Why middle-aged Americans are falling behind peers abroad in various health measures
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Americans born in the 1960s and early 1970s report higher loneliness and depressive symptoms, and show poorer memory and physical strength, than earlier generations. Such declines are largely absent in peer countries, particularly in Nordic Europe, where outcomes have improved over time.
In a new study, psychologist Frank Infurna of Arizona State University and co-authors analyzed survey data from 17 countries seeking to identify why U.S. trends diverge from other wealthy nations.
“The real midlife crisis in America isn’t about lifestyle choices or sports cars. It’s about juggling work, finances, family and health amid weakening social supports,” Infurna said. “The data make this clear.”
The findings, published in Current Directions in Psychological Science, point the way to likely solutions for individuals and U.S. society.
Since the early 2000s, public spending on family benefits has risen in Europe while it has remained largely static in the U.S. The U.S. does not have extensive family policy programs, such as cash transfers to families with children, income support during parental leave or subsidized child care, compared with European nations.
These differences matter for midlife adults, who often juggle full-time work while supporting children and caring for aging parents. In countries with stronger family policies, middle-aged adults reported lower loneliness and smaller increases in loneliness over time. In the U.S., loneliness rose steadily across generations.
Health care costs also have an impact. Although the U.S. spends more on health care than any other wealthy nation, access and affordability are worse. Rising out-of-pocket costs strain household budgets, discourage preventive care and contribute to stress, anxiety and medical debt, the authors noted.
Income inequality can contribute to international differences. Income inequality has risen in the U.S. since the early 2000s, while it has stabilized or narrowed in most European nations. Infurna’s research found that higher inequality is linked to poorer health and greater loneliness among middle-aged adults. Income inequality exacerbates poverty rates, reduces the possibility of moving up the socioeconomic status ladder and impacts access to education, jobs and social services — each of which has downstream effects on health, other studies have shown.
Cultural factors could also contribute to cross-national differences, the researchers reported. Americans, for example, are more likely to live far from family and move frequently, making long-term social connections and caregiving support harder to sustain.
Later-born cohorts of U.S. middle-aged adults have accumulated less wealth and more financial vulnerabilities, compared to earlier-born cohorts, due to wage stagnation and the Great Recession. Stronger social safety nets in European nations appear to have helped buffer middle-aged adults from negative health effects.
Strikingly, U.S. middle-aged adults showed declines in episodic memory despite rising educational attainment — a pattern not observed in most peer nations.
“Education is becoming less protective against loneliness, memory decline and depressive symptoms,” Infurna said.
Chronic stress, financial insecurity and higher rates of cardiovascular risk factors may undermine the cognitive benefits of education, the researchers found.
The authors emphasize that the U.S. disadvantage is not inevitable. Psychosocial resources such as social support, a sense of control and positive views on aging can help buffer stress, but broader policy changes are needed to reverse the trend.
“At the individual level, social engagement is crucial. Finding community — through work, hobbies or caregiving networks — can buffer stress and improve well-being,” Infurna said. “At the policy level, countries with stronger safety nets — paid leave, child care support, health care — tend to have better outcomes.”
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