Arkansans are struggling with depression and anxiety at rates among the highest in the nation, according to estimates from the Centers for Disease Control and Prevention and other reports.
Securing access to mental health care is an especially difficult obstacle for people, especially children, in the Natural State, experts say.
Recent CDC figures rank the state the second worst in the nation for the percentage of survey respondents who reported depression symptoms associated with diagnoses of major depressive disorder. Arkansas ranked seventh for reports of anxiety symptoms associated with diagnoses of generalized anxiety disorder.
The rankings reflect figures from Aug. 23 to Sept. 4, the most recent time frame for which the CDC reported the data on its National Health Center statistics page on depression and anxiety. According to the report, 26.1% of respondents in Arkansas reported symptoms of depression during the roughly two-week period. Only Mississippi ranked higher, at 26.6% of respondents.
The national estimate for reported symptoms of depression was 19%.
With regard to anxiety, 27.5% of Arkansans reported symptoms associated with diagnoses of generalized anxiety disorder over that same period. Mississippi ranked the worst in this category as well, at 31.3%.
The national estimate for reported anxiety symptoms was 24.2%.
However, Arkansas ranked worst in the nation in both depression and anxiety symptoms during the previous reporting period: July 26 to Aug. 7. In that time frame, 27.2% of respondents in Arkansas reported symptoms of depression, while 34.2% reported depression symptoms.
Nevada ranked second in terms of depression symptoms, at 27.1%, while Mississippi ranked second in terms of anxiety symptoms, at 33.6%. The national estimates for depression and anxiety symptoms during that period were 21.9% and 28.2%, respectively.
The figures come from the CDC's Household Pulse Survey. The "20-minute online survey" was developed through a partnership between the CDC's National Center for Health Statistics and the Census Bureau. It was initially designed to provide information about the impact of the coronavirus pandemic, according to the agency. The CDC began data collection April 23, 2020.
Medline Plus, a service of the National Library of Medicine, describes depression as a "serious mental illness" that is "more than just a feeling of being sad or 'blue' for a few days." Instead symptoms persist and can interfere with daily life. Those symptoms can include but aren't limited to: a loss of interest in daily activities; overeating or not wanting to eat at all; sleeping too much or struggling to get to sleep; and feeling hopeless, irritable, anxious or guilty.
More than 19 million teens and adults in the United States have depression, the service reports.
Causes of depression include genetic, biological, environmental and psychological factors, according to the service. Treatments can include antidepressants and talk therapy.
Anxiety is "a feeling of fear, dread, and uneasiness," according to Medline Plus. Anxiety disorders describe conditions in which the anxiety doesn't go away and may get worse over time.
While the service states the cause of anxiety is unknown, factors that contribute to anxiety can include genetics; stress, brain biology and chemistry as well as a person's environment. Cognitive Behavioral Therapy, medicines and education about stress management techniques are among the common treatments for anxiety.
STATE OF MENTAL HEALTH
A report from Mental Health America suggests possible factors contributing to the pervasiveness of depression and anxiety in Arkansas. The "State of Mental Health in America" report, published yearly by the national nonprofit, ranks mental health across the nation across a variety of categories.
For instance, the state is the eighth worst in the nation in the report's "youth rankings."
Maddy Reinert, Mental Health America's senior director of population health, said Arkansas' poor standing in that category is due more to low access to care than a high prevalence of mental health conditions among children.
"The indicator that drove Arkansas' Youth ranking down the most was Youth with Private Insurance that Did Not Cover Mental or Emotional Problems," Reinert said in an email on Friday.
In Arkansas, 23.2% of youth with private insurance didn't have coverage for mental or emotional problems, making it the worst for that category in the country, according to the report. Nationally, only 10.3% didn't have that coverage.
Arkansas is the second to worst state in terms of "Students Identified with Emotional Disturbance for an Individualized Education Program," ranking above only Alabama. An individualized education program (IEP) is a special education plan detailing "individualized services, supports, and accommodations a student can receive to succeed in school," Reinert said. Low rates of IEPs can suggest that students aren't getting needed support.
Reinert said schools should be given the resources needed to thoroughly address students' trauma and mental distress. Without that support, marginalized youth may face greater disparities.
