YOUTH MENTAL HEALTH IS WORSENING AND ACCESS TO CARE IS LIMITED THERE IS A SHORTAGE OF PROVIDERS HEALTHCARE REFORM IS HELPING

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5 MENTAL HEALTH AND SUBSTANCE USE CONDITIONS ARE COMMON MOST AMERICANS LACK ACCESS TO CARE OF AMERICAN ADULTS WITH A MENTAL ILLNESS DID NOT RECEIVE TREATMENT ONE IN FIVE REPORT AN UNMET NEED NEARLY HALF HAVE A CO-OCCURRING SUBSTANCE ABUSE DISORDER YOUTH MENTAL HEALTH IS WORSENING AND ACCESS TO CARE IS LIMITED THERE IS A SHORTAGE OF PROVIDERS IN ALABAMA, THERE S ONLY ONE MENTAL HEALTH PROFESSIONAL PER 1,260 PEOPLE HEALTHCARE REFORM IS HELPING 5 T H E S T A T E O F M E N T A L H E A L T H I N A M E R I C A 20 18

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9 Massachusetts South Dakota Minnesota Vermont Connecticut Iowa North Dakota Maine Hawaii New Jersey Illinois Maryland New York Delaware District of Columbia Pennsylvania Michigan Nebraska Kansas Ohio New Mexico Kentucky Rhode Island California Wisconsin Georgia Montana Alaska New Hampshire Missouri Wyoming North Carolina Florida Washington Arkansas Oklahoma Utah Louisiana Texas Virginia Alabama West Virginia Colorado Oregon South Carolina Tennessee Idaho Indiana Arizona Mississippi Nevada

10 Rank State 1 Massachusetts 2 Iowa 3 Hawaii 4 North Dakota 5 South Dakota 6 Maine 7 Minnesota 8 Illinois 9 New Jersey 10 Connecticut 11 Wisconsin 12 Delaware 13 New York 14 Maryland 15 California 16 Pennsylvania 17 Vermont 18 Texas 19 Michigan 20 Rhode Island 21 Nebraska 22 Kansas 23 Virginia 24 Florida 25 New Mexico 26 Arkansas 27 Alabama 28 Ohio 29 Georgia 30 Wyoming 31 West Virginia 32 Kentucky 33 District of Columbia 34 Montana 35 Oklahoma 36 Missouri 37 North Carolina 38 Washington 39 South Carolina 40 Colorado 41 Louisiana 42 Arizona 43 Mississippi 44 Tennessee 45 Idaho 46 New Hampshire 47 Indiana 48 Oregon 49 Alaska 50 Nevada 51 Utah 10

11 Rank State 1 South Dakota 2 Vermont 3 Minnesota 4 Massachusetts 5 Connecticut 6 North Dakota 7 District of Columbia 8 Iowa 9 New Jersey 10 Pennsylvania 11 Ohio 12 Maine 13 Illinois 14 Maryland 15 Kentucky 16 Alaska 17 Michigan 18 New York 19 Kansas 20 Georgia 21 Nebraska 22 New Hampshire 23 Delaware 24 Utah 25 New Mexico 26 Montana 27 Hawaii 28 Alabama 29 North Carolina 30 Missouri 31 Louisiana 32 Tennessee 33 Rhode Island 34 West Virginia 35 Washington 36 Wyoming 37 Florida 38 Indiana 39 California 40 Idaho 41 Oregon 42 South Carolina 43 Wisconsin 44 Texas 45 Oklahoma 46 Arkansas 47 Virginia 48 Colorado 49 Mississippi 50 Arizona 51 Nevada 11

12 Rank State 1 South Dakota 2 Hawaii 3 Georgia 4 North Dakota 5 Texas 6 New Jersey 7 South Carolina 8 Alabama 9 Illinois 10 Florida 11 Mississippi 12 Iowa 13 Kansas 14 Louisiana 15 Maryland 16 Tennessee 17 Missouri 18 Connecticut 19 District of Columbia 20 Nebraska 21 Pennsylvania 22 New York 23 Michigan 24 California 25 Oklahoma 26 Minnesota 27 Arkansas 28 Virginia 29 Delaware 30 North Carolina 31 New Mexico 32 Kentucky 33 Massachusetts 34 Montana 35 Wyoming 36 Ohio 37 Utah 38 West Virginia 39 Idaho 40 Maine 41 Washington 42 Wisconsin 43 Nevada 44 Alaska 45 Arizona 46 Vermont 47 Indiana 48 Rhode Island 49 Colorado 50 New Hampshire 51 Oregon 12

