Trends and Inflection Points in Poor Mental Health Among US Adults, 1993‒2024

Objectives. To describe long-term trends and inflection points in adult mental health in the United States. Methods. We estimated the annual prevalence of frequent mental distress (≥ 14 poor mental health days during the past 30 days) from more than 10 million US adults in the Behavioral Risk Factor Surveillance System survey between 1993 and 2024. We estimated trends and inflection points using joinpoint regression. We analyzed trends overall and for groups defined by sex, age, race/ethnicity, education, and income. Results. Age-adjusted prevalence of frequent mental distress doubled from 8.3% in 1993 to 16.4% in 2024. Annual increases in poor mental health were steeper from 2016 to 2024 than they had been in previous decades. Patterns varied across demographic groups, but we consistently observed that the mid-2010s was an inflection point marking the acceleration of poor mental health. Conclusions. While increasing poor mental health has been a persistent problem among American adults since at least 1993, this trend accelerated during the last decade. This inflection point preceded the COVID-19 pandemic. Health researchers should investigate the fundamental causes of this worsening trend. (Am J Public Health. Published online ahead of print October 1, 2026:e1-e8. https://doi.org/10.2105/AJPH.2026.308732).