America's mental health crisis, mapped

The United States is confronting an unprecedented mental health crisis. Even before the pandemic began, rates of depression and anxiety were increasing—but the isolation, lifestyle disruptions, decreasing availability of care, and the grief of the last few years have worsened the situation.

Mental illness is a complex condition with components of genetics and family history, situational stressors, and contextual characteristics. Together, these factors combine to challenge an individual’s resilience, happiness, and wellbeing. Researchers are uncovering an expanding list of factors associated with worsening mental health. Perhaps as a reflection of the growing crisis, general interest in mental health has increased significantly in recent years. Search engine activity shows that Americans are seeking more information and resources about mental health than ever before.

But understanding the causes and effects of the mental health crisis—much less addressing them—is a hugely difficult proposition, as mental health needs and resources vary significantly across the United States. Mental health, just like physical health, cannot be evaluated outside of its geographic context.

Responding to worsening mental health in the U.S. will require better understanding of localized stressors, as well as a review of the healthcare system’s capacity to support those in need. The  geographic approach —a broad method of combining geospatial data and technology to ask, and then answer, questions about the world—may hold the key.

Evaluating mental health through a geographic lens can enable researchers and policymakers to determine cumulative conditions that affect mental health and wellbeing, to identify the communities at highest risk for mental illness, and to make decisions about which interventions should be applied where.

To demonstrate the potential of the geographic approach for mental health challenges, this story uses data from  County Health Rankings , a product of the Wisconsin Population Health Institute, funded by the Robert Wood Johnson Foundation.

Let’s begin by comparing the change in average number of poor mental health days per county, according to self-reported data captured over a 5-year period.  

While the maps above reveal some geographic variation in mental health, the widespread increase in the average number of poor mental health days across America is alarming. Seeing the data mapped this way demonstrates the urgent need to expand and develop policies and programs that address mental distress and the factors that exacerbate it.

The maps and charts that follow highlight factors associated with mental illness across four domains: health risk factors, economic risk factors, contextual risk factors and social risk factors. Each risk factor is correlated with frequent mental distress, meaning those with 14+ poor mental health days per month.

Studies have shown that physical health and mental wellbeing are correlated: People that adhere to a healthy diet and exercise regularly are generally more resilient to mental distress.

However, those who struggle with obesity face a myriad of challenges including impaired mobility and occupational functioning, weight bias and discrimination, poor body image, chronic pain and higher likelihood of comorbid medical conditions.

In the scatterplot below, each point represents an individual county, and is scaled to reflect the county's total population. The line of best fit, in gray, illustrates the positive correlation between rates of obesity and mental distress.

Adult obesity, in particular, has been linked with a 55% increased risk for developing depression and is also connected to increases in bipolar disorder, panic disorder and agoraphobia.  ^[1]  

There is a statistically significant correlation between a county's unemployment rate and the proportion of the population experiencing frequent mental distress. Unemployment not only affects an individual’s sense of purpose and self-esteem, but it also causes financial stress that can result in housing and food insecurity.  

Unemployment has been shown to have negative consequences for mental health including depression, anxiety, insecurity, and irritability. Jobless Americans are more than twice as likely to be treated for depression than those who are employed.  ^[2]  

Americans living in economically diverse, integrated communities are more resilient to mental distress than those cleaved by economic or racial divisions. One way to understand the difference between economic diversity and economic division is to look at the places with a high income inequality ratio—the places with a greater division between the top and bottom ends of the income spectrum.  

Income inequality can lead to a loss of social connectedness in the community, as well as decreases in trust and social support.  ^[4]   These, in turn, negatively impact mental wellness. 

Both the adults and the children living in single-parent households are at increased risk for severe mental distress. And while each family unit is unique, it's worth considering the issue at a population level. What does it mean for a county to have a higher rate of single-parent households? Is there a political or systemic problem that influences the rate? 

Being a child in a single-parent household affects health, wellbeing and life opportunities. Common mental illnesses associated with living in a single-parent household include substance abuse, depression, suicide risk and unhealthy behaviors. 

Access to quality, affordable mental health resources—including counseling and therapy, as well as prescription-based treatment—is a driver of mental health outcomes. However, it's also an effect, as providers respond to demand for mental health services. Both primary care providers as well as mental health care providers treat mental illness. The following maps show the landscape of both provider types, per 100,000 population, individually and in combination.

Mental ill health is markedly increasing in the United States. The types and numbers of stressors are also increasing. Are we too focused on keeping up with the Joneses? Is social media isolating us from reality and from one another? Are we losing our sense of family and community?

Whatever the causes, our country’s mental ill health is at a crisis level. And its not just mental illness that is at issue, it’s the ripple effect of mental illness that deepens the emergency:

• Greater risk of chronic illnesses like cardiovascular disease and metabolic disorders
• Comorbid substance use disorder
• Increases in unemployment due to mental illness
• Decreases in education attainment, especially high school graduation

The drivers, outcomes and resource allocation needs for addressing mental illness are complex. Mapping and spatial analysis can expand our understanding of where various risk factors are most highly correlated with outcomes and suggest the types and places for effective interventions.

It is worth noting that the 2022 release of the County Health Rankings is based on data collected in previous years. All of the data referenced or visualized in this story is from 2019, unless otherwise noted. This is the nature of public health data: The most current data available is often a few years old.

Dig into the 2022 County Health Rankings data in ArcGIS Online, and create your own county-level health maps:

Develop your GIS skills with a free health-focused mapping curriculum:

Understand the methodology behind the County Health Rankings:

Explore the Center for Disease Control's mental health resources:

 ^[1]  Luppino, Floriana S., et al. “Overweight, Obesity, and Depression.” Archives of General Psychiatry, vol. 67, no. 3, 2010, p. 220.,  https://doi.org/10.1001/archgenpsychiatry.2010.2 .

 ^[2]  Simon, Gregory E., et al. “Association between Obesity and Psychiatric Disorders in the US Adult Population.” Archives of General Psychiatry, vol. 63, no. 7, 2006, p. 824.,  https://doi.org/10.1001/archpsyc.63.7.824 .

 ^[3]  Gallup News

 ^[4]  Pickett, Kate E., and Richard G. Wilkinson. “Income Inequality and Health: A Causal Review.” Social Science & Medicine, vol. 128, 2015, pp. 316–326.,  https://doi.org/10.1016/j.socscimed.2014.12.031 .

 ^[5]   U.S. Health Resources & Services Administration