Adults With Intellectual Disabilities Face Nine Times the Anxiety Rate of General Population

A Mental Health Crisis Hidden in Plain Sight

The United States has spent considerable public attention in recent years on the mental health of teenagers and young adults. Less visible is a parallel crisis among a population of approximately 2.9 million Americans -- adults with intellectual and developmental disabilities such as autism, Down syndrome, and related conditions. A new national study places numbers on a burden that clinicians have long suspected but never fully quantified.

Published in JAMA Network Open, the study analyzed data from the 2021-2023 National Health Interview Survey, an annual, nationally representative survey conducted by the U.S. National Center for Health Statistics. Researchers identified 796 adults with likely intellectual and developmental disabilities within the dataset -- representing roughly 2.9 million Americans -- and compared their mental health profiles against 43,682 general-population adults.

The Scale of Disparity

Adults with intellectual and developmental disabilities were nine times more likely to have a diagnosis of anxiety (56.8% versus 10.6%) and approximately nine times more likely to have a diagnosis of depression (56.9% versus 9.9%). More than half of adults carry a diagnosed anxiety disorder and more than half carry a diagnosed depressive disorder simultaneously.

Daily symptom burden tells a similar story. Nearly half of study-population adults (48.9%) experienced daily anxiety symptoms, compared to 7.7% in the general population. Daily depression was reported by 24.2%, versus just 1.3% in the general population -- symptoms that interfere with daily function, relationships, employment, and quality of life, every day, for nearly a quarter of this population.

"Our findings paint a distressing picture of the mental health and healthcare for people with these disabilities in the United States," said senior author Dr. Dimitri Christakis, a professor of pediatrics at the University of Washington School of Medicine. "The scale of burden is shocking."

Treatment Patterns: Too Much Medication, Too Little Therapy

The treatment data revealed a structural imbalance. Among study-population adults, 40% and 37% reported using psychiatric medication for anxiety and depression, respectively. Only 40% received counseling or psychotherapy in the previous year. This medication-over-therapy pattern is notable because evidence-based behavioral interventions -- particularly cognitive behavioral therapy adapted for intellectual disability -- are effective and carry no pharmacological side effects.

The access barriers underlying this pattern were severe. Study-population adults were five times more likely than general-population peers to delay therapy because of cost (17.4% versus 3.4%), and five times more likely to forgo mental health care entirely because of expense (18.6% versus 3.2%). "Having insurance doesn't automatically translate to having access," said Christakis. "Our data suggest that, even with coverage, people with intellectual disabilities face significant out-of-pocket costs and difficulty finding providers who accept their insurance and have appropriate expertise."

What the Authors Recommend

The study calls for three concrete policy responses: increased Medicaid reimbursement rates for mental health practitioners serving this population; integration of disability status into routine public health surveillance; and expansion of training programs in disability-informed mental health care. The population's life expectancy is already 10 to 20 years shorter than the general population average. Unaddressed mental illness compounds that gap.

The study is cross-sectional and relies on survey-based identification of intellectual disability, which may undercount individuals with less visible presentations. The 796 identified adults represent a relatively small sample for subgroup analysis. Lead author is Anthony Osuna, a clinical psychologist and acting assistant professor of pediatrics at the University of Washington.