Banner image for The NSDUH (National Survey on Drug Use and Health) Report
May 31, 2012

State Estimates of Adult Mental Illness

In Brief
  • Mental illness is one of the leading causes of disability in the United States; new State-level data produced by the Substance Abuse and Mental Health Services Administration (SAMHSA) will advance our understanding of the nature and extent of mental illness, which is critical in the planning and implementation of effective programs and services in communities which can improve the lives of individuals with mental illness and the families of these individuals
  • Nationally, 44.7 million adults aged 18 or older experienced any mental illness in the past year, corresponding to a rate of 19.8 percent of the adult population; among States, the highest rate occurred in Rhode Island (24.0 percent), whereas the lowest rate occurred in Maryland (17.2 percent)
  • Among adults aged 18 or older, the rate of serious mental illness (SMI) in the past year ranged from 3.5 percent in South Dakota to 7.0 percent in Rhode Island. Nationally, the rate was 4.6 percent, which equates to 10.4 million Americans with SMI

Mental illness is a major public health concern in the United States; it is a primary cause of disability and carries a high financial cost.1 Information on the prevalence of mental illness is critically needed to help guide the provision of effective treatment and prevention programs to restore lives and to reduce economic and societal costs. The Substance Abuse and Mental Health Services Administration (SAMHSA) provides block grant funding to States in support of programs and services for adults with mental illness with the goal to improve the capacity of these adults to live and work in the communities of their choice.2

SAMHSA defines mental illness based on diagnostic criteria in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).3 Any mental illness among adults aged 18 or older is the presence of any mental, behavioral, or emotional disorder in the past year that met DSM-IV criteria. Among adults with a disorder, those adults whose disorder caused substantial functional impairment (i.e., substantially interfered with or limited one or more major life activities) are defined as having serious mental illness (SMI) and the most urgent need for treatment.4 Nationally, only 60 percent of adults (6.6 million people) with SMI had received mental health treatment in the past 12 months.4

This issue of The NSDUH Report presents State-level estimates of SMI based on data collected from 91,287 adults aged 18 or older from the combined 2008 and 2009 National Surveys on Drug Use and Health (NSDUHs) and 68,231 adults aged 18 or older for estimates of any mental illness (only half of the 2008 sample was available for two creating estimates of any mental illness). Estimates are displayed in two tables and on two U.S. maps. In the table, State estimates are listed alphabetically for easy reference. To produce the maps, State estimates were first rank ordered from lowest to highest and then divided into quintiles (fifths). States with the lowest estimates (i.e., the lowest fifth) are assigned to the bottom quintile and are shown in dark blue. States with the highest estimates are assigned to the top quintile and are shown in red. All other States are assigned to one of three quintiles between the lowest and highest quintiles.5, 6 These estimates, available for the first time at the State level, are the result of an expanded mental health component in the NSDUH that will generate State estimates of various mental health indicators annually.


Serious Mental Illness

Nationally among adults aged 18 or older, the rate of SMI was 4.6 percent, which equates to 10.4 million Americans. Among individual States, the percentage of adults aged 18 or older with SMI ranged from 3.5 percent in South Dakota to 7.0 percent in Rhode Island. Including South Dakota, States with the lowest rates included Hawaii and North Dakota (each with a rate of 3.6 percent), District of Columbia (3.8 percent), and Maryland (3.9 percent) (Figure 1 and Table 1). Along with Rhode Island, States with high SMI rates included Arkansas (6.7 percent), Utah and West Virginia (each with a rate of 6.1 percent), and Indiana (5.9 percent). States with high and low rates of SMI occurred in all regions of the United States, with no notable regional clustering of high and low rates.


Figure 1 (REVISED). Serious Mental Illness in Past Year among Persons Aged 18 or Older, by State: Percentages, Annual Averages Based on 2008 and 2009 NSDUHs
This is a (REVISED) U.S. map comparing serious mental illness in past year among persons aged 18 or older, by state: percentages, annual averages based on 2008 and 2009 NSDUHs. Accessible table located below this figure.

