Health Insurance

More Than 1 in 5 Americans Report Feeling Serious Anxiety or Depression Recently — Here’s Where Residents Are Most and Least Likely to Need Mental Health Resources

More Than 1 in 5 Americans Report Feeling Serious Anxiety or Depression Recently — Here’s Where Residents Are Most and Least Likely to Need Mental Health Resources

Money is a significant factor, and Southerners are the most likely to report feeling anxious or depressed.
A woman feels anxious at work.
A woman feels anxious at work. Source: Getty Images

Even before the COVID-19 pandemic, the U.S. was battling a serious health crisis: declining mental health. Over the last four years, the U.S. has increased its spending on mental health care more than any other condition, according to a ValuePenguin study on health care spending — and it looks like it may go up even further. That’s because the latest data reveals that more than 1 in 5 Americans report they’ve been feeling symptoms of anxiety or depression over a two-week period.

In this study, we analyzed the latest U.S. Census Bureau Household Pulse Survey data to determine the prevalence of mental health concerns across the U.S. We’ll take a look at the national data, then discuss the prevalence of mental health concerns on a state level.

Key findings

  • More than 1 in 5 Americans report feeling symptoms of anxiety or depression in the past two weeks. Across four questions about anxiety and depression, an average of 21.5% of adults report experiencing these feelings more than half the days in a two-week period.
  • Money is a significant factor in whether people report feeling anxious or depressed. Americans earning less than $25,000 a year are three times as likely to report feeling anxious as Americans earning $200,000 or more a year. Meanwhile, residents who recently lost income are twice as likely to report feeling depressed.
  • Residents in Southern states are most likely to report mental health struggles. Six of the 10 states with the highest average of residents reporting feeling symptoms of anxiety or depression are in the South, including Alabama (30.1%) and West Virginia (28.4%) at the top.
  • The states where residents are least likely to report mental health struggles are more spread across the U.S. Each region of the U.S. is represented at the bottom, led by South Dakota (16.3%) and North Dakota (16.6%) in the Midwest.
  • Mississippi, Louisiana and New Mexico are among the states that have the biggest need for mental health support, but they have the least access. These states have the fewest psychiatrists per capita in the U.S. Meanwhile, Rhode Island, New York and Connecticut have the most psychiatrists per capita.

21.5% of Americans report feelings of anxiety or depression

When asked four questions about depression and anxiety, we found that more than 1 in 5 (21.5%) Americans report having feelings of depression and anxiety more than seven days out of a 14-day period. Compared to their older counterparts, Americans between the ages of 18 and 29 are the most likely to report symptoms of anxiety (34.2%) and depression (27.7%). By race, Latino Americans were the most likely to experience both depression and anxiety, while Asian Americans were the least likely.

Education also plays a role: Those who didn’t have a high school degree were more than twice as likely to report feelings of depression than those with bachelor’s degrees.

Meanwhile, physical and mental impairments are also linked to a higher prevalence of depression. When asked to rank their difficulty completing common tasks on a scale of "no difficulty," "some difficulty," "a lot of difficulty" or "cannot do at all," respondents who report having "a lot of difficulty" also have the highest percentage of depressed thoughts. The greatest correlations are found among those who reported a lot of difficulty:

  • Understanding or being understood (63.8%)
  • Remembering or concentrating (62.3%)
  • Seeing (47.2%)
  • Walking or climbing stairs (38.5%)

Meanwhile, 48.2% of those who can't hear at all report feeling depressed, while only 29.5% of those who can’t see report the same. Beyond these impairments, 62.9% of Americans who have a lot of difficulty with self-care also report frequent feelings of depression.

Money plays a significant role in depression and anxiety

Though feelings of depression and anxiety vary among different demographic groups, income level is a major contributing factor that remains consistent across the population. Americans earning less than $25,000 a year are three times as likely to report feeling anxious as Americans earning $200,000 or more a year. Feelings of depression are also comparatively higher among lower earners:

Frequency of anxious or depressed feelings among household income groups

Annual household income
Average feelings of anxiety
Average feelings of depression
Less than $25,00037.8%30.8%
$25,000 - $34,99933.7%28.5%
$35,000 - $49,99927.1%22.3%
$50,000 - $74,99924.3%18.8%
$75,000 - $99,99921.1%15.0%
$100,000 - $149,99917.5%11.7%
$150,000 - $199,99913.5%8.7%
$200,000 and above11.9%7.4%
Didn't report24.0%17.4%

Source: ValuePenguin analysis of U.S. Census Bureau Household Pulse Survey data

Notably, Americans who recently lost income are twice as likely to report feeling depressed as those who haven’t. According to ValuePenguin health insurance expert Robin Townsend, it’s not surprising that consumers with low income are more likely to report mental health concerns.

