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Across the U.S., Stress Varies by Region

CDC surveys find more relaxed people in Hawaii, fewer in Kentucky, W. Va.,,,,

TUESDAY, April 14 (HealthDay News) -- Life in America is getting more stressful, especially if you live in the Appalachian or Mississippi Valley regions.

Almost 10 percent of some 1.2 million people surveyed annually by the U.S. Centers for Disease Control and Prevention from 2003 to 2006 reported having frequent mental distress, defined as 14 or more days a month of feeling depressed, stressed or having emotional problems.

That was up 1 percentage point from the CDC surveys conducted from 1993 to 2001. The findings appear in the June issue of the American Journal of Preventive Medicine.

But some states seem to be faring decidedly worse than others.

West Virginia had the highest percentage of residents, 14.9 percent, who reported frequent mental distress in the 2003-2006 survey. Kentucky had 14.4 percent.

In Mississippi, Oklahoma and West Virginia, incidence of frequent mental distress rose by 4 percentage points between the first and second surveys. Other states with higher than average rates included Alabama, Arkansas and Indiana.

Given the current state of the economy, the 2008 statistics, which are not yet compiled, will probably show ever worsening levels of mental distress, said lead investigator Dr. Matthew Zack, a medical epidemiologist with the CDC.

"I would predict that some areas not affected in this study may become affected, in part because of job losses or unemployment," Zack said.

Despite brutal weather, one region that seems to be weathering the stress storm is the upper Midwest region, including North and South Dakota, Nebraska, Kansas, Minnesota, Iowa, Montana, Wisconsin and Illinois, where fewer than 8 percent of residents reported frequent mental distress.

And in a finding that should come as no surprise to anyone who has visited its pristine beaches, Hawaii was the most kicked-back state of all, with just 6.6 percent of residents reporting frequent mental distress.

"We were somewhat surprised to see the differences over geographic areas in levels of frequent mental distress," Zack said. "They were fairly substantial differences."

The data, which was also broken down by county, was collected as part of the Behavioral Risk Factor Surveillance System.

Reasons for the differences in emotional distress and stress levels might include socioeconomic disparities and levels of chronic illnesses, such as cardiovascular disease and diabetes, Zack said.

States that tended to have higher rates of mental distress are also those with higher rates of poverty, which can lead to financial strain, poorer health and less access to doctors and mental health services.

Although the recession had not yet hit when the surveys used in the study were last taken, Zach speculated that stress levels may have already been increasing, with workers feeling more pressure to produce and rising health-care costs leading some to put off seeking medical or mental health care.

Joshua Klapow, an associate professor of psychology and public health at the University of Alabama at Birmingham, said the study results were not surprising.

"What this speaks to is that psychological distress is quite prevalent and that rates tend to be higher in states with the poorest health status and the lowest socioeconomic status," Klapow said.

However, he said, the research says little about the degree of the psychological distress, such as how many people have a diagnosable mental health problem such as bipolar or anxiety disorder versus how many are just feeling upset because of financial worry, a marital breakup or a transitory issue.

"One of the problems with the study is that it's very limited in the inferences we can draw about the causes of the stress," Klapow said.

More information

The American Academy of Family Physicians has more on coping with stress.

SOURCES: Matthew Zack, M.D., M.P.H., medical epidemiologist, U.S. Centers for Disease Control and Prevention, Atlanta; Joshua Klapow, Ph.D., associate professor, psychology and public health, University of Alabama at Birmingham; June 2009 American Journal of Preventive Medicine

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