Frequent Physical Distress



Why do we measure frequent mental and physical distress?

Health-related quality of life is often measured by asking people how they would characterize their physical and mental health in the past month.(1,2) These self-reported measures can help assess how many people are experiencing more chronic physical and mental health conditions and can help identify unmet health and social service needs in a community.(3,4)

Frequent mental distress: Mental health is often overlooked when evaluating the health of a community, yet it is an important indicator of economic hardship and overall well-being. People who report many poor mental health days may have difficulties in their daily life and are more likely to experience chronic diseases.(5,6) 

Frequent physical distress: Similarly, those who report frequent poor physical health days are at higher risk of mortality, more commonly utilize health care services, and have lower health-related quality of life.(2,7,8) Frequent physical distress is highly linked with having chronic conditions such as cancer, diabetes, obesity, and arthritis, as well as health behavior risk factors, such as physical inactivity, binge drinking, and smoking.(2,9,10) Physical debility that accompanies such chronic conditions can affect all aspects of life.

How do we measure frequent mental and physical distress?

We report two measures of health-related quality of life.

  1. Frequent mental distress measures adults 18 or older, who report experiencing poor mental health for 14 days or more in the past month. 

  2. Frequent physical distress measures adults 18 or older, who report experiencing poor physical health for 14 days or more in the last month.

Strengths of Metrics

Limitations of Metrics

Frequent mental and physical distress can be used to better understand health-related quality of life.(2)

The metrics are easy to capture through standard surveys such as the Behavioral Risk Factor Surveillance System (BRFSS).(1) 

The metrics rely on the person surveyed to define “distress.” This makes it difficult to assess reliability and validity, particularly when comparing responses across groups.

The metrics are not cause-specific, which makes identifying the best means to intervene difficult.

People often experience both chronic physical conditions and poor mental health at the same time, making it difficult to separate how one might be causing the other.(3)


FMD/FPD formula

This metric was calculated by aggregating estimates from smaller geographies to the congressional district level. For more information, please refer to the Congressional District Health Dashboard Technical Document.

Data Source

Estimates for these metrics are from one year modeled PLACES Project Data (formerly 500 Cities Project)from the Centers for Disease Control and Prevention. 

Years of Collection

Calculated by the Dashboard Team using data from 2021, 1 year modeled estimate.


  1. Moriarty DG, Zack MM, Kobau R. The Centers for Disease Control and Prevention's Healthy Days Measures - population tracking of perceived physical and mental health over time. Health and quality of life outcomes. 2003;1:37.

  2. Centers for Disease Control Prevention. Measuring healthy days: Population assessment of health-related quality of life. Atlanta, GA: Centers for Disease Control and Prevention. 2000.

  3. Thurston-Hicks A, Paine S, Hollifield M. Rural psychiatry: Functional impairment associated with psychological distress and medical severity in rural primary care patients. Psychiatric Services. 1998;49(7):951-955.

  4. Moriarty DG, Zack MM, Holt JB, Chapman DP, Safran MA. Geographic Patterns of Frequent Mental Distress. American Journal of Preventive Medicine. 2009;36(6):497-505.

  5. Liu Y, Croft JB, Wheaton AG, et al. Association between perceived insufficient sleep, frequent mental distress, obesity and chronic diseases among US adults, 2009 behavioral risk factor surveillance system. BMC Public Health. 2013;13:84.

  6. Strine TW, Balluz L, Chapman DP, Moriarty DG, Owens M, Mokdad AH. Risk behaviors and healthcare coverage among adults by frequent mental distress status, 2001. Am J Prev Med. 2004;26(3):213-216.

  7. Dominick KL, Ahern FM, Gold CH, Heller DA. Relationship of health-related quality of life to health care utilization and mortality among older adults. Aging clinical and experimental research. 2002;14(6):499-508.

  8. Taylor RM, Gibson F, Franck LS. A concept analysis of health-related quality of life in young people with chronic illness. Journal of clinical nursing. 2008;17(14):1823-1833.

  9. Chen HY, Baumgardner DJ, Rice JP. Health-related quality of life among adults with multiple chronic conditions in the United States, Behavioral Risk Factor Surveillance System, 2007. Prev Chronic Dis. 2011;8(1):A09.

  10. Doll HA, Petersen SE, Stewart-Brown SL. Obesity and physical and emotional well-being: associations between body mass index, chronic illness, and the physical and mental components of the SF-36 questionnaire. Obesity research. 2000;8(2):160-170.

Last updated: February 20, 2024