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Mental Health and COVID-19: Two Years After the Pandemic, Mental Health Concerns Continue to Increase

April 2022

KEY FINDINGS

  • The number of people looking online for help with their mental health increased significantly from 2019-2021. In 2021, over 5.4 million (N=5,441,125) people took a mental health screen, representing a nearly 500% increase over the number of people who completed a screening in 2019 and a 103% increase over 2020.
  • More youth are struggling with their mental health and are seeking support online. Forty-five percent of individuals in the U.S. who took a screen in 2021 were youth ages 11-17 – 16% higher than the average in 2019.
  • The largest increases in the percentage of people scoring positive from 2019-2021 were on the parent and youth screens, indicating a large increase in the percentage of youth experiencing emotional, attentional, or behavioral difficulties during the pandemic. There were also significant increases in the percentage of people scoring at risk for PTSD, severe anxiety, and psychotic-like experiences from 2019-2021.
  • Across all screens, 76% (N=3,177,747) of users in the U.S. scored positive or with moderate to severe symptoms of a mental health condition in 2021. This was a 2% increase over the average in 2019 and a 1% increase over the percentage of individuals who screened at risk in 2020.
  • The number and percentage of people screening with moderate to severe symptoms of anxiety remain higher than rates prior to COVID-19, and are particularly severe for youth and multiracial screeners. In total, 850,267 people in the U.S. took an anxiety screen in 2021, which was 422% higher than the total number of anxiety screens taken in 2019 and 56% higher than the number taken in 2020. Of the nearly one million people who took an anxiety screen in 2021, 79% (N=673,811) scored with symptoms of moderate to severe anxiety.
  • Black individuals in the U.S. had the largest increase in anxiety during the pandemic, compared to other races/ethnicities. The percentage of Black individuals screening with symptoms of moderate to severe anxiety increased 5% from 2019-2021.
    • The percentage of people in the U.S. reporting frequent thoughts of suicide and self-harm in 2021 is the highest recorded since the MHA Screening Program launched in 2014. Overall, 39% (N=516,372) of individuals in the U.S. who took the depression screen reported frequent suicidal ideation in 2021. This was 8% higher than the average rate of suicidal ideation in 2019 (31%, N=101,815) and 2% higher than the rate in 2020 (37%, N=347,782).
  • Rates of suicidal ideation are highest among youth, especially LGBTQ+ youth. Overall, 51% (N=245,979) of all youth depression screeners ages 11-17 reported frequent suicidal ideation on more than half or nearly every day of the previous two weeks. Sixty-three percent (N=99,048) of youth ages 11-17 who identified as LGBTQ+ reported frequent suicidal ideation.
  • Suicidal ideation has increased most for Black youth and adults from 2019-2021. Black or African American screeners had the highest increase in reported suicidal ideation from 2019-2021 (8.59% increase) and 2020-2021 (1.70% increase). The increase in rate of reported suicidal ideation for Black screeners from 2019-2021 was nearly 2% higher than the increase among screeners of any other race/ethnicity.
  • Over 300,000 people took a psychosis screen in 2021, with 78% scoring at risk for psychotic-like episodes in February and March. In total, 362,144 individuals took the psychosis screen in 2021, a 188% increase over the number of psychosis screens taken in 2019 (N=125,461) and a 46% increase over 2020 (N=248,186).
  • People screening at risk for mental health conditions are struggling most with loneliness or isolation. The differences in the things contributing most to mental health concerns among individuals of different races and ethnicities reveal inequities in the experience of 2020-2021. Among individuals who screened positive or moderate to severe for a mental health condition in 2021, 63% reported that one of the top three things contributing to their mental health concerns was loneliness or isolation. This was followed by 49% reporting past trauma and 37% reporting relationship problems.

In 2014, Mental Health America (MHA) created the Online Screening Program (www.mhascreening.org), a collection of 10 free, anonymous, confidential, and clinically validated screens that are among the most commonly used mental health screening tools in clinical settings. Since its launch, over 14 million people have taken a screen to check their mental health concerns online, making this program the nation’s largest ongoing, real-time mental health early identification program.

COVID-19 has had a profound negative effect on the mental health of the nation. Throughout the COVID-19 pandemic, MHA has witnessed increasing numbers of people experiencing anxiety, depression, psychosis, loneliness, and other mental health concerns.

In 2021, over 5.4 million (N=5,441,125) people took a mental health screen, representing a nearly 500% increase over the number of people who completed a screening in 2019 and a 103% increase over 2020.

The following findings emerged from analysis of the over 4.1 million people who took a mental health screen in the United States from January-December 2021.

2021 Screening Demographics

In total, 4,155,728 people from the United States took a screen through MHA Screening in 2021. Of them, the majority took a depression screen (32%), followed by the anxiety screen (20%), and the bipolar screen (16%).

The percentage of individuals who took a depression screen decreased slightly from 2020-2021, while the percentage of individuals who took an anxiety screen remained the same. Individuals were more likely to take eating disorder, PTSD, youth, alcohol or substance use, parent, and postpartum depression screens in 2021 compared to 2020.

