Economic determinants of county-level mental health – United States, 2019

A better understanding of whether and how economic factors impact mental health can inform policy and program decisions to improve mental health. This study looked at the association between county-level economic factors and the prevalence of self-reported poor mental health among adults in US counties in 2019, overall and separately for urban and rural counties. General dominance analyses were completed to rank-order the relative importance of the selected variables in explaining county prevalence of adults reporting > 14 poor mental health days in the last 30 days (“poor mental health”). The highest weighted variables were assessed for the statistical significance of their relationships with county-level poor mental health through multiple linear regression. Across all models, the four highest-ranked economic factors were household income, receipt of Supplemental Security Income (SSI), population with a college degree, and receipt of Supplemental Nutrition Assistance Program (SNAP) benefits. The overall, rural, and urban models explained over 69% of the variation in poor mental health prevalence between counties. Urban and rural models also showed notable differences in the relationship between poor mental health and median home value and population with public insurance. The findings from this study indicate a significant association between several economic factors and poor mental health, which may inform decision makers in addressing mental health in the US. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The author(s) received no specific funding for this work. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: N/A - not human subjects research I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data is available from public data sources, including the US Bureau of Economic Analysis (www.bea.gov/data), the US Census (data.census.gov), and CDC PLACES data (www.cdc.gov/PLACES).