Table 1 (REVISED). Serious Mental Illness (SMI) in Past Year among Persons Aged 18 or Older, by Location: Percentages, Annual Averages Based on 2008 and 2009 NSDUHs
Location Serious Mental Illness (%) 95% Confidence Interval
Nation 4.62% (4.42-4.83)
Alabama 4.53% (3.59-5.69)
Alaska 4.17% (3.26-5.31)
Arizona 4.22% (3.28-5.41)
Arkansas 6.73% (5.37-8.39)
California 4.29% (3.68-5.00)
Colorado 5.19% (4.12-6.53)
Connecticut 4.35% (3.42-5.52)
Delaware 4.38% (3.42-5.61)
District of Columbia 3.82% (2.99-4.87)
Florida 4.72% (4.05-5.51)
Georgia 4.18% (3.24-5.37)
Hawaii 3.59% (2.76-4.65)
Idaho 5.77% (4.64-7.15)
Illinois 4.39% (3.80-5.07)
Indiana 5.89% (4.74-7.30)
Iowa 4.95% (3.97-6.16)
Kansas 4.46% (3.52-5.64)
Kentucky 5.40% (4.34-6.71)
Louisiana 4.72% (3.79-5.87)
Maine 4.64% (3.67-5.85)
Maryland 3.85% (2.96-5.00)
Massachusetts 4.22% (3.32-5.34)
Michigan 5.19% (4.52-5.95)
Minnesota 5.31% (4.22-6.66)
Mississippi 4.15% (3.25-5.30)
Missouri 5.14% (4.09-6.45)
Montana 5.02% (4.00-6.28)
Nebraska 4.68% (3.70-5.92)
Nevada 4.63% (3.62-5.90)
New Hampshire 4.57% (3.65-5.70)
New Jersey 4.10% (3.18-5.28)
New Mexico 4.41% (3.45-5.62)
New York 4.58% (3.95-5.30)
North Carolina 4.34% (3.39-5.53)
North Dakota 3.64% (2.83-4.66)
Ohio 5.17% (4.47-5.96)
Oklahoma 5.04% (4.00-6.34)
Oregon 5.35% (4.26-6.71)
Pennsylvania 4.24% (3.61-4.98)
Rhode Island 7.03% (5.43-9.06)
South Carolina 4.14% (3.20-5.35)
South Dakota 3.53% (2.68-4.64)
Tennessee 5.01% (3.97-6.30)
Texas 4.33% (3.73-5.01)
Utah 6.09% (4.98-7.44)
Vermont 4.64% (3.68-5.84)
Virginia 4.00% (3.11-5.12)
Washington 4.70% (3.75-5.89)
West Virginia 6.08% (4.83-7.62)
Wisconsin 4.91% (3.94-6.12)
Wyoming 5.13% (4.12-6.36)
Note: Some 2008-2009 estimates may differ from previously published estimates due to updates (see End Note 6).
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2008 to 2009 (Revised March 2012).


Any Mental Illness

Nationally, 44.7 million adults aged 18 or older experienced any mental illness in the past year, corresponding to a rate of 19.8 percent. Among States, the highest rate occurred in Rhode Island (24.0 percent), whereas the lowest rate occurred in Maryland (17.2 percent) (Figure 2 and Table 2). Along with Rhode Island, the States with the highest rates included Utah (23.6 percent), Idaho (22.4 percent), West Virginia (22.1 percent), and Indiana (21.9 percent). Including Maryland, States with the lowest rates included Illinois (18.1 percent), Florida (18.2 percent), and North Dakota and New Jersey (each with a rate of 18.3 percent). Similar to SMI, high and low rates of any mental illness occurred in all regions of the United States.


Figure 2 (REVISED). Any Mental Illness in Past Year among Persons Aged 18 or Older, by State: Percentages, Annual Averages Based on 2008 and 2009 NSDUHs
This is a (REVISED) U.S. map comparing any mental illness in past year among persons aged 18 or older, by state: percentages, annual averages based on 2008 and 2009 NSDUHs. Accessible table located below this figure.