Screen 2021 Percentage 2020 Percentage
Depression 32.26% 35.26%
Anxiety 20.46% 20.36%
Bipolar 16.48% 17.21%
Psychosis 8.71% 9.27%
Eating Disorder 7.37% 5.47%
Youth 5.57% 5.25%
PTSD 5.46% 4.24%
Alcohol or Substance Use 1.54% 1.30%
Parent 1.08% 0.79%
Postpartum Depression 1.06% 0.85%

Seventy percent of screeners identified as female, 25% identified as male, and 5% identified as another gender. The percentage of screeners who identified as another gender increased 2.35% from 2020 to 2021. In April 2020, MHA added a separate option to identify as transgender. Four percent of screeners from the U.S. (N=177,425) identified as transgender in 2021.

People who accessed screening in 2021 were younger than the 2019 and 2020 averages. Forty-five percent of screeners in 2021 were youth ages 11-17, a 16% increase over 2019 (29%) and a 3% increase over 2020 (42%).

The race/ethnicity demographics of U.S. screeners in 2021 largely matched the race/ethnicity of screeners in 2020. Similar to 2020, 15% of individuals who took a screen in the U.S. in 2021 identified as Asian or Pacific Islander, a 6% increase over the percentage in 2019, prior to the COVID-19 pandemic.

In May 2021, MHA added “Middle Eastern or North African” to the race/ethnicity categories. Two percent of screeners from the U.S. identified as Middle Eastern or North African in 2021.

Race/Ethnicity 2019 Count 2019 Percentage 2020 Count 2020 Percentage 2021 Count 2021 Percentage
Asian or Pacific Islander 35,021 9.13% 293,721 15.46% 474,987 15.34%
Black or African American (non-Hispanic) 33,696 8.79% 159,449 8.39% 235,795 7.61%
Hispanic or Latino 47,414 12.36% 232,274 12.22% 365,168 11.79%
More than one of the above 20,883 5.45% 95,631 5.03% 158,212 5.11%
Native American or American Indian 5,020 1.31% 22,969 1.21% 44,745 <1.44%
Other 12,893 3.36% 94,510 4.97% <159,312 <5.14%
White (non-Hispanic) 228,596 59.60% 1,001,855 52.72% <1,594,232 <51.48%
Middle Eastern or North African

 

 

 

 

64,648 2.09%*
Grand Total 383,523 100.00% 1,900,409 100.00% 3,097,099

 

*Middle Eastern or North African was not added as an option on the demographic questions until May 2021.

Screeners in 2021 reported slightly higher household incomes than those in 2019 and 2020. Forty-nine percent of screeners in the U.S. reported a household income of less than $40,000 in 2021, compared to 52% in 2019 and 50% in 2020. One quarter (25%) of screeners in the U.S. reported a household income greater than $80,000 in 2021, compared to 22% in 2019 and 24% in 2020.

Household Income 2019 Count 2019 Percentage 2020 Count 2020 Percentage 2021 Count 2021 Percentage
Less than $20,000 77,086 30.17% 374,020 29.36% 672,301 28.87%
$20,000 - $39,999 56,749 22.21% 263,897 20.71% 469,120 20.15%
$40,000 - $59,999 38,840 15.20% 187,123 14.69% 339,598 14.59%
$60,000 - $79,999 26,309 10.30% 138,027 10.83% 256,506 11.02%
$80,000 - $99,999 19,034 7.45% 96,813 7.60% 180,041 7.73%
$100,000 - $149,999 22,050 8.63% 117,331 9.21% 218,009 9.36%
$150,000+ 15,422 6.04% 96,739 7.59% 192,775 8.28%
Grand Total 255,490 100.00% 1,273,950 100.00% 2,328,350  

Across all screens, 76% (N=3,177,747) of users in the U.S. scored positive or with moderate to severe symptoms of a mental health condition in 2021. This was a 2% increase over the average in 2019 (74%, N=673,696) and a 1% increase over the percentage of individuals who screened at risk in 2020 (75%, N=2,018,627). Since August 2020, the percentage of individuals scoring positive or with moderate to severe symptoms of any mental health condition has been higher than pre-COVID-19 rates.

Among people who screened positive or with moderate to severe symptoms, 66% (N= 1,706,300) had never been diagnosed with a mental health condition. Sixty-four percent (N= 1,647,492) had never received treatment or support before, which was equivalent to 2020 and 7% higher than the percentage who had not received treatment in 2019 (57%).

The largest increases in the percentage of people scoring positive from both 2019-2021 and 2020-2021 were on the parent screen (12% increase from 2019-2021 and 3% increase from 2020-2021). This was followed by the youth screen (9% increase from 2019-2021 and 3% increase from 2020-2021). Both screens are designed to measure emotional, attentional, or behavioral difficulties among youth, and these increases reflect the increasing mental health needs among youth in the United States during the COVID-19 pandemic.

