Does Cost of Living Affect Mental Health? What the Data Shows Across All 50 US States

The ten most expensive US states report less diagnosed depression than the ten cheapest (18.5% against 23.4%), according to the CDC’s 2024 state survey and the Bureau of Economic Analysis (BEA). Adults on low incomes report far more: 37.4% of those in households earning under $24,000 are depressed or treated for depression, against 15.8% at $120,000 and over (Gallup, 2026).

The price link is weaker than it looks. It largely disappears once rural share is taken into account, and a second federal survey finds no link at all. The depression rate itself depends on the survey: the Substance Abuse and Mental Health Services Administration (SAMHSA) counts 7.4% of adults with a major depressive episode in the past year, while the CDC finds 22.0% who have ever been told they have depression.

This page covers how common depression and mental illness are, what the 50 states show when price levels are set against mental health, what money worries and income do to mood, and what mental health care costs and who can reach it. Every figure links to the agency, survey or statistics office that published it. Data updated October 2026.

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How common it is

• Adult depression: 7.4% (SAMHSA, past-year episode), 13.1% (CDC, symptom screen, ages 12+), 19.1% (Gallup, current or treated), 22.0% (CDC BRFSS, ever told)
• Any mental illness: 20.6% of adults, 54.6 million, in 2025 (SAMHSA)
• Age gap: 28.6% of adults aged 18 to 25 had any mental illness, against 12.8% of those aged 50 and over (SAMHSA)
• Teenagers: 15.1% of 12 to 17 year olds had a major depressive episode in 2025, down from 20.8% in 2021 (SAMHSA)

Cost of living and mental health by state

• Ten priciest states: 18.5% of adults told they have depression. Ten cheapest: 23.4% (CDC BRFSS 2024, BEA; our calculation)
• Highest: West Virginia 30.2%, Kentucky 28.3%. Lowest: New Jersey 13.3%, Hawaii 14.4% (CDC BRFSS 2024)
• Correlation of state price level with diagnosed depression: -0.43, falling to -0.15 once urban share is held constant (our calculation)
• Correlation of state price level with SAMHSA’s model-based mental illness rate: -0.09, no link (our calculation)
• Price-adjusted income per head and poor mental health days: -0.44, still -0.37 after holding rural share and prices constant (our calculation)

Money and mood

• Gallup depression rate: 37.4% of adults in households earning under $24,000, 15.8% at $120,000 and over (Gallup, Q1 2026)
• Below the poverty line, 22.1% have depression symptoms; at four times the line or more, 7.4% (CDC NHANES)
• 77% of adults cite the cost of living as a significant source of stress (American Psychological Association, 2026)
• 63% of adults could cover a $400 emergency from cash or savings (Federal Reserve)
• Adults with depression were 2.9 times as likely to have medical debt: 27.3% against 9.4% †

Care and cost

• 26.9 million adults with a mental illness, about 49%, received no treatment in 2025 (SAMHSA)
• Among untreated adults who wanted care, 61.4% thought it would cost too much (SAMHSA)
• 5.4% of all adults went without needed mental health care because of cost (CDC NHIS, 2025)
• Psychiatrists per 100,000 people: 20.0 in urban areas, 5.7 in rural areas (WWAMI Rural Health Research Center)
• 7,109 mental health shortage areas covering 157.1 million people (HRSA, June 2026)
• Uninsured rate: 2.8% in Massachusetts, 16.7% in Texas (Census ACS, 2024)

How Many Americans Have Depression?

Between 7.4% and 22.0% of US adults, depending on the survey. The four main measures count different things over different periods, so none is the “real” rate and they cannot be averaged.

Source: SAMHSA 2025 Annual National Report (July 2026); CDC NCHS Data Brief 527; Gallup (21 April 2026); America’s Health Rankings. NHANES measures symptoms in an examination survey, so it is not a diagnosis.

Our working: the highest of the first four figures (22.0%) is 3.0 times the lowest (7.4%). The gap is definitional. A lifetime diagnosis counts everyone who has ever had one, while the SAMHSA figure counts only people who met full diagnostic criteria for a two-week episode within the past year.

How common is mental illness overall?

One in five US adults had a mental illness in 2025. SAMHSA counted 54.6 million adults, 20.6%, with any mental illness and 18.2 million, 6.9%, with serious mental illness, the form that substantially limits daily life.

