Everybody Hurts

What 48 Million Messages Say About the State of Mental Health in America

In 2020, Crisis Text Line supported 843,982 texters in crisis, exchanging more than 48 million messages through 1.4 million conversations between texters and Crisis Counselors. In a year like no other, we wanted to know what issues remained prevalent and what crisis trends emerged.

Peak Anxiety

In March 2020, COVID-19 began to spread throughout the country and anxiety and stress surged, becoming the number one issue in conversations. Between lockdowns and stay-at-home orders, school and business closures, and climbing death tolls, it isn’t hard to imagine why anxiety was

top of mind for texters, and there was higher than average conversation volume almost every day after March 16. As the pandemic year rolled on, anxiety remained one of the top two issues in conversations, along with depression. Grief, eating disorders and body image issues also appeared more frequently than in 2019.

This map represents the percentage of conversations about anxiety and stress with texters from each state as categorized by a Crisis Text Line Crisis Counselor

Significant Dips in Depression and Suicidal Ideation

In a year where all of humanity was experiencing a series of traumatic events together, including racial trauma and an economic recession, conversations in which texters shared feelings of depression and sadness dropped in 2020 by 10% from 2019. Conversations in which texters expressed thoughts of suicide dropped significantly in 2020, a 20% overall decrease from the previous year. This trend was also noticeable in the relative drop in conversations flagged as “at imminent risk of suicide,” where a texter indicated they were thinking about ending their life, and they also had a plan, the means, and wanted to make an attempt within 48 hours.

While there may be several reasons for this downward trend in texters with suicidal thoughts, including an overall increase of conversations from texters, this could be a signal that suicidality dropped. In March 2021, The Journal of American Medicine (JAMA) reported that suicides in 2020 were lower than the previous three years based on information from the National Center for Health Statistics.

This map represents the percentage of conversations about depression and sadness with texters from each state as categorized by a Crisis Text Line Crisis Counselor

This map represents the percentage of conversations about suicide with texters from each state as categorized by a Crisis Text Line Crisis Counselor

New Volunteers Rise Up

As the pandemic raged on, thousands of people found themselves quarantining at home, wanting to do something positive and productive. In March and April, more than 15,000 applied to become a Crisis Counselor. Through this report, volunteers across the country share why they give their time to support strangers in crisis.

National Summary

Crisis Text Line had 1.4 million conversations with texters during 2020, with higher than average volume almost every day after March 16th. We wanted to understand how mental health issues like anxiety, depression, and suicide shifted in 1.4 million crisis conversations in 2020.

In 2020, Crisis Text Line supported:

843,982 Texters in crisis

1,539,934 Conversations with texters

48,000,0000 Messages

65% Conversations in which the texter shared something for the first time

26,629 Conversations when a texter was deemed to be at imminent risk of suicide because they mentioned they had a suicidal thoughts, a plan, and wanted to make an attempt within 48 hours

8,577 Conversations in which Crisis Text Line initiated an active rescue and worked with emergency services (which could include first responders of EMT, Fire, Police or Mobile Crisis Units)

In a year like no other, with a pandemic, racial trauma, and a polarizing election, we wanted to know what issues remained prevalent and what crisis trends emerged. Early in 2020, anxiety and stress surged, followed by grief, and eating disorders and body image issues. Conversations about depression and sadness, suicide, bullying, emotional and physical abuse, and substance abuse dropped.

Anxiety

Anxiety and stress became the top issue in conversations for a several month period beginning in March, and overall increased 5% over 2019. Nationally, anxiety was a topic in 35% of all conversations with texters in 2020. In Puerto Rico, Connecticut, Massachusetts, and New York, the average was significantly higher. The heightened levels of anxiety in Crisis Text Line conversations coincided more closely with the weeks of the lockdown, while the drop in depression-related conversations persisted for most of the year.

Depression

While anxiety soared during the Spring, conversations about depression dipped significantly lower than in 2019. Overall conversations in which texters shared feelings of depression and sadness dropped in 2020, a 10% overall decrease from 2019—though by the end of the year it remained the top issue of all conversations. Nationally, depression was a topic in 36% of all conversations with texters. In West Virginia, South Carolina, and Arkansas, the average was significantly higher.

Suicidal Ideation

Conversations in which texters expressed thoughts of suicide dropped signifciantly in 2020, a 20% overall decrease from 2019. Nationally, suicide was a topic in 23% of all conversations with texters. In Wyoming, South Dakota, and Utah, the average was significantly higher. This trend was also noticeable in the relative drop in conversations flagged as “at imminent risk of suicide,” where a texter indicated they were thinking about ending their life, and they also had a plan, the means, and wanted to make an attempt within 48 hours.

There may be several reasons for this downward trend in texters with suicidal thoughts. It is possible that people in a mental health crisis who reached out to Crisis Text Line were overall less likely to contemplate suicide in 2020, in a year where all of humanity was experiencing a series of traumatic events together. It is just as likely that during the first months of the pandemic and a more intensive nationwide quarantine, a different type of texter felt compelled to contact Crisis Text Line, more likely to discuss anxiety than depression or suicide.

Historic data indicates that during spikes when the percentage of new texters increases, the percentage of imminent-risk-conversations often drops. In March 2021, the Journal of American Medicine reported that suicides in 2020 were lower than the previous three years based on information from the National Center for Health Statistics.

Our texter demographics do not mirror the population of the United States. They highlight who is reaching out for support in managing their mental health.

Crisis Text Line’s service is anonymous, but we ask texters to complete a voluntary anonymous survey once a conversation ends. About 20% of texters complete this survey. In the texter survey, any one person can identify with multiple races or ethnicities. We allow texters to select multiple options or write in their own response as they respond to the post-conversation survey question about race and ethnicity. This option for texters to multi-select results in the ethnicity percentages below totaling more than 100%.

Young. In 2020, 74% of our texters were 24 or younger. Texters aged 13 and under accounted for 13.7% of conversations, texters ages 14 to 17 accounted for 34.1% of conversations and texters aged 18 to 24 made up 26.4% conversations. It is our hope that with this understanding of the generational challenge facing American youth, Crisis Text Line can play an integral role in expanding America’s mental-health safety net to support our youth as they build our collective future.

Diverse. In 2020, texters who reached out to Crisis Text Line were more diverse than in previous years. Texters who identify as Black accounted for 14.2% of conversations, texters who identify as Hispanic, Latino or Spanish origin accounted for 20.5% of conversations, texters identifying as Asian made up 6.8% of conversations, texters identifying as American Indian / Alaska Native came in at 3.9%, and, those identifying as Middle Eastern, North African or Arab made up 1.6% of conversations. Racism is a public health threat that can worsen mental health, and we continue to work to increase access to mental health support for BIPOC and diverse communities.