From 2019-2021 there were also significant increases in the percentage of individuals who scored at risk for PTSD (5% increase, from 84% screening positive in 2019 to 89% screening positive in 2021), severe anxiety (5% increase, from 43% in 2019 to 48% in 2021), and risk for psychosis (3% increase, from 73% scoring at risk in 2019 to 76% in 2021). The increased rates of severe anxiety, PTSD, and psychosis continued throughout 2021, indicating a meaningful change during the pandemic for these conditions.

Screen Results:  2019 Count  2019 Percentage  2020 Count  2020 Percentage  2021 Count  2021 Percentage
Alcohol or Substance Use Screening 15,086 1.66% 34,823 1.30% 64,126 1.54%
Likely Substance Use 11,815 78.32% 28,398 81.55% 50,797 79.21%
Unlikely Substance Use 3,271 21.68% 6,425 18.45% 13,329 20.79%
Anxiety Screening 162,958 17.89% 545,150 20.36% 850,264 20.46%
Minimal Anxiety 9,982 6.13% 22,102 4.05% 33,637 3.96%
Mild Anxiety 32,028 19.65% 93,359 17.13% 142,816 16.80%
Moderate Anxiety 50,323 30.88% 170,206 31.22% 265,199 31.19%
Severe Anxiety 70,625 43.34% 259,483 47.60% 408,612 48.06%
Bipolar Screening 138,130 15.17% 460,914 17.21% 685,026 16.48%
Negative Bipolar 83,359 60.35% 273,493 59.34% 401,322 58.58%
Positive Bipolar 54,771 39.65% 187,421 40.66% 283,704 41.42%
Depression Screening 331,089 36.35% 944,108 35.26% 1,340,791 32.26%
Minimal Depression 13,552 4.09% 33,877 3.59% 50,764 3.79%
Mild Depression 37,495 11.32% 111,646 11.83% 153,792 11.47%
Moderate Depression 70,693 21.35% 217,031 22.99% 296,471 22.11%
Moderately Severe Depression 89,294 26.97% 283,212 30.00% 391,882 29.23%
Severe Depression 120,055 36.26% 298,342 31.60% 447,882 33.40%
Eating Disorder 43,340 4.76% 146,341 5.47% 306,141 7.37%
At Risk for ED 39,338 90.77% 131,603 89.93% 283,535 92.62%
Avoidant/Restrictive Food Intake Disorder 2,975 6.86% 11,378 7.77% 18,584 6.07%
Low Risk for ED 1,027 2.37% 3,360 2.30% 4,022 1.31%
Postpartum Depression  *   22,851 0.85% 44,692 1.08%
Depression is not likely     998 4.37% 1,936 4.40%
Depression is possible     1,323 5.79% 4,074 9.27%
Depression is highly possible     1,447 6.33% 3,827 8.71%
Depression is probable     19,083 83.51% 34,124 77.62%
Parent Screening 11,927 1.31% 21,095 0.79% 43,961 1.06%
At Risk 7,219 60.53% 14,704 69.70% 32,485 72.69%
Low Risk 4,708 39.47% 6,391 30.30% 12,207 27.31%
Psychosis Screening 125,461 13.78% 248,186 9.27% 362,144 8.71%
Low/No Risk 33,387 26.61% 60,613 24.42% 85,143 23.51%
Possible Risk 92,074 73.39% 187,573 75.58% 277,001 76.49%
PTSD Screening 43,838 4.81% 113,668 4.24% 226,998 5.46%
Negative PTSD 6,933 15.82% 11,829 10.41% 24,671 10.87%
Positive PTSD 36,905 84.18% 101,839 89.59% 202,327 89.13%
Youth Screening 38,921 4.27% 140,598 5.25% 231,585 5.57%
At Risk 27,609 70.94% 108,344 77.06% 185,144 79.95%
Low Risk 11,312 29.06% 32,254 22.94% 46,441 20.05%
Grand Total 910,750 100.00% 2,677,734 100.00% 4,155,728 100.00%

*The Postpartum Depression Screen was not implemented until May 2020.

High Rates of Anxiety Persist in the U.S., Especially for Youth and Black or African American Individuals

MHA uses the Generalized Anxiety Disorder 7-item (GAD-7) tool to screen for anxiety. The number of help-seekers experiencing anxiety and the severity of that anxiety increased in 2020-2021. In total, 850,267 people in the U.S. took an anxiety screen in 2021, which was 422% higher than the total number of anxiety screens taken in 2019 and 56% higher than the number taken in 2020. On average, 2,329 people in the U.S. took an anxiety screen each day in 2021.

Rates of moderate to severe anxiety began increasing in June 2020 and have remained above pre-COVID-19 levels through December 2021. Of the nearly 1 million people who took an anxiety screen in 2021, 79% (N=673,811) scored with symptoms of moderate to severe anxiety. This was equal to the average rate in 2020, and nearly 5% higher than the average rate in 2019 (74%, N=120,948).

