Mental Health

Students in grades 9–12.

Number of students in grades 9 through 12 who reported poor mental health during the past 30 days.

Number of students in grades 9 through 12.

Prevalence (crude).

Past 30 days.

In 2021, 29% of high school students experienced poor mental health (most of the time or always) during the past 30 days.¹ While mental health affects children and adolescents of all ages, ethnic/racial backgrounds, and regions, the magnitude of health issues vary across subpopulations.^1,2 For example, female students were more likely than male students and Asian and Black students were less likely than Hispanic and multiracial students.¹ Children and adolescents growing up in poverty are two to three times more likely to develop mental health issues than peers who are not living in poverty.^2,3 Although mental health issues in children and adolescents are widespread, they are treatable, and often preventable. In 2021, the Surgeon General issued an advisory that provides actionable recommendations for various audiences and sectors to support the mental health of children and adolescents^.1

Students might have a biased response because of the topic of the question.

Youth Risk Behavior Surveillance System (YRBSS).

None.

Student Health

National Center for HIV, Viral Hepatitis, STD, and TB Prevention. Youth Risk Behavior Survey Data Summary & Trends Report: 2011-2021. Centers for Disease Control and Prevention. Accessed May 5, 2023. https://www.cdc.gov/healthyyouth/data/yrbs/pdf/YRBS_Data-Summary-Trends_Report2023_508.pdf

Office of the Surgeon General (OSG). Protecting Youth Mental Health: The U.S. Surgeon General’s Advisory. US Dept of Health and Human Services; 2021. https://www.hhs.gov/sites/default/files/surgeon-general-youth-mental-health-advisory.pdf

National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. What Is Children’s Mental Health? Centers for Disease Control and Prevention, US Dept of Health and Human Services. https://www.cdc.gov/mentalhealth/tools-resources/children/index.htm

Reiss F. Socioeconomic inequalities and mental health problems in children and adolescents: a systematic review. Soc Sci Med (1967). 2013;90:24–31. doi:10.1016/j.socscimed.2013.04.026

All adults.

Adults who responded yes to having ever been told by a doctor, nurse, or other health professional they had a depressive disorder, including depression, major depression, dysthymia, or minor depression.

All adults.

Prevalence (crude and age-adjusted).

Lifetime.

Depression is a common and serious mood disorder. It causes severe symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working.¹ In 2019, an estimated 47 million U.S. adults (19%) reported they had been told by a doctor they had a depressive disorder, including depression, major depression, dysthymia, or minor depression in their lifetime.² In 2019, 7% of all U.S. adults experienced moderate or severe symptoms of depression within the past 2 weeks with women more likely than men and adults ages 18–29 more likely than adults 30 years and older to experience any level of severity of symptoms.³ Depression, even the most severe cases, can be treated. The earlier treatment begins, the more effective it is.¹

The question only assesses lifetime, not necessarily current, depression, and does not assess severity or duration of depression.

Behavioral Risk Factor Surveillance System (BRFSS).

None.

None.

National Institute of Mental Health. Depression. National Institutes of Health, US Dept of Health and Human Services. Accessed October 14, 2022. https://www.nimh.nih.gov/health/topics/depression

National Center for Chronic Disease Prevention and Health Promotion. BRFSS Web Enabled Analysis Tool. Centers for Disease Control and Prevention, US Dept of Health and Human Services. Accessed October 14, 2022. https://nccd.cdc.gov/weat/#/analysis

Villarroel MA, Terlizzi EP. Symptoms of depression among adults: United States, 2019. NCHS Data Brief. 2020;379.

Women who have had a recent live birth.

Number of respondents who reported that they always or often felt down, depressed, or hopeless or had little interest or little pleasure in doing things since delivery of their most recent live birth.

Number of respondents who reported that they always, often, sometimes, rarely, or never felt down, depressed, or hopeless and reported that they always often, sometimes, rarely or never had little interest or little pleasure in doing things since delivery of their most recent live birth.

Prevalence (crude).

Since the most recent live birth.