13 Rank State 1 Vermont 2 Massachusetts 3 Minnesota 4 Maine 5 Connecticut 6 Rhode Island 7 New Hampshire 8 South Dakota 9 Iowa 10 Delaware 11 New York 12 Oregon 13 Wisconsin 14 Ohio 15 North Dakota 16 Michigan 17 Colorado 18 Pennsylvania 19 Maryland 20 Alaska 21 District of Columbia 22 Illinois 23 New Mexico 24 Hawaii 25 Kentucky 26 New Jersey 27 Nebraska 28 Washington 29 Montana 30 California 31 Wyoming 32 Kansas 33 Indiana 34 Utah 35 West Virginia 36 North Carolina 37 Idaho 38 Arkansas 39 Arizona 40 Missouri 41 Oklahoma 42 Virginia 43 Georgia 44 Florida 45 Louisiana 46 Tennessee 47 Nevada 48 Alabama 49 Texas 50 South Carolina 51 Mississippi 13

14 Rank State % # 1 Hawaii ,000 2 Texas ,127,000 3 Illinois ,570,000 4 New Jersey ,107,000 5 Maryland ,000 6 Florida ,630,000 7 North Dakota ,000 8 California ,997,000 9 Iowa , New York ,638, Connecticut , Georgia ,299, Kansas , South Carolina , South Dakota , Nevada , District of Columbia , Mississippi , Missouri , Arkansas , Michigan ,373, Alaska , Nebraska , Pennsylvania ,803, Arizona , Louisiana ,000 Rank State % # 27 Delaware , Wisconsin , Minnesota , Alabama , Massachusetts ,008, Maine , Oklahoma , Virginia ,203, North Carolina ,459, Wyoming , Colorado , Washington ,062, Tennessee , New Mexico , Montana , Ohio ,778, Vermont , Idaho , Utah , Rhode Island , Indiana ,014, West Virginia , Kentucky , Oregon , New Hampshire ,000 National ,486,000 14

15 Rank State Weighted Sum of Z scores Adult Alcohol Dependence and Marijuana, Heroin, Cocaine Use 1 Mississippi Utah Iowa Arkansas Alabama Kansas Texas North Dakota Tennessee Oklahoma Idaho Missouri Georgia West Virginia South Dakota Virginia Nebraska Florida North Carolina Hawaii Michigan Wyoming Wisconsin Minnesota South Carolina Indiana Rank State Weighted Sum of Z scores Adult Alcohol Dependence and Marijuana, Heroin, Cocaine Use 27 Illinois Nevada Ohio New Jersey Kentucky Louisiana Montana Pennsylvania Washington Maine California Maryland New Mexico Massachusetts Delaware Arizona New York Oregon Rhode Island Connecticut New Hampshire Colorado Vermont Alaska District of Columbia National

16 Rank State % 1 Maine Alabama Utah Arkansas Tennessee Mississippi New Jersey Kansas Florida Iowa Georgia Washington Michigan Missouri West Virginia Hawaii Texas Delaware Minnesota North Carolina Illinois Kentucky Oklahoma Wisconsin North Dakota South Carolina 3.09 Rank State % 27 Virginia Maryland Idaho Massachusetts Pennsylvania Nevada Ohio Connecticut Indiana Nebraska South Dakota New York Wyoming Montana California Rhode Island New Hampshire Oregon Louisiana Arizona Vermont Alaska Colorado District of Columbia New Mexico National

17 Rank State % 1 Mississippi Iowa Utah Alabama North Dakota Texas Wyoming South Dakota Nebraska West Virginia Tennessee Idaho Oklahoma Louisiana Arkansas Virginia New Jersey North Carolina Wisconsin Ohio Kentucky Kansas Pennsylvania Florida Illinois South Carolina Rank State % 27 Hawaii Georgia Minnesota Nevada Delaware Arizona Missouri Indiana New Mexico Maryland Michigan New York California Montana Connecticut New Hampshire Washington Massachusetts Rhode Island Oregon Maine Vermont Alaska Colorado District of Columbia National

18 .12% 1.36% Rank State % 1 Texas Iowa Kansas Mississippi Georgia Louisiana Arkansas Montana New Mexico California North Carolina North Dakota Nebraska Oklahoma Hawaii Florida Utah Massachusetts Missouri Tennessee South Dakota Alabama Idaho South Carolina Indiana Idaho 0.92 Rank State % 27 Nevada Illinois Oregon Minnesota West Virginia Virginia Wyoming Michigan Ohio Colorado Washington Rhode Island New York Kentucky Pennsylvania Arizona Maine District of Columbia New Hampshire New Jersey Vermont Connecticut Maryland Delaware Alaska 1.36 National.35 18