Only 19.7% of children in the state with severe depression receive at least some consistent treatment, according to Mental Health America.
For the purposes of the report, treatment was considered "consistent" if a child visited a "specialty outpatient mental health service, including a day treatment facility, mental health clinic, private therapist, or in-home therapist more than seven times in the previous year."
Adults in Arkansas also struggle with accessing mental health care. Cost is often to blame, Reinert said.
The state ranked the sixth worst for adults reporting "14+ mentally unhealthy days a month who could not see a doctor due to cost," with 29.26% of respondents saying they couldn't afford care.
"Prevention and early intervention are important to lowering rates of mental health conditions, but if individuals experiencing frequent mental distress are unable to afford care, they are even more likely to develop chronic conditions and experience increased morbidity and mortality," Reinert said.
LOCAL PROFESSIONALS
Emily Price said she also sees difficulty accessing services, especially in rural areas, as an issue.
Price is the clinical therapist supervisor for UAMS Health's AR ConnectNow program, a completely virtual service that offers help for Arkansans struggling with mental health.
People living in rural areas often don't have as many resources, such as therapists and psychiatrists, money or means of transportation, as their urban counterparts, according to Price. Teletherapy, the use of mental health counseling over the phone or online, and other remote clinical services can help to overcome some of those challenges.
"AR ConnectNow is completely virtual," Price said. "We're able to get those people in who might not be able to drive or have transportation issues."
She observed that some people may not have the necessary phone, tablet or computer to access even remote care options. Access to broadband internet can also be an obstacle, but efforts have been under way across the state in recent years to improve access to underserved areas.
"I feel like there's a lot more access as a clinician in this day and age than what I had earlier on," she said.
Price also said she believed a stigma may still surround mental health, even though its power has diminished in recent years. She described that stigma as a "longstanding issue where people feel shame and discomfort being vulnerable about those things."
However, the supervisor said she hoped therapists have been doing better to help people allow themselves to be vulnerable enough to seek help.
"If someone had diabetes we wouldn't want them to tough it out," she said. "We would want them to seek some assistance. We all are human and need help in our lives for different things."
Dr. Nioka Smith, a licensed marriage and therapy counselor operating in Little Rock, said talking about mental health around children can often still be seen as "very taboo." However, she believes such conversations are critical to improving mental health outcomes among the state's youth.
She highlighted three things as especially important to communicate to one's children. The first is to help them recognize mental illness.
"It's very important to teach them what it looks like, because our children don't know what it looks like," Smith said. "Our students today, they don't know what anxiety is. They just know there's something in their belly, and that something doesn't feel right."
She also said parents must tell their children it's OK to talk about their mental health, and to help them to feel comfortable doing so. Children should be told that nothing is wrong with them because of the way that they're feeling, but that their health may need to be addressed.
Finally, it's important for children to know who they can talk to, whether that's a family member, friend or mental health expert.
Such conversations don't have to be verbal. For instance, they can be texted, or even take place through written notes slipped under a closed door, according to Smith.
"I think all of those things are important," she said.
Parents should strive to do at least monthly check-ins with their children about their mental health.
Smith said that it's not enough to focus solely on how your children are doing. Instead, parents often also need to learn about how to talk about their issues. The counselor said she believes resistance to talking about one's emotions is something parents are taught as they grow up. She witnessed this in her own family when she was a child.
When parents don't learn how to discuss their mental health, the trauma they may have experienced during their upbringing can be projected onto their children, often unknowingly, according to Smith.
"It's important that we as parents learn for our children, so that they don't repeat the cycle," said Smith, who is a mother of three children.
The key, she said, is education. She encourages parents to do what they can to learn more about their mental health, and that of their children. Smith developed a "counselors lounge" for women, which is going to talk about behaviors that people learn as they grow up. The city of Little Rock is also hosting free events to help parents learn more about mental health.
Smith said she would also like to see more advertising of the 988 Suicide and Crisis Lifeline.
People can call, text or chat with the 988 Lifeline for free 24 hours a day, seven days a week across the U.S., according to its website. Anyone who contacts the Lifeline is connected to counselors trained to provide "free and confidential emotional support and crisis counseling to people in suicidal crisis or emotional distress, and connect them to resources," the website states.