Mental Health Index

U.S. Worker Edition – September 2020 Update

Brain Capacities Are Under Attack and Fluctuating Due to the Ongoing Pandemic

Adapting to Ongoing Mental Strain is Driving Ups and Downs for U.S. Workers

U.S. workers have become very familiar with the mental strain and stress of the pandemic. Our brain capacities continue to be attacked, and the drawn-out nature of the situation means we’re under constant pressure to adapt and reframe. Fully adapting to COVID-19 is proving to be a challenging process for working Americans, as demonstrated by both negative and positive fluctuations in this month’s Mental Health Index. In the positive column are signs that employee’s ability to focus, complete tasks, and make decisions improved in August. On the other hand, stress, anxiety, and feelings of depression — which had each improved some in recent months — showed no new improvement between August and September. Instead, they remained elevated, as did employees’ risk of depression and general anxiety disorders. Ultimately, the positive and negative mental health fluctuations recorded in September are a reminder that mental health is not a static condition.

Best Case

Workers are showing pockets of improvement as they gradually adapt to living and working under the strain of COVID-19.

Worst Case

The lack of a resolution to COVID-related threats means workers are stuck in an ongoing chronic state of adaptation — and they are unable to function as well as they did before the pandemic.

Every Case

In all cases, adapting to the burden of prolonged stress, anxiety, and feelings of depression is bringing about fluctuations in brain capacities that impact Americans’ performance at work.

Don’t miss our monthly webinars where industry thought leaders gather to review the latest Mental Health Index data and discuss the mental health of working Americans.

State of Mental Health Among Working Americans

Focus Shows Signs of Improvement, Risk Remains High for Depression and General Anxiety

Despite Persistent Elevated Stress, Cognition Improved


Workers’ ability to focus and complete tasks improved 28% in September.


Decision making improved 9% since August.

Depression and Anxiety Disorder Risks Rise Again in Men


Risk for general anxiety disorder is up 24% in men since August.*


Men’s risk for depression is up 36% since August.*

Risk of PTSD is on the Decline


Risk of PTSD dropped 22% from August to September.*


Only 8% above February, the risk of PTSD is approaching a pre-COVID level.*

*This data changed directionally but does not reflect a statistically significant difference.

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Your Total Brain

Your brain’s 85 billion highly interconnected neurons self-organize into four core systems — emotion, feeling, cognition and self-control. Each of these systems is measured by 12 core capacities, and they fluctuate continuously along a performance continuum from well-being to risk of a mental health condition such as depression, addiction, and ADHD.

You Can Rewire Your Brain

Listen to Total Brain Founder Dr. Evian Gordan and Professor Anthony Hannan, PhD, discuss how to rewire your brain to better manage emotions, stress and anxiety. Listen to learn more.

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Total Brain measures the 12 brain capacities that define your mental health and screen for your risk of common mental conditions. Contact us to learn how Total Brain can help improve the mental health and wellness of your employees.

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Mental Health Index

The Mental Health Index data is updated monthly so our workers’ mental health and capacity can be monitored as we muddle through these uncertain times. Explore this month’s findings by clicking through the key findings tabs. Learn more about our methodology.

Emotional Capacities Are Nearly Identical to Pre-Covid Levels

Our emotions greatly influence all other brain capacities, which can also be impaired by mental conditions like depression, anxiety, and ADHD. Watch to learn more.

Emotional Awareness

Emotional awareness helps us build relationships and trust. It impacts how well we read emotional cues in others and informs our behavior in uncertain situations.

Emotional Awareness is Stable

Month after month, American workers have shown that the pandemic has had relatively little impact on their ability to perceive others’ emotions accurately. Emotional awareness is at the same level now as it was in February.*

Nonconscious Negativity Bias

Nonconscious negativity bias is our natural intuition formed by life experiences. It strongly influences our feelings, motives and decisions. And, it determines how effectively we communicate and collaborate with others. Watch to learn more.

Negativity Lessened Again Last Month

Nonconscious negativity spiked between February and April. However, since May, negativity has been lessening gradually. Between August and September, nonconscious negativity bias improved 3% among U.S. workers. Working Americans are now 2% less negative than they were at the beginning of February.*

Negativity Is Dropping Among Working Men

The level of negativity among working women didn’t change between August and September. However, working men are 6% less negative now than they were the previous month.

Emotions Remain the Same or Slightly Improved

For most working Americans, the brain capacities that relate to emotions (emotional awareness and nonconscious negativity bias) continue to either hold steady or improve slightly. This is in contrast to the other capacities, which have been more volatile during the pandemic.

