Education Level Predicts Depression Rates and Access to Care
As rates of depression rise, access to care drops, at least for some.
Posted March 16, 2019
A recent survey reported in the American Journal of Orthopsychiatry points to a clear trend in the prevalence of depression and the access people have to treatment (psychotherapy and medication). The survey looked at data for adults in the United States over the years 2005-2014 and found that the incidence of depression went up over these years. This, despite more attention being given to mental health and policy changes on the local, state, and national level aimed at increasing access and coverage for mental health services.
More disturbingly, the increases were uneven across the population such that people with the lowest education levels suffered the greatest increases in depression. In contrast, among the highest educated group, women saw no change in the prevalence of depression while men actually saw a reduction.
The findings regarding access to treatment were no better. Women in the lowest education group saw their chances of getting treatment for depression decline (men in that group remained at the same level) while treatment rates for men among the highest education group increased (for women in that group, they remained stable).
The general picture presented by the survey was that people in the lowest education group suffered the highest rates of clinical depression while having the least access to treatment.
What makes these findings so unfortunate is that the public discourse about the importance of mental health has actually increased in the past fifteen years. More and more politicians openly call for improved access to mental health services, and the issue seems to be getting more attention in the press. However, these statements are clearly not being translated into action.
Polls during the 2018 midterm elections indicated healthcare was often a leading priority for voters, yet few polls separated out mental health as a distinct category. Given how obsessed politicians tend to be with poll numbers, the absence of mental health as a data point further marginalizes the lack of adequate mental health services for large swaths of the U.S. population, especially those with less education and those of lower socioeconomic status.
One potential solution on the horizon is using teletherapy as a vehicle by which lower served populations can access mental health care via video platforms. However, currently, Medicare only covers teletherapy services for those who live in rural areas and even then, