Trends in Extreme Distress in the United States, 1993-2019

Am J Public Health. 2020 Oct;110(10):1538-1544. doi: 10.2105/AJPH.2020.305811. Epub 2020 Aug 20.


Objectives. To investigate changes from 1993 to 2019 in the percentage of US citizens suffering extreme distress.Methods. Using data on 8.1 million randomly sampled US citizens, we created a new proxy measure for exceptional distress (the percentage who reported major mental and emotional problems in all 30 of the last 30 days). We examined time trends for different groups and predictors of distress.Results. The proportion of the US population in extreme distress rose from 3.6% in 1993 to 6.4% in 2019. Among low-education midlife White persons, the percentage more than doubled, from 4.8% to 11.5%. Regression analysis revealed that (1) at the personal level, the strongest statistical predictor of extreme distress was "I am unable to work," and (2) at the state level, a decline in the share of manufacturing jobs was a predictor of greater distress.Conclusions. Increasing numbers of US citizens report extreme levels of mental distress. This links to poor labor-market prospects. Inequality of distress has also widened.Public Health Implications. Policymakers need to recognize the crisis of an ever-growing group of US citizens in extreme distress.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Female
  • Humans
  • Male
  • Middle Aged
  • Socioeconomic Factors*
  • Stress, Psychological / epidemiology*
  • Surveys and Questionnaires
  • Unemployment*
  • United States / epidemiology