Among U.S. workers, emotional awareness has shown very little positive or negative swing since February. This is true across workers of different ages and genders. An interesting finding is that working women have consistently been able to more accurately read emotional cues than working men. Also, workers in the 20-39 and 40-59 age groups routinely rate higher in emotional awareness than workers age 60 and older.

In the previous month’s Mental Health Index, it was reported that negativity, which had been heightened for a period of time, had improved and was back to the pre-COVID level. This month, negativity decreased again, slightly. This further confirms the previous report that the pandemic hasn’t delivered quite the same shock to Americans’ emotions that it has to other capacities.*

*This data changed directionally but does not reflect a statistically significant difference.

PODCAST – How Emotions and Feelings Drive You

Total Brain’s Founder, Dr. Evian Gordon, is joined by Dr. David Whitehouse for this podcast about the science behind emotions, feelings, and how they impact us all.

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PODCAST – How to Deal with Negativity in the COVID Era

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Stress, Anxiety, and Depressive Mood Continue to Measure Higher than Before COVID

Feelings are your conscious awareness of, and body’s response to, your unconscious emotions. For example, when you’re feeling stressed or anxious, your body will respond with changes in heart rate, breathing, muscle tension, and sweating. Feelings are triggered by emotions, and emotions are triggered by cues of threat or reward. Watch to learn more.


Stress is a response to an external “stressor” such as a work deadline, an argument with a loved one, the loss of a job, or a major life change. Stressors ranging from COVID-19’s impact on health and the economy, to clashes about mask mandates, crisis fatigue, and even tension related to the upcoming election are a few of the major stressors affecting us right now. When external stressors are not resolved, stress becomes chronic and leads to anxiety and depression. Watch to learn more.

Seven Consecutive Months of Elevated Stress

Increased stress has become the norm. U.S. workers have been experiencing elevated stress levels for seven straight months. Currently, U.S. workers are 16% more stressed than they were during the first week of February.

Stress Crept Upward in Men Last Month

From August to September, stress among working men increased 6%. During that same time period, stress did not change among working women. However, stress remains 12% higher in women than men.*


Anxiety is the internal reaction to stress. It is often accompanied by persistent worrying and fearing something bad will happen. Unlike stress, anxiety persists even after the stressor has been resolved. In severe cases, anxiety can lead to an anxiety disorder. Watch to learn more.

Lasting Elevated Anxiety Continues to Affect Workers

Anxiety climbed in the early part of 2020, peaked in April, and then declined for several months between May and August. That decrease in anxiety did not continue between August and September. Instead, anxiety again made a very slight upward turn, increasing 2% during the past month. Overall, American workers remain 25% more anxious now vs. in February.*

By Comparison, Older Workers Are Experiencing Less Anxiety

Anxiety among workers in the 20-39 age group is 93% higher than in workers age 60+. Since February, there has not been a significant difference in anxiety levels for workers 60 and older, however, anxiety is up 21% in workers between 20-39. Anxiety is also 39% higher since February in workers in the 40-59 age group.*

Depressive Mood Level

Feeling sadness, frustration, anger, loneliness, or grief often make up what is considered “depressive mood.” These feelings, however, lift after a few days or weeks. When these feelings persist over time, you can become clinically depressed. Watch to learn more.

Noticeable Pockets of Worsening Depressive Mood

Despite seeing a period of slight improvement during the late spring and into summer, depressed mood is 31% higher overall now vs. at the beginning of February. Additionally, depressive mood has started to be more problematic for certain groups of workers in the U.S., such as men and working adults over the age of 60.

Feelings of Depressed Mood Are Increasing Among Men and Older Workers

From the beginning of August to the end of September, depressed mood rose 22% in working men. Also, depressed mood has consistently been rising across the oldest group of working Americans. Since June, feelings of depressed mood grew 56% in workers age 60+.*

Recent Improvements in Workers’ Stress, Anxiety, and Depressed Mood Have Stalled

Once the initial shock of the COVID-19 outbreak began to wear off, some of the stress, anxiety, and feelings of depressed mood that working Americans were feeling also began to dissolve. From late spring into summer, stress, anxiety, and depressive feelings declined somewhat — indicating that Americans were adapting to the strain of the pandemic. Yet, stress, anxiety, and depressive feelings never returned to pre-COVID levels. Now, we’re seeing that the incremental improvements didn’t continue between August and September.

Not only did stress, anxiety, and depressed mood not improve during the past month, there is some indication these capacities could worsen again. The next month will be telling. Particularly because if workers see new COVID spikes, they may take on a learned helplessness and ultimately begin to feel helpless in the face of the turmoil around them.

*This data changed directionally but does not reflect a statistically significant difference.

