Why are so many young adults with depression not getting treatment?

Depression affects more young adults than any other adult age group. Each year, 7.5% of American adults suffer from at least one major depressive episode: characterized by persistent sadness, decreased interest in activities, feelings of emptiness, hopelessness, or other similar symptoms that last for at least two weeks. But 17% of people ages 18 to 25 did so in 2020, according to the National Institute of Mental Health (NIH). Major depressive episodes are usually signs of clinical depression.

That’s an even bigger problem than it seems, as a study published May 10 in JAMA network opened found that most of these young people are also not being treated. From 2011 to 2019, 53% of young adults who had experienced a major depressive episode in the past year did not receive treatment. And the biggest reason young adults gave for avoiding treatment was cost.

Wenhua Lu, a professor in the Department of Human Health and Social Medicine at the City University of New York (CUNY) School of Medicine, led the study, which was based on data from an annual national survey of 70,000 Americans. In the survey, participants answer a comprehensive range of questions about their mental health, including whether they are in treatment and the reasons why they are or are not.

Over the nine years they studied, Lu and her colleagues found that more than 21,000 young adults had suffered at least one major depressive episode — and more than 11,000 said they had not received any mental health treatment. The respondents mentioned ten reasons for not seeking treatment. In addition to the cost — which topped the list each year the researchers studied, with an average of 51% of people citing this as the top reason — many also feared being admitted to a mental institution, taking medications. , discovering people, or the consequences of work. Others said they didn’t have time to see a healthcare provider or were unsure whether treatment would help.

Lack of adequate insurance was the seventh most common reason for avoiding treatment, but it was the fastest growing category, jumping from 7.2% in 2011 to 15.8% in 2019.

Whatever the reason, untreated depression can be dangerous. Depression increases the risk of many serious health problems and consequences, including suicide. Of all adults, suicide attempts are highest for people ages 18-25, according to the NIH, and suicide is the third leading cause of death in this age group after homicides and accidents. Substance use may also increase among young people with depression, says Lu. “The effort to self-medicate with drugs and alcohol is very high,” she says.

Read more: Suicide is preventable. Hospitals and doctors are finally catching up

Lu’s study only followed people through 2019, but other research shows that the COVID-19 pandemic has led to increased stressors and a spike in depression across all age groups. According to a study by the Boston University School of Public Health, published in the Lancet Regional Health, self-reported depression in people aged 18 and older jumped from 8.5% in 2019 to 27.8% in 2020, and then to a whopping 32.8% in 2021. The sample was much smaller – just 1470 participants – than in the large national study using Lu, and the study participants, may have suffered as much from the transient stressors of the pandemic as they did from the chronic pain of clinical depression. The study also broke out no results by age group. Yet the pandemic has clearly exacerbated the emotional suffering of many people.

“Overall, we expect an increase in depression during COVID,” says Lu. “So there is an even greater need to improve access to treatment for young adults.”

One benefit of healthcare during the pandemic is that telehealth has expanded, which research has shown can be as effective in treating depression as personal therapy. And while costs and insurance coverage still pose barriers to treatment, telecare is generally cheaper than in-office care. Plus, it takes less time as it eliminates the commute to and from a healthcare provider’s office. “Telehealth is a promising option for young adults to improve their access to mental health services,” says Lu.

To make both in-person and telehealth more affordable, some solutions include finding a therapist who offers sliding scales based on a person’s ability to pay, or seeking the services of free public health clinics. The insurance problem, meanwhile, could be mitigated by further expanding Medicaid. Since 2014, 39 states and the District of Columbia have expanded Medicaid eligibility under the Affordable Care Act (ACA), but more needs to be done, Lu says. “We need more efforts to expand Medicaid further and enroll those people who are already eligible so they can use the services they need.”

The ACA’s stipulation that young people can stay on their parents’ insurance until they’re 26 — and come out of the highest risk group for depression — could also help alleviate both costs and insurance problems. Since so many Americans in the 18 to 25 age group are college students, Lu also sees the need for greater reach and access to mental health services on college campuses.

Finally, Lu urges young adults suffering from depression to take the first steps toward treatment by using an option closest to home — and one that costs nothing. “If I could speak to these young adults directly,” she says, “I would encourage them to reach out to their families and friends, who can help them seek professional help if needed.”

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Write to Jeffrey Kluger at jeffrey.kluger@time.com.

This post Why are so many young adults with depression not getting treatment?

was original published at “https://time.com/6175288/depression-untreated-young-adults/”