Mental Health Risk Among Members of the Millennial Population Cohort: A Concern for Public Health

Abstract

Purpose:

Within the millennial population cohort, identify groups reporting increased risk of nonspecific psychological distress. As the largest living population cohort, taking stock of health and well-being early is necessary as substantial national resources may be needed as this cohort ages.

Design:

The 2017 National Health Interview Survey data, an annual multipurpose survey of the US population, was used.

Sample:

A sample of 7303 respondents were created by limiting data set to birth years 1980 to 1998.

Measures:

Outcomes were feeling like everything is an effort, worthlessness, hopelessness, restlessness, nervousness, and sadness. Combined these statements of feeling make up a measure of nonspecific psychological distress, past 30 days.

Analysis:

A logistic regression was performed on each outcome. All models controlled for demographic variables known to be associated with psychological distress.

Results:

Females are 1.4 times more likely than males to report nonspecific psychological distress (P < .001), whereas Hispanics and Blacks are less likely to report nonspecific psychological distress (odds ratio [OR] = 0.49, OR = 0.57, P < .001). American Indians were less likely to report worthlessness (OR = 0.30, P < .05). However, multiple race individuals increasingly reported hopelessness (OR = 1.55, P < .05). Young adults are less likely than emerging adults to report sadness (OR = 0.85, P < .05).

Conclusion:

In this sample, racial/ethnic groups fared better than referent groups. Health programs need to integrate intersectional identities into promotion of mental health.

Keywords

awareness strategies college age women gender-specific specific populations underserved populations mental health

Nearly 45 million adults in the United States (U.S.) are affected by mental health issues, and roughly 75% of issues start during adolescence or young adulthood.^1,2 Young adulthood is considered a time of optimum health, yet is a period of psychosocial transition. Millennials, born between 1980 and 1996, currently make up the young adult population.³ Growing concern for the physical and mental health of contemporary young adults has been documented and a call to action established.^4,5 As the largest living cohort, it is important to monitor the health of the Millennial population to avoid the need for substantial, national health resources as they age.

Between 2008 and 2017, Twenge et al report a 71% increase in serious psychological distress among young adults based on previous 30-day account.⁵ For example, mood disorders and suicide-related outcomes disproportionately impact 18- to 25-year-olds, females, and those of wealthier circumstances.⁵ With age, unaddressed psychological distress coupled with comorbidities can be detrimental. As a case in point, between 2000 and 2017, white men 45 to 54 years saw the fastest growing suicide rate from 14.3% to 20.2% and by 2018 represented nearly 70% of total U.S. suicides.⁶ Early identification of at-risk populations and associated social factors can improve quality of life for those living with mood disorders.

Social factors, such as poverty, economic hardships, social media, and social isolation, are contributors and consequences of mood disorders in the U.S..⁷ Currently, poverty is highest among young adults due to flat wages and reduced employer-based benefits, despite the increased college enrollment and completion.^8,9 With the advent of social media, social isolation has increased while social connections decreased.^5,10 Acculturative stress is an additional risk factor^11,12 as the Millennial population is the most racial/ethnically diverse; approximately 55% identify as non-Hispanic white.¹³ Multiracial college students have been reported to be more likely to express feelings of hopelessness and difficulty functioning compared with other racial ethnic groups.¹⁴ Compared to previous cohorts, contemporary young adults have additional stressors that potentially increase psychological distress during the transition into adulthood. The purpose of this study was to identify subgroups experiencing increased risk of nonspecific psychological distress when controlling for known social indicators.

Methods

Data Source

This inquiry was limited to publicly available data from the 2017 National Health Interview Survey (NHIS), an annual health survey of US civilians conducted by the National Center for Health Statistics.¹⁵ From the NHIS core set of questions, 2 files were merged to create the data set: the adult sample file and person file. The former contained outcome variables of interest and the latter sociodemographic variables. More on design and content is located at www.cdc.gov/nchs/nhis/index.htm.

Study Sample

The authors were concerned with the millennial population cohort. The data set was limited to birth year 1980 to 1998, creating a sample of 7303 young adults aged 19 to 36, to include millennials and generational cuspers who are often included in studies concerned with unique generational issues. To understand age groups at greater risk, 2 age categories were developed: (1) emerging adults 18 to 26 years and (2) young adults 27 to 36 years.

Analysis

A logistic regression was performed to assess whether subpopulations of interest were more likely to report greater risk on each outcome while holding specific sociodemographic variables constant. There were 7 binary outcome variables, feeling (1) worthless, (2) hopeless, (3) restless, (4) nervous, (5) sad, (6) like everything was an effort, and (7) nonspecific psychological distress, a composite of previous 6 statements.¹⁶ Participants were asked to respond to “in the past 30 days, I have felt.” For this inquiry, the outcome variables were relabeled “yes” and “no” for each statement. The main independent variables were gender, race/ethnicity, and age. Control variables were smoking status, body mass index (BMI), average sleep, children at home, marital status, and amount of worry (1) if an accident occurs, (2) paying monthly bills, (3) maintaining living standard, and (4) cost of child’s college education. Data were analyzed using R version 3.2.2.

