Although the USA remains an economic giant and a global super-power, and American innovation is still a driving force for commercial activity around the world, living in the USA can be downright depressing.
In fact, depression is the most common disability among Americans aged 15 to 44. Over 21 million Americans suffer a major depressive episode every year, and the treatment of depression costs over $31 billion a year. Suicide is the leading cause of death among young adults in America, and millions of older Americans become clinically depressed when the are diagnosed with heart disease, cancer, or other chronic illnesses.
Rates of Depression, Psychological Distress, and Suicide Differ Widely State by State
Some of the US states, however, are remarkably less depressed than others. According to a report entitled Ranking America's Mental Health: An Analysis of Depression Across the States, in the "happiest" state in the United States, South Dakota, 7.31% of adults experienced a major depressive episode and 11.16% experienced significant psychological distress in the most recent year for which comprehensive statistics are available. In the most depressed state in the United States, Utah, 10.14% of adults experienced a major depressive episode and 14.58% experienced significant psychological distress in the same year.
Suicide rates also differ widely by state. The District of Columbia, New York, and Massachusetts have the lowest suicide rates in the United States. Alaska is followed by Nevada and New Mexico for the highest suicide rates in the United States. The suicide rate in Washington, D.C. is less than one-quarter of the suicide rate in Alaska.
Sick days for depression differ widely state by state, too. In South Dakota, the average adult suffers an average of 2.41 "mental health days" per year. In Utah, the most depressed state in the US, that average is 3.27 days per year. That may not sound like a lot, but multiplied by millions of people depression racks of costs of billions of dollars. And the toll in human suffering is especially high in the USA.
A Ten-Year Wait to Get Treatment
In the United States, almost all health insurance policies put a strict limit on mental health care costs. Visits to a psychologist or psychiatrist may be limited to 20 per year, and some plans do not offer mental health coverage at all.
Uninsured people find it difficult to access mental health care unless they live in poverty. A marginally middle class family earning $20,000 a year, for example, might be asked to pay $150 to $200 in cash up front for each and every 50-minute visit with a counselor. Even sliding scale clinics seldom offer any kind of fee discount to patients who have total assets over $2,000 (patients who own a car or furniture, for example) and who have two members of the family working even 30 hours a week at minimum wage.
Eventually, 80% of Americans who need mental health services get them, but the average wait between diagnosis and treatment, according to the Thompson Research Group, is 10 years.
Top- And Bottom-Ten Lists Of American States For Mental Health
Which other states have serious problems with depression? Which other states have relatively effective mental health care? Here are the top- and bottom-ten US states on several measures of public mental health.
The least depressed states in the USA are, in order from least depressed to more depressed:
- South Dakota
- New Jersey
- North Dakota
These states all have pro-active public mental care systems to make sure that people who need treatment for depression get it. The system in Texas is relatively rough and tumble, a policeman may escort you to a psychiatric evaluation if even a neighbor or email contact suspects you are seriously depressed, but even this relatively crude approach has its benefits.
The most depressed states in the USA tend to offer few public resources for people who suffer depression, in order from most depressed to less depressed:
- West Virginia
- Rhode Island
These states tend to have high rates of unemployment, and severely stressed state budgets, permitting few public mental health services. West Virginia has had a state-sponsored risk pool for lower-cost health insurance for many years, as has Kentucky, but insurance in these states generally offer relatively little coverage for mental health care.
What about suicide rates by state?
These ten states have the lowest rates of suicide in the nation, beginning with the very lowest:
- District of Columbia (Washington, D.C.)
- New York
- New Jersey
- Rhode Island
Other states in the top 10 list for lowest rates of depression mostly rank 11 to 20 in suicide prevention. Texas, for instance, ranks 14th lowest in suicide rates in the USA.
These ten states have the highest rates of suicide in the USA:
- New Mexico
- West Virginia
All of these states are mountain states, where people can live in severe physical isolation, sometimes hundreds of miles from mental health professionals. Nevada, home of Reno and Las Vegas, has been suffering severe economic distress, but many people in Nevada live in very isolated locations.
Mental health days, however, differ widely by North and South. The states with the lowest rates of absenteeism due to mental health issues are all in the North or the colder reaches of the Rocky Mountains, Vermont, Connecticut, Minnesota, Iowa, North Dakota, South Dakota, Nebraska, Montana, Colorado, and Oregon. The states with the highest rates of absenteeism due to mental health issues are scattered across the United States, California, Ohio, West Virginia, Kentucky, Oklahoma, Mississippi, Alabama, and Indiana.
What Makes the Difference in Depression Rates?
What makes the difference between the most depressed states and not-so-depressed states of the United States? The US Centers for Disease Control believes that the answer is, and this answer won't surprise anyone, higher incomes.
Some other findings of studies by the Centers for Disease Control are not entirely expected.
The more prescriptions are written for antidepressants in a state, for example, the less likely the state is to have a high rate of depression.
Anti-depressants may not be perfect, the data show, but they do seem to work. And the easier it is for people to see mental health professionals, the lower the rates of depression and suicide. Urban states tend to be less depressed than rural states, because of travel distances (up to 250 miles/400 km to see a doctor in some parts of the western United States, even more in Alaska). Richer states such as Massachusetts and New Jersey tend to have better access to mental health care and lower rates of depression and suicide.
Should you pack up and move to get over your depression?
Maybe you should and maybe you shouldn't, but don't make your decision on the basis of these data. The decisive factor in an individual's recovery from depression is that individual's access to mental health care, never the state of the state in which he or she lives.