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How Race Matters: What We Can Learn from Mental Health America’s Screening in 2020

During the COVID-19 pandemic, Mental Health America has witnessed unprecedented numbers of people who come to its website (www.mhascreening.org) to take a voluntary, free, anonymous mental health screening.

In September 2020, more than 341,000 screenings were completed, now reaching a total of more than one million since the start of the pandemic.

Part of the mission of the MHA online screening program is to further data-driven, upstream, population-level efforts to improve mental health. MHA Screening is not only the largest existing data set of help-seeking individuals for mental health conditions, but it collects data in real time – as people are actively taking screens. This allows MHA to engage in rapid analysis and dissemination of information – so we can recognize and react to trends in mental health quickly.

In our screening program we use voluntary demographic questions and additional surveys to learn more about people who are often not captured in traditional research. Our data provides us an opportunity to better understand and disseminate findings on unmet needs and gaps in care among specific populations, such as youth, Black, Indigenous and people of color, trauma survivors and LGBTQ+ individuals. Our work is designed primarily to provide the earliest supports to people in need.

As part of this rapid analysis and dissemination of screening data, we are sharing some of our analyses of screening data with a focus on race and ethnicity. This analysis is not complete - the hope is that we will provide some of the trends we are seeing for researchers, partners, journalists, or providers, to work towards creating new interventions for mental health and furthering research.

If something in this data speaks to you or raises questions that you would like us to explore further, please email Maddy Reinert at mreinert@mhanational.org or Theresa Nguyen at tnguyen@mhanational.org

Demographics

The following analysis is from the 579,793 screens for anxiety and depression where race/ethnicity was reported from January 1st to September 22nd, 2020.

The race/ethnicity demographics of our anxiety and depression screening population has shifted in 2020 compared to the 2019 average. In 2020, Asian or Pacific Islander screeners made up 17 percent of the anxiety and depression screening population, compared to 10 percent in 2019. Screeners who identified their race as “Other” also made up a greater proportion of anxiety and depression screeners in 2020 compared to 2019, at about 5 percent.

Race/Ethnicity among Anxiety (GAD-7) and Depression (PHQ-9) Screeners

2019 Count

2019 Percentage

Jan-Sept 2020 Count

Jan-Sept 2020 Percentage

Asian or Pacific Islander

21835

10.21%

100213

17.28%

Black or African American (non-Hispanic)

20459

9.57%

50455

8.70%

Hispanic or Latino

28341

13.26%

73455

12.67%

More than one of the above

10487

4.90%

25934

4.47%

Native American or American Indian

2422

1.13%

6102

1.05%

Other

6815

3.19%

27296

4.71%

White (non-Hispanic)

123451

57.74%

296338

51.11%

Grand Total

213810

100.00%

579793

100.00%

 


From these screens, we have found:

  • The September average for moderate to severe anxiety was higher than the monthly average for May, June, July, and August for nearly every racial/ethnic group (excluding screeners who identified as more than one race and screeners who identified as another race, whose July averages were higher, and White screeners, whose August average was higher). However, the September averages were above the 2019 averages for every racial/ethnic group. Black or African American screeners had the highest average percent change over time for anxiety, at 0.74 percent, followed by screeners who identified with more than one race at 0.51 percent.
     
  • The September average for moderate to severe depression among Black or African American and Native American or American Indian screeners was higher than the monthly average for August 2020 (September averages were lower than August for every other race/ethnicity). Black or African American screeners had the highest average percent change over time for depression at 0.62 percent, followed by Native American or American Indian screeners at 0.56 percent and Hispanic or Latino screeners at 0.38 percent.
     
  • The September average for suicidal ideation was higher than the May-August averages, as well as the 2019 average for nearly every racial/ethnic group (excluding Asian or Pacific Islander and White screeners, whose August averages were higher). Native American or American Indian screeners had the highest average percent change over time for suicidal ideation at 1.03 percent, followed by Asian or Pacific Islander screeners at 0.57 percent and Black or African American screeners at 0.55 percent.
     
  • Since the end of May 2020, nearly every racial/ethnic group has been experiencing consistently higher rates of suicidal ideation than the 2019 average (excluding Native American or American Indian screeners and screeners who identified as another race/ethnicity, who experienced consistently higher rates of suicidal ideation than the 2019 average beginning in July).
     
  • For all racial/ethnic groups, loneliness or isolation was most likely to be selected as one of the top three things contributing to the individual's mental health concerns at the time of taking a screen.
     