19 .94% 3.35% Rank State % 1 Utah Mississippi South Dakota Idaho Iowa Wyoming Arkansas Oklahoma North Dakota Kansas Alabama Virginia Indiana Michigan Missouri Nebraska Texas Nevada Ohio Montana Maryland Minnesota Tennessee West Virginia Wisconsin Kentucky 1.69 Rank State % 27 Pennsylvania South Carolina New Jersey Georgia Louisiana Maine North Carolina Illinois Washington Hawaii Florida New Mexico Alaska Oregon California Delaware Arizona Connecticut Massachusetts Rhode Island New York Vermont Colorado New Hampshire District of Columbia 3.35 National

20 Rank State % # 1 Texas ,000 2 Connecticut ,000 3 Florida ,000 4 Maryland ,000 5 South Dakota ,000 6 South Carolina ,000 7 New Jersey ,000 8 California ,115,000 9 New York , Hawaii , Massachusetts , Illinois , Missouri , Iowa , Virginia , North Dakota , Oklahoma , Alabama , Delaware , Georgia , Minnesota , New Mexico , Maine , Pennsylvania , Mississippi , Wyoming ,000 Rank State % # 27 Kansas , Michigan , Indiana , District of Columbia , Nebraska , Wisconsin , Louisiana , North Carolina , West Virginia , Tennessee , Arizona , Oregon , Idaho , Arkansas , Rhode Island , Nevada , Colorado , Washington , Vermont , Ohio , Kentucky , Alaska , New Hampshire , Montana , Utah ,000 National ,653,000 20

21 Rank State % # 1 Hawaii ,000 2 South Dakota ,000 3 District of Columbia ,000 4 Georgia ,000 5 New Jersey ,000 6 North Dakota ,000 7 Tennessee ,000 8 South Carolina ,000 9 Alabama , Louisiana , Maryland , Kentucky , Mississippi , Kansas , Illinois , Montana , Delaware , Connecticut , Missouri , New Mexico , Texas , Pennsylvania , Michigan , Ohio , Iowa , Florida ,000 Rank State % # 27 New York , Utah , Vermont , Nebraska , California , North Carolina , Massachusetts , Alaska , Virginia , Maine , Washington , Minnesota , Oklahoma , Arkansas , Idaho , Rhode Island , Arizona , West Virginia , Wyoming , New Hampshire , Wisconsin , Colorado , Nevada , Oregon , Indiana ,000 National ,969,000 21

22 Rank State Weighted Sum of Z scores 1 Mississippi Alabama Louisiana North Carolina Utah Georgia Iowa Tennessee South Carolina District of Columbia Oklahoma Virginia Missouri Nebraska South Dakota Arkansas Minnesota Florida North Dakota Ohio Kansas Illinois Maryland Pennsylvania Kentucky Idaho Rank State Weighted Sum of Z scores 27 Wyoming Michigan Montana West Virginia Indiana Hawaii Delaware New Jersey Massachusetts Texas Connecticut Alaska New York Wisconsin Washington Maine Nevada Rhode Island California New Mexico Oregon New Hampshire Vermont Arizona Colorado National Center for Substance Abuse Treatment. Substance Abuse Treatment and Family Therapy. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); (Treatment Improvement Protocol (TIP) Series, No. 39.) Chapter 5 Specific Populations. Available from: 22

23 Rank State % 1 Maryland Tennessee Alabama South Carolina North Carolina Kentucky Virginia Missouri District of Columbia Hawaii Oklahoma Georgia Minnesota Mississippi Louisiana Maine Florida Alaska New Hampshire Pennsylvania Illinois New Jersey Massachusetts Delaware Nebraska Idaho 0.92 Rank State % 27 Connecticut Washington Montana Iowa Kansas Utah South Dakota Michigan Ohio Arkansas West Virginia Rhode Island Vermont North Dakota Wisconsin Indiana New York Nevada Oregon Wyoming California Arizona Colorado Texas New Mexico 1.23 National.95 23

