Frequent Mental Distress Among U.S. Adults With Disabilities, 2018

This page summarizes a CDC report in MMWR using 2018 Behavioral Risk Factor Surveillance System (BRFSS) data.

Frequent mental distress, reporting 14 or more days of poor mental health in the past 30, is linked to unhealthy behaviors, heavier use of health services, mental disorders such as major depression, chronic diseases and functional limitations. Adults with disabilities report more depression and anxiety, less access to health care, and more health risk behaviors than adults without disabilities.

The survey

BRFSS is a yearly telephone survey, by landline and cell phone, of noninstitutionalized U.S. adults. In 2018 it reached 430,949 people, with a median response rate of 49.9%; 404,973 answered the disability and mental health questions. People counted as having a disability if they reported any of six types: hearing, vision, cognition, mobility, self-care or independent living.

Findings

About 26.2% of adults reported a disability.

Adults with disabilities reported frequent mental distress 4.6 times as often as those without.

Who reported more distress. Among adults with and without disabilities alike, distress was more common among women, and among people who were unmarried, unemployed, identified as lesbian, gay, bisexual or something else, or lived in lower-income households. Adults below the federal poverty level reported it 70% more often than those in higher-income households. Non-Hispanic Asian and Hispanic adults, and middle-aged and older adults, reported it less often than non-Hispanic white and younger adults. Among adults without disabilities, veterans and retirees were 20% less likely to report distress, but these differences did not appear among adults with disabilities.

Linked factors. Among adults with disabilities, those who smoked, slept too little, were physically inactive, had obesity, had a diagnosed depressive disorder, or had gone without needed care because of cost more often reported frequent mental distress. About half of those with a diagnosed depressive disorder reported distress, and so did one in six of those without such a diagnosis, who may have undiagnosed conditions.

By state, among adults with disabilities:

Frequent mental distress among adults with disabilities (A) and prevalence ratios compared with adults without disabilities (B), by state, 2018. Figure: CDC.

• Highest: New Hampshire (42.9%), South Carolina (39.2%), Maine (38.7%).
• Median: Louisiana (32.5%).
• Lowest: Alaska (25.2%), Hawaii (26.7%), Illinois (26.9%).
• The gap with adults without disabilities was widest in Minnesota, Kansas, Georgia, Iowa and Delaware (5.4–5.7 times) and narrowest in Illinois (3.5) and West Virginia (3.6).

What could help

• Screening. Providers may focus on a patient's primary disability and miss co-occurring mental health conditions. Some physical symptoms and functional impairment may worsen with mental distress and improve with treatment, so screening for mental health symptoms, even when they seem unrelated to the visit, could help.
• Healthy lifestyles: a healthy weight, enough physical activity and sleep, and quitting smoking.
• Social connection. In one 6-year study, more social support was linked to fewer depressive symptoms among adults with physical disabilities. Disabilities can limit social engagement, and lower distress among married and employed adults with disabilities suggests programs that build social connectedness could help.
• Access to care. Cost-related unmet need was linked to distress, and policies such as the Affordable Care Act that improve access, especially for lower-income adults with disabilities, might help narrow the gap.

Limitations

• The survey is cross-sectional, so cause cannot be established; distress might also worsen disability or risk.
• People may underreport mental health symptoms.
• Adults with severe functional and cognitive disabilities may be underrepresented, which could understate distress.
• Disability categories are broad, and the primary disabling condition was unknown. With 4.6% of U.S. adults having a serious mental illness in 2018, mental disorders not captured by the survey may partly explain the high distress among adults reporting cognitive disabilities.

Sources

• Cree RA, Okoro CA, Zack MM, Carbone E. "Frequent Mental Distress Among Adults, by Disability Status, Disability Type, and Selected Characteristics — United States, 2018." MMWR 69(36). https://www.cdc.gov/mmwr/volumes/69/wr/mm6936a2.htm
• Supplementary tables: https://stacks.cdc.gov/view/cdc/92748