PODCAST – Modifying Your Reaction to Stress Can Improve Your Mental Health

Listen to Total Brain Founder Dr. Evian Gordon’s podcast “The Role of Stress in Mental Health” with Dr David Whitehouse MD. PhD. Dr. Whitehouse shares how stress damages mental health and how you can reframe your reaction to stress.

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PODCAST – Anxiety: It’s Trying to Teach Us Something

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Rather Than Continuing to Worsen, Workers’ Cognition Improved

Your cognitive capacity determines how well you learn, remember, pay attention, and solve problems. It impacts how quickly you can complete tasks and how many mistakes you make while doing so. Chronic stress and anxiety can result in cognitive decline over time. Watch to learn more.


Stress and anxiety can hinder the way we form and retrieve memories. It can make you more forgetful. For example, you may find yourself forgetting where you left your phone, or have a hard time recalling names. Watch to learn more.

Memory Continues to Remain Stable

Between August and September, memory did not change significantly for U.S. workers. Also, workers demonstrated in September that they are able to remember things correctly now just as well as they could at the beginning of the pandemic.

Memory Bounced Back This Month in Older Workers

After declining in August, the 60+ age group showed improvement in memory during September. In this age group, memory increased 15% from August to September.*

Focus: Sustained Attention

Increased levels of stress not only cause us to become more irritable, but also tend to impact our ability to focus. For example, it’s common for stress to cause people to make more mistakes. Watch to learn more.

Workers Showed a Renewed Ability to Focus After Summer

Mistakes were down and sustained attention improved 28% in September. This recent improvement boosted focus levels 6% higher than in February. The decrease in errors during September was unexpected given current stress levels. However, because it coincides with the back-to-school season and the end of summer vacation, it may reflect workers’ transition from a summer to fall mindset.*

Workers of All Ages, Genders Made Significantly Fewer Mistakes Last Month

From August to September, focus improved 41% among working men, and 19% among working women. It also improved 31% among those 20-39, 19% among workers 40-59, and 45% among those 60 and older.*


Stress can negatively affect your ability to plan and complete tasks on time. When you’re stressed, concentration declines and the amount of time it takes you to complete tasks increases. Watch to learn more.

Planning Capacity Improved Unexpectedly

As with focus, planning showed a somewhat surprising improvement during the past month. Between August and September, planning improved by 9%, closing the gap between where it is now and where it was in February.

Planning Improvement Was Greater in Male vs. Female Workers in September

Planning performance improved by 13% in men, and 7% in women during September.*

Cognition’s Fluctuation is Something to Watch Going Forward

Considering that stress, anxiety, and depressed mood continue to weigh heavily on American workers, it is somewhat surprising that multiple cognitive capacities showed improvement in September. Focus improved 28%. Planning improved 9%. These unanticipated improvements serve as a reminder that even factors such as a change in seasons and routines can impact our mindset and performance at work.

Again, mental health is not static. While businesses can celebrate the fact that employees were more focused and able to perform better in September, it is important to realize that this improvement isn’t guaranteed to last. The connection between stress and cognition is strong. At least some of the improvement to cognition was likely related to workers reinvigorated mindset as they were wrapping up summer breaks and feeling eager to return to work and school routines in the fall. In that case, workers’ focused mindset may not hold up against sustained stress in coming months. Time will tell.

*This data changed directionally but does not reflect a statistically significant difference.

PODCAST – Learn How Your Brain Works to Improve Your Performance

Listen to Total Brain Founder Dr. Evian Gordon’s podcast “The Brain — From Knowing to Doing,” with Chris Darwin, a great, great grandson of Charles Darwin. They discuss 5 concepts that impact how you process information and your ability to be a peak performer.

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Self-Control Capacities Showed Little New Improvement During the Month of September

Our ability to control our behavior enables us to achieve goals, resist temptation, avoid acting on impulse, and maintain our mental and physical health. When under high levels of stress, people tend to become more negative and less resilient. As a result, they may lose the ability to self-regulate their behavior, which leads to a myriad of problems, including obesity, addiction, poor financial decisions, sexual infidelity, and more. Watch to Learn More


Resilience allows us to bounce back when something bad happens. It’s the ability to adapt in the face of adversity, trauma, tragedy, or other significant sources of stress. Resilience can drop quickly after an emotionally distressing event or a particularly stressful period in life. Watch to learn more.