Throughout the pandemic, youth ages 11-17 were more likely to score with moderate to severe symptoms of anxiety than any other age group. Eighty-four percent (N=254,807) of 11-17-year-olds who took an anxiety screen in 2021 scored with symptoms of moderate to severe anxiety, equal to the rate of youth who scored at risk for anxiety in 2020.

 

Anxiety Screen Result by Age, 2021   11-17 18-24 25-34 35-44 45-54 55-64 65+
Minimal to Mild Anxiety % 16.37% 19.94% 23.86% 27.75% 32.10% 36.96% 42.62%
Count 49,874 40,439 22,875 11,165 6,193 4,141 2,201
Moderate to Severe Anxiety % 83.63% 80.06% 76.14% 72.25% 67.90% 63.04% 57.38%
Count 254,807 162,370 72,983 29,071 13,099 7,063 2,963
Grand Total   304,681 202,809 95,858 40,236 19,292 11,204 5,164

 

Rates of moderate to severe anxiety continue to be much higher in 2021 than the pre-pandemic average for screeners of every race/ethnicity. The percentage of people in 2021 scoring with moderate to severe symptoms of anxiety was highest among individuals who identified as more than one race (83%). Between 2020-2021, rates of anxiety only increased for individuals who identified as Black or African American (1.02% increase), more than one race (0.53% increase), and Hispanic or Latino (0.08% increase).

The largest increases in the percentage of people scoring for moderate to severe anxiety between 2019 and 2021 was for Black screeners (4.63% increase), followed by screeners who identified their race as “other” (3.55% increase), and Asian or Pacific Islander screeners (3.54% increase).

Average Rate's of Moderate to Severe Anxiety, by Race/Ethnicity Asian or Pacific Islander Black or African American (non-Hispanic) Hispanic or Latino More than one of the above White (non-Hispanic) Native American or American Indian Other Middle Eastern or North African
2019 Average 73.71% 72.94% 76.81% 80.67% 77.84% 80.88% 77.91% *
2020 Average 78.24% 76.55% 79.12% 82.76% 80.84% 84.00% 82.58%
2021 Average 77.25% 77.57% 79.20% 83.29% 80.69% 82.94% 81.46% 81.24%

*Middle Eastern or North African was not added as an option on the demographic questions until May 2021.

Suicidal Ideation and Thoughts of Self-Harm Reach a New High

Suicidal/self-harm thinking, especially among young people, was epidemic in 2020 and 2021. Overall, 39% (N=516,372) of individuals in the U.S. who took the Patient Health Questionnaire 9-item (PHQ-9) screen for depression reported frequent suicidal ideation (defined as more than half or nearly every day of the previous two weeks) in 2021. This was 8% higher than the average rate of suicidal ideation in 2019 (31%, N=101,815) and 2% higher than the rate in 2020 (37%, N=347,782).

Suicidal Ideation Reported at Highest Rates Among Youth, Especially LGBTQ+ Youth

When examined by age, youth ages 11-17 have the highest rate of suicidal ideation. Overall, 51% (N=245,979) of all youth depression screeners ages 11-17 reported frequent suicidal ideation on more than half or nearly every day of the previous two weeks. This was 2% higher than the average reported rate of suicidal ideation among 11-17-year-olds in 2019 (49%, N=20,263) and equivalent to the percentage of youth reporting suicidal ideation in 2020 (51%, N=158,490).

Thoughts that you would be better off dead, or of hurting yourself” (youth ages 11-17) 2019 Count 2019 Percent of age 2020 Count 2020 Percentage 2021 Count 2021 Percentage
Of or nearly every day 20,263 48.92% 158,490 50.73% 245,979 50.76%
Not at all or several days 21,161 51.08% 153,947 49.27% 238,586 49.24%
Grand Total 41,424 100.00% 312,437 100.00% 484,565 100.00%

When examined by month, there are larger differences between reported rates of suicidal ideation from 2019-2021. In 2019, rates of reported suicidal ideation were elevated in the summer months, between April and August, and lower from September-December. In 2020, rates of reported frequent suicidal ideation among youth increased drastically in March, decreased in April and May, and increased each month from June-December. In 2021, there was a very slight increase in rates of reported suicidal ideation from March-June, but overall suicidal ideation among youth remained steady at 51-52% throughout the year. November and December 2020 were the two months with the highest percentages of youth reporting frequent suicidal ideation during the 36-month period from January 2019 through December 2021.

Rates of frequent suicidal ideation are also higher among people who identify as LGBTQ+, particularly among LGBTQ+ youth. Fifty-six percent of LGBTQ+ individuals who took a depression screen in 2021 reported experiencing suicidal ideation more than half or nearly every day of the previous two weeks (N=139,265). This was nearly 7% higher than the reported rate in 2019 (49%, N=15,586) and 2% higher than the rate in 2020 (54%, N=86,416). Sixty-three percent (N=99,048) of youth ages 11-17 who identified as LGBTQ+ reported frequent suicidal ideation, 3% higher than the average rate reported by LGBTQ+ youth in 2019 (60%, N=7,104) and 1% higher than the rate in 2020 (62%, N=58,873).