"For people with low or no income, the struggle to afford basic needs can cause serious anxiety or depression," Townsend says. "That stress level is even higher for caregivers trying to provide for loved ones and for families who don’t have a financial safety net to cover a major life event."

In social research, higher income has typically been associated with increased feelings of happiness. According to a 2021 study published in the Proceedings of the National Academy of Sciences (PNAS), a person’s reported sense of well-being rises linearly with their income levels — an increase that’s consistently steep throughout all income brackets. Notably, higher incomes are also associated with significantly higher levels of overall positive feelings and significantly lower levels of overall negative feelings.

In contrast, respondents who rely on government support report higher levels of anxiety than those who don’t. When asked what they’ve used to meet their spending needs over the last seven days, Americans who’ve used regular income report feeling anxious just 21.3% of the time. That compares to:

  • 46.5% of Americans who’ve used government rental assistance
  • 38.8% of Americans who’ve used Supplemental Nutrition Assistance Program (SNAP) benefits
  • 38.6% of Americans who’ve used unemployment benefits

Anxiety levels are also comparatively high among consumers who’ve borrowed money (46.5%) or used credit cards (32.8%) to meet their spending needs.

Southerners are most likely to struggle with mental health

Your likelihood of experiencing depression or anxiety isn’t just dependent on who you are — where you are matters, too. In fact, Southerners are the most likely to struggle with mental health: six of the 10 states that had the highest average percentage of residents who reported feelings of anxiety and depression were in the South. Of these, Alabama (30.1%) and West Virginia (28.4%) topped the list.

Rank
State
Frequency of feeling nervous, anxious or on edge
Frequency of not being able to stop or control worrying
Little interest in doing things
Feeling down
Average feelings of anxiety and depression
1Alabama34.1%31.7%26.8%28.0%30.1%
2West Virginia36.1%29.7%24.3%23.6%28.4%
3Montana31.0%23.8%23.8%24.0%25.7%
4Oklahoma28.4%26.1%22.3%21.7%24.6%
5New Mexico28.5%25.4%21.8%21.3%24.2%
6Texas30.8%24.6%21.8%19.1%24.1%
7Louisiana27.2%26.0%21.7%20.7%23.9%
8Alaska29.6%25.5%20.7%19.7%23.8%
8Rhode Island30.3%22.4%23.4%19.0%23.8%
10Florida29.3%24.8%21.6%19.3%23.7%

Source: ValuePenguin analysis of U.S. Census Bureau Household Pulse Survey data

On the other hand, no singular region dominated the list of states with the lowest prevalence of anxiety and depression, though the two lowest-ranking states — South Dakota (16.3%) and North Dakota (16.6%) — are in the Midwest. Two other Midwestern states, Minnesota and Wisconsin, were also in the bottom 10, ranking fourth-lowest and 10th-lowest, respectively.

Following that, three Northeastern states (New Jersey, Maine and New York) and two Western states (Oregon and Wyoming) made the bottom 10 list. Just one Southern state — South Carolina — also ranked among that group.

Full rankings: States with the highest prevalence of anxiety and depression

Rank
State
Frequency of feeling nervous, anxious or on edge
Frequency of not being able to stop or control worrying
Little interest in doing things
Frequency of feeling down
Average feelings of anxiety and depression
1Alabama34.1%31.7%26.8%28.0%30.1%
2West Virginia36.1%29.7%24.3%23.6%28.4%
3Montana31.0%23.8%23.8%24.0%25.7%
4Oklahoma28.4%26.1%22.3%21.7%24.6%
5New Mexico28.5%25.4%21.8%21.3%24.2%
6Texas30.8%24.6%21.8%19.1%24.1%
7Louisiana27.2%26.0%21.7%20.7%23.9%
8Alaska29.6%25.5%20.7%19.7%23.8%
8Rhode Island30.3%22.4%23.4%19.0%23.8%
10Florida29.3%24.8%21.6%19.3%23.7%
11Pennsylvania29.1%25.0%20.4%19.8%23.6%
11Mississippi29.2%25.9%20.4%18.7%23.6%
Show All Rows