24 % (Alaska) Rank State % 1 Utah Iowa Mississippi Alabama Louisiana Nebraska South Dakota Tennessee Ohio Virginia Minnesota North Carolina Illinois Kentucky Georgia Texas Oklahoma North Dakota Pennsylvania South Carolina Arkansas West Virginia New Jersey Kansas Missouri Delaware Rank State % 27 New York Wyoming Idaho Arizona Florida Nevada Hawaii Indiana Wisconsin Michigan California Maryland Montana New Mexico Washington Connecticut Massachusetts Rhode Island New Hampshire District of Columbia Vermont Maine Oregon Colorado Alaska National Medical marijuana laws and adolescent marijuana use in the USA from 1991 to 2014: results from annual, repeated cross-sectional surveys Hasin, Deborah S et al.the Lancet Psychiatry, Volume 2, Issue 7,

25 .04% (District of Columbia).22% Rank State % 1 District of Columbia Wyoming Louisiana Mississippi Texas Georgia North Carolina Iowa Florida Kansas Arkansas Montana North Dakota New Mexico Massachusetts Nebraska Oklahoma Alaska Alabama Missouri South Carolina Tennessee South Dakota Utah California Connecticut 0.10 Rank State % 27 Idaho Hawaii Illinois Indiana Minnesota Virginia New York Ohio Michigan West Virginia Wisconsin Oregon Colorado Rhode Island Nevada Pennsylvania Delaware Washington Maryland New Jersey Maine Kentucky Vermont Arizona New Hampshire 0.22 National

26 .34% (District of Columbia).98% (Colorado) Rank State % 1 District of Columbia Mississippi Utah Alabama Louisiana Michigan Maryland Virginia Iowa Arkansas South Dakota Missouri South Carolina Oklahoma Ohio Indiana Georgia North Carolina Pennsylvania Tennessee Nebraska Wyoming Delaware Kentucky North Dakota Minnesota Rank State % 27 Idaho West Virginia Illinois New Jersey Kansas Montana Florida Alaska Maine Connecticut Washington Texas Massachusetts Nevada Wisconsin New York Rhode Island Hawaii Oregon Vermont New Mexico New Hampshire Arizona California Colorado 0.98 National

27 Rank State % # 1 South Dakota 5.4 4,000 2 Kentucky ,000 3 Georgia ,000 4 New Mexico 5.8 9,000 5 Montana 5.9 4,000 6 North Dakota 6.0 3,000 7 Hawaii 6.2 6,000 8 Tennessee ,000 9 New Jersey , District of Columbia 6.7 2, Alabama , Louisiana , South Carolina , New York , Pennsylvania , Texas , Nebraska , Utah , Kansas , California , Illinois , Ohio , Connecticut , Florida , Minnesota , Massachusetts ,000 Rank State % # 27 West Virginia , Vermont 8.5 4, Alaska 8.7 5, Michigan , New Hampshire 8.7 8, Wyoming 8.8 4, Mississippi , Iowa , Delaware 8.9 6, Arkansas , Oklahoma , Washington , Idaho , Maryland , Missouri , North Carolina , Virginia , Maine , Nevada , Arizona , Colorado , Wisconsin , Rhode Island , Indiana , Oregon ,000 National 8.2 1,996,000 27

28 Rank State % # 1 Maine ,000 2 Vermont ,000 3 Minnesota ,000 4 Iowa ,000 5 Massachusetts ,104,000 6 Montana ,000 7 New Hampshire ,000 8 Rhode Island ,000 9 North Carolina , Delaware ,557, Kentucky , Oregon , Wyoming , Idaho , Missouri , Wisconsin , Connecticut , Ohio , Virginia , Pennsylvania , Illinois , Kansas , Michigan , West Virginia , Alabama , South Dakota ,000 Rank State % # 27 Arkansas , Indiana , North Dakota , Washington , Utah , Oklahoma , New York ,468, New Mexico , Colorado , Georgia , Nebraska , Tennessee , Mississippi , Louisiana , New Jersey , South Carolina , Arizona , District of Columbia ,890, Maryland , Texas , California , Florida , Hawaii , Alaska , Nevada ,000 National ,280,000 28

29 Rank State % # 1 Hawaii ,000 2 Massachusetts ,000 3 Texas ,000 4 Delaware ,000 5 New Jersey ,000 6 Rhode Island ,000 7 New Mexico ,000 8 California ,000 9 Florida , Montana , New York , Wisconsin , Maine , Nebraska , Alaska , Georgia , Arkansas , South Dakota , Louisiana , Alabama , Tennessee , Maryland , Ohio , Michigan , Vermont , Iowa ,000 Rank State % # 27 Wyoming , Pennsylvania , Arizona , North Dakota , Illinois , South Carolina , Connecticut , Oklahoma , Colorado , Virginia , West Virginia , Nevada , Kansas , Utah , Mississippi , Kentucky , Washington , New Hampshire , Minnesota , North Carolina , Oregon , Indiana , Idaho , Missouri , District of Columbia ,000 National ,752,000 29

