health problems, or are these several distinct populations all experiencing their own trends? Also, what are we to make of sometimes opposing trends in AMI and SMI prevalence, such as what we see along racial and ethnic lines? For example, what would cause mental health problems to become more prevalent in White and highly educated populations, but more severe (although not necessarily much more prevalent) in Black and less educated populations?

One of the biggest questions for me is how do changes in mental health awareness and literacy affect these findings. Is the increase in AMI among the well off because this population became more willing to express distress or because they are genuinely feeling more distress? Does awareness impact rates of SMI?

Comparing with our happiness findings may help. Both happiness and mental health grew worse among those that are younger and those that are relatively well off financially. We also see some potentially similar disparities by race and ethnicity. Mental health though showed stronger differences based on gender, geography, and educational attainment than happiness. Some of these differences between happiness and mental health may be due to psychometrics – different measures may be more sensitive to the way that different populations express distress. This is always a major danger in this work because the measures are generally developed with White, affluent individuals. Positive and negative affect are also likely governed by distinct psychological systems, not quite different ends of a spectrum, so the differences may also reflect differential impacts on these two systems. For example, a racial or ethnic group could face more stressors or traumas that influence either the positive or negative affective systems more, leading to different trends across happiness and mental health measures. More on this later.

To get answers to some of these questions, we’ll look at more concrete measures in the later posts – death and biomarkers related to mental health. We might also need to drill down further on the data. What do you think? How do you make sense of the patterns we see?