Results

Table 1 provides demographics. The median age for the entire sample was 28 years, 22 years for emerging adults, and 32 years of age for young adults (not shown in the table). Emerging adults account for 42.9% of the sample population. Smoking rates by race range from 14.1% (Asian) to 36.4% (American Indian/Alaska Native). The Asian subgroup reports lowest BMI (26.5%) and highest level of education (bachelor’s degrees, 66.9%). About 44% of Hispanic respondents report children at home and report lower educational attainment. Approximately 50% of the sample report never been married. Compared to other subgroups, Hispanics and African Americans are more concerned about specific financial issues.

Table 1.

Demographics by Race and Ethnicity: Percentage Reported by Participants.

Demographic	Total, N = 7303	Non- Hispanic, n = 6048	Hispanic, n = 1255	White, n = 5609	Black, n = 880	Asian, n = 496	AI/AN, n = 107	Multiple race, n = 211
27-36 years old	57.1	57.2	56.7	57.3	57.8	55.6	55.1	53.1
Female	52.7	52.0	56.1	51.8	60.2	48.2	56.1	53.6
Current smokers	27.5	29.0	20.6	29.8	19.3	14.1	36.4	29.4
Mean body mass index (BMI)	28.9	28.8	29.8	28.9	30.5	26.5	29.1	29.8
Average hours of sleep^a	7.0	7.0	7.1	7.0	6.9	7.1	7.0	6.9
Child living at home	34.5	32.5	44.0	35.0	39.1	21.2	40.2	28.9
Education of adult with highest education in family
High school graduate	21.7	18.4	37.5	21.4	29.2	8.3	38.3	22.7
Some college or AA degree^b	35.9	35.6	37.4	35.7	42.0	24.8	37.4	42.7
Bachelor’s degree or higher	42.3	45.9	24.9	42.9	28.7	66.9	24.3	34.6
Marital status
Married with spouse in home	30.3	29.8	32.7	32.9	14.7	32.7	28.0	23.2
Never married	51.4	52.6	45.8	48.1	66.9	58.5	53.3	57.8
Living with partner	11.7	11.5	12.3	12.4	10.1	4.2	12.1	15.6
Other	6.6	6.1	9.2	6.6	8.3	4.6	6.6	3.4
Financial concerns^c
Paying medical bills if accident or illness occurred	46.4	43.9	58.2	46.2	49.3	43.8	45.8	47.4
Maintaining standard of living	30.9	28.8	41.2	30.9	35.7	23.6	22.4	33.2
Paying for monthly bills	23.9	21.3	36.3	23.4	31.0	14.9	19.6	32.2
Paying for children’s college	24.9	23.0	33.7	25.6	26.9	15.9	17.8	22.3
Nonspecific psychological distress score
Respondents^d	7096	5879	1217	5459	851	478	104	204
Zero score	37.5	35.3	48.3	36.1	44.2	42.7	46.2	30.9
1-12 score	59.2	61.2	49.2	60.6	52.9	55.8	51.9	59.3
13 or more score	3.3	3.5	2.5	3.3	2.9	1.5	1.9	9.8

^a In 24-hour period.

^b Includes academic, technical, or vocational.

^c Very worried about.

^d Number who provided a response to each question.

Outcomes, Past 30 Days

Table 2 provides logistic regression odds ratios for outcomes and P values for ethnicity, race, age, and sex. Reference groups are non-Hispanic ethnicity, white race, male sex, and 18 to 26 years of age.

Table 2.

Psychological Distress Questions and Composite Outcome: Adjusted Odds Ratio.^a

Odds ratio	Everything an effort	Worthless	Hopeless	Restless	Nervous	Sadness	Psychological distress
Ethnicity^b
Hispanic	.57^c	.58^c	.70^c	.55^c	.52^c	.71^c	.49^c
Race^d
Black	.87	.48^c	.63^c	.58^c	.45^c	.84	.57^c
AI/AN	.64	.30	.61	.73	.73	.75	.76
Asian	.87	1.08	1.10	.64^c	.66^c	1.16	.73^e
Multiple races	1.32	1.42	1.55	1.12	1.11	1.17	1.18
Sex^f
Female	1.27 ^c	1.36 ^c	1.40 ^c	1.16^e	1.48 ^c	1.40 ^c	1.40 ^c
Age^g
Young adults: 27-36 years	.95	.82	.98	.90	.80^c	.83^e	.85

^a Significant values at P < .05 are bold.

^b Non-Hispanic is the reference group.

^c P < .001.

^d White non-Hispanic is the reference group, race groups are non-Hispanic.

^e P < .01.

^f Male is the reference group.

^g Emerging adults is the reference group.

