1 of 4 | Research suggests that more residents of the United States have been diagnosed with depression than those in other countries, and while this may be debatable, a lot of people nationally don't feel very good about themselves. Photo courtesy of the University of Texas Health Science Center at San Antonio
NEW YORK, Nov. 14 (UPI) -- Research suggests that more residents of the United States have been diagnosed with depression than those in other countries, and while this may be debatable, a lot of people nationally don't feel very good about themselves.
More than 1 in 5 adults in the United States have a depression diagnosis, according to the Centers for Disease Control and Prevention -- largely because access to mental healthcare services and treatments is widely available in most areas of the country, said Parvati Singh, an assistant professor of epidemiology at Ohio State University.
That access to care leads to "more acceptance of mental health disorders" in society here, compared with other countries, Singh, who moved to the United States from India just over a decade ago, told UPI in a phone interview.
"I can tell you for sure that acceptance and tolerance of mental health disorders is higher here and the stigma is lower comparatively than it is in India, which makes it more acceptable to get treatment -- that's certainly a factor," she said.
Even though there are shortages of mental health professionals in some parts of the United States, Dr. Melissa Martinez, an associate professor of psychiatry and behavioral sciences at the University of Texas Health Science Center at San Antonio, said people in wealthier countries generally have better access to care for disorders like depression than those living in low- and middle-income countries.
One federal program, Medicare, has boosted the statistics for people who say or act like they are depressed. That's because in many parts of the United States, and for most patients, the annual Medicare wellness exam includes screening for depression.
Martinez, who has developed a free online screening test for depression to assist physicians in diagnosing the condition, says the more screening, the more people can be helped.
"I am a big proponent of mental health screening in primary care and other physical health settings, and this has been started to be implemented, [which] is necessary," she added.
Given that the numbers are high, "It's hard to definitively say what is causing higher rates of depression in the United States," UCLA psychologist Lauren Marlotte said.
"However, we do know that as we become less active, less socially connected, have poorer sleep and are more stressed, we are at higher risk for depression," said Marlotte, assistant director of training for the Nathanson Family Resilience Center within the UCLA Semel Institute for Neuroscience and Human Behavior.
Although data for some countries is lacking, it's likely that depression actually is more common in regions of the world that face political conflict and widespread poverty, but these areas lack healthcare professionals and facilities to diagnose and treat these cases, Ohio State's Singh added.
Social and health factors
National averages indicate that about 20% of people age 18 years and older have been diagnosed with depression at some point, and as many as 1 in 3 are dealing with the condition in some parts of the country, CDC data shows.
By state, West Virginia has the highest prevalence for the disorder, at 28%, while California, at roughly half that rate, has the lowest, agency figures indicate.
Some of these regional disparities may be linked with socioeconomic factors, according to Texas Health Science Center's Martinez.
Household incomes in California are about 50% higher than those in West Virginia, for example, based on data from World Population Review.
"Social stress in general, financial stress and job stress are all factors that can drive an increase in depression symptoms," Martinez said.
Better access to healthcare also may be a factor in seeing large numbers of depression diagnoses, with higher concentrations of doctors and hospitals in densely populated areas, like much of California, than in rural ones, such as many parts of West Virginia, she said.
Having less access to care can contribute to poorer health, and, in turn more reports of depression.
For example, between 40% and 45% of adults in West Virginia are severely overweight, while that figure is between 20% and 25% in California, CDC data shows.
Research has tied obesity, which raises the risk for diabetes, heart disease and other physical health problems, with an increased risk for depression, according to the agency.
"Physical and mental health conditions are linked, and individuals with physical health conditions are at greater risk for depression," UCLA's Marlotte said.
"Unfortunately, depression also increases your risk of physical health conditions because it impacts your immune system."
Racial disparities may also be factor, she said.
Although rates of depression remain higher among White adults in the United States, at 21%, than Black and Hispanic/Latino adults, at 16% and 15%, respectively, according to the CDC, those latter figures have increased in recent years, she said.
"We are seeing more depression in women and young adults as well as Black, Indigenous, People of Color so we cannot ignore the impact of racial and social injustices experienced in our country historically and particularly in the past couple of years," Marlotte said.
"Race-based stress absolutely impacts mental health," she said, citing racial disparities in healthcare nationally.
The prevalence of depression nationally has also increased since the onset of the COVID-19 pandemic in March 2020, when it was below 19%, according to the CDC.
"We have all experienced increased social isolation in the wake of the COVID-19 pandemic, which is a risk factor for depression and other health consequences," Marlotte said.
"As we become less active, less socially connected, have poorer sleep and are more stressed, we are at higher risk for depression," she said.
Depression globally
The pandemic may help explain why up to 30% of adults in the United States reported being diagnosed with the mental health disorder in a Gallup poll released in May.
Still, that same Gallup survey found that just 19% of adults globally have been diagnosed with depression and/or anxiety, two conditions that are linked with each other.
That gap is much narrower than the one seen between the CDC figures and those of the World Health Organization, which estimate global prevalence of the disorder at just under 4%, and it isn't necessarily a sign that depression is more common here, though, Ohio State University's Singh said.
"It may simply be a case of who has access to psychiatrists and doctors who can make diagnosis," she said.
"There is an element of better screening," Marlotte said.
"I am a big proponent of mental health screening in primary care and other physical health settings, and this has been started to be implemented, [which] is necessary," she added.
In addition, some research suggests that depression is being over-diagnosed in some areas of the United States, particularly in wealthier communities, according to Singh.
Adding to the confusion is that depression is typically based on patients "self-reporting their symptoms," she added. "There is no blood test for depression, like there is for diabetes, for example.
"So, it's possible more people here are reporting depressive symptoms to their doctors."