30 Rank State % # 1 Massachusetts ,000 2 District of Columbia 4.9 5,000 3 Hawaii ,000 4 Vermont 5.6 6,000 5 Minnesota ,000 6 Kentucky ,000 7 Rhode Island ,000 8 Colorado ,000 9 Wisconsin , Connecticut , Iowa , Pennsylvania , New York , North Dakota , New Mexico , New Hampshire , Delaware , New Jersey , Maryland , South Dakota , Ohio , Washington , West Virginia , Michigan , California , Maine ,000 Rank State % # 27 Illinois , Oregon , Virginia , Alaska , North Carolina , Nebraska , Arizona , Indiana , Louisiana , Utah , Oklahoma , Arkansas , Kansas , Montana , Nevada* , Georgia , Alabama , Idaho , Mississippi , Wyoming , Florida , Missouri , Texas , Tennessee , South Carolina ,000 National ,389,000 30

31 Rank State % # 1 Hawaii ,097 2 Iowa ,455 3 Vermont ,144 4 North Dakota ,981 5 New Hampshire ,019 6 Massachusetts ,320 7 District of Columbia ,597 8 Minnesota ,523 9 Illinois , Kentucky , Maine , South Dakota , Rhode Island , Colorado , Connecticut , Washington , Wisconsin , Ohio , Montana , Maryland , California ,006, New York , Kansas , Oregon , Nebraska , Delaware ,943 Rank State % # 27 West Virginia , Pennsylvania , Idaho , Alaska , New Mexico , Wyoming , Michigan , Virginia , Utah , New Jersey , Indiana , Missouri , Arkansas , Arizona , Nevada , Tennessee , North Carolina , Oklahoma , Alabama , Georgia , Florida , South Carolina , Louisiana , Texas , Mississippi ,133 National ,663,174 Bradford, Kim, Braxton, and others, "Access to medical care among persons with psychotic and major affective disorders," Psychiatric Services 59(8), pp , 2008 (AHRQ grant HS13353). 31

32 Rank State % # 1* Connecticut ,000 2 Maine ,000 3 Vermont ,000 4 Minnesota ,000 5 Alaska ,000 6 Oregon ,000 7 Massachusetts ,000 8 Maryland ,000 9 Wyoming , Iowa , Ohio , New Hampshire , South Dakota , Delaware , West Virginia , Idaho , New York , Rhode Island , Illinois , Michigan , Colorado , Nebraska , Arizona , North Carolina , Washington , North Dakota ,000 Rank State % # 27 Indiana , Oklahoma , Kansas , New Jersey , Nevada , District of Columbia , Montana , Utah , Kentucky , California , Louisiana , Georgia , Missouri , Pennsylvania , Arkansas , Hawaii , Florida , Alabama , New Mexico , Texas , Mississippi , South Carolina , Virginia , Wisconsin , Tennessee ,000 National ,548,000 Due to data limitations, figures were taken from two sets of data: annual averages from and Data set denoted for each state in the Appendix- Table

33 High percentages are associated with positive outcomes and low percentages are associated with poorer outcomes. Rank State % # 1 Minnesota ,000 2 South Dakota ,000 3 Vermont ,000 4 Alaska ,000 5 Massachusetts ,000 6 Maine ,000 7 New Hampshire ,000 8 North Dakota ,000 9 Colorado , Ohio , Oregon , Michigan , Utah , New York , Kansas , West Virginia , Nebraska , Iowa , Wyoming , Delaware , Rhode Island , New Jersey , Illinois , Connecticut , North Carolina , Pennsylvania ,000 Rank State % # 27 Arkansas , Maryland , Washington , Louisiana , Indiana , New Mexico , California , Arizona , Wisconsin , Alabama , Idaho , Kentucky , Texas , Hawaii , Missouri , Florida , Oklahoma , District of Columbia < 1, Virginia , South Carolina , Nevada , Montana < 1, Tennessee , Georgia , Mississippi ,000 National ,000 Due to data limitations, figures were taken from three sets of data: annual averages from , , and Data set denoted for each state in the Appendix-Table 2 33

