Middle-aged Americans — those born in the 1960s and 70s — report higher rates of depression and loneliness and have poorer physical health than people of the same age in earlier generations. Their middle-aged peers in Europe do much better. In fact, rates of depression and loneliness have actually declined in Nordic countries.

To understand why Europeans are doing better than their American counterparts, a team led by researchers at Arizona State University analyzed survey data from the U.S., 12 European countries and Israel, China, South Korea and Mexico. The paper was the result of five years of research, Frank Inferna, first author on the study, told TheDoctor.

Benefits that would help middle-aged adults, such as family leave and subsidized childcare, have increased in Europe but have not changed in the U.S. since the early 2000s.

Spending on family benefits has not changed in the U.S. since the early 2000s, while it has increased in Europe. European countries offer cash transfers to families with children, paid parental leave and subsidized childcare, for example. The U.S. does not offer these benefits on the federal level.

These benefits would help middle-aged adults, often called the sandwich generation, who might need to juggle a full-time job with caring for both young children and aging parents.

The cost of health care is another reason why middle-aged Americans are not doing as well as their European counterparts. Although the U.S. spends more on health care than other countries, care is less affordable and more difficult to access.

Health care coverage in the U.S. is largely tied to employment through private insurance plans. In Europe it is more likely to be public. When people lose their job in the U.S., many also lose their health insurance, which can lead to poor health and pose a major financial burden.

More people have been insured since the Affordable Care Act was passed, but with subsidies expiring because of recent Congressional changes, costs are rising.

The type of insurance middle-aged Americans have also makes a difference. Plans with a high deductible require many out-of-pocket expenses until that deductible is met. “It is one thing to have insurance, but if you are paying a lot for out-of-pocket medical costs, that adds to financial stress,” Inferna, a professor of psychology at Arizona State University, said. Health insurance purchased through an employer usually comes with a much lower deductible.

Research has found that daily life is more stressful for middle-aged adults today compared to previous generations, Inferna explained. Workers have been more productive, but their wages have not increased. Goods are more expensive, and people cannot contribute as much to their retirement savings as their parents. “Those financial stressors play into this as well,” he said.

In addition to the higher health care cost issues affecting citizens, the risk factors for dementia and poor cognitive functioning such as physical inactivity, high blood pressure and high cholesterol, are also more common in the U.S.

The researchers were surprised to find that although educational achievement has increased in the U.S. across generations, memory recall has declined, a pattern not seen in other countries.

The U.S. spends more on health care than other countries, but care is less affordable and more difficult to access.

Although the U.S. has had opportunities to expand the kinds of benefits that could ease the economic stressors faced by middle-aged adults, they have not come to fruition. “At the national level there have been some initiatives, but it is happening more at the state level,” Inferna said. Some states have expanded the Family and Medical Leave Act, so people can take time off and get paid a certain percentage of their salary if they have a child or need to care for aging parents.

Some states also have income caps for subsidized childcare. In New York, for example, households with an income below $80,000 can apply for these subsidies. Some states, including New York, have universal pre-K, so parents don't have to pay for childcare or will pay much less for it.

Inferna hopes to look at the differences between states based on policies that have been implemented, examining trends in mental and physical health among middle-aged U.S. adults at the state level in future research.

The study is published in Current Directions in Psychological Science.