Geographic and Sociodemographic Variations in Prevalence of Mental Health Symptoms Among US Youths, 2022

Abstract

Objectives. To assess geographic and sociodemographic variations in prevalence of mental health symptoms among US youths.

Methods. We analyzed data from the Household Pulse Survey, phases 3.5 and 3.6, between June 1 and November 14, 2022. The sample included 103 296 households with an estimated 190 017 youths younger than 18 years. We defined mental health symptoms based on parental responses and estimated prevalence by state and subgroups, including race/ethnicity, parental education, household income, housing tenure, household food sufficiency, and health insurance coverage. All analyses incorporated sampling weight.

Results. An estimated 34.5% (95% confidence interval [CI] = 33.7%, 35.3%) of youths had parent-reported mental health symptoms. The prevalence of symptoms varied across states, ranging from 27.9% (95% CI = 23.8%, 32.0%) in Florida to 46.4% (95% CI = 41.9%, 50.9%) in New Hampshire. We observed variations by subgroup, with youths in households that did not pay rent reporting a prevalence of 43.8% (95% CI = 39.3%, 48.4%) and those experiencing food insufficiency reporting a prevalence of 56.0% (95% CI = 50.9%, 61.2%).

Conclusions. There is an urgent need for attention to mental health challenges among youths, taking into account geographic and sociodemographic variations. (Am J Public Health. 2023;113(10):1116–1119. https://doi.org/10.2105/AJPH.2023.307355)

There has been a growing concern regarding youths’ mental health, with an increasing prevalence of symptoms over the past decade and further exacerbation during the COVID-19 pandemic.^1–3 According to a US Centers for Disease Control and Prevention report, more than a third of high school students reported mental health challenges during the pandemic.⁴ In a 2022 Pew Research Center survey, 40% of US parents listed mental health as a top concern for their children.⁵ In October 2022, the US Preventive Services Task Force released a recommendation for anxiety screening in children and adolescents aged 8 to 18 years based on the comprehensive evaluation of existing evidence and the need for timely detection and intervention.⁶ Because of the rising trend in prevalence of mental health symptoms, widespread concerns have been observed globally.³ However, the current knowledge regarding geographic and sociodemographic variations in the prevalence of these symptoms among US youths remains limited.

We examined geographic and sociodemographic variations in the prevalence of mental health symptoms among US youths younger than 18 years in 2022.

METHODS

The Household Pulse Survey (HPS) is a nationally representative survey conducted by the US Census Bureau in collaboration with multiple federal agencies to collect data on the social and economic effects of the COVID-19 pandemic on US households and to measure household experiences during the pandemic and recovery. We included phases 3.5 and 3.6 (earlier phases of HPS did not have information on youths’ mental health), which were conducted between June 1 and November 14, 2022. Among 322 361 households, we included 103 296 households with an estimated population of 190 017 youths younger than 18 years. We defined the presence of mental health symptoms among youths as positive responses by parents or caregivers to either of the questions “In the past 4 weeks, did any children living in your household: 1) ‘feel anxious or clingy’ or 2) ‘feel very sad or depressed?’ ”

Although the data collected by the HPS was at the household level, we followed the technical documentation of the HPS to generate individual-level estimates for youths.⁷ Specifically, we adjusted the final HPS person weights offered by the US Census Bureau by multiplying them by the ratio of the number of adults to the number of children that were reported to live in each household (see Appendix [available as a supplement to the online version of this article at http://www.ajph.org]). As a result, the constructed weights accounted for household nonresponse, the number of children per household, and the sampling coverage.

Using these weights, we estimated the outcomes of interest via a Hájek-type estimator accounting for nonresponses to the questions regarding youths’ mental health symptoms.⁸ We constructed 95% confidence intervals (CIs) following Fay’s method of balanced repeated replication, as suggested by the Census Bureau.⁹ For subgroup analyses, we included race/ethnicity (Hispanic, non-Hispanic Asian, non-Hispanic Black, non-Hispanic White, and other), parental educational level, household income level, housing tenure, household food sufficiency, health insurance coverage, and geographic region.