Rates of Suicidal Ideation by Race/Ethnicity

Rates of suicidal ideation continue to be much higher than the pre-pandemic average for screeners of every race/ethnicity. The proportion of people reporting frequent thoughts of suicide or self-harm was highest among screeners who identified their race/ethnicity as “other” in 2021 (46%), followed by Native American or American Indian screeners (46%). Black or African American screeners had the highest increase in reported suicidal ideation from 2019-2021 (8.59% increase) and 2020-2021 (1.70% increase). The increase in rate of reported suicidal ideation for Black screeners from 2019-2021 was nearly 2% higher than the increase among screeners of any other race/ethnicity.

Suicidal Ideation More Than Half or Nearly Every Day, by Race/Ethnicity Asian or Pacific Islander Black or African American (non-Hispanic) Hispanic or Latino More than one of the above White (non-Hispanic) Native American or American Indian Other Middle Eastern or North African
2019 Average 37.97% 30.55% 31.85% 39.44% 30.56% 38.77% 42.06% *
2020 Average 42.36% 37.44% 37.95% 43.71% 35.32% 46.27% 46.07% *
2021 Average 42.67% 39.14% 38.37% 44.56% 35.58% 45.54% 46.24% 40.74%

*Middle Eastern or North African was not added as an option on the demographic questions until May 2021.

Rates of suicidal ideation were also higher among Black, Indigenous, and youth of color than among white youth. Among youth of color, 52% (N=130,896) reported thoughts of suicide or self-harm more than half or nearly every day, compared to 49% (N=91,705) of white youth. The percentage of youth ages 11-17 reporting frequent thoughts of suicide or self-harm was also highest among those who identified their race as “other” (56%, N=17,208), youth who identified as Native American or American Indian (54%, N=5,016), and Black or African American youth (53%, N=17,438) in 2021.

The largest increases in the percentage of youth experiencing suicidal ideation between 2019 and 2021 were for Black or African American youth (5% increase) and Hispanic or Latino youth (4% increase).

“Thoughts that you would be better off dead, or of hurting yourself” among Youth (Ages 11-17) by Race/Ethnicity 2019 Count 2019 Percentage 2020 Count 2020 Percentage 2021 Count 2021 Percentage
Asian or Pacific Islander 4,412 12.12% 48,897 17.18% 86,580 19.75%
More than half or nearly every day 2,397 54.33% 26,345 53.88% 45,831 52.93%
Not at all or several days 2,015 45.67% 22,552 46.12% 40,749 47.07%
Black or African American (non-Hispanic) 2,557 7.02% 23,226 8.16% 32,855 7.49%
More than half or nearly every day 1,240 48.49% 12,308 52.99% 17,438 53.08%
Not at all or several days 1,317 51.51% 10,918 47.01% 15,417 46.92%
Hispanic or Latino 5,148 14.14% 40,471 14.22% 55,238 12.60%
More than half or nearly every day 2,336 45.38% 19,865 49.08% 27,138 49.13%
Not at all or several days 2,812 54.62% 20,606 50.92% 28,100 50.87%
Middle Eastern or North African * * * * 9,850 2.25%
More than half or nearly every day * * * * 4,910 49.85%
Not at all or several days * * * * 4,940 50.15%
More than one of the above 2,842 7.81% 17,451 6.13% 25,328 5.78%
More than half or nearly every day 1,462 51.44% 9,143 52.39% 13,355 52.73%
Not at all or several days 1,380 48.56% 8,308 47.61% 11,973 47.27%
Native American or American Indian 501 1.38% 4,132 1.45% 9,242 2.11%
More than half or nearly every day 286 57.09% 2,348 56.82% 5,016 54.27%
Not at all or several days 215 42.91% 1,784 43.18% 4,226 45.73%
Other 1,584 4.35% 17,154 6.03% 30,813 7.03%
More than half or nearly every day 897 56.63% 9,754 56.86% 17,208 55.85%
Not at all or several days 687 43.37% 7,400 43.14% 13,605 44.15%
White (non-Hispanic) 19,368 53.19% 133,358 46.84% 188,540 43.00%
More than half or nearly every day 9,118 47.08% 65,001 48.74% 91,705 48.64%
Not at all or several days 10,250 52.92% 68,357 51.26% 96,835 51.36%
Grand Total 36,412 100.00% 284,689 100.00% 438,446 100.00%

*Middle Eastern or North African was not added as an option on the demographic questions until May 2021.

Rates of suicidal ideation were particularly high among people of color who identified as LGBTQ+. LGBTQ+ individuals who identified their race as “other” had the highest reported rates of suicidal ideation (65%, N=8,080), followed by LGBTQ+ individuals identifying as Native American or American Indian (62%, N=2,872) and those identifying as Middle Eastern or North African (61%, N=1,929).

