All depression is not created equal—severity levels and
treatment effects differ from person to person. But a new analysis of
aggregate data shows that depression rates also vary widely in this country by
The differences, according to researchers and mental health advocates, are
directly linked to the availability of mental health resources and state
mental health policies.
"Depression is one of the most disabling conditions affecting people
in this country," said David Shern, Ph.D., president and CEO of Mental
Health America, the organization that issued the report of the state rankings.
Shern made his remarks at a press conference last November in Washington, D.C."
The good news is that we can do something about it—we must
continue with the progress we've made in providing equitable, appropriate
access to depression care."
Using data from a number of nationally representative surveys between 2000
and 2006, including the Center for Disease Control and Prevention's Behavioral
Risk Factor Surveillance System and the federal National Survey on Drug Use
and Health Survey, researchers found that South Dakota was rated the
healthiest state in terms of depression, with Utah ranking last.
Mental Health Resources Drive Depression and Suicide Rankings
They gathered data on depression using the following measures: the
percentage of adults and adolescents experiencing at least one major
depressive episode a year, the percentage of adults experiencing serious
psychological distress (defined on the K6 scale by six questions about how
frequently they experienced psychological distress during the one-month period
in the past year when they were at their worst emotionally), and the average
number of days in the past month in which those surveyed reported that their
mental health was not good.
South Dakota showed the best results for the measures used to develop a
composite depression status indicator, according to the report.
On average, residents of South Dakota experienced 2.41 poor mental health
days a month. Among adults, 7.31 percent experienced a major depressive
episode in the prior year, and 11.16 percent experienced serious psychological
distress. Slightly more than 7 percent of adolescents experienced a major
depressive episode in the prior year.
In contrast, Utah residents had the highest reported depression rates, with
West Virginia and Kentucky following closely in terms of depression
Among adults and adolescents in Utah, 10.14 percent experienced a
depressive episode in the past year, and 14.58 percent experienced serious
Each state also was ranked by suicide rate, using 2004 data from the
National Vital Statistics System. According to the report, the District of
Columbia had the lowest suicide rate, with 5.32 suicide deaths per 100,000
people. Alaska had the highest suicide rate, with 23.05 suicide deaths per
To better understand differences between states in terms of depression and
suicide rates, researchers also studied the association between prevalence
rates and the following in each state: mental health policies, mental health
treatment resources, the prevalence of barriers to mental health care, use of
psychiatric treatment, and socioeconomic characteristics of residents.
Not surprisingly, researchers found that state characteristics such as
availability of mental health treatment providers and the presence of mental
health parity laws were linked to a state's depression and suicide rates and
its subsequent ranking.
For instance, the higher the percentage of a state's population who
reported unmet mental health care needs, the worse the state's depression
status (p<.001). Utilization, measured as antidepressant prescriptions per
capita in the state and the percentage of the adult population who received
treatment in the past year, was also positively correlated with depression
rates. The percentage of residents receiving mental health treatment was
positively correlated with mental health status (p<.001). In addition, the
more educated the state population, the higher the depression rates.
With regard to suicide, researchers found that the more mental health
professionals there were in a state, the lower the suicide rate was
(p<.001). Higher levels of mental health care utilization and higher
educational levels were also associated with lower suicide rates.
Moreover, "Those with greater access to mental health coverage in
insurance had lower suicide rates," Shern pointed out.
Mental health advocate and consumer Cynthia Evans, who attended the press
conference, added a personal dimension to the statistics. Evans, raised by a
mother with schizophrenia and a father involved with drugs, was first
hospitalized for depression at around the age of 13.
This was the first of many subsequent hospitalizations and suicide
attempts, she told attendees at the press conference.
As an adult, Evans had difficulty getting mental health treatment due to
inadequate insurance coverage. "I was almost going without groceries to
try and maintain my mental health," she noted. Evans, who is in
recovery, commented that "this isn't rocket science. The more people who
have access to affordable mental health care, the fewer who kill
Shern suggested that enacting parity legislation on a broader basis, thus
expanding access to affordable mental health treatment, will vastly improve
depression and suicide rates in the United States.
Despite the fact that some states did better than others in terms of
depression and suicide, he noted, "no state can be satisfied with its
current status... .These rates can be driven lower by encouraging state
policies designed to improve coverage, end discriminatory practices in
insurance, and assure that qualified mental health professionals are available
to serve everyone in need."
The study was conducted on behalf of Mental Health America by researchers
from Thomson Healthcare (a company that provides clients "integrated
information-based solutions"), along with an unrestricted educational
grant from Wyeth Pharmaceuticals.
"Ranking America's Mental Health: An Analysis of Depression
Across the States" is posted online at<www.mentalhealthamerica.net/go/state-ranking>.▪