RESULTS

In 2022, an estimated 34.5% (95% CI = 33.7%, 35.3%) of youths reported experiencing mental health symptoms. The prevalence of symptoms varied significantly across states, ranging from 27.9% (95% CI = 23.8%, 32.0%) in Florida to 46.4% (95% CI = 41.9%, 50.9%) in New Hampshire (Appendix Table A and Figure A). Moreover, there were significant variations in the prevalence of mental health symptoms observed in sociodemographic subgroups (Table 1). For example, the prevalence of symptoms was 22.6% (95% CI = 19.9%, 27.3%) among non-Hispanic Asian youths, 28.5% (95% CI = 26.2%, 30.7%) among non-Hispanic Black youths, 32.2% (95% CI = 29.6%, 34.8%) among Hispanic youths, 37.7% (95% CI = 36.8%, 38.5%) among non-Hispanic White youths, and 41.0% (95% CI = 37.6%, 44.4%) among others.

TABLE 1—

Prevalence of Mental Health Symptoms and Number of Affected Individuals by Sociodemographic Factors Among US Youths Aged < 18 Years: Household Pulse Survey, 2022

Characteristic	Prevalence Estimate, % (95% CI)	No., Millions, Estimate (95% CI)
Race/ethnicity
Hispanic	32.2 (29.6, 34.8)	5.4 (4.9, 5.8)
Non-Hispanic Asian	22.6 (19.9, 27.3)	0.9 (0.7, 1.1)
Non-Hispanic Black	28.5 (26.2, 30.7)	3.3 (3.0, 3.6)
Non-Hispanic White	37.7 (36.8, 38.5)	15.2 (14.8, 15.5)
Other	41.0 (37.6, 44.4)	1.5 (1.4, 1.6)
Parental education
< high school	30.3 (23.8, 36.8)	0.9 (0.7, 1.1)
Some high school	28.8 (23.5, 34.1)	1.5 (1.2, 1.8)
High school graduate or equivalent	29.3 (27.5, 31.2)	7.0 (6.6, 7.4)
Some college	38.0 (36.2, 39.8)	5.8 (5.6, 6.1)
Associate’s degree	39.3 (37.4, 41.3)	2.7 (2.6, 2.9)
Bachelor’s degree	37.3 (36.1, 38.4)	4.3 (4.2, 4.5)
Graduate degree	37.4 (36.3, 38.5)	3.9 (3.8, 4.1)
Household income level, $
< 25 000	37.3 (34.8, 39.8)	4.1 (3.7, 4.4)
25 000–34 999	36.3 (33.1, 39.4)	3.0 (2.7, 3.3)
35 000–49 999	35.2 (32.7, 37.7)	3.0 (2.8, 3.2)
50 000–74 999	34.3 (31.9, 36.7)	3.8 (3.6, 4.1)
75 000–99 999	34.4 (32.3, 36.5)	2.8 (2.7, 3.0)
100 000–149 999	35.1 (33.3, 36.9)	3.6 (3.4, 3.8)
150 000–199 999	34.2 (31.9, 36.5)	1.8 (1.6, 1.9)
≥ 200 000	30.7 (29.1, 32.3)	2.1 (2.0, 2.2)
Housing tenure
Owned by you or someone in this household free and clear	29.5 (27.2, 31.7)	3.1 (2.9, 3.4)
Owned by you or someone in the household with a mortgage or  loan, including home equity loans	34.8 (33.9, 35.7)	13.1 (12.7, 13.5)
Rented	35.2 (33.5, 37.0)	8.5 (8.0, 9.0)
Occupied without payment of rent	49.0 (40.8, 57.3)	0.7 (0.5, 0.9)
Household food sufficiency for last 7 d
Enough	26.3 (25.4, 27.1)	9.9 (9.5, 10.2)
Enough, but not always	38.9 (37.3, 40.5)	10.4 (9.9, 10.9)
Sometimes not enough	46.3 (43.2, 49.3)	4.3 (4.0, 4.6)
Often not enough	58.0 (51.7, 64.2)	1.6 (1.4, 1.9)
Public insurance coverage
Yes	37.7 (36.1, 39.2)	9.7 (9.2, 10.2)
No	32.9 (32.9, 33.9)	14.9 (14.4, 15.4)
Private insurance coverage
Yes	34.4 (32.6, 34.3)	17.8 (17.3, 18.2)
No	37.1 (35.4, 38.9)	7.9 (7.4, 8.3)