“Thoughts that you would be better off dead, or of hurting yourself”
among LGBTQ+ Individuals by Race/Ethnicity
2021 Count 2021 Percentage
Asian or Pacific Islander 26,720 11.40%
More than half or nearly every day 16,004 59.90%
Not at all or several days 10,716 40.10%
Black or African American (non-Hispanic) 18,546 7.91%
More than half or nearly every day 10,477 56.49%
Not at all or several days 8,069 43.51%
Hispanic or Latino 31,335 13.37%
More than half or nearly every day 17,274 55.13%
Not at all or several days 14,061 44.87%
Middle Eastern or North African 3,171 1.35%
More than half or nearly every day 1,929 60.83%
Not at all or several days 1,242 39.17%
More than one of the above 16,335 6.97%
More than half or nearly every day 9,384 57.45%
Not at all or several days 6,951 42.55%
Native American or American Indian 4,633 1.98%
More than half or nearly every day 2,872 61.99%
Not at all or several days 1,761 38.01%
Other 12,366 5.28%
More than half or nearly every day 8,080 65.34%
Not at all or several days 4,286 34.66%
White (non-Hispanic) 121,314 51.75%
More than half or nearly every day 64,722 53.35%
Not at all or several days 56,592 46.65%
Grand Total 234,420 100.00%

Numbers of Individuals Screening for Depression Increased

MHA uses the Patient Health Questionnaire 9-item (PHQ-9) tool to screen for depression. Over 1 million – 1,340,791 – people in the U.S. took a depression screen in 2021, which was 304% higher than the total number of depression screens taken in 2019 (N=331,089) and 42% higher than the number of depression screens taken in 2020 (N=944,108). On average, 3,673 people in the U.S. took a depression screen per day in 2021.

Of those who took a depression screen in 2021, 85% (N=1,136,235) scored with moderate to severe symptoms of depression. This was equal to the proportion of people who screened at risk for depression in 2019 (85%, N=280,042) and 2020 (85%, N=798,585), although the number of people was significantly higher in 2021.

Depression Highest Among Youth

On average, 90% (N=434,447) of 11-17-year-olds in the U.S. who took a depression screen scored with symptoms of moderate to severe depression in 2021, 1% lower than the percentage of youth who scored with moderate to severe depression in 2020.

Depression Screen Results by Age, 2021   11-17 18-24 25-34 35-44 45-54 55-64 65+
Minimal to Mild Depression % 10.34% 13.27% 19.56% 25.20% 28.57% 33.34% 38.41%
Count 50,118 45,208 32,116 17,440 10,119 7,084 4,088
Moderate to Severe Depression % 89.66% 86.73% 80.44% 74.80% 71.43% 66.66% 61.59%
Count 434,447 295,552 132,111 51,779 25,300 14,162 6,554
Grand Total   484,565 340,760 164,227 69,219 35,419 21,246 10,642

Depression Higher Among Individuals Who Identify as LGBTQ+, More Than One Race, and Black or African American

Adults who identified as LGBTQ+ and took a depression screen were nearly 10% more likely to screen with moderate to severe depression than non-LGBTQ+ adults (90.38% and 80.66%, respectively). LGBTQ+ youth ages 11-17 were more likely than non-LGBTQ+ youth to screen with symptoms of moderate to severe depression. Ninety-five percent (N=150,560) of youth ages 11-17 who took a depression screen and identified as LGBTQ+ scored with moderate to severe depression, compared to 87% (N=283,887) of youth who did not identify as LGBTQ+.

Depression Screen Results Among
Individuals Identifying as LGBTQ+
LGBTQ+ Adults Non-LGBTQ+ Adults LGBTQ+ Youth (Ages 11-17) Non-LGBTQ+ Youth (Ages 11-17)
Negative or Minimal to Mild 9.62%  (N=7,951) 19.34% (N=108,104) 4.89% (N=7,748) 12.99% (N=42,370)
Positive or Moderate to Severe 90.38% (N=74,661) 80.66% (N=450,797) 95.11% (N=150,560) 87.01% (N=283,887)

The percentage of people scoring with moderate to severe symptoms of depression was highest among screeners who identified as more than one race in 2021 (89%). Average rates of moderate to severe depression were lower in 2021 than in 2019 for screeners of nearly every race/ethnicity, except for Black or African American screeners

 

Average Rates of Moderate
to Severe Depression,
by Race/Ethnicity
Asian or
Pacific Islander
Black or African American
(non-Hispanic)
Hispanic or Latino More than one
of the above
White
(non-Hispanic)
Native American or
American Indian
Other Middle Eastern or North African

2019 Average

85.52%

83.25%

87.08%

90.97%

86.92%

88.02%

88.18%

*

2020 Average

84.98%

83.18%

86.33%

89.89%

85.42%

89.34%

87.89%

*

2021 Average

84.06%

83.55%

86.02%

89.31%

85.17%

86.17%

86.85%

87.21%

*Middle Eastern or North African was not added as an option on the demographic questions until May 2021.