Source: SAMHSA 2025 Annual National Report; CDC FastStats and NHIS Early Release of Selected Estimates 2025 (preliminary); America’s Health Rankings. SAMHSA’s mental illness figures come from a statistical model, not a clinical interview.

SAMHSA changed its mental illness model in 2025. Under the new model its 2024 estimate was 21.5%, not the 23.4% originally published, so 2025 figures should not be set against the 2024 report.

Who is most affected?

Young adults, women and people on low incomes report the most depression, in every survey that breaks it down.

Source: SAMHSA 2025 Annual National Report; CDC YRBS 2023; CDC NCHS Data Brief 527; Gallup (21 April 2026). The YRBS question asks about feeling so sad or hopeless almost every day for two weeks that usual activities stopped; it is not a diagnosis.

Our working: Gallup’s rate for adults aged 18 to 29 (28.0%) is 2.9 times its rate for those aged 65 and over (9.8%). In SAMHSA’s data, adults aged 18 to 25 are 2.2 times as likely as those aged 50 and over to have any mental illness (28.6% against 12.8%).

Is mental illness getting worse?

It depends on the survey. Two sources show a rise since the mid-2010s, while SAMHSA’s data show a fall since 2021.

Source: as above. SAMHSA’s trend runs from 2021, when it changed to a mixed in-person and web survey, and it cannot see the earlier rise. Gallup’s 2017 and 2026 readings come from different survey modes, and it took no readings in 2021 or 2022.

Do Expensive States Have Worse Mental Health?

No. Across the 50 states, higher prices go with lower rates of diagnosed depression and fewer poor mental health days in the CDC’s survey, and with no difference in SAMHSA’s model-based estimates. No measure shows pricier states doing worse.

We set BEA’s 2024 regional price parities, which measure how much more or less a state costs than the US average, against four state-level mental health measures from two independent federal surveys. A correlation of -1 would mean mental health is always better where prices are higher, 0 means no relationship and +1 means it is always worse.

Source: CostLiving calculation from BEA Regional Price Parities, all items (2024), CDC BRFSS Mental Health Indicators (2024), SAMHSA 2023-2024 NSDUH state estimates (model-based) and the 2020 Census. Pearson correlation, 95% ranges from 10,000-sample bootstrap. Tennessee has no 2024 BRFSS data; DC is excluded.

Our working: the first two lines are statistically significant before controlling for rural share (p = 0.002 and 0.003); the SAMHSA lines are not (p = 0.53 and 0.20). After holding urban share constant, diagnosed depression drops to -0.15 (p = 0.30) and poor mental health days to -0.33 (p = 0.02). The two CDC measures agree with each other (correlation 0.67), and the two SAMHSA measures agree closely with each other (0.91), but the two surveys agree only partly (0.65 for diagnosed depression against SAMHSA’s mental illness rate).

What do the ten priciest and ten cheapest states look like?

The ten priciest states report diagnosed depression at 18.5% against 23.4% in the ten cheapest, a gap of nearly five points. On SAMHSA’s measures the gap is under one point.

Source: CostLiving calculation. Priciest: California, Hawaii, New Jersey, New York, Washington, Massachusetts, Maryland, New Hampshire, Connecticut, Florida. Cheapest: Arkansas, Mississippi, Iowa, Oklahoma, Louisiana, South Dakota, Alabama, North Dakota, West Virginia, Kansas. Simple averages of state values, not population-weighted.

The last row is the catch. The priciest ten are 85.8% urban and the cheapest ten 59.4%, and rural states report more diagnosed depression in the CDC data (see below).

Which states report the most and the least depression?

West Virginia has the highest rate of diagnosed depression at 30.2% and New Jersey the lowest at 13.3%, a gap of more than two to one.

Source: CDC BRFSS Mental Health Indicators (2024), adults who have ever been told they have a depressive disorder. Michigan and Maine tie for fourth highest. 49 states; Tennessee did not collect enough data.

Our working: West Virginia’s rate (30.2%) is 2.3 times New Jersey’s (13.3%). West Virginia is 44.6% urban with prices 10.5 points below the US level; New Jersey is 93.8% urban with prices 8.8 points above it. SAMHSA’s model also puts New Jersey lowest for any mental illness (18.1%), but West Virginia third highest (28.1%), behind Oregon (31.6%) and Vermont (29.1%).

The range of price levels is wide too. California (110.7) is 27% more expensive than Arkansas (86.9), and its housing is 2.8 times as expensive as West Virginia’s (154.3 against 54.2, BEA housing price parities).