  • In September 2020, Black or African American screeners who screened positive or moderate to severe for a mental health condition were most likely to say that racism was one of their top three concerns (20%, N=2,946), followed by screeners identifying as more than one race (12%, N=1,155) and Native American or American Indian screeners (11%, N=284).

Anxiety

MHA uses the GAD-7 as its anxiety screening tool. For nearly all racial/ethnic groups, rates of moderate to severe anxiety increased during the last few days of February 2020 and into the beginning of March, as people became more aware of the pandemic and its spread into the United States. All racial/ethnic groups also experienced an increase in the rate of moderate to severe anxiety from the first weeks of May into the first weeks of June.

*Dotted line to represent where N < 100 people.

The September average for moderate to severe anxiety was higher than the monthly average for May, June, July, and August for nearly every racial/ethnic group (excluding screeners who identified as more than one race and screeners who identified as another race, whose July averages were higher, and White screeners, whose August average was higher). However, the September averages were above the 2019 averages for every racial/ethnic group. Black or African American screeners had the highest average percent change over time for anxiety, at 0.74 percent, followed by screeners who identified with more than one race at 0.51 percent.

 

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

Jan 29 - Feb 11

76.11%

65.83%

76.30%

75.94%

77.31%

89.29%

75.71%

Feb 12 - 25

74.02%

71.97%

71.18%

78.91%

76.56%

80.00%

77.03%

Feb 26 - Mar 10

75.48%

76.19%

75.99%

79.85%

77.12%

73.68%

80.18%

Mar 11 - 24

72.85%

70.61%

73.24%

84.06%

78.46%

86.21%

71.60%

Mar 25 - Apr 7

68.35%

66.83%

75.45%

80.41%

77.02%

74.29%

81.82%

Apr 8 - 21

69.96%

64.29%

73.43%

81.25%

76.31%

74.00%

71.34%

Apr 22 - May 5

73.24%

64.62%

70.36%

76.95%

71.45%

83.33%

77.09%

May 6 - 19

72.84%

70.55%

75.37%

77.80%

73.73%

80.00%

75.33%

May 20 - Jun 2

76.40%

73.39%

76.61%

80.18%

77.61%

80.34%

78.33%

Jun 3 - 16

77.59%

75.55%

79.23%

82.35%

80.35%

82.24%

79.01%

Jun 17 - 30

74.43%

73.94%

75.91%

78.43%

79.67%

79.50%

78.93%

Jul 1 - 14

78.80%

76.08%

78.71%

84.63%

81.34%

82.20%

82.34%

Jul 15 - 28

78.00%

75.38%

78.85%

84.59%

81.84%

83.44%

85.40%

Jul 29 - Aug 11

77.30%

74.48%

77.90%

83.31%

81.75%

85.86%

82.47%

Aug 12 - Aug 25

77.35% 78.07% 80.36% 82.44% 82.44% 87.17% 82.18%

Aug 26 - Sep 8

79.58% 78.66% 81.17% 81.04% 81.93% 86.38% 82.12%

Sep 9 - Sep 22

79.89% 77.73% 79.91% 84.09% 81.57% 86.52% 82.86%

Avg May

74.14%

70.06%

74.82%

78.70%

74.26%

80.30%

76.16%

Avg June

75.89%

74.31%

77.03%

80.12%

79.89%

81.14%

78.89%

Avg July

78.35%

75.49%

78.73%

84.11%

81.70%

83.77%

84.22%

Avg August

77.42% 77.09% 79.59% 82.56% 81.97% 86.21% 81.27%

Avg September

80.06% 77.98% 79.92% 82.83% 81.91% 86.61% 83.59%

2019 Average

73.71%

72.94%

76.81%

80.67%

77.84%

80.88%

77.91%

*Cells highlighted in yellow where N < 100 people.

Depression

MHA uses the PHQ-9 as its depression screening tool. This nine-question instrument is one of the most used depression screening tools. There is also a shorter version of it, the PHQ-2, which along with the GAD-2 is used as a brief screening tool by the U.S. Census Bureau (2020 Pulse Survey) and others.

 

*Dotted line to represent where N < 100 people.

The September average for moderate to severe depression among Black or African American and Native American or American Indian screeners was higher than the monthly average for August 2020 (September averages were lower than August for every other race/ethnicity). Black or African American screeners had the highest average percent change over time for depression at 0.62 percent, followed by Native American or American Indian screeners at 0.56 percent and Hispanic or Latino screeners at 0.38 percent.