Rates of moderate to severe depression among youth of color were slightly lower than white youth in the U.S. In 2021, 89% (N=223,245) of youth of color ages 11-17 who took a depression screen scored with moderate to severe depression, compared to 90% (N=169,876) of white youth.

However, when results are broken down by race/ethnicity, there are more notable differences. Rates of moderate to severe depression were highest among youth who identified as more than one race (92%, N= 23,178) and youth who identified their race as “other” (91%, N= 27,899).

Race/Ethnicity (Youth ages 11-17) Depression Screen Result 2020 Count 2020 Percentage 2021 Count 2021 Percentage
Asian or Pacific Islander Negative or Minimal to Mild 4,953 10.13% 10,147 11.72%
Positive or Moderate to Severe 43,943 89.87% 76,433 88.28%
Black or African American (non-Hispanic) Negative or Minimal to Mild 2,453 10.56% 3,724 11.33%
Positive or Moderate to Severe 20,773 89.44% 29,131 88.67%
Hispanic or Latino Negative or Minimal to Mild 3,782 9.34% 5,839 10.57%
Positive or Moderate to Severe 36,689 90.66% 49,399 89.43%
More than one of the above Negative or Minimal to Mild 1,283 7.35% 2,150 8.49%
Positive or Moderate to Severe 16,168 92.65% 23,178 91.51%
 Middle Eastern or North African Negative or Minimal to Mild * * 1,006 10.21%
Positive or Moderate to Severe * * 8,844 89.79%
Native American or American Indian Negative or Minimal to Mild 300 7.26% 881 9.53%
Positive or Moderate to Severe 3,832 92.74% 8,361 90.47%
Other Negative or Minimal to Mild 1,425 8.31% 2,914 9.46%
Positive or Moderate to Severe 15,729 91.69% 27,899 90.54%
White (non-Hispanic) Negative or Minimal to Mild 12,271 9.20% 18,664 9.90%
Positive or Moderate to Severe 121,087 90.80% 169,876 90.10%

*Middle Eastern or North African was not added as an option on the demographic questions until May 2021.

Continued Increases in Emotional, Attentional, or Behavioral Difficulties Among Youth MHA uses the Pediatric Symptom Checklist (PSC-35) tool to screen youth for emotional, attentional, or behavioral difficulties. In total, 231,585 individuals in the U.S. took the youth screen in 2021, a 495% increase over the number of youth screens taken in 2019 (N=38,921) and a 64% increase over the number taken in 2020.

Of the individuals who took the youth screen in 2021, 80% (N=185,144) scored at risk for emotional, attentional, or behavioral difficulties. This was 9% higher than the average rate in 2019 (71%, N=27,609) and 3% higher than the average rate in 2020 (77%, N=108,344). The percentage of youth scoring at risk for emotional, attentional, or behavioral difficulties was higher throughout 2021 than in either 2019 or 2020. In December 2021, 82% (N=18,305) of youth scored at risk for emotional, attentional, or behavioral difficulties, the highest percentage recorded in any month from 2019-2021, and 11% higher than the average rate prior to the pandemic.

Highest Rates of Psychosis Risk in Early 2021

MHA uses the Prodromal Questionnaire – Brief version (PQ-B) to screen for psychosis. In total, 362,144 individuals took the psychosis screen in 2021, a 188% increase over the number of psychosis screens taken in 2019 (N=125,461) and a 46% increase over 2020 (N=248,186).

Of the individuals who took the psychosis screen, 76% (N=277,001) scored at risk for psychotic-like experiences. This was 2% higher than the average rate in 2019 (73%, N=92,074) and equal to the rate in 2020 (76%, N=187,573), but over three times the number of people scoring at risk for psychotic-like experiences prior to the COVID-19 pandemic. In early 2021, the percentage of people scoring at risk for psychotic-like experiences reached the highest levels recorded from 2019-2021. Of those individuals who took a psychosis screen, 78% scored at risk for psychotic-like experiences in February and March of 2021.

Loneliness, Past Trauma, and Relationship Problems Continue to be Main Concerns

In April 2020, MHA added the question, “Think about your mental health test. What are the main things contributing to your mental health problems right now? Choose up to three.” Similar to 2020, feelings of loneliness and isolation were cited by screeners as a major reason for their mental health struggles in 2021. Among individuals who screened positive or moderate to severe for a mental health condition in 2021, 63% reported that one of the top three things contributing to their mental health concerns was loneliness or isolation. This was followed by 49% reporting past trauma and 37% reporting relationship problems. The percentage of individuals reporting coronavirus as one of the three things contributing to their mental health concerns was lower in 2021 than in 2020 (17% in 2021, compared to 26% in 2020).