Is It Prices, Rural Life or Income?

Rural share explains much of the pattern. Pricier states are more urban (correlation +0.65), and urbanity on its own tracks lower diagnosed depression (-0.51) and lower SAMHSA mental illness (-0.30).

Source: as listed. America’s Health Rankings reports that nonmetropolitan adults were 1.13 times as likely as metropolitan adults to report diagnosed depression in 2023. Census urban share (2020) is used in all of our state calculations.

Our working: holding urban share constant cuts the link between price and diagnosed depression from -0.43 to -0.15. It does not reach zero everywhere. Among the 21 states that are at least 75% urban, price and diagnosed depression stay strongly linked (-0.62); among the 28 less urban states with data they are not linked at all (+0.03). The 75% cut-off is ours and the split was run after seeing the data, so treat it as a lead rather than a finding.

Does Income Matter More Than Prices?

Slightly, for frequent poor mental health. After adjusting for local prices, higher incomes go with fewer poor mental health days (-0.44, against -0.42 for price level), and the link holds up better once rural share is held constant (-0.41, against -0.33 for price level). For diagnosed depression and SAMHSA’s estimates, income shows little or no link.

Source: BEA Real Personal Income for States (2024), CDC BRFSS (2024), SAMHSA (2023 to 2024; treatment 2024). Real income here is per-capita personal income in 2017 dollars, adjusted for each state’s price level. “Loneliness” is the BRFSS optional-module question “How often do you feel lonely?”; the dataset does not give the response threshold behind the percentage.

Our working: the highest real income (Wyoming) is 1.56 times the lowest (Mississippi). Holding rural share and price level constant, states with higher real incomes have higher treatment rates (+0.35, p = 0.014) but no lower rates of mental illness. That may reflect access to care, though the data cannot show it.

How does income relate to depression for individuals?

Sharply, in both main US sources. Gallup’s depression rate is 37.4% for adults in households earning under $24,000 and 15.8% for those earning $120,000 or more.

Source: Gallup (21 April 2026); CDC NCHS Data Brief 527. The two surveys use different income bands and different depression measures. NHANES covers ages 12 and over, and 11.9% of respondents had no income recorded.

Our working: Gallup’s lowest band is 2.4 times its highest (37.4% against 15.8%); in NHANES, people below the poverty line are 3.0 times as likely as those at four times the line or more to have depression symptoms (22.1% against 7.4%). Gallup’s lowest band was at 22.1% in 2017 and its highest at 8.6%, so the gap in points has grown from 13.5 to 21.6 even though the ratio has narrowed from 2.6 to 2.4. Gallup’s 2017 and 2026 readings come from different survey modes.

How Many Americans Are Struggling With Everyday Costs?

A majority say prices have hurt them. In October 2025, 58% of adults told the Federal Reserve that price changes had made their financial situation worse, down from 60% in 2024 and 65% in 2023.

Source: Federal Reserve Economic Well-Being of US Households in 2025 (May 2026); APA Stress in America 2026 (Harris Poll, n = 3,132, online); Gallup and West Health (n = 19,535); CRS R48945 (13 May 2026); BLS CPI and Employment Situation (Sep 2026); Census Bureau P60-289. The APA release does not tie the “doing everything right” item to money. The cost-burden counts will be replaced by 2025 ACS figures due 29 October 2026.

Our working: the same households can say they are fine and under strain at once, because the questions differ. 73% describe their finances as at least okay, yet 58% say prices have hurt them and 77% call cost of living a significant stressor. The Federal Reserve survey was fielded in October 2025 and the APA survey in July and August 2026. US consumer prices were 3.7% higher in September 2026 than a year earlier; the oil and fuel price rises behind part of that are covered in CostLiving’s War and the Cost of Living statistics.

Does Money Stress Cause Depression, or the Other Way Round?

Both, probably, and most US data cannot tell them apart. The strongest causal evidence comes from experiments, and it is small: anti-poverty programmes raised mental health scores by 0.09 standard deviations across 30 randomised trials, all in low- or middle-income countries.

Source: NBER Working Paper 27157 (May 2020, revised November 2020); Picchio and Ubaldi, DOI 10.1111/joes.12588; Johns Hopkins Bloomberg School of Public Health (July 2024), summarising a paper we did not open. The medical debt figures are cross-sectional and do not show which came first.

Our working: adults with current depression were 2.9 times as likely to have medical debt as adults without (27.3% against 9.4%). The unemployment effect is small; the authors call it “quite small”, although mental health was the health domain they found most affected.