Depression

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

Jan 29 - Feb 11

84.63%

74.11%

80.13%

88.15%

81.01%

81.82%

88.34%

Feb 12 - 25

79.11%

76.98%

79.62%

82.22%

82.42%

82.54%

81.94%

Feb 26 - Mar 10

85.91%

80.78%

82.95%

88.61%

83.07%

86.44%

85.99%

Mar 11 - 24

83.27%

82.19%

84.87%

88.31%

86.26%

82.69%

89.64%

Mar 25 - Apr 7

83.75%

79.71%

84.91%

88.18%

85.24%

90.57%

86.19%

Apr 8 - 21

83.41%

80.29%

80.68%

88.20%

85.56%

83.58%

86.77%

Apr 22 - May 5

80.23%

73.70%

79.13%

83.30%

77.50%

83.04%

83.08%

May 6 - 19

82.79%

77.31%

83.85%

86.77%

80.35%

83.62%

85.26%

May 20 - Jun 2

85.16%

79.30%

85.42%

89.48%

83.06%

86.12%

87.05%

Jun 3 - 16

82.21%

80.51%

85.23%

90.98%

85.32%

89.96%

84.22%

Jun 17 - 30

82.21%

81.30%

84.15%

89.28%

84.57%

86.18%

85.92%

Jul 1 – 14

84.38%

83.09%

86.15%

90.78%

85.97%

87.11%

87.01%

Jul 15 - 28

84.97%

82.06%

87.50%

89.81%

86.41%

92.11%

88.21%

Jul 29 - Aug 11

84.67%

81.67%

86.46%

89.06%

85.59%

88.26%

89.36%

Aug 12 - Aug 25

84.91% 85.15% 88.01% 90.83% 85.74% 88.63% 88.32%

Aug 26 - Sep 8

85.39% 83.10% 87.27% 90.08% 85.92% 89.96% 85.92%

Sep 9 - Sep 22

84.34% 83.97% 86.17% 89.03% 83.66% 90.75% 85.89%

Avg May

83.31%

76.97%

83.41%

87.24%

80.30%

83.76%

85.59%

Avg June

82.35%

80.82%

84.59%

90.09%

84.91%

88.17%

85.39%

Avg July

84.64%

82.47%

86.95%

90.02%

86.14%

89.72%

87.87%

Avg August

84.94% 83.41% 87.18% 90.15% 85.74% 88.64% 88.08%

Avg September

84.60% 83.56% 86.42% 89.37% 84.51% 89.87% 86.88%

2019 Average

85.52%

83.25%

87.08%

90.97%

86.92%

88.02%

88.18%

*Cells highlighted in yellow where N < 100 people.

Suicidal Ideation

Suicidal or self-harm thinking can be associated with many mental health conditions, but it is a specific question in the depression screening tool, the PHQ-9. We have seen an increase in the numbers of people who – in answering the question – report suicidal or self-harm thinking on either "more than half the days" or "nearly every day" of the previous two weeks.

*Dotted line to represent where N < 100 people.

The September average for suicidal ideation was higher than the May-August averages, as well as the 2019 average for nearly every racial/ethnic group (excluding Asian or Pacific Islander and White screeners, whose August averages were higher). Native American or American Indian screeners had the highest average percent change over time for suicidal ideation at 1.03 percent, followed by Asian or Pacific Islander screeners at 0.57 percent and Black or African American screeners at 0.55 percent. Since the end of May 2020, nearly every racial/ethnic group has been experiencing consistently higher rates of suicidal ideation than the 2019 average (excluding Native American or American Indian screeners and screeners who identified as another race/ethnicity, who experienced consistently higher rates of suicidal ideation than the 2019 average beginning in July).