34 Massachusetts 2.4 7,000 Connecticut 2.7 4,000 South Dakota 4.2 1,000 Wisconsin ,000 Indiana ,000 New Hampshire 4.5 3,000 Michigan ,000 New Mexico 4.7 3,000 Vermont 4.7 1,000 Oregon 5.0 7,000 New Jersey ,000 Minnesota ,000 Rhode Island 5.4 2,000 Pennsylvania ,000 Kentucky ,000 Maryland ,000 Kansas 6.1 7,000 Washington ,000 Montana 6.6 2,000 New York ,000 District of Columbia 6.7 1,000 Colorado ,000 Delaware 6.9 3,000 Tennessee ,000 Illinois ,000 Missouri ,000 Utah ,000 Alaska 7.6 2,000 North Carolina ,000 Iowa ,000 California ,000 Maine 8.1 4,000 North Dakota 8.1 3,000 Ohio ,000 Nebraska 8.3 6,000 Georgia ,000 Virginia ,000 Arizona ,000 Idaho 9.7 6,000 Florida ,000 Arkansas ,000 West Virginia ,000 Nevada ,000 Alabama ,000 Hawaii ,000 Texas ,000 South Carolina ,000 Oklahoma ,000 Wyoming ,000 Louisiana ,000 Mississippi ,000 National ,000

35 High percentages are associated with positive outcomes and low percentages are associated with poorer outcomes. 35 Vermont ,968 Minnesota ,736 Massachusetts ,137 Wisconsin ,217 Pennsylvania ,322 District of Columbia Maine ,234 Indiana ,642 Iowa ,610 Rhode Island ,629 New Hampshire ,107 Connecticut ,395 Illinois ,198 New York ,377 Ohio ,979 South Dakota ,099 North Dakota Oregon ,704 Nebraska ,313 Michigan ,325 Virginia ,398 Maryland ,203 Mississippi ,544 Missouri ,439 Georgia ,546 Arizona ,456 Kentucky ,422 Colorado ,624 Oklahoma ,078 Delaware Wyoming Florida ,333 New Mexico ,959 New Jersey ,955 Montana Texas ,558 Hawaii Alaska Idaho ,422 West Virginia ,284 Kansas ,290 Washington ,601 Nevada ,826 California ,199 North Carolina ,462 Tennessee ,237 South Carolina ,418 Utah ,871 Louisiana ,763 Alabama ,348 Arkansas National ,609

36 6 200:1 (Massachusetts) :1 (Alabama) 5 Health Resources & Services Administration, Shortage Designation: Health 6 United States. (2013). Report to Congress on the nation's substance abuse and mental health workforce issues. Massachusetts 200:1 District of Columbia 230:1 Maine 240:1 Oregon 250:1 Vermont 260:1 Oklahoma 270:1 New Mexico 280:1 Rhode Island 290:1 Alaska 300:1 Connecticut 310:1 California 350:1 Colorado 350:1 Wyoming 350:1 Missouri 360:1 Washington 360:1 Utah 380:1 New Hampshire 390:1 Montana 410:1 New York 420:1 Nebraska 440:1 Delaware 460:1 Michigan 460:1 Hawaii 470:1 Maryland 490:1 North Carolina 490:1 Arkansas 510:1 Minnesota 510:1 Idaho 550:1 Kentucky 560:1 Illinois 580:1 Kansas 580:1 Nevada 580:1 New Jersey 580:1 Louisiana 600:1 Pennsylvania 600:1 Wisconsin 600:1 Ohio 630:1 North Dakota 640:1 South Dakota 660:1 South Carolina 680:1 Indiana 730:1 Virginia 730:1 Florida 750:1 Tennessee 780:1 Iowa 820:1 Mississippi 820:1 Arizona 850:1 Georgia 900:1 West Virginia 950:1 Texas 1070:1 Alabama 1260:1 National 536:1

37 Spotlight: Online Depression Screening 7 Christensen, K. S., Toft, T., Frostholm, L., Ørnbøl, E., Fink, P., & Olesen, F. (2005). Screening for common mental disorders: who will benefit? Results from a randomised clinical trial. Family practice, 22(4), Pignone, M. P., Gaynes, B. N., Rushton, J. L., Burchell, C. M., Orleans, C. T., Mulrow, C. D., & Lohr, K. N. (2002). Screening for depression in adults: a summary of the evidence for the US Preventive Services Task Force. Annals of internal medicine, 136(10), O Connor, E. A., Whitlock, E. P., Beil, T. L., & Gaynes, B. N. (2009). Screening for depression in adult patients in primary care settings: a systematic evidence review. Annals of Internal Medicine, 151(11),