The Gallup, NHANES and medical debt figures above are correlations. Depression can reduce earnings, and poverty can produce depression, so none should be read as money causing illness.

Can Americans Afford Mental Health Care?

Not always. Of the 26.9 million adults with a mental illness who received no treatment in 2025, 21.4% (5.6 million) said they wanted or thought they should get help, and 61.4% of those said it would cost too much.

Source: SAMHSA 2025 Annual National Report; CDC NHIS Early Release 2025 (preliminary, released May 2026); Federal Reserve SHED; KFF column by Drew Altman; CDC NCHS Data Brief 564 (June 2026). SAMHSA warns that the reasons for not getting care should not be ranked, as differences between them are not necessarily significant.

Our working: the cost figures differ by a factor of ten across sources because the groups differ. 5.4% is of all adults, 44% of insured adults who went without care, and 61.4% of untreated adults with a mental illness who wanted help. Do not read 61.4% as the share of people with a mental illness who skip care because of cost. About 49% of adults with a mental illness (26.9 of 54.6 million) got no treatment, but only about one in five of those said they wanted it.

What does mental health care cost?

Privately insured adults treated for depression or anxiety paid $1,501 out of pocket in 2021, against $863 for adults with no mental health diagnosis. No federal or peer-reviewed source gives an average price per session.

Source: Peterson-KFF Health System Tracker (23 June 2023), non-elderly adults on large-employer insurance, claims only; Gao and Olfson, Psychiatric Services 76(2):200 to 203 (8,923 adults, high burden means out-of-pocket costs of at least 10% of disposable income); RTI International (commissioned by a foundation and part-funded by US psychiatric and psychological associations); KFF. “High cost-burden” figures are group means, not typical prices. Participation does not mean accepting new patients.

Where Is Mental Health Care Hardest to Reach?

In rural areas, and in Alabama, Texas and South Carolina, which rank bottom in Mental Health America’s access ranking. Rural parts of the US have 5.7 psychiatrists per 100,000 people against 20.0 in urban parts.

Source: HRSA Designated HPSA Quarterly Summary; WWAMI Rural Health Research Center data briefs (2025 to 2026); HRSA National Center for Health Workforce Analysis, State of the Behavioral Health Workforce (2025); Mental Health America, State of Mental Health in America 2025; Census Bureau ACS Brief 24 and P60-291. Rural uses the federal Office of Rural Health Policy definition in the WWAMI data. The HRSA population count can include people in overlapping designations. KFF reported 137.1 million people in shortage areas as of December 2025; we did not find HRSA’s explanation for the rise to 157.1 million. The ACS 2025 state figures are due 29 October 2026.

Our working: rural psychiatrist density (5.7) is 28.5% of urban (20.0), under a third. The gap between states is larger than the gap between rural and urban areas within them: rural Vermont has 24.9 psychiatrists per 100,000, nearly twice as many as urban Alabama (13.0), and 6.9 times as many as rural Alabama (3.6). Texas’s uninsured rate (16.7%) is six times Massachusetts’s (2.8%). Nevada’s rural figures rest on only 8 psychiatrists.

Mental Health and Cost of Living in Every State

All 50 states, sorted from the highest price level to the lowest. Click a state for its cost of living page.

Source: BEA Regional Price Parities, all items (2024; US = 100); CDC BRFSS Mental Health Indicators (2024); SAMHSA 2023-2024 NSDUH state estimates, adults 18+, model-based; US Census Bureau 2020 urban share. n/a means no data; Tennessee did not collect enough 2024 BRFSS data. Full data, with confidence intervals, in the downloadable CSV.