Suicidal Ideation

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

Jan 29 - Feb 11

33.78%

29.69%

33.33%

44.55%

30.84%

29.55%

41.72%

Feb 12 - 25

38.13%

29.26%

28.08%

36.00%

31.07%

31.75%

31.94%

Feb 26 - Mar 10

41.88%

31.46%

30.35%

39.15%

32.17%

40.68%

39.30%

Mar 11 - 24

41.55%

31.12%

34.96%

43.15%

37.90%

40.38%

40.41%

Mar 25 - Apr 7

41.13%

30.43%

33.74%

40.00%

34.15%

41.51%

45.61%

Apr 8 - 21

36.75%

31.72%

30.76%

42.18%

33.79%

34.33%

40.65%

Apr 22 - May 5

34.17%

27.54%

28.57%

36.05%

25.27%

33.04%

42.93%

May 6 - 19

37.55%

29.48%

31.44%

38.97%

29.15%

38.68%

40.29%

May 20 - Jun 2

40.84%

32.94%

35.24%

42.73%

31.90%

44.50%

41.53%

Jun 3 - 16

38.54%

32.88%

35.11%

42.88%

34.01%

40.56%

39.73%

Jun 17 - 30

38.17%

32.93%

34.51%

41.25%

33.31%

37.45%

41.03%

Jul 1 - 14

41.72%

34.43%

36.18%

42.80%

34.81%

44.53%

45.30%

Jul 15 - 28

41.46%

35.74%

35.64%

42.52%

34.84%

43.85%

44.35%

Jul 29 - Aug 11

42.59%

36.58%

37.06%

41.07%

35.01%

46.95%

45.62%

Aug 12 - Aug 25

43.58% 38.47% 38.68% 43.84% 35.27% 43.99% 43.58%

Aug 26 - Sep 8

44.06% 36.81% 39.38% 43.39% 35.50% 51.50% 45.92%

Sep 9 - Sep 22

42.84% 38.46% 39.02% 43.69% 33.76% 46.07% 44.06%

May Average

38.38%

30.30%

31.70%

39.21%

29.17%

38.94%

40.65%

June Average

38.54%

32.78%

34.97%

42.23%

33.59%

39.78%

40.65%

July Average

41.75%

35.35%

35.90%

42.39%

34.79%

44.39%

44.78%

Avg August

43.38% 37.40% 38.26% 42.53% 35.28% 46.68% 45.05%

Avg September

43.01% 37.78% 38.94% 43.61% 33.58% 47.40% 45.43%

2019 Average

37.97%

30.55%

31.85%

39.44%

30.56%

38.77%

42.06%

*Cells highlighted in yellow where N < 100 people.

Main Concerns by Race/Ethnicity

Beginning in April 2020, MHA included 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," to the optional demographic questions following each screen. In mid-June 2020, "Racism" was added as an option for screeners to select.

In September 2020, Black or African American screeners who screened positive or moderate to severe for a mental health condition were most likely to say that racism was one of their top three concerns (20%, N=2,946), followed by screeners identifying as more than one race (12%, N=1,155) and Native American or American Indian screeners (11%, N=284).

Among the 37,459 anxiety screeners who screened for moderate to severe anxiety and reported their race/ethnicity in September 2020:

  • Screeners who identified as more than one race were most likely out of all racial/ethnic groups to select current events (33%) as one of their top three concerns, followed by White screeners (32%) and Native American or American Indian screeners (32%).
  • Black or African American screeners were most likely to select financial problems (29%), followed by Native American or American Indian screeners (27%) and Hispanic or Latino screeners (26%).
  • Screeners who identified as more than one race were most likely to select loneliness or isolation (70%), followed by Hispanic or Latino screeners (69%) and Native American or American Indian screeners (68%).
  • Native American or American Indian screeners were most likely to select grief or loss (41%) followed by Black or African American screeners (28%), and screeners who identified as more than one race (27%).
  • Native American or American Indian screeners were most likely to select past trauma (56%), followed by screeners who identified as more than one race (56%) and Hispanic or Latino screeners (52%).
  • Native American or American Indian screeners were most likely to select relationship problems (43%) followed by Black or African American screeners (42%) and Asian or Pacific Islander screeners (41%).
  • Hispanic or Latino screeners were most likely to select coronavirus (28%), followed by White screeners (27%) and screeners who identified as more than one race (26%).

Anxiety Screen (Positive) – August

Total Count

Current events

Financial Problems

Loneliness or isolation

Grief or loss of someone or something

Past trauma

Relationship problems

Coronavirus

Asian or Pacific Islander

5934

25.38%

25.73%

68.57%

23.56%

43.76%

43.60%

24.94%

Black or African American (non-Hispanic)

2710

25.65%

32.32%

62.32%

27.79%

50.52%

41.96%

29.48%

Hispanic or Latino

4058

31.96%

28.44%

69.32%

24.08%

52.78%

39.16%

32.48%

More than one of the above

1492

31.03%

23.86%

68.50%

28.15%

55.76%

41.89%

27.75%

Native American or American Indian

353

30.31%

28.90%

67.14%

36.54%

54.96%

43.34%

26.91%

Other

1594

26.54%

23.21%

65.37%

27.60%

45.23%

42.72%

24.47%

White (non-Hispanic)

