What the data shows
Across the United States in 2020, an age-standardized 18.5% of adults reported ever being told by a health professional that they had a depressive disorder, according to CDC analysis of Behavioral Risk Factor Surveillance System (BRFSS) data published in the *Morbidity and Mortality Weekly Report* (June 2023). State-level estimates ranged more than two-fold, from a low of 12.7% in Hawaii to a high of 27.5% in West Virginia, with a median of 19.9%.
Regional patterns
The geographic concentration is striking. The states with the highest reported prevalence fall predominantly in the Appalachian region and the southern Mississippi Valley. West Virginia (27.5%), Kentucky (25.0%), and Tennessee (24.4%) lead the nation, with Arkansas (24.2%), Missouri (23.4%), and Alabama and Louisiana (both 23.8%) close behind. Maine (23.1%) and Vermont (24.2%) stand out as high-prevalence states in the Northeast.
By contrast, several of the most populous and coastal states report the lowest figures. Hawaii (12.7%), California (13.9%), and Florida (14.9%) are the only three states below 15%, joined by New Jersey (15.6%), Alaska (15.7%), Delaware (15.8%), and Illinois (15.0%) in the lowest tier. The Mid-Atlantic and parts of the Mountain West and Southwest generally sit below the national figure.
Important caveats
These figures measure self-reported lifetime diagnosis, not current depression or clinical incidence. BRFSS is a telephone survey, so estimates depend on respondents accurately recalling and disclosing whether a professional ever gave them a depression diagnosis. State differences therefore reflect not only true differences in mental-health burden but also differences in access to care, willingness to seek diagnosis, screening practices, stigma, and survey response patterns. Lower-prevalence states may partly reflect *underdiagnosis* — fewer people obtaining a diagnosis — rather than genuinely better mental health.
Estimates are age-standardized to the 2000 U.S. standard population to make cross-state comparison fairer, and each carries a confidence interval (for example, West Virginia's 27.5% has a 95% CI of 25.9-29.1%), so small rank differences between adjacent states are not statistically meaningful. This 2020 BRFSS analysis is the most recent complete per-state table CDC has published for lifetime depression diagnosis; CDC's BRFSS Prevalence and Trends Tool offers more recent single-year survey estimates but uses a different methodology.
*This summary describes population survey data and is not medical advice.*