Table 2 (REVISED). Any Mental Illness in Past Year among Persons Aged 18 or Older, by Location: Percentages, Annual Averages Based on 2008 and 2009 NSDUHs
Location Any Mental Illness (%) 95% Confidence Interval
Nation 19.77% (19.23-20.32)
Alabama 20.43% (17.87-23.26)
Alaska 19.04% (16.65-21.69)
Arizona 18.77% (16.26-21.57)
Arkansas 21.34% (18.68-24.26)
California 19.66% (18.09-21.33)
Colorado 20.61% (18.00-23.49)
Connecticut 19.64% (17.12-22.42)
Delaware 19.68% (17.14-22.49)
District of Columbia 20.99% (18.45-23.78)
Florida 18.15% (16.54-19.87)
Georgia 19.40% (16.87-22.22)
Hawaii 19.53% (16.88-22.48)
Idaho 22.37% (19.76-25.21)
Illinois 18.08% (16.57-19.70)
Indiana 21.88% (19.34-24.64)
Iowa 19.11% (16.82-21.63)
Kansas 20.60% (18.15-23.28)
Kentucky 20.19% (17.57-23.09)
Louisiana 19.81% (17.48-22.38)
Maine 20.75% (18.19-23.57)
Maryland 17.23% (14.79-19.98)
Massachusetts 20.16% (17.66-22.92)
Michigan 20.56% (19.01-22.21)
Minnesota 19.35% (16.96-21.99)
Mississippi 19.51% (17.06-22.23)
Missouri 20.83% (18.29-23.63)
Montana 20.43% (17.81-23.32)
Nebraska 20.47% (18.08-23.08)
Nevada 21.42% (18.60-24.52)
New Hampshire 19.58% (17.18-22.24)
New Jersey 18.30% (15.73-21.18)
New Mexico 18.93% (16.60-21.49)
New York 19.90% (18.26-21.64)
North Carolina 19.72% (17.26-22.44)
North Dakota 18.29% (15.99-20.84)
Ohio 20.45% (18.85-22.15)
Oklahoma 21.45% (18.69-24.49)
Oregon 20.51% (17.92-23.36)
Pennsylvania 19.49% (17.86-21.24)
Rhode Island 24.04% (20.99-27.38)
South Carolina 18.88% (16.47-21.55)
South Dakota 18.44% (16.02-21.14)
Tennessee 21.46% (18.75-24.43)
Texas 19.62% (18.05-21.28)
Utah 23.63% (20.96-26.53)
Vermont 19.84% (17.32-22.63)
Virginia 18.48% (16.22-20.98)
Washington 21.22% (18.60-24.10)
West Virginia 22.14% (19.42-25.13)
Wisconsin 21.01% (18.43-23.84)
Wyoming 21.80% (19.20-24.65)
Note: Some 2008-2009 estimates may differ from previously published estimates due to updates (see End Note 6).
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2008 to 2009 (Revised March 2012).


Discussion

Indiana, Rhode Island, Utah, and West Virginia had the highest rates for both SMI and any mental illness. Maryland and North Dakota had the lowest rates across both measures. States with high and low rates of SMI and any mental illness are located in all regions of the United States. Factors that potentially contribute to the variation are not well understood and need further study. As data from the 2010 and subsequent NSDUHs are accumulated, more in-depth analysis of this data will provide insight into the patterns of mental illness in the United States, such as variations by age and gender within each State, as well as co-occurring substance use disorders and substate area differences.

SAMHSA plans to update these estimates annually so that trends can be tracked and data users will have current estimates.