16656

32.66%

24.64%

61.78%

25.01%

47.55%

38.50%

30.90%

Anxiety Screen (Positive) – September

Total Count

Current events

Financial Problems

Loneliness or isolation

Grief or loss of someone or something

Past trauma

Relationship problems

Coronavirus

Asian or Pacific Islander

6347

24.17%

23.90%

67.75%

21.90%

42.85%

41.00%

23.95%

Black or African American (non-Hispanic)

2940

27.45%

29.39%

63.67%

28.03%

51.43%

42.07%

25.78%

Hispanic or Latino

4928

30.22%

25.55%

69.07%

25.49%

51.68%

38.58%

27.68%

More than one of the above

1715

33.12%

20.70%

69.56%

26.65%

55.80%

39.48%

25.89%

Native American or American Indian

479

31.73%

26.51%

68.48%

41.13%

55.95%

43.42%

24.22%

Other

1958

26.05%

21.91%

66.34%

26.20%

47.60%

40.40%

22.52%

White (non-Hispanic)

19092

32.01%

23.12%

62.98%

24.68%

47.35%

38.49%

27.48%

Among the 80,269 depression screeners who screened for moderate to severe depression and reported their race/ethnicity in September 2020:

  • White screeners were most likely out of all racial/ethnic groups to select current events (27%) as one of their top three concerns, followed by screeners who identified as more than one race (26%) and Native American or American Indian screeners (25%).
  • Black or African American screeners were most likely to select financial problems (32%), followed by screeners who identified as another race (25%) and Asian or Pacific Islander screeners (24%).
  • Hispanic or Latino were most likely to select loneliness or isolation (78%), followed by screeners who identified as more than one race (75%) and Native American or American Indian screeners (75%). 
  • Native American or American Indian screeners were most likely to select grief or loss (41%) followed by Black or African American screeners (30%) and screeners who identify as another race (29%).
  • Native American or American Indian screeners were most likely to select past trauma (56%), followed by screeners with more than one race (52%) and Hispanic or Latino screeners (50%).
  • Native American or American Indian screeners were most likely to select relationship problems (48%) followed by Asian or Pacific Islander screeners (46%) and Black or African American screeners (46%).
  • White screeners were most likely to select coronavirus (25%), followed by Hispanic or Latino screeners (24%) and screeners with more than one race (24%).

Depression Screen (Positive) - August

Total Count

Current events

Financial Problems

Loneliness or isolation

Grief or loss of someone or something

Past trauma

Relationship problems

Coronavirus

Asian or Pacific Islander

12950

19.87%

26.10%

73.99%

24.59%

41.04%

47.24%

22.22%

Black or African American (non-Hispanic)

6285

19.79%

32.14%

73.33%

29.90%

49.09%

47.13%

22.85%

Hispanic or Latino

9206

23.15%

25.10%

77.26%

26.55%

51.25%

43.83%

25.80%

More than one of the above

3408

26.79%

23.83%

77.82%

29.46%

54.34%

42.99%

27.29%

Native American or American Indian

898

22.05%

23.05%

75.28%

39.76%

55.90%

47.22%

23.27%

Other

3316

21.17%

24.40%

72.65%

29.25%

46.44%

45.75%

20.72%

White (non-Hispanic)

33338

26.77%

23.54%

73.02%

27.35%

45.62%

42.42%

26.90%

Depression Screen (Positive) - September

Total Count

Current events

Financial Problems

Loneliness or isolation

Grief or loss of someone or something

Past trauma

Relationship problems

Coronavirus

Asian or Pacific Islander

14316

20.13%

24.46%

73.43%

24.59%

40.93%

46.17%

21.38%

Black or African American (non-Hispanic)

6904

20.92%

31.79%

73.13%

29.65%

48.62%

46.10%

20.83%

Hispanic or Latino

10667

23.57%

23.72%

77.92%

25.86%

49.56%

42.86%

24.06%

More than one of the above

3768

26.25%

21.58%

74.73%

27.49%

52.34%

42.49%

23.91%

Native American or American Indian

1041

25.07%

23.73%

74.64%

40.83%

55.52%

47.84%

21.23%

Other

4274

22.18%

25.18%

71.69%

28.87%

43.78%

44.78%

19.65%

White (non-Hispanic)

39299

27.27%

22.84%

72.72%

26.75%

44.02%

42.51%

25.05%