Young adults in the United States continue to be more likely than their older counterparts to be experiencing symptoms of anxiety or depression, according to the latest federal data analyzed by KFF researchers.

The analysis of the Census Bureau’s Household Pulse Survey finds that half (50%) of adults ages 18-24 reported anxiety and depression symptoms in 2023, compared to about a third of adults overall. The data also show that young adults are more likely than adults of any other age group to experience mental health symptoms.

Many young adults have come of age in an era of pandemic-related school closures, remote work and job and income loss, all of which may contribute to poor mental health. Additionally, young adults in college settings may encounter increased difficulty accessing treatment.

But young adults are not alone in experiencing heightened mental health symptoms. The mental health and substance use concerns that were present during the COVID-19 crisis continue to affect many Americans, even as many people try to move beyond the pandemic, Census data show.

Nearly 4 in 10 (39.3%) adults reported symptoms of anxiety or depression in February 2021, compared to 32.3 percent in 2023.  A KFF/CNN survey in October 2022 found that 90 percent of the public believes there is a mental health crisis in the U.S..

Poor mental health has also been more pronounced among adolescent females during the pandemic, with 57 percent reporting feelings of hopelessness and sadness compared to 29 percent of their male peers in 2021, the latest such data available. In the same period, 30 percent of adolescent females reported that they seriously considered attempting suicide, compared to 14 percent of adolescent males.

Additionally, drug overdose deaths have sharply increased during the pandemic. According to Centers for Disease Control and Prevention data, in 2021 there were over 106,600 deaths due to drug overdose in the U.S. — the highest on record. This spike in deaths has primarily been driven by substances laced with synthetic opioids, including illicitly manufactured fentanyl.

Here again young people especially have been affected.  Research suggests that while substance use among adolescents has declined, drug overdose deaths have sharply increased among this population, primarily due to fentanyl-laced substances. Among adolescents, drug overdose deaths have more than doubled from 2019 (282 deaths) to 2021 (637 deaths). Male, Black, and Hispanic youth have experienced the highest increases in deaths due to drug overdose.

The analysis details several changes in the delivery of mental health and substance use services that have been implemented since the onset of the pandemic, including the growth of telehealth, steps to improve access to treatment for opioid use disorders, expansion of school-based mental health care, and the rollout of the 988 national suicide prevention and crisis line.

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Rural hospitals fared worse financially in states that have not expanded their Medicaid programs under the Affordable Care Act than in states that expanded Medicaid, a new KFF analysis finds.

Nearly one third of all rural hospitals nationally are in the 11 states that have not approved the expansion of their Medicaid programs to cover low-income childless adults, and concerns about their ongoing viability has been an issue in legislative debates about whether to do so.

The analysis reveals that the median operating margin for rural hospitals has been consistently higher in states that have expanded their Medicaid programs than in non-expansion states from July 2017 through June 2022, although the financial stability of individual rural hospitals varies widely.

For the most recent period, from July 2021 through June 2022, the median operating margins for rural hospitals in states that have not expanded their Medicaid programs was 2.2%, compared to 3.9% in expansion states, based on the 438 hospitals analyzed.

If not for federal COVID-19 relief funds, rural hospitals would be facing even more challenging times as their finances have worsened, with median operating margins dipping to 1.2% in expansion states and -0.7% in non-expansion states when subtracting out documented relief funds.

Based on an analysis of hospital cost reports, Rural Hospitals Face Renewed Financial Challenges, Especially in States That Have Not Expanded Medicaid is part of KFF’s expanding work examining the business practices of hospitals and other providers and their impact on costs and affordability.

Booster update remains modest; half of those already boosted are waiting for updated CDC guidelines to get another dose

Nearly four in ten (38%) people say their households were affected by this winter’s triple threat of viruses, with someone getting sick with the flu, COVID-19, or respiratory syncytial virus (RSV), and nearly half (46%) say the news of these three viruses spreading has made them more likely to wear masks or take other precautions to avoid getting sick, the latest KFF COVID-19 Vaccine Monitor survey finds.

At the same time, almost three years into the COVID-19 pandemic, most of the public says they are “not too” or “not at all” worried about getting seriously ill from the virus (69%), though 31% still say they are worried. That’s somewhat more than say the same about the flu (26%) or RSV (25%).

The flu affected the largest share of households over the past month or so (27%), with smaller shares saying someone in their homes got sick with COVID-19 (15%) or RSV (10%).

A relatively small share (14%) of adults in households affected by COVID-19 say they tried to get Paxlovid, the anti-viral prescription pill used to treat COVID-19. Similarly, among those households affected by the flu, 16% say they tried to get Tamiflu, an antiviral prescription medicine used to treat the flu.

Amid media reports of shortages of over-the-counter medicines often used to treat symptoms of these ailments, the survey finds that 75% of adults in affected households tried to obtain over-the-counter medicines such as Tylenol or cough syrup, including about one in five (representing 6% of all adults) who say they had difficulties getting that medicine.

News about the three viruses also made some people more likely to take preventive measures such as wearing a mask in public (31%), avoiding large gatherings (26%), traveling less (20%), or avoiding eating indoors at restaurants (18%).

People who say they are immunocompromised are more likely than those who aren’t to take many of those extra precautions. In addition, Black and Hispanic adults are more likely than White adults, and Democrats are more likely than Republicans, to say they are more likely to modify their behavior.

Nearly 3 in 10 Adults Now Say They’ve Gotten Updated Bivalent Booster Shot

As the federal government prepares to end its public health emergency declaration, the latest survey finds nearly three in ten (28%) adults report having received an updated COVID-19 bivalent vaccine booster shot, up slightly from December (22%). The increase largely reflects a shift in booster rates among Republicans (from 12% in December to 20% in January, though Democrats still are twice as likely to have gotten the updated booster (39%).

Among high-risk groups, nearly half (47%) of adults at least 65 years old, and about a third (36%) of those who are immunocompromised, say they have already received a bivalent booster dose.

Those who already received a bivalent booster are eager to get an additional booster in the future. The vast majority (86%) say that getting another shot is important to them, and just over half (54%) say they are waiting for the Centers for Disease Control and Prevention (CDC) to issue new guidelines to make them eligible for another booster.

On the other side, vaccinated adults who have not gotten the bivalent booster yet cite a number of reasons for why they haven’t done so.  Half (51%) say they feel they have enough protection from their initial vaccination or a prior infection, and nearly as many (44%) say they don’t think they need the new booster.

Smaller shares say that they have been too busy or have not had the time to get the updated booster (29%), that they had bad side effects from a previous dose (19%), or that they cannot afford to take time off work to get the shot and deal with side effects from the vaccine (15%).

Designed and analyzed by public opinion researchers at KFF, the survey was conducted from January 17-24, 2023, online and by telephone among a nationally representative sample of 1,234 U.S. adults, in English and in Spanish. The margin of sampling error is plus or minus 4 percentage points for the full sample. For results based on other subgroups, the margin of sampling error may be higher.

The KFF COVID-19 Vaccine Monitor is an ongoing research project tracking the public’s attitudes and experiences with COVID-19 vaccinations. Using a combination of surveys and qualitative research, this project tracks the dynamic nature of public opinion as vaccine development and distribution unfold, including vaccine confidence and acceptance, information needs, trusted messengers and messages, as well as the public’s experiences with vaccination.