Resilience Shifted Course in September

Resilience had been improving each month since May, however, that trend did not continue into September. Rather than showing more resilience, workers were measured as 2% less resilient between August and September. Working Americans are now slightly less resilient than in February — resilience is down 1% since the beginning of the pandemic.*

Resilience Is Declining in Older Americans

Resilience decreased noticeably among working Americans age 60 and older. In September, resilience fell 6% across the oldest group of workers, but showed no significant increase or decrease in workers between the ages of 20-39 or 40-59.*

Conscious Negativity Bias

Conscious negativity bias – the tendency to see the “cup half empty” rather than the “cup half full” – can rise in times of uncertainty and discouragement. It’s a disproportionate focus on problems rather than opportunity. And, it’s highly contagious. That’s why one very negative person can disrupt an entire group or team.

Workers Continue to Be Somewhat More Negative than Normal

Even after decreasing 9% between May and September, conscious negativity bias — how negative workers consciously are — remains 13% higher now than in February.

Negativity Has Increased Most in Younger Workers

Workers age 20-39 are 14% more negative now vs. in February. Conscious negativity is 10% higher now among workers 40-59 and 60+.*

Social Connectivity

Social connectivity reflects the extent to which people proactively seek and gain enjoyment from social interaction. Social connection plays a powerful role in supporting our mental and physical health. Watch to learn more. 

Social Connectivity Remains a Priority for Workers

The Mental Health Index has repeatedly shown that maintaining social connections is a higher priority now than it was at the start of the pandemic. Overall, social connectivity among U.S. workers is up 5% since February.

Social Connectivity Worsened Among Older Workers in September

Following an increase in August, social connectivity dropped 10% in September among workers 60 and older. Not only is this the only age group that saw social connectivity decline significantly during the past month, but considering resilience worsened and depressive feelings have been more prevalent across this age group, worsening social connectivity appears to be part of a larger trend of worsening mental health in the oldest group of working Americans.

After Improving for Months, Self Control Capacities Showed Less Positive Movement in September

Last month’s Mental Health Index revealed that workers’ self-control capacities (resilience, conscious negativity, and social connectivity) had all trended toward improvement between May and August. Unfortunately, rather than continuing in the right direction, social control capacities looked different in September.

Resilience and negativity worsened in September. Even social connectivity, a capacity that had been an area of strength, declined slightly. Examining these trends reminds us that there was a period of shock right when COVID first hit the U.S. Because of that, many of the mental capacities were heavily impacted in February, March, and April. Then workers began to adapt, which brought some months of improvement. But, the COVID crisis isn’t over. In fact, COVID-19 spikes are happening in many areas of the country. As long as this continues, it is likely that chronic stress will prevent many capacities from stabilizing at pre-COVID levels.

*This data changed directionally but does not reflect a statistically significant difference.

PODCAST – COVID-19 Captivity: Social Connectivity During Pandemic

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Risk of PTSD is Declining, Anxiety and Depressive Disorder Risks Remain Chronically Elevated

COVID-19 is causing more Americans to screen at risk for certain mental disorders compared to before the pandemic.


When chemicals from drugs or alcohol hit the brain’s reward receptors in bursts, it triggers a response similar to a highly pleasurable event. As the person repeats and increases substance use, the receptors degrade to the point that they cannot respond to un-intoxicated pleasure in the same way as they once did. The brain gets re-mapped to seek pleasure through intoxication rather than healthier activities, and as this new mapping takes hold, addiction is born. Watch to learn more.

Addiction Risk Increased in September

After rising early during the pandemic and then eventually falling, the risk of addiction for working Americans was no higher in August than it was in February. That changed in September when the risk of addiction ticked upward once again. Between August and September, addiction risk rose 9%.*

Working Men Are More At Risk of Addiction than Working Women

From August to September, risk of addiction rose 12% among men and 7% among women. Currently, men are 41% more at risk of addiction than women.*

Depressive Disorder

Depression is more than a bout with the blues. When feelings of sadness and hopelessness persist and worsen, you may be clinically depressed. Some people are predisposed to depression based on genetics and the brain’s chemical makeup. Chronic stressful life situations can also increase the risk of developing depression if you aren’t coping well. Watch to learn more.

Risk of Depression Remains Elevated Among Working Americans

From August to September, risk of depression increased 6%. It is now 64% higher than February’s (pre-COVID) level.*

Risk of Depression Is Rising for Both Men, and the Oldest Working Americans

Risk of depression has climbed sharply during the pandemic. Men’s risk of depression rose 36% in September and is 104% higher now than it was in February. Also, the risk of depressive disorder has been steadily increasing since June among workers age 60 and older — a trend that may be related to this age group’s worsening resilience and social connectedness.*

General Anxiety Disorder

Persistent and excessive worry are common indicators of general anxiety disorder. People with this condition have an inappropriate triggering of the fight-flight stress system that can make it difficult to control worrying or stop the worry cycle. As a result, they overthink, lose sleep, and agonize more than seems warranted for the situation. Stress is a common trigger for anxiety and if it becomes chronic it can lead to an anxiety disorder. Watch to learn more.

