Are more people depressed & anxious, or are we just getting better at talking about mental health?

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Over the last decade, and especially since 2020, the knowledge that more and more people are struggling with mental health conditions has almost become rote, along with a dizzying list of interacting factors that contribute to this reality.

When a 75-year-old reader sent us the question, “Why does mental illness seem to be on the rise?” I considered laying out in this newsletter the many reasons why a growing number of people are anxious and depressed.

The 24/7 news cycle is harming our mental health. The 40+-hour workweek and grind culture are harming our mental health. Social media’s algorithms, designed to keep us angry, distracted and siloed, are harming our mental health, and so, too, are social isolation, income inequality, climate change, racism, sexism, sizeism, homophobia and transphobia. And on and on.

But that type of reporting (while vital) is everywhere right now, saturating TV news and social media timelines. So I decided to diverge from the causes of these conditions and look into how we actually know mental health issues are on the rise, and how such data are shaped by our increasing awareness of mental health issues.

So how is it tracked?

Before the 1970s, mental health conditions were tracked solely through hospital reporting data. But that method revealed an incomplete picture, as the only people being accounted for were largely those being treated in the throes of a crisis, explained Bernice A. Pescosolido, a sociology professor at Indiana University whose research focuses on how social networks and culture provide insights into health.

Then, in 1977, President Carter’s mental health commission released a report that emphasized the importance of using epidemiological research to frame physical health and mental health policies. Born from this call to action was the Epidemiologic Catchment Area (ECA) program, which aimed to collect data on the prevalence of mental illness in the U.S. and determine the need for services to treat those disorders. It was one of the largest such investigations ever conducted.

“Those researchers were the first to go into the population and develop questionnaires that were really very good at estimating the rate of depression and anxiety in the population, not just those who get to the hospital or doctor,” Pescosolido told me.

Since then, surveys that seek to understand rates of mental illness in the U.S. population have continued to be tweaked and refined. Two large, ongoing and yearly surveys conducted by the federal government are the Centers for Disease Control’s National Health Interview Survey — for which 88,000 people nationally are randomly selected to participate, and which includes short questions about anxiety and depression symptoms — and the federal Substance Abuse and Mental Health Services Administration’s National Survey on Drug Use and Health. The latter has a sample size of about 67,000 and collects information on substance use and mental health issues among Americans ages 12 and older.

What these surveys and others have told us is that symptoms of anxiety and depression doubled during the pandemic. But mental health issues were already on the rise in the United States, with emergency room visits related to depression, anxiety and similar conditions up 28% between 2011 and 2015.

These surveys aren’t taken in a vacuum, though. “Willingness to talk about this stuff has changed dramatically,” said Ronald Kessler, a Harvard University sociologist whose research focuses on the social determinants of mental health conditions from an epidemiological perspective.

“In the past 15 years, we have famous people going on evening talk shows, talking about their mental health struggles and suicide attempts,” he said. That would’ve been almost unfathomable in the not-so-distant past (when suicide attempts were quasi-illegal).

And public opinion has changed dramatically over time, too. Much like society changed its views on cancer, which used to be referred to only in whispers as “the big C,” more people are growing willing to talk about their mental health diagnoses. According to a 2019 poll, 87% of American adults agreed that having a mental health disorder is nothing to be ashamed of, and 86% said they believe that people with mental health disorders can get better. (It should be noted, though, that there’s a difference between society embracing anxiety and depression, versus how we view people diagnosed with mental illnesses with greater stigma attached to them, such as personality disorders and schizophrenia.)

It’s likely that someone who may have been hesitant to report their depression symptoms to a national survey worker in 2005 is willing to do so now.

“This is why numbers aren’t a pure indicator of whether there are more mental health problems in society,” Pescosolido said.

So how much, exactly, is the shifting narrative around mental health shaping the reporting data?

“We know that reports of anxiety and depression are going up, and we suspect that some part of that is real, and some part of it is due to greater awareness and willingness to talk,” Kessler said. “The question is, how would we ever really in a rigorous way be able to figure that out? We can’t.”