Everything feels like an effort

Females are 27% more likely than males to report everything feels like an effort (P < .001). Hispanic respondents are 43% less likely than non-Hispanics to report everything feels like an effort (P < .001).

Worthlessness

Females are 36% more likely than males to report feeling worthless (P < .001). Young adults are 18% less likely than emerging adults to report feeling worthless (P < .05). American Indian/Alaska Native (AI/AN) and African Americans are 70% (P < .05) and 52% (P < .001) less likely than whites to report feeling worthless, respectively. Hispanics are 42% less likely (P < .001) than non-Hispanics to report feeling worthless.

Hopelessness

Females are 40% more likely than males to report feeling hopeless (P < .001). Respondents who identify as multiple race are 55% more likely than whites to report feeling hopeless (P < .05). Blacks and Hispanics are 37% (P < .001) and 30% (P < .001) less likely than whites and non-Hispanics, respectively, to report feeling hopeless.

Restlessness

Females are 16% more likely than males to report feeling restless (P < .01). Hispanics are 45% less likely than non-Hispanics to report this feeling (P < .001). Blacks and Asians are 42% and 36% (P < .001) less likely than whites to report restlessness, respectively.

Nervousness

Females are 48% more likely than males to report feeling nervousness; young adults are 20% less likely than emerging adults to report feeling nervous (P < .001). Blacks and Asians are 55% and 34% less likely to report feeling nervous compared to white respondents (P < .001). Hispanics are 48% less likely than non-Hispanics to report feeling nervous (P < .001).

Sadness

Females are 40% more likely than males to report feeling sadness (P < .001). Young adults are 17% less likely than emerging adults to report sadness (P < .01). Hispanics are 29% less likely to report feeling sadness compared to non-Hispanics (P < .001).

Nonspecific psychological distress

Females are 40% more likely than males to report nonspecific psychological distress (P < .001). Young adults are 15% less likely than emerging adults to report distress (P < .05). Hispanics are 51% less likely to report distress compared to non-Hispanics (P < .001). Blacks and Asians are 43% (P < .001) and 27% (P < .01) less likely than whites, respectively, to report distress.

Age and gender interactions

Young adult females have significantly better outcomes than both emerging females and emerging males for all outcomes. Young adult males also have significantly better outcomes than emerging females for each outcome. A small difference was seen between young males and was for the restless outcome (P = .03); young adult females were slightly more restless than males in the same age category.

Discussion

This research supports previous findings on mental health of young adults.^5,12
-14 In this sample, emerging adults were more likely than young adults to report feeling worthless, restless, nervous, sad, and overall psychological distress. Furthermore, female respondents experienced higher distress than males. This supports previous research that found women report higher levels of anxiety, depression, and overall distress as compared to males.¹² The authors assert that female millennials are experiencing higher distress because of economic uncertainty and loneliness created by technology.^7,8 School and workplace stress compounds the issue. Females are increasingly entering higher education compared to males and matriculating into higher positions in the professional workforce.⁹ However, more research is needed to fully understand this finding.

A unique contribution of this project is the finding that, overall, when controlling for confounding factors, racial/ethnic minorities are faring better than their white and white non-Hispanic counterparts and were less likely to report feeling worthless, restless, sadness, nervous, and hopeless. This may be a result of individuals possessing a higher level of racial/ethnic and self-clarity identity, which previous research has shown to be negatively associated with hopelessness and other negative feelings.^12,13

Another point of interest is that respondents who identified as multiple race were more likely than whites to report feeling hopeless. This is consistent with findings presented by Chen et al.¹⁴ Previous research has highlighted acculturative stress and perceived discrimination, as well as lacking identity clarity at the personal and collective levels to have a negative impact on multiracial individuals’ overall well-being, self-esteem, and hope in the future.^12,13

As a secondary analysis study, the results must be interpreted within the context of the study design, and several limitations exist. Self-report data are subject to recall and to other biases including self-stigmatization related to mental health topics. There is no diagnosis avialable to confirm or deny self-report data. There is also concern that males may not confess to the feelings inquired about in this study. Also, ethnic/racial minorities may have different perceptions and interpretations of mental health. Future work should continue to merge multiple years of the NHIS to see the mental health trends among this unique population cohort.

So What? (Implications for Health Promotion Practitioners and Researchers)

What is already known on this topic?

Mental health concerns are among young adults and women. Untreated illness can result in major problems or suicide.

What does this article add?

Results presented in the current article suggest that white, non-Hispanic, and multiracial women are at increased risk for nonspecific psychological distress. Those often reported at increased risk are most likely treated when the symptoms are no longer ignorable.

What are the implications for health promotion practice or research?

Widen the scope of mental health promotion for women, emerging adults, and multiracial individuals. Factors that reduce the risk should be investigated by engaging underrepresented groups. This study illustrates the need for more research to identify social stressors and the role of intersectionality for promotion of mental health.

Footnotes

Authors’ Note

The listed authors are solely responsible for the content of this manuscript.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Julie E. Lucero

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