Main Concerns: People Scoring at
Risk for Any Screen
(Excluding Parent and Youth Screens)
Count 2021 Average 2021
Loneliness or Isolation 1,446,349 63.46%
Past Trauma 1,118,358 49.07%
Relationship Problems 845,076 37.08%
Grief or loss of someone or something 496,662 21.74%
Coronavirus 384,802 16.88%
Current Events (news, politics, etc.) 358,684 15.74%
Financial Problems 390,634 17.14%
Racism 78,339 3.44%

Main Concerns Among Youth

Among youth ages 11-17 who scored positive or with moderate to severe symptoms of a mental health condition, the top three contributors to their mental health problems were the same as the general population of screeners – loneliness or isolation, past trauma, and relationship problems. However, 11-17-year-olds were even more likely to report experiencing loneliness than the general population of screeners (70%, compared to 63%). They were also more likely to report coronavirus (18%, compared to 17%) and racism (5%, compared to 3%) as one of their top three concerns than the general screening population.

Main Concerns, Scoring Positive for a
Mental Health Condition
(Excluding Parent and Youth Screens),
11-17-Year-Olds
Count 2021 Average 2021
Loneliness or Social Isolation 687,254 70.19%
Past Trauma 463,585 47.34%
Relationship Problems 339,711 34.69%
Grief or loss of someone or something 208,110 21.25%
Coronavirus 180,310 18.41%
Current Events (news, politics, etc.) 159,585 16.30%
Financial Problems 53,862 5.50%
Racism 44,594 4.55%

Individuals who took the parent or youth screens were offered different options than the above, including other concerns that are more likely to affect youth, such as difficulties at school or bullying. Among youth who screened at risk for emotional, attentional, or behavioral difficulties, loneliness or social isolation was the most frequently reported contributor to mental distress (63%). This was followed by social life or relationships (57%) and past trauma (38%).

 

Main Concerns, Scoring At Risk
on Parent and Youth Screens
2021 Count 2021 Percentage
Loneliness or Social Isolation 95,689 62.58%
Social life or relationships 87,212 57.04%
Past Trauma 57,852 37.84%
Difficulties at school (academics or learning) 53,941 35.28%
Coronavirus 24,060 15.74%
Grief or loss of someone or something 23,953 15.67%
Current Events (news, politics, etc.) 18,267 11.95%
Financial Problems 13,720 8.97%
Being Bullied 11,646 7.62%

 

 

Although the averages across screeners reveal the main concerns of the population throughout this year, the events of 2020 and 2021 had profoundly different mental health impacts on different racial and ethnic groups, and the differences reveal some of the inequities that Black, Indigenous, and people of color face in the U.S. that directly affect their mental health.

Among the 2,258,180 screeners who scored positive or moderate to severe for a mental health condition and reported their race/ethnicity in 2021:

·       Asian screeners were most likely to select coronavirus (19%), followed by white screeners (17%) and screeners who identified their race as “other” (16%).

·       White screeners were most likely out of all racial/ethnic groups to select current events (17%) as one of their top three concerns, followed by Middle Eastern or North African screeners (17%) and screeners who identified as more than one race (16%).

·       Black or African American screeners were most likely to select financial problems (22%), followed by Middle Eastern or North African screeners (18%) and Asian or Pacific Islander screeners (17%).

·       Native American or American Indian screeners were most likely to select grief or loss (29%) followed by white screeners (22%), and screeners who identified as more than one race (22%).

·       Screeners who identified as Hispanic or Latino were most likely to select loneliness or isolation (69%), followed by screeners who identified with more than one race (66%) and Black or African American screeners (64%).

·       Screeners who identified as more than one race were most likely to select past trauma (56%), followed by Native American or American Indian screeners (55%) and Hispanic or Latino screeners (53%).

·       Black or African American screeners were most likely to report racism as one of the three things contributing to their mental health problems (11%), followed by screeners who identified as more than one race (6%) and Native American or American Indian screeners (5%).

·       Black or African American screeners were most likely to select relationship problems (36%) followed by Hispanic or Latino screeners (35%) and white screeners (35%).

Main Concerns,
Scoring Positive for a
Mental Health Condition
Average by Race/Ethnicity
Coronavirus Current Events (news, politics, etc.) Financial Problems Grief or loss of someone or something Loneliness or Isolation Past Trauma Racism Relationship Problems
Native American or American Indian 14.44% 15.58% 13.08% 28.75% 64.06% 55.09% 4.74% 34.90%
Asian or Pacific Islander 18.66% 13.42% 17.36% 17.97% 62.92% 38.85% 4.71% 35.12%
Black or African American (non-Hispanic) 14.54% 11.63% 21.76% 21.73% 64.23% 49.58% 11.15% 36.45%
Hispanic or Latino 16.23% 14.09% 17.08% 20.61% 68.64% 52.93% 3.36% 35.22%
Middle Eastern or North African 14.89% 17.10% 17.58% 18.02% 62.58% 41.33% 4.17% 34.53%
More than one of the above 15.30% 15.66% 14.82% 22.34% 66.16% 55.86% 5.99% 34.23%
Other 16.24% 13.40% 14.44% 21.33% 59.34% 44.43% 4.32% 32.10%
White (non-Hispanic) 16.89% 17.23% 16.64% 22.35% 62.68% 50.07% 1.19% 35.14%