Popular Rap Songs’ Mental Health References Double from 1998 to 2018

Researchers studied whether mental health references have increased as mental health distress and suicide risk among US youth have increased over the past 2 decades.

The proportion of rap songs in the United States that include references to mental health more than doubled over the period from 1998 to 2018, according to the researchers who analyzed 5 years of the top 25 most popular US song charts. The qualitative study, published in JAMA Pediatrics, investigated whether mental health references have increased as mental health distress and suicide risk among youth in the US have increased in the past couple of decades.

The researchers analyzed the lyrics of the 25 highest ranked rap songs for 1998, 2003, 2008, 2013, and 2018 on the Billboard hot rap songs’ year-end chart, which is based on popularity estimates derived from Nielsen Broadcast Data System radio airplay data and Nielsen SoundScan sales data from nearly the whole US market.

The researchers identified lyrics conveying negative emotional sentiment based on a 2019 typology created by Steven Fokkinga of the Delft University of Technology, which describes various forms of conflict. Two coders independently analyzed lyric sheets to determine the presence of a mental health reference including anxiety/anxious thinking, depression/depressive thinking, suicide/suicidal ideation, and mental health metaphors (insufficient context to qualify as specific reference) based on the DSM-5 and the Mayo Clinic descriptions of anxiety and depression and Fokkinga’s high-arousal/low-arousal negative affect or stressor (authority, environmental conditions, faith, family life, financial strain, love life, social ally/friend, social rival/foe, societal issues, work life) known to relate to mental health across each song.

A random 46% of the full sample was coded independently by each coder to test interrater reliability, which was found to be “above acceptable level for all codes” based on Gwet AC coefficients. The coefficients were all greater than .90 except for coding environmental conditions, which had a Gwet AC score of .76.

The researchers found that the proportion of sampled songs per year with a mental health reference increased significantly, in a linear trend, from 1998 to 2018 for all categories except anxiety or anxious thinking. The number of songs in the top 25 that referenced mental health more than doubled (12 to 30) from 1998 to 2018.

The largest increase was seen with mental health metaphors, which rose from 2 of 25 in 1998 to 11 of 25 in 2018 (P <.001). Depression and depressive thinking references rose from 4 of the top 25 songs of 1998 to 8 of the top 25 songs of 2018 (P =.03).

The top 25 charts from 2013 and 2018 had 6 of 8 total songs that referenced suicide or suicidal ideation, while there were 0 in the top 25 from 1998 or 2003 (P =.02). Out of 94 songs, a total of 57 referenced negative emotion related to mental health.

The most common coded stressors that co-occurred with mental health references were social rivalry (59 co-occurrences), environmental conditions (42 co-occurrences), and love life (38 co-occurrences).

Regression analyses showed significant association between presence of mental health reference and environmental conditions (adjusted odds ratio (AOR), 8.1; 95% CI, 2.1-32.0) and love life (AOR, 4.8; 95% CI, 1.3-18.1) while family life (AOR, 5.6; 95% CI, 1.2-26.9), faith (AOR, 15.1; 95% CI, 1.5- 150.7), and social rivals (AOR, 0.2; 95% CI, 0.1-0.7) were significantly associated with the presence of depression or depressive thinking references.

Limitations of the study included interpreting artists’ intended meanings behind lyrics and solely including the top 25 songs from year-end charts.


Kresovich A, Reffner Collins MK, Riffe D, Carpentier FRD. A content analysis of mental health discourse in popular rap music. JAMA Pediatr. Published online December 7, 2020. doi:10.1001/jamapediatrics.2020.5155