“The other piece of it is — who cares,” he went on. “We know it’s a big problem right now. The pandemic helped us realize that a very high prevalence of mental disorders has been there all along, and that many people have been suffering in silence.”

The real crisis, Kessler said, is the number of people who aren’t getting adequate care, if any at all. “We know how to treat people,” he said, “but the great majority who need it aren’t getting help.”

Fewer than half of Americans with an identified mental health condition were treated in 2020, according to the National Alliance on Mental Illness — and that doesn’t even account for the quality of care. The average delay between onset of disorder symptoms and treatment is 11 years.

A silver lining

TLDR; experts believe that both prevalence and awareness of mental health conditions are on the rise. And there is, I think, a silver lining to all of this. Because the statistics are so grim and people are finally talking about mental health, there’s heightened pressure on state and federal governments to provide access to care, and hopefully to fund related research. People are realizing that job-related stress is affecting their mental health and are quiet-quitting or literally quitting, so an increasing number of employers are offering mental health benefits to retain workers.

I hear far more people in my own life talking about their anxiety and depression than I did 10 years ago. It’s difficult to know that so many of my family members and friends are struggling, but it gives me some hope that we’re finally able to talk about it openly, without the burden of shame. I’m wishing that for all of you, too.

Until next week,

Laura

If what you learned today from these experts spoke to you or you’d like to tell us about your own experiences, please email us and let us know if it is OK to share your thoughts with the larger Group Therapy community. The email [email protected] gets right to our team. As always, find us on Instagram at @latimesforyourmind, where we’ll continue this conversation.

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More perspectives on today’s topic & other resources

Article after article shows us that America’s teenagers aren’t doing well, without putting their finger on what is wrong beyond issues of individual “mental illness” and the usual causes trotted out — social media, video games, the weakening of the family unit, writes clinical psychologist Jamieson Webster. But what are the teenagers telling us is wrong? “We seem to have forgotten that adolescents are lightning rods for the zeitgeist,” Webster said. “They live at the fault lines of a culture, exposing our weak spots, showing the available array of solutions and insolubilities. They are holding up a mirror for us to see ourselves more clearly.”

Is the U.S. experiencing a mental health pandemic? In this piece by psychiatrist Ronald Pies, he argues that while millions of people are suffering emotionally because of COVID-19, CDC surveys cannot tell us whether more people are actually meeting the threshold of a mood or anxiety disorder, but instead just screen for symptoms. “The difference between symptoms and disorder is not merely semantic,” he writes. “A formal, clinical diagnosis of a mental disorder has wholly different implications — medical, legal, and psychological — than those associated with, say, a normal or adaptive response to the stress and strain of the COVID-19 pandemic.”

These two major shifts have sparked a mental health crisis among LGBTQ+ kids and teens in California: the ripple effects of pandemic isolation along with a hostile political climate that is targeting queer and transgender youth. One survey found that during the 2021-22 school year, nearly 80% of bisexual, gay and lesbian middle schoolers reported depression, stress and anxiety as an obstacle to learning, double the rate of straight students.

Other interesting stuff

The mental health field is increasingly looking to chatbots to relieve escalating pressure on a limited pool of licensed therapists. But it’s entering uncharted ethical territory as it confronts questions about how closely AI should be involved in such deeply sensitive support, according to this piece from STAT news.

Disability and civil rights advocates filed a lawsuit last week asking the California Supreme Court to block the rollout of Gov. Gavin Newsom’s far-reaching new plan to address severe mental illness by compelling treatment for thousands of people. Advocates urged the state’s high court to strike down as unconstitutional the program known as CARE Court (for Community Assistance, Recovery and Empowerment). The groups argue that the new court system will violate due process and equal protection rights under the state Constitution, while “needlessly burdening fundamental rights to privacy, autonomy and liberty.”

How can we support Asian American seniors who’ve been affected by the recent mass shootings? The victims of the Monterey Park and Half Moon Bay shootings were mainly Asian American first-generation immigrants in their 50s, 60s and 70s. And their healing, experts say, will be helped by younger generations checking in on their elders — the ones who were directly affected as well as the ones feeling secondary trauma from seeing violence inflicted on people who look like them, write my colleagues Karen Garcia and Ada Tseng.