How to Read These Numbers

• Four depression figures. NSDUH measures a past-year episode, NHANES two weeks of symptoms, Gallup current or treated depression and BRFSS a lifetime diagnosis. They are not comparable and none is the true rate.
• Diagnosis depends on care. BRFSS asks whether a health professional has ever said you have depression. Places where people see clinicians less often can report less diagnosed depression than they have. SAMHSA’s state estimates do not rely on a diagnosis.
• Model-based state estimates. SAMHSA’s state figures are hierarchical Bayesian model estimates pooled across 2023 and 2024 (treatment: 2024 only), not direct counts. Small states borrow strength from others, rank order does not imply a significant difference, and the national total for these tables (23.1%) uses SAMHSA’s old mental illness model, so it should not be set against the 20.6% 2025 figure.
• Poor mental health days. The CDC state dataset asks how many of the past 30 days mental health was “not good”. The dataset record does not state the cut-off or age adjustment behind the percentage. America’s Health Rankings, using the same question, reports 15.6% nationally for 14 or more days. We label it “poor mental health days”.
• States are not people. A state-level correlation says nothing about any individual. A pricey state might have wealthier residents who report less depression, or the reverse. This is the ecological fallacy, and it applies to every correlation here.
• Association, not cause. Price level, rural share and income move together. Our controls are limited to the variables listed and the 50 data points give wide ranges.
• Price level is not your bill. BEA’s regional price parities compare the price of a typical basket across states for 2024 and say nothing about what any household pays. CostLiving’s own state pages use a different index (MERIC/C2ER) and household budget, so figures can differ. DC is excluded from the 50-state analysis.
• Rural definitions. The Census urban/rural split (2020), the metropolitan/nonmetropolitan split (BRFSS) and the federal Office of Rural Health Policy definition (WWAMI) are different classifications.
• NSDUH changes. SAMHSA introduced a new mental illness model in 2025 and does not test 2024 against 2025. National 2025 figures here do not compare with the old-model 2023-24 state estimates.
• Survey response. BRFSS 2024 had a median response rate of 43.9% and the NSDUH 2025 report has an overall rate of 8.5%.
• Preliminary data. NHIS 2025 early-release figures are before final editing and weighting.
• † Secondary source. The medical debt figures come from a Johns Hopkins summary of a JAMA Psychiatry paper; we did not open the paper.

Conclusion

Expensive states do not have worse mental health. If anything, the CDC’s diagnosed depression and poor mental health day figures run lower in pricier states, and SAMHSA’s estimates show no difference, but the pattern shrinks or disappears once rural share is controlled for, and the two surveys disagree. What does show up consistently is the role of income and access: lower-income adults report much more depression, price-adjusted income tracks frequent poor mental health across states, and about half of adults with a mental illness got no treatment. Cost is one reason for not getting care, but only one in five of the untreated say they wanted it. Rural areas have the thinnest supply of psychiatrists, and Alabama, Texas and South Carolina rank lowest for access. As SAMHSA, the CDC, Gallup and the Federal Reserve publish their next releases and BEA updates its price parities in December, these figures will move.

Sources

SAMHSA, 2025 NSDUH Annual National Report (Jul 2026); 2024 NSDUH Annual National Report (Jul 2025); 2023-2024 NSDUH state prevalence estimates and small area estimation guide · CDC NCHS, Data Briefs 527, 528, 564; NHIS Early Release of Selected Estimates 2025; FastStats · CDC BRFSS, Mental Health Indicators (data.cdc.gov 5eh7-pjx8), 2024 Overview and Data Quality Report · CDC, Youth Risk Behavior Survey 2023 · America’s Health Rankings (United Health Foundation), 2025 Annual Report measures · Gallup, depression (21 Apr 2026); loneliness; West Health-Gallup (2025) · KFF, column (10 Dec 2024), HPSA state indicator, facility participation indicator, Medicaid brief (13 May 2026), KFF/CNN survey (2022) · Federal Reserve Board, Economic Well-Being of US Households in 2025 (May 2026) · American Psychological Association, Stress in America 2026 · BEA, Regional Price Parities (19 Feb 2026), Real Personal Income for States · US Census Bureau, 2020 Census urban and rural (Dec 2022), P60-289, P60-291, ACS Brief 24 · BLS, CPI (Sep 2026), Employment Situation (Sep 2026), Consumer Expenditure Survey 2024 · Congressional Research Service, R48945 · Harvard Joint Center for Housing Studies, State of the Nation’s Housing 2026 · HRSA, Designated HPSA Quarterly Summary (30 Jun 2026); State of the Behavioral Health Workforce (Dec 2025) · WWAMI Rural Health Research Center, behavioral health workforce data briefs (2025 to 2026) · Mental Health America, State of Mental Health in America 2025 · Peterson-KFF Health System Tracker (Jun 2023) · Gao and Olfson, Psychiatric Services (2024) · RTI International (2025) · Fujita, Parish and Mark, Psychiatric Services (2025) · Ridley, Rao, Schilbach and Patel, NBER WP 27157 / Science (2020) · Picchio and Ubaldi, Journal of Economic Surveys (2023) · Johns Hopkins Bloomberg School of Public Health (Jul 2024) †