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40 1 District of Columbia 7.54% 19.83% 28.59% 24.57% 19.46% % 2 Minnesota 4.96% 14.58% 26.77% 29.18% 24.51% % 3 North Dakota 5.23% 15.61% 24.65% 29.87% 24.65% % 4 Utah 12.18% 16.64% 21.99% 24.53% 24.68% % 5 Massachusetts 3.20% 14.46% 27.78% 29.57% 24.99% % 6 Maryland 4.02% 13.79% 25.78% 30.55% 25.86% % 7 Nebraska 7.84% 13.90% 24.17% 27.65% 26.43% % 8 Iowa 3.68% 12.97% 26.06% 30.17% 27.12% % 9 Delaware 3.53% 12.78% 24.94% 31.23% 27.52% % 10 New York 3.50% 12.75% 25.79% 30.42% 27.54% % 11 Connecticut 3.15% 13.21% 25.65% 30.31% 27.67% % 12 Rhode Island 2.46% 13.51% 25.68% 30.65% 27.70% % 13 New Jersey 3.58% 12.63% 25.09% 30.97% 27.73% % 14 Wisconsin 3.70% 13.03% 24.76% 30.78% 27.73% % 15 Vermont 3.32% 15.21% 25.53% 28.20% 27.74% % 16 Illinois 3.41% 12.91% 24.74% 31.01% 27.94% % 17 Colorado 3.84% 13.51% 23.97% 30.69% 27.99% % 18 Pennsylvania 3.23% 12.41% 25.33% 31.02% 28.00% % 19 New Hampshire 2.82% 13.11% 25.21% 30.56% 28.30% % 20 South Dakota 4.90% 13.04% 26.00% 27.66% 28.41% % 21 Wyoming 4.18% 12.64% 25.76% 28.99% 28.42% % 22 California 3.70% 12.58% 24.71% 30.54% 28.46% % 23 Hawaii 4.47% 11.59% 24.22% 31.02% 28.70% % 24 Montana 3.38% 13.03% 23.82% 30.81% 28.97% % 25 Virginia 3.15% 12.36% 24.46% 31.03% 29.00% % 26 Michigan 3.13% 12.00% 25.17% 30.62% 29.08% % 27 Alaska 3.96% 13.44% 24.15% 29.17% 29.27% % 28 Oregon 3.36% 12.28% 24.73% 30.34% 29.29% % 29 North Carolina 3.45% 12.32% 24.62% 30.27% 29.34% % 30 Missouri 3.08% 12.06% 24.27% 30.68% 29.91% % 31 Georgia 6.86% 11.15% 22.91% 29.08% 30.00% % 32 Kansas 3.07% 12.26% 24.02% 30.63% 30.02% % 33 Ohio 2.94% 11.15% 24.52% 31.35% 30.04% % 34 Washington 2.90% 12.19% 24.43% 30.17% 30.31% % 35 Maine 2.76% 11.00% 24.22% 31.48% 30.54% % 36 Indiana 3.94% 11.53% 23.74% 30.09% 30.70% % 37 Arkansas 4.34% 11.33% 22.75% 30.76% 30.82% % 38 Louisiana 2.76% 10.24% 23.96% 32.20% 30.83% % 39 Florida 3.63% 11.49% 23.25% 30.53% 31.10% % 40 Alabama 2.93% 10.84% 23.90% 31.22% 31.10% % 41 New Mexico 2.94% 11.13% 23.98% 30.55% 31.40% % 42 Arizona 4.17% 11.48% 22.67% 30.26% 31.42% % 43 Texas 2.88% 10.81% 23.44% 31.30% 31.57% % 44 Tennessee 3.10% 10.32% 23.90% 31.02% 31.67% % 45 Kentucky 2.57% 10.37% 22.81% 31.90% 32.36% % 46 Idaho 2.87% 10.69% 23.48% 30.59% 32.38% % 47 South Carolina 2.38% 10.51% 22.93% 31.32% 32.86% % 48 Mississippi 3.55% 9.88% 23.38% 30.28% 32.91% % 49 West Virginia 2.94% 10.07% 23.46% 29.93% 33.61% % 50 Oklahoma 2.21% 10.39% 23.24% 30.49% 33.66% % 51 Nevada 3.38% 9.89% 22.13% 30.87% 33.72% % National 3.67% 12.19% 24.44% 30.49% 29.22% % 40

41 100.00% 90.00% 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% '11-17' '18-24' '25-34' '35-44' '45-54' '55-64' '65+' Total Not at all to Several Days More than half to Nearly everyday 41