Risk of General Anxiety Disorder Decreased Very Slightly in September

The risk of general anxiety disorder in U.S. workers increased dramatically during the first few months of the pandemic. Since then, the risk has decreased somewhat — 27% between April and September, with a 2% drop in September. Yet, the overall risk of anxiety disorder remains 43% higher now compared to February.*

Youngest Workers Are Most Susceptible to General Anxiety Disorder

Risk for general anxiety disorder is 114% higher in workers between the ages of 20-39 vs. those 40-59. Also, the 20-39 age group has a 98% higher risk of general anxiety disorder vs. the 60+ workers.*

Social Anxiety Disorder

People who have social anxiety disorder have intense fear of being judged negatively or rejected in social situations. They often worry about being perceived as stupid, awkward, or boring. It can significantly impact your ability to socialize and communicate with other people. Watch to learn more.

Risk of Social Anxiety Fell Again in September

For U.S. workers, the risk of social anxiety disorder decreased by 15% between August and September. This is part of a trend of gradual risk decline that has resulted in a 39% decrease in risk since April. Currently, the number of working Americans screening at risk for social anxiety disorder is 10% above where it was in February.*

Women Had a Higher Risk of Social Anxiety Disorder Until Recently

At nearly every point during the pandemic, women’s risk of social anxiety disorder measured higher than men’s risk. However, risk has declined recently among women, and risen among men. Between February and September, risk of social anxiety disorder decreased 14% among working women, and increased 43% among working men. As of the end of September, there was no significant difference in the risk of social anxiety disorder between women and men.*

Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) is a mental health condition that’s triggered by a traumatic event. Most people who experience a distressing event may temporarily have trouble coping. However, they get through it with time and self-care. When symptoms persist for months and years, interfering with daily life, you may have PTSD. Watch to learn more.

September Revealed a Further Drop in the Number of Workers Screening At Risk of PTSD

From August to September, risk of PTSD declined 22%. The peak point of risk for PTSD was in April. Since then, risk of PTSD among working Americans has decreased 42%, and it is only 8% higher now than it was in February. A declining number of workers screening at risk of PTSD may be because Americans are less triggered by COVID now compared to at the beginning of the pandemic. When the COVID-19 outbreak first happened, it likely caused greater stress that triggered memories of past trauma.*

More Women Are Continuing to Flag At Risk of PTSD than Men

Between August and September, risk of PTSD dropped 29% among working men, compared to 19% among working women. At the end of September, risk of PTSD was 86% higher for women vs. men.*

Sleep Apnea

Stress and anxiety may cause sleeping problems. Having an anxiety disorder compounds the problem. Sleep apnea is a condition in which breathing repeatedly stops and starts while sleeping. Watch to learn more.

Working Americans Are More at Risk of Sleep Apnea than Before

Overall, the risk of sleep apnea is up 16% in U.S. workers since February.*

The Risk of Sleep Apnea Is Higher Among Women vs. Men

Since February, working men’s risk of sleep apnea has risen 17%, while women’s risk has increased 131%. Between August and September, men’s risk of sleep apnea decreased, and women’s risk increased. One reason for the greater risk of sleep apnea in women is that body mass index (BMI) has been increasing in women and decreasing in men. Higher BMI is a factor that increases the risk of sleep apnea. Since February, BMI has increased 8% among working women, but BMI has decreased 1% among working men.*

Risk for PTSD Dropped, Depression Rose, and Addiction Remained Relatively Stable in September

The risk levels for several mental health disorders have followed a similar pattern during the pandemic. Risks rose immediately after the COVID-19 pandemic began and the shock and stress of the situation first set in. Then, a few months into the pandemic, as Americans started to adapt, risks began to fall. Now, risks have become less predictable, proving that this is truly uncharted territory in terms of mental health.

What we know right now is that the sustained stress of the pandemic is keeping risks higher than normal for mental health disorders. At the end of September, risk of addiction was up 9%, risk of depressive disorder was up 64%, risk of general anxiety disorder was up 43%, risk of social anxiety disorder was up 10%, risk of PTSD was up 8%, and risk of sleep apnea was up 16% since February. But some risks are trending upward and others appear to be trending downward. This signals a new phase where elevated, but fluctuating risk levels may become normal.*

*This data changed directionally but does not reflect a statistically significant difference.

PODCAST – Genetic Information is a Roadmap that Can Teach Us How to Improve Mental Health

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