Source: ValuePenguin analysis of U.S. Census Bureau Household Pulse Survey data

Greater access to mental health professionals is often needed

In states where feelings of depression and anxiety are most prevalent, poor access to mental health care likely plays a role. The states with the highest percentage of residents with depressed or anxious thoughts are also generally those with the fewest psychiatrists per capita. For example, Mississippi, Louisiana and New Mexico are among the states that have the biggest need for mental health support, yet they have the fewest psychiatrists per capita.

Top 10 states with the fewest psychiatrists per capita

Rank
State
Psychiatrists per capita
1New Mexico0.23
1Louisiana0.23
3Mississippi0.24
4Kansas0.28
5West Virginia0.35
6South Dakota0.41
6Iowa0.41
8Nebraska0.42
9Oklahoma0.43
10Indiana0.44

Source: ValuePenguin analysis of U.S. Census Bureau Household Pulse Survey data

While access to mental health professionals is important, Townsend says that’s not the only indicator that needs to be addressed.

"While it's critical that residents of any state have access to mental health support services, states with higher rates of mental illness but less access to care are also among those with the highest uninsured rates," Townsend says. "Since a lack of health insurance contributes to mental stress and lack of access, all three things must be addressed."

In Texas, 21.5% of residents with mental illnesses are uninsured — the highest of any state. Texas also happens to have one of the highest percentages of residents with serious mental illnesses who didn’t receive mental health treatment, according to a Kaiser Family Foundation analysis of Substance Abuse and Mental Health Services Administration (SAMHSA) data from 2018 and 2019.

In fact, five of the states that had the highest prevalence of residents with mental health concerns also had the highest rates of those who didn’t receive treatment for a serious mental illness.

Meanwhile, states with the lowest percentage of adults with mental health concerns have the lowest rate of adults who didn't receive treatment, leading with Wisconsin (14.4%), North Dakota (19.7%), West Virginia (22.8%) and South Dakota (23.9%).

Seeking mental health support with (and without) health insurance: What it means for you

While many Americans are increasingly struggling to afford the cost of health care, Townsend advises not to cut back on support you might need for your mental health.

"With inflation rising and budgets tightening, even those with insurance are delaying health services due to high copays or deductibles," Townsend says. "But while you might put off a routine dental checkup, mental health care is too important to skip."

If cost is an issue, Townsend says there are many resources available to get the help you need. Particularly, she recommends you:

  • Compare health care plans. If you don’t have employer coverage, you may find an affordable individual insurance plan via the health insurance marketplace. The Affordable Care Act guarantees mental health coverage, so you may be able to find help for your mental care needs within your financial means. Consider comparing health care insurance rates to find an affordable plan for you.
  • Find out if you qualify for Medicare or Medicaid. If you do qualify for Medicaid, you can get low-cost — or even free — health care. Because Medicaid rules vary by state, Townsend recommends calling your state’s Medical Assistance office to determine if you’re eligible.
  • Look into nonprofit mental health agencies. If you can’t rely on insurance, Townsend says that nonprofit agencies dedicated to providing low-cost or free mental health assistance can help you obtain affordable mental health care. For example, the National Alliance on Mental Illness (NAMI) has a toll-free line for free mental health support and advice at any time.

Methodology

ValuePenguin researchers analyzed the latest U.S. Census Bureau Household Pulse Survey data to rank the states where residents are most and least likely to need mental health resources.

Specifically, we analyzed four survey responses related to anxiousness and depression:

  • Feeling nervous, anxious or on edge (anxiousness)
  • Not being able to stop or control worrying (anxiousness)
  • Having little interest or pleasure in doing things (depression)
  • Feeling down, depressed or hopeless (depression)

Across these questions, researchers averaged the percentage of U.S. adults who reported feeling symptoms of anxiety or depression on at least half the days over a two-week period. The survey was fielded from July 27 to Aug. 8, 2022 — the last time it was conducted.