2020 Mind Diagnostics
Mental Health

A nation in pain

Insights based on analysis of over 3 million online mental health test results.


Over 44 million American adults have a diagnosable mental health condition. We’re a nation in pain. In this inaugural report we present findings from our analysis of over 3 million mental health test results generated through our web and mobile applications.

The results confirm worrying trends and further confirm the relationship between economic disadvantage and mental illness.

But there were some surprises too:

  • Moving into this election year, 2016 Trump-voting counties show elevated rates of anxiety, panic disorder, depression, and social anxiety compared to the national average.
  • Unlike most mental health issues which increase with economic disadvantage, addiction has become a serious problem among the most wealthy Americans.
  • New York and Los Angeles, reflecting a broader bi-coastal trend, are the least depressed cities in America.

We'd love to hear your thoughts on the report and how you're thinking about the mental health challenges facing us today. Feel free to email us at

Michael Mayers
Mind Diagnostics

US Regions

Bicoastal blessings: The West and Northeast have the lowest rates of mental illness

Dividing the US into 6 geographic regions we noted significant variance in rates of depression, anxiety, PTSD, adult ADHD, addiction, and social anxiety.

The Northeast showed significantly lower rates of mental illness scoring below the national average on all six issues. And while the West had the highest rate of substance & alcohol addiction - an area for concern - it otherwise presented a similar picture to the Northeast.

This bicoastal effect is reversed in the rest of the country with comparatively elevated rates of mental illness in the Southeast (highest for anxiety and PTSD), the Rocky Mountains (highest for adult ADHD and social anxiety), and the Southwest (highest for depression).


New York is the least depressed city in America

Delving deeper into our regional analysis, we isolated results from the 15 largest metropolitan areas in the US.

Our researchers, while conducting their analysis to a background symphony of honking and sirens, were surprised to find that rates of depression, panic disorder, and PTSD were lowest in New York City compared to the other 14 most populous cities in the US, and by a significant margin.

The data for the rest of the cities reinforces the bicoastal effect described above: New York, Los Angeles, San Jose, San Diego, and San Francisco all show markedly lower rates of mental illness compared to cities elsewhere in the country.

We hypothesize that economic advantage, easier access to treatment, and reduced social stigma may be responsible for this substantial divergence.


Mental health issues continue to blight our rural communities

We matched test-takers to one of three categories for population density:

  • Bottom 10% (most rural)
  • Middle 80%
  • Top 10% (most urban)

We found increased rates of depression, anxiety, adult ADHD, and social anxiety in the most rural areas. Of particular note was the substantial divergence in rates of social anxiety between the most rural and most urban areas.

The higher prevalence of mental health issues in areas of lower population density is well documented with contributing factors including socioeconomic disadvantage, social stigma, and a shortage of specialist mental health services creating a perfect storm of missed treatment opportunities.

More surprising was the significantly lower prevalence of addiction in rural areas compared to our most densely populated urban areas. This divergence warrants further study.


White populations suffer higher rates of panic disorder and social anxiety

The data allowed us to analyze the racial mix of areas within which test-takers resided, allowing us to gain a broad view on racial disparities in test results.

Areas with a greater proportion of white people presented higher rates of adult ADHD, panic disorder, and social anxiety as well as more modest but still elevated rates of depression, generalized anxiety disorder, and eating disorders.

These results corroborate other research showing that white Americans present higher rates of generalized anxiety disorder, panic disorder, and social anxiety compared to African Americans.

The reasons for these racial disparities are less clear. Some researchers have hypothesized that increased religiosity and the attendant sense of community within minority groups, coupled with language or cultural differences in the conceptualization or description of mental health symptoms may play a role.

Note: Unfortunately there was insufficient data to report conclusively on minority ethnic groups other than white and Caribbean Black/African American, and our racial mix reference data did not include data for Hispanic/Latino. This is something we hope to address in next year’s report.


Trump-voting counties suffer more mental illness

Taking the 2016 General Election results we classified each US county as either Trump-majority or Clinton-majority and segmented test results on that basis.

Trump-majority counties showed significantly higher rates of depression, anxiety, PTSD, adult ADHD, panic disorder, and social anxiety compared to Clinton-majority counties.

Given the current tone of our political debate we would urge caution in drawing partisan conclusions from these findings. In particular, we note that our analysis was conducted at the county, rather than individual, level. In other words the results for a Trump-voting county include individuals in that county who voted for Clinton and vice versa.

Nonetheless we’d encourage candidates of all political stripes to do some soul-searching on the state of mental health in America and speak to our most mentally distressed populations when creating their platform for 2020.


Bachelor’s degrees are the turning point for mental health

Our analysis allowed us to compare the density of high-school diploma, bachelor’s degree, and graduate degree holders within the areas in which test-takers resided.

Areas with the greatest density of bachelor's degree holders showed significantly lower prevalance on a range of mental issues including PTSD, social anxiety, generalized anxiety and, in particular, depression.

This is hardly surprising given the relationship between bachelor's degree density and economic advantage. Interestingly, areas with the highest density of bachelor’s degrees showed higher rates of addiction compared to more moderately dense areas which correlates with our findings on affluence and addiction below.


Addiction is a poor AND a rich problem

Our research team had access to a range of indicators which in combination allowed us to derive a picture of the overall economic advantage or disadvantage in the area in which the test-taker lives. These include the percentage of that area’s population in poverty, average income, and average home value.

Just as we might expect, areas with greater economic disadvantage associated strongly with depression and anxiety compared to more affluent areas.

Taking average home value as a broad indicator of an area’s level of economic advantage, we also found that both the top and bottom quartiles for home value had a positive association with alcohol and substance addiction. This supports findings from Rutgers University Center of Alcohol Studies that found alcohol and marijuana use in young adulthood were associated with higher childhood family socioeconomic status (SES).

About Mind Diagnostics

Through our website and mobile apps we enable anyone concerned with their mental health to take self-directed screens such as depression, anxiety, borderline personality disorder, and many others.

Providing instant, confidential, on-screen results, concerned users can also search for and find a therapist. Users are also able to track their results over time, make notes relating to each test, and send test results to a mental health professional or support person.

Founded in 2017, and based in New York, Mind Diagnostics is on a mission to destigmatize mental health issues and encourage sufferers to find professional support. In service of that goal over 4 million screening tests have been delivered to more than 1.5 million people in 124 countries worldwide.


Full methodological notes can be found in the downloadable report.


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Academic Inquiries

If you are from an academic institution and would like to access our data set for this analysis please contact us at with "Research Inquiry" in the subject line.

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