Who gets depression? In the U.S., poverty, race and ethnicity, domestic abuse victims, adolescents, LGBTQ, and the elderly: these groups have a higher incidence of mental health challenges due to a complicated mix of factors. One thing is certain, regardless of age and circumstance: access to quality diagnosis and treatment is crucial to support these groups through whatever challenges they face.
Who gets depression: Those living in poverty
People living in poverty in the U.S. are more than twice as likely to suffer from depression as those living above the poverty line. This is due in part to the following:
- Lack of education: Education about the signs and symptoms of depression is crucial for early diagnosis and treatment. For people who remain undiagnosed, depression is often further complicated with substance abuse. Forty percent of people who succeed in their suicide attempt suffer from undiagnosed depression.
- Lack of insurance: Even with passage of the Affordable Care Act, people living below the poverty line may have difficulty obtaining insurance for various reasons including not understanding how the new law works or not knowing that they have insurance options.
- Shortage of mental health professionals: Once people in poverty are enrolled in insurance plans, there is often a dearth of qualified professionals in their neighborhoods. This is true for both rural and urban settings. There is a particular lack of mental health professionals in rural settings that makes evaluating for depression difficult. There is a shortage of mental health professionals in general, and those who are qualified are generally working with patients above the poverty line. In the U.S., 55% of the 3,100 counties in the nation have no psychiatrists, psychologists, or social workers.
Who gets depression: Minorities
If you are poor and ethnically diverse in the U.S., the chances of receiving mental health care is extremely low. There is also a racial component to incidence of mental health issues. Minorities are less likely at any income level to seek counseling or support for mental health issues, both due to access to care and the stigma that mental illness holds in these communities.
Former Surgeon General of the United States David Satcher put it this way:
“There are major disparities in access, use, and quality of mental health services for racial and ethnic minorities. Minorities are less likely to receive mental health care, and when they do receive it the quality of [that] care is not good. Minority populations experience greater disability from mental illness than their majority counterparts. This is not because they have more mental illnesses but because they lack access to care. If you are already a victim of stigmatization [of mental illness], you don’t want to go out and announce you have a mental [problem] if you think it is going to be held against you.”
Not only are minorities less likely to seek treatment for mental health, but they are also likely to suffer mental health issues due to everyday discrimination. A study of nearly 4,500 African American and Caribbean black Americans found that:
“[P]erceived discrimination is an often overlooked but major source of health-related stress, with effects comparable to other major stressors such as the death of a loved one or the loss of a job.”
The National Survey of American Life, a comprehensive survey of the mental health of black and non-Hispanic white populations in the United States funded by the National Institute of Mental Health, found that 83% of respondents experienced at least one incident of discrimination, while 50% reported regular, recurrent acts of discrimination that ranged from rude or poor service to hostile or threatening discrimination.
Who gets depression: Domestic abuse victims
Another startling connection is that of poverty to domestic violence and mental health issues. One in four women will be victims of domestic violence in their lifetime, and these women often suffer long-term mental health issues including post-traumatic stress disorder (PTSD), anxiety, and depression.
Here again there is a connection between poverty and mental health. Poverty causes tremendous stress to a family, and many families are caught in a cycle of poverty and domestic abuse. Children who live in homes where domestic violence is present experience high rates of neglect and often become abusers when they grow up (or depressed, as noted below). Domestic abuse is the third leading cause of homelessness, a state that causes considerable trauma, both long- and short-term.
Who gets depression: Adolescents
Long seen as a time of emotional turmoil, adolescence is also a period of time when intervention in mental health issues can have a profound effect on the success of care in the long-term. Irene Li Yin Tan and colleagues at the Universiti Putra Malaysia looked at the effects of perceived parental warmth towards children in adolescence and found that those children ages 13-15 who felt parental warmth were less likely to view themselves negatively and thus experienced less depression.
These findings imply that early intervention in the family dynamic could help predict which children may experience depression, treating them early and helping them to feel loved and valued.
Who gets depression: LGBTQ population
Another population that experiences a high rate of depression and mental illness is the lesbian, gay, bisexual, transgender, and questioning (LGBTQ) community, particularly in adolescence. The National Alliance for Mental Illness reports that:
“LGBTQ individuals are almost 3 times more likely than others to experience a mental health condition such as major depression or generalized anxiety disorder. This fear of coming out and being discriminated against for sexual orientation and gender identities, can lead to depression, posttraumatic stress disorder, thoughts of suicide and substance abuse.”
For more information on how to support this population, visit the National Alliance for Mental Illness.
Who gets depression: The elderly
Whether is it the natural cognitive decline that occurs as we age, the struggles with physical health, or some other factor, mental health issues affect the elderly in rising numbers as they age. Depression in the elderly is linked to an increase in mortality risk as well as an increased risk of suicide in elderly men. Depression is not a normal part of aging, as is sometimes thought, and it is important to be alert to signs in elder friends and relatives.
Reducing risk of depression
There are treatment options that can ameliorate some of the risks of depression in these populations.
- For chronic illness: A new treatment approach for patients with cancer and depression incorporates mental health treatments, including medications if necessary and therapy, and could also show promise for elderly people with multiple health problems and chronic pain.
- For postpartum women: This approach is similar to the approach for cancer patients in that it emphasizes collaboration and integration of mental health care with regular, physical care.
- For everyone: Building a strong social network can help people through mental illness even in areas where mental health care is sparse. Senior Fellow Alexander Haslam, lead author Tegan Cruwys, and their colleagues at the University of Queensland found that people being treated for depression had only a 33% chance of still being clinically depressed a month after they joined a social group (such as a class or a hobby-based group). Those who did not have this social tie had a 50% chance of still being clinically depressed. While this may seem a small difference, it speaks to the power of connection in treatment of depression.
There is a particular population that does not experience depression in such great numbers – financially stable white men between the ages of 25 and 40 – but for the rest of the population, it is important to get at the root of the problem and promote equality in diagnosis and treatment.