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45 40% 35% 30% 25% 20% 15% 10% 5% 0% 40% 35% 30% 25% 20% 15% 10% 5% 0% 45

46 45% 40% 35% 30% 25% 20% 15% 10% 5% 0%

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49 Moderate Depression among Race/Ethinicity by Income 250% 200% 150% 31% 29% 29% 32% 31% 30% 32% 29% 28% 35% 36% 31% 29% 29% 29% 27% 28% 33% 27% 26% 30% 100% 31% 32% 33% 37% 29% 32% 30% 32% 32% 31% 31% 32% 30% 31% 50% 0% 30% 31% 28% 30% 28% 29% 27% 31% 31% 31% 28% 28% 29% 28% Severe Depression among Race/Ethnicity by Income 250% 34% 200% 150% 100% 36% 38% 39% 35% 29% 31% 35% 35% 25% 29% 29% 31% 24% 21% 19% 20% 27% 25% 28% 28% 29% 32% 24% 32% 28% 30% 26% 31% 50% 34% 28% 26% 25% 23% 25% 22% 27% 25% 22% 20% 21% 22% 0% 31% 26% 24% 23% 23% 21% 21% 49

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51 What next steps do you plan to take after screening? 51

52 50.00% 45.00% 46.24% 40.00% 35.00% 34.00% 30.00% 25.00% 20.00% 15.00% 18.71% 24.84% 10.00% 7.41% 5.00% 0.00% 52

53 40.00% 37.07% 35.00% 30.00% 25.00% 27.37% 26.84% 31.57% 20.00% 15.00% 17.84% 17.78% 16.20% 15.26% 10.00% 5.00% 5.44% 4.63% 0.00% 53

54 45.00% 40.00% 35.00% 30.00% 25.00% 20.00% 15.00% 10.00% 5.00% 0.00% 28.74% 19.11% 23.51% 6.52% 40.61% Asian or Pacific Islander Black or African American (non- Hispanic) Hispanic Latino More than one of the above Native American or American Indian Other White (non- Hispanic) Total 54

55 35.00% 30.00% 30.79% 32.82% 25.00% 20.00% 20.80% 20.74% 15.00% 10.00% 5.00% 0.00% 55

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57 Rank State % # 1 Connecticut* ,000 2 Maine* ,000 3 Vermont* ,000 4 Minnesota* ,000 5 Alaska* ,000 6 Oregon ,000 7 Massachusetts* ,000 8 Maryland* ,000 9 Wyoming* , Iowa* , Ohio , New Hampshire , South Dakota* , Delaware* , West Virginia* , Idaho* , New York , Rhode Island , Illinois , Michigan , Colorado , Nebraska* , Arizona , North Carolina , Washington* , North Dakota* ,000 Rank State % # 27 Indiana , Oklahoma* , Kansas* , New Jersey* , Nevada , District of ,000 Columbia* 33 Montana* , Utah* , Kentucky* , California , Louisiana* , Georgia* , Missouri* , Pennsylvania , Arkansas* , Hawaii* , Florida , Alabama* , New Mexico* , Texas , Mississippi* , South Carolina* , Virginia , Wisconsin , Tennessee* ,000 National ,548,000 * Measures collected from Annual Averages based on , other measures are based on Annual Averages for

58 Rank State % # 1 Minnesota* ,000 2 South Dakota** ,000 3 Vermont** ,000 4 Alaska** ,000 5 Massachusetts* ,000 6 Maine* ,000 7 New Hampshire* ,000 8 North Dakota** ,000 9 Colorado* , Ohio , Oregon* , Michigan , Utah** , New York , Kansas* , West Virginia* , Nebraska** , Iowa* , Wyoming* , Delaware* , Rhode Island* , New Jersey* , Illinois , Connecticut* , North Carolina* , Pennsylvania ,000 Rank State % # 27 Arkansas* , Maryland* , Washington* , Louisiana** , Indiana* , New Mexico* , California , Arizona* , Wisconsin* , Alabama* , Idaho** , Kentucky* , Texas , Hawaii* , Missouri* , Florida , Oklahoma** , District of Columbia** 15.9 < 1, Virginia* , South Carolina** , Nevada* , Montana** 12.8 < 1, Tennessee** , Georgia* , Mississippi* ,000 National* ,000 *Measures collected from annual averages based on ** Measures collected from annual averages based on Unmarked states: measures collected from annual averages based on

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60 data/population-datansduh/reports?tab=38 s/annual_data/annual_2 014.html data/population-datansduh/reports?tab=38 60

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