Note. CI = confidence interval. All estimates and their corresponding 95% CIs are weighted, accounting for the sampling survey design.

Youths with parents with higher education had more mental health symptoms; the prevalence of mental health symptom was 37.4% (95% CI = 36.3%, 38.5%) among youths whose parents had graduate degrees compared with 30.3% (95% CI = 23.8%, 36.8%) among those whose parents had less than a high school–level education. By contrast, youths from households with the highest income level (≥ $200 000) had a lower prevalence of mental health symptoms at 30.7% (95% CI = 29.1%, 32.3%) than did those from households with the lowest income level (< $25 000) at 37.3% (95% CI = 34.8%, 39.8%). The prevalence of mental health symptoms varied by housing status, with a lower prevalence of 29.5% (95% CI = 27.2%, 31.7%) observed among youths from households who owned their housing free and clear and with a higher prevalence of 49.0% (95% CI = 40.8%, 57.3%) observed among youths from household units occupied without rent payments.

Furthermore, the prevalence of mental health symptoms was 58.0% (95% CI = 51.7%, 64.2%) among youths who frequently experienced food insufficiency, which was more than double the prevalence observed among those who did not: 26.3% (95% CI = 25.4%, 27.1%). Prevalence of mental health symptoms also differed by household health insurance coverage, with a higher prevalence of 37.7% (95% CI = 36.1%, 39.2%) observed among youths with public health insurance compared with a prevalence of 34.4% (95% CI = 32.6%, 34.3%) among youths with private health insurance. We also estimated the number of youths affected by mental health symptoms by state (Appendix Table A) and sociodemographic subgroup (Table 1).

DISCUSSION

We found that more than a third of US youths experienced mental health symptoms in 2022, with substantial variations observed across states (from 27.9% in Florida to 46.4% in New Hampshire) and sociodemographic subgroups (from 26.3% for youths who had enough and satisfactory food to 58.0% for those who frequently experienced insufficient food). Research on mental health among children and adolescents during the pandemic is sparse, and comparability of estimates across studies is challenging because of differences in age ranges and definitions of mental health symptoms.¹⁰ In addition to national estimates before the pandemic,¹¹ a recent study¹² found that mental health visits doubled from 2011 to 2020, highlighting the urgent need to prioritize mental health among the youth population. Our study further provides new insight into the disparities in mental health across states and sociodemographic characteristics.

Several limitations in this study need to be noted. First, the assessment of mental health symptoms relied on parental report of symptoms of anxiety and depression over the past 4 weeks, which is not a diagnostic method and may not capture long-term symptoms or other mental health conditions. In addition, because of the lack of individual-level data for youths, we estimated the prevalence of mental health symptoms among youths using personal weights adjustment according to the analytical guideline provided by the US Census Bureau. Despite these limitations, our findings underscore the urgent need to address mental health challenges facing youths in the United States.

Our results highlight the necessity of developing and implementing tailored and targeted interventional programs that take into account geographic and sociodemographic variations in mental health symptoms. Policymakers and health care providers should pay special attention to the subgroups of youths who are disproportionately affected by mental health symptoms, such as those living in households that do not pay rent and those experiencing food insufficiency, and incorporate increased access to youths’ mental health resources as part of overall strategies to address broader social determinants of health.