Frequent Mental Distress

Percentage of adults who report ≥14 days of poor mental health in the past 30 days

PLACES Project, Centers for Disease Control. Data from 2021, 1 year modeled estimate.
Dashboard-City Average

Why do we measure frequent mental distress?

Over half of Americans will be diagnosed with a mental illness or disorder at some point in their lifetime, and many more go undiagnosed.3 Our measure of frequent mental distress is based on surveyed respondents reporting that they experienced poor mental health for 14 or more days in the past month. These self-reported measures can be used to assess how many people are experiencing more chronic physical and mental health conditions, and can help identify unmet health and social service needs in a community.1,2

Mental health is an important indicator of economic hardship and overall well-being in a community. It describes a range of symptoms and experiences that contribute to one’s overall mental health.  Mental health can help determine how we handle stress, relate to others, and make healthy choices. Several factors can contribute to risk for poor mental health and mental illness, ranging from adverse life experiences, comorbid chronic medical conditions, and substance use.3 People reporting worse mental health are also at higher risk for physical health problems, including diabetes, heart disease, and stroke. Similarly, those with chronic disease are often at higher risk of reporting depression, anxiety, and related symptoms of mental health distress.3

Though mental health challenges are experienced by all people, some structural factors disproportionately affect specific communities. Notably, stressors associated with economic hardship, immigration, and structural racism and stigma are experienced by Black, Latino, Native American, and Asian communities.4,5,6,7  In addition, mental illness-related stigma in the health care system, negative stigma around mental health in certain cultures, and limited access to mental health care in rural communities all contribute to poor mental health outcomes. Further, the overall state of mental health has decreased since the beginning of the Covid-19 pandemic in early 2020. Notably, about half of young adults reported symptoms of depression; and women with children, Hispanic and Black people, unemployed persons, and essential workers were more likely to report mental health issues during the pandemic than the general population.8  

How do we measure frequent mental distress?

Frequent mental distress measures adults, aged 18 or older, who report experiencing poor mental health for 14 days or more in the past month. 

Strengths and Limitations

Strengths of Metric

Limitations of Metric

• Frequent mental and physical distress can be used to better understand health-related quality of life.

• The metrics are easy to capture through standard surveys such as the Behavioral Risk Factor Surveillance System (BRFSS).9


• The metric relies on the person surveyed to define “distress”. This makes it difficult to assess reliability and validity, particularly when comparing responses across groups.

• The metric is not cause-specific, which makes identifying the best means of intervention difficult.

• People often experience both chronic physical conditions and poor mental health at the same time, making it difficult to separate how one might be causing the other.9  


Frequent mental distress is calculated by the following formula:

Frequent Mental Distress Calculation

For more information on the calculations, please refer to the City Health Dashboard Technical Document.

Data Source

Estimates for these metrics are from 2018 one year modeled PLACES Project Data (formerly 500 Cities Project) from the Centers for Disease Control and Prevention. Multi-year data are available for these metrics. For more information, please refer to Using Multi-Year Data: Tips and Cautions


  1. Moriarty DG, Zack MM, Kobau R. The Centers for Disease Control and Prevention's Healthy Days Measures - population tracking of perceived physical and mental health over time. Health and quality of life outcomes. 2003;1:37.

  2. Centers for Disease Control Prevention. Measuring healthy days: Population assessment of health-related quality of life. Atlanta, GA: Centers for Disease Control and Prevention. 2000.

  3. Thurston-Hicks A, Paine S, Hollifield M. Rural psychiatry: Functional impairment associated with psychological distress and medical severity in rural primary care patients. Psychiatric Services.1998;49(7):951-955.

  4. Moriarty DG, Zack MM, Holt JB, Chapman DP, Safran MA. Geographic Patterns of Frequent Mental Distress. American Journal of Preventive Medicine. 2009;36(6):497-505.

  5. Liu Y, Croft JB, Wheaton AG, et al. Association between perceived insufficient sleep, frequent mental distress, obesity and chronic diseases among US adults, 2009 behavioral risk factor surveillance system. BMC Public Health. 2013;13:84.

  6. Strine TW, Balluz L, Chapman DP, Moriarty DG, Owens M, Mokdad AH. Risk behaviors and healthcare coverage among adults by frequent mental distress status, 2001. Am J Prev Med. 2004;26(3):213-216.

  7. Dominick KL, Ahern FM, Gold CH, Heller DA. Relationship of health-related quality of life to health care utilization and mortality among older adults. Aging clinical and experimental research. 2002;14(6):499-508.

  8. Taylor RM, Gibson F, Franck LS. A concept analysis of health-related quality of life in young people with chronic illness. Journal of clinical nursing. 2008;17(14):1823-1833.

  9. Chen HY, Baumgardner DJ, Rice JP. Health-related quality of life among adults with multiple chronic conditions in the United States, Behavioral Risk Factor Surveillance System, 2007. Prev Chronic Dis. 2011;8(1):A09.

  10. Doll HA, Petersen SE, Stewart-Brown SL. Obesity and physical and emotional well-being: associations between body mass index, chronic illness, and the physical and mental components of the SF-36 questionnaire. Obesity research. 2000;8(2):160-170.

Last updated: July 26, 2023