Mental Health in America: A Growing Crisis

This article is a companion piece to "DTx and Cognitive Behavioral Therapy." - Ed.

In the United States, the Centers for Disease Control and Prevention (CDC) reported that in 2019, 4.7% of adults aged 18 years or older reported regular feelings of depression, and 11.2% reported regular feelings of worry, nervousness, or anxiety.¹ Forty percent of Americans with a 12-month history of severe mental disorders do not receive any treatment.² Disorders were assessed by structured diagnostic interview using the World Health Organization’s World Mental Health Composite International Diagnostic following DSM-IV criteria. The analyzed disorders included mood (ie, major depressive disorder, dysthymia, or bipolar disorder type I or II), anxiety (ie, generalized anxiety disorder, panic disorder, agoraphobia, social phobia, specific phobia), posttraumatic stress disorder, and substance use disorders (ie, alcohol or drug abuse or dependence). In lower- and middle-income countries, this figure can exceed 75%.²

The ongoing COVID-19 pandemic has increased mental health care needs while simultaneously restricting access, with unknown long-term consequences. From August 2020 to February 2021, the CDC described an increase in the proportion of adults reporting recent symptoms of anxiety or depression from 36.4% to 41.5%, with the fraction reporting unmet mental health care needs increasing from 9.2% to 11.7%.³ Among children and adolescents, the proportion of mental health–related emergency department visits for those aged 5 to 11 years and 12 to 17 years increased 24% and 31%, respectively, compared with 2019.⁴

Dr Darcy is a clinical research psychologist, an adjunct faculty member in the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine, and the founder and president of Woebot Health. Dr Mariano is a practicing psychiatrist, an adjunct assistant professor of psychiatry and human behavior at the Warren Alpert Medical School of Brown University, and vice president and medical director of Woebot Health.

References

1. Norris T, Clark TC, Boersma P, Schiller JS. Technical notes for early release of selected estimates based on data from the National Health Interview Survey. National Center for Health Statistics. February 2021. Accessed June 25, 2021.

2. Wang PS, Aguilar-Gaxiola S, Alonso J, et al. Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. Lancet. 2007;370(9590):841-850.

3. Vahratian A, Blumberg SJ, Terlizzi EP, Schiller JS. Symptoms of anxiety or depressive disorder and use of mental health care among adults during the COVID-19 pandemic – United States, August 2020-February 2021. MMWR Morb Mortal Wkly Rep. 2021;70(13):490-494.

4. Leeb RT, Bitsko RH, Radhakrishnan L, et al. Mental health–related emergency department visits among children aged <18 years during the COVID-19 pandemic – United States, January 1-October 17, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(45):1675-1680.