When it comes to well-being, 2017 was a tough year for Americans. A Gallup-Sharecare report examining well-being across the nation found that, for the first time in a decade, no state improved. In addition, 21 states experienced a decline in well-being in 2017 — the largest year-over-year decline in the 10-year history of the Gallup-Sharecare Well-Being Index.

Drops in well-being occurred primarily in the West and South, according to the report. States that have been historically high in well-being, such as Hawaii and Alaska, as well as states that have typically scored low in well-being, such as Mississippi and Ohio, all took a hit in 2017.

According to the study, there was a seven percent increase in adults who felt “little interest or pleasure in doing things,” and up to 32 percent of adults reported “significant worry on any given day.”

South Dakota ranked highest, and West Virginia maintained its place as the state with the lowest well-being score for the ninth year in a row. West Virginia has long been grappling with mental health challenges, and research has found that hopelessness and isolation contribute to the severe drop in life expectancy among West Virginians. 

Gallup-Sharecare’s findings are based on telephone interviews with over 160,000 individuals aged 18 and up across all states, according to the report. The study measured well-being using five elements: purpose, social, financial, community and physical. Purpose entails “liking what you do each day and being motivated to achieve your goals,” and social involves “having supportive relationships and love in your life.”

The news isn’t all bad. Dan Witters, Research Director of the Gallup-Sharecare Well-Being Index, told Thrive Global that while the more “emotional and psychological metrics” declined, several traditional well-being metrics reached their highest levels in well-being in 10 years. For example, in 2017, over half of American adults exercised at least three times a week and less than 18 percent of Americans smoked.

However, depression reached its peak in 2017, with nearly 20 percent of American adults having been diagnosed with depression at some point in their life, according to Witters. Depression, which globally afflicts approximately 322 million people — 4.4 percent of the human race, and a figure just shy of the entire U.S. population — has become the leading cause of disability worldwide.  

2017 was the first year since 2009 — a year in the midst of the Great Recession — that more states declined than improved, according to Witters.

“[2017] has a pretty unique profile, especially when you consider the macroeconomic measures that were so prevalent and so significant in driving down well-being in 2009,” he said. “Those pieces were removed in 2017. Economy’s not really the issue.”

Evaluating the results demographically, Witters said there are “clues” as to what caused 2017’s drop in well-being. He explained that the well-being of women, minority groups and lower-income households decreased more than that of men and higher-income households.

After looking at political identity, Witters found that Republicans’ well-being remained “officially unchanged,” while Democrats’ well-being went down. He said “any honest reading of the data” suggests both the 2016 presidential election and the 2017 inauguration of President Donald Trump have impacted Americans’ mental health.

“I think it’s pretty uncontroversial to assert that 2017 was a tumultuous year for America,” he said. “I think that’s reflected in these declining numbers that we find on these mental, emotional and psychological aspects of well-being. It’s objectively true that it’s disproportionately manifested itself among groups of individuals that tend to vote Democrat or self-identify as Democrats.”

In terms of the future, Witters said he’s “hopeful” the nation will level off in terms of well-being.

“This is the first time in a long time that we’ve been in a well-being bear market,” he said. “As far as 2018 is concerned, who knows? There’s early indications that things are flattening out now, but so far, we don’t have any data that directly supports that.”

Read the full report from Gallup and Sharecare here.