Experiencing symptoms of depression in the postpartum period is common^1-3 and symptoms often reoccur—over half of women with depression in the postpartum period had a diagnosis either during or preceding pregnancy.³ Postpartum depression has negative effects on maternal health, relationships, and behaviors; infant cognitive and language development and quality of sleep; and on mother-child interactions, including bonding and breastfeeding.⁴

This indicator represents self-reported depressive symptoms only and is not equivalent to a diagnosis of depression. Further, it cannot be used to distinguish reoccurring symptoms or new symptoms, only those at time of survey. Various similar tools assessing self-reported depressive symptoms including feelings of being down, depressed, sad, or hopeless, have been recommended for depression case-finding. Sensitivity measures for these tools is generally high with moderate to high specificity measures.^{5, 6}

Pregnancy Risk Assessment Monitoring System (PRAMS).

None.

Maternal Health

Bauman BL, Ko JY, Cox S, et al. Vital Signs: postpartum depressive symptoms and provider discussions about perinatal depression — United States, 2018. MMWR Morb Mortal Wkly Rep. 2020;69(19):575–581. doi:10.15585/mmwr.mm6919a2

Le Strat Y, Dubertret C, Le Foll B. Prevalence and correlates of major depressive episode in pregnant and postpartum women in the United States. J Affect Disord. 2011;135(1–3):128–138. doi:10.1016/j.jad.2011.07.004

Dietz PM, Williams SB, Callaghan WM, Bachman DJ, Whitlock EP, Hornbrook MC. Clinically identified maternal depression before, during, and after pregnancies ending in live births. Am J Psychiatry. 2007;164(10):1515–1520 doi:10.1176/appi.ajp.2007.06111893

Slomian J, Honvo G, Emonts P, Reginster J, Bruyère O. Consequences of maternal postpartum depression: a systematic review of maternal and infant outcomes. Womens Health (Lond). 2019;15. doi:10.1177/1745506519844044

Manea L, Gilbody S, Hewitt C, et al. Identifying depression with the PHQ-2: a diagnostic meta-analysis. J Affect Disord. 2016;203:382–395. doi:10.1016/j.jad.2016.06.003

Kroenke K, Spitzer RL, Williams JBW. The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care. 2003;41(11):1284–1292. doi:10.1097/01.MLR.0000093487.78664.3C

All adults.

Sum of the number of days during the past 30 days for which adults report that their mental health (including stress, depression, and problems with emotions) was not good.

Adults who report ≥0 days during the past 30 days for which their mental health was not good.

Mean number of days (crude and age-adjusted).

Past 30 days.

In 2021, US adults reported an average of 4.7 recent mentally unhealthy days, defined as the number of days in the past 30 days a respondent experienced poor mental health because of stress, depression, or problems with emotions.¹ The average number of mentally unhealthy days was higher for women than men.¹ Mentally unhealthy days is one of CDC’s health-related quality of life measures (CDC HRQOL-4).² As mental health and physical health are closely connected, promoting good mental and physical health through individual- and community-level interventions (e.g., physical activity programs; smoking cessation programs, screening programs) can improve health by preventing and managing chronic disease risk factors and adverse outcomes.³

Although this indicator is based on self-assessment, it has been demonstrated to have good reliability, validity, and responsiveness.

Behavioral Risk Factor Surveillance System (BRFSS).

None.

None.

National Center for Chronic Disease Prevention and Health Promotion. Chronic Disease Indicators. Centers for Disease Control and Prevention, US Dept of Health and Human Services. Accessed on October 14, 2022. https://www.cdc.gov/cdi

National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. Health-Related Quality of Life (HRQOL). Centers for Disease Control and Prevention, US Dept of Health and Human Services. https://www.cdc.gov/hrqol/methods.htm

National Center for Chronic Disease Prevention and Health Promotion. How You Can Prevent Chronic Diseases. Centers for Disease Control and Prevention, US Dept of Health and Human Services. Accessed November 29, 2022. https://www.cdc.gov/chronicdisease/about/prevent/index.htm

All adults.

Proportion of adults aged ≥ 18 years report that their mental health (including stress, depression, and problems with emotions) was not good for 14 or more days during the past 30 days.

All adults.

Prevalence (crude and age-adjusted).

Past 30 days.

