Poor mental health days

Poor Mental Health Days is based on survey responses to the question: “Thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?” The value reported in the County Health Rankings is the average number of days a county’s adult respondents report that their mental health was not good. The measure is age-adjusted to the 2000 US population. Please note that the methods for calculating this measure changed in the 2016 Rankings.

Measure Tabs

Reason for Ranking

Overall health depends on both physical and mental well-being. Measuring the number of days when people report that their mental health was not good, i.e., poor mental health days, represents an important facet of health-related quality of life.

Measurement Strengths and Limitations

Both self-reported health and healthy/unhealthy days have been widely used and studied for their validity. One study that investigated the reliability of the HRQoL questions included in BRFSS found high retest reliability for the healthy days measures.[1]

A study examining the validity of healthy days as a summary measure for county health status found that counties with more unhealthy days were likely to have higher unemployment, poverty, percentage of adults who did not complete high school, mortality rates, and prevalence of disability.[2] Physically unhealthy days were more strongly associated with all county-level variables than mentally unhealthy days.[1]

Andresen et al.’s study of HRQoL questions included in BRFSS found that the healthy days summary measure had slightly higher reliability than each of its component measures, physical health and mental health. This suggests that the summary item is a more consistent measure and that both components are important elements of HRQoL.[2] However, reporting the two components separately in the Rankings highlights the importance of mental health in addition to physical health.

Please note that changes in the method CDC used to create this measure in 2016, 2017, and 2018 means that new estimates should not be compared with earlier years. To see more about these changes, look in the Data Source tab.