End Notes
1 National Institute of Mental Health. (2008, June). The numbers count: Mental disorders in America. Retrieved from http://wwwapps.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america.shtml
2 Public Law No. 102-321, the Alcohol, Drug Abuse, and Mental Health Administration(ADAMHA) Reorganization Act of 1992, established a block grant for States within the United States to fund community mental health services for adults with serious mental illness. The law required States to include prevalence estimates in their annual applications for block grant funds. This legislation also required the Substance Abuse and Mental Health Services Administration (SAMHSA) to develop an operational definition of serious mental illness. Information about SAMHSA's block grant programs can be found at http://www.samhsa.gov/grants/blockgrant/
3 American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (DSM-IV) (4th ed.). Washington, DC: Author.
4 A discussion of the methodology used to generate SMI and any mental illness estimates can be found in Appendix B of the report listed here. For information on mental illness and mental health service utilization, please see chapter 2 in Office of Applied Studies. (2010). Results from the 2009 National Survey on Drug Use and Health: Mental health findings (HHS Publication No. SMA 10-4609, NSDUH Series H-39). Rockville, MD: Substance Abuse and Mental Health Administration. Retrieved from http://store.samhsa.gov/product/Mental-Health-Findings-Results-from-the-2009-National-Survey-on-Drug-Use-and-Health-NSDUH-/SMA10-4609
5 In this report, State estimates are discussed in terms of their observed rankings because it provides a useful context. When it is indicated that a State has the highest or lowest rate, it does not imply that the State's rate is significantly higher or lower than the rate of the next highest or lowest State. When comparing two State prevalence rates, two overlapping 95 percent confidence intervals do not imply that the State prevalence rates are statistically equivalent at the 5 percent level of significance. For details on a more accurate test to compare State prevalence rates, please see Section A.9 in Appendix A of Center for Behavioral Health Statistics and Quality. (2007). State estimates of substance use and mental disorders from the 2004-2005 National Surveys on Drug Use and Health (HHS Publication No. SMA 07-4235, NSDUH Series H-31). Rockville, MD: Substance Abuse and Mental Health Services Administration. Retrieved from http://www.samhsa.gov/data/
6 This report, originally published in October 2011, was revised due to updates in March 2012. Updates made to the NSDUH data used in this report affected all the estimates, although they are most notable for Pennsylvania, Maryland, and the national estimates. See http://www.samhsa.gov/data/ for more information. This report uses State estimates based on model-based small area estimation methodology. Where model-based techniques are used, estimates for all States may be affected by any data updates because the model-based estimate for a given State is a combination of the direct estimate for that State and the State estimate obtained from a national model. Therefore, this report's estimates may not match estimates in other NSDUH reports. Updated tables containing the revised estimates of SMI and any mental illness abstracted for this report, as well as other measures, can be found at http://www.samhsa.gov/data/


Suggested Citation
Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (May 31, 2012). The NSDUH Report: State Estimates of Adult Mental Illness. Rockville, MD.

The National Survey on Drug Use and Health (NSDUH) is an annual survey sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA). The 2008 and 2009 data used in this report are based on information obtained from 92,300 persons aged 18 or older. The survey collects data by administering questionnaires to a representative sample of the population through face-to-face interviews at their place of residence.

The NSDUH Report is prepared by the Center for Behavioral Health Statistics and Quality (CBHSQ), SAMHSA, and by RTI International in Research Triangle Park, North Carolina. (RTI International is a trade name of Research Triangle Institute.)

Information on the most recent NSDUH is available in the following publication:

Center for Behavioral Health Statistics and Quality. (2011). Results from the 2010 National Survey on Drug Use and Health: Summary of national findings (NSDUH Series H-41, HHS Publication No. SMA 11-4658). Rockville, MD: Substance Abuse and Mental Health Services Administration.

Also available online: http://www.samhsa.gov/data/.

The NSDUH Report is published periodically by the Center for Behavioral Health Statistics and Quality (formerly the Office of Applied Studies), Substance Abuse and Mental Health Services Administration (SAMHSA). All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Additional copies of this report or other reports from the Center for Behavioral Health Statistics and Quality are available online: http://www.samhsa.gov/data/. Citation of the source is appreciated. For questions about this report, please e-mail: shortreports@samhsa.hhs.gov.

NSDUH_110


This is the page footer.

This page was last updated on .