Americans’ latest assessment of their mental health is worse than it has been at any point in the last two decades. Seventy-six percent of U.S. adults rate their mental health positively, representing a nine-point decline from 2019.

Each year since 2001, Gallup has asked Americans as part of its November Health and Healthcare survey to say whether their own mental or emotional wellbeing is excellent, good, only fair or poor. The reading for those rating their mental health as excellent or good ranged from 81% to 89% until this year’s 76%.

Although the majority of U.S. adults continue to rate their mental health as excellent (34%) or good (42%), and far fewer say it is only fair (18%) or poor (5%), the latest excellent ratings are eight points lower than Gallup has measured in any prior year.