In 2021, 14.7% of US adults reported frequent mental distress (FMD), defined as 14 or more mentally unhealthy days during the past 30 days where the person has experienced poor mental health because of stress, depression, or problems with emotions.¹ FMD estimates are higher for women than men.¹ FMD is also negatively associated with life expectancy and positively associated with behavioral and metabolic risk factors.² Mentally unhealthy days is one of CDC’s health-related quality of life measures (CDC HRQOL-4). FMD is used to identify individuals with more severe or persistent health problems in the previous month.¹ Many chronic diseases can impact general health status, including mental distress. Practicing healthy behaviors (e.g., not smoking, eating healthy, being active, and limiting drinking) can reduce the likelihood of getting a chronic disease and improve the odds of staying well, feeling good, and living longer.³

Although this indicator is based on self-assessment, number of days has been demonstrated to have good reliability, validity, and responsiveness.

Behavioral Risk Factor Surveillance System (BRFSS).

None.

None.

United Health Foundation. America’s Health Rankings. Accessed 2023. https://www.americashealthrankings.org

Zahran HS, Kobau R, Moriarty DG, et al. Health-related quality of life surveillance–United States, 1993-2002. MMWR Surveill Summ. 2005;54(4):1–35.

National Center for Chronic Disease Prevention and Health Promotion. How You Can Prevent Chronic Diseases. Centers for Disease Control and Prevention, US Dept of Health and Human Services. Accessed November 30, 2022. https://www.cdc.gov/chronicdisease/about/prevent/index.htm

Women who have had a recent live birth.

Number of respondents who reported that, since their most recent live birth, a healthcare provider assessed whether they were feeling down, depressed, anxious, or irritable.

Number of respondents who reported that, since their most recent live birth, a healthcare provider had or had not assessed whether they were feeling down, depressed, anxious, or irritable.

Prevalence (crude).

Since the most recent live birth.

Perinatal mental health conditions are often underdiagnosed and under- or untreated.¹ Detection or screening is often the first step in the care pathway for mental health conditions,¹ including depression.^{2, 3} Multiple professional and clinical organizations recommend screening for perinatal depression, including the American College of Obstetricians and Gynecologists,⁴ the American Academy of Pediatrics⁵, and the United States Preventive Services Task Force.⁶ The Women’s Preventive Services Initiative, a federally supported collaborative program led by the American College of Obstetricians and Gynecologists (ACOG), recommends screening for anxiety in adolescent and adult women, including those who are pregnant or postpartum.

Indicates whether a health care provider inquired about depression and anxiety during postpartum visits but does not indicate whether recommended screening and referrals were performed or of the content of any care provided outside of the health care setting. Self-report data on sensitive topics are subject to social desirability bias; challenges with recalling past experiences also may introduce bias. This indicator results from a new question in a new phase of the PRAMS survey, Phase 9. Phase 9 PRAMS data will not be available until 2024 (Phase 9 will begin with 2023 births).

Pregnancy Risk Assessment Monitoring System (PRAMS).

Healthy People 2030 objective MICH-D01: Increase the proportion of women who get creened for postpartum depression.

Maternal Health

The American College of Obstetricians and Gynecologists. Perinatal Mental Health Tool Kit. The American College of Obstetricians and Gynecologists. https://www.acog.org/programs/perinatal-mental-health

Byatt N, Xu W, Levin LL, Moore Simas TA. Perinatal depression care pathway for obstetric settings. Int Rev Psychiatry. 2019;31(3):210–228. doi:10.1080/09540261.2018.1534725

Bauman BL, Ko JY, Cox S, et al. Vital Signs: postpartum depressive symptoms and provider discussions about perinatal depression — United States, 2018. MMWR Morb Mortal Wkly Rep. 2020;69(19):575–581. doi:10.15585/mmwr.mm6919a2

American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice. ACOG committee opinion no. 757: screening for perinatal depression. Obstet Gynecol. 2018;132(5):e208–e212. doi:10.1097/AOG.0000000000002927

Earls MF, Yogman MW, Mattson G, et al. Incorporating recognition and management of perinatal depression into pediatric practice. Am Acad Pediatr. 2019;143(1). doi:10.1542/peds.2018-3259

Siu AL; US Preventive Services Task Force. Screening for depression in adults: US Preventive Services Task Force recommendation statement. JAMA. 2016;315(4):380–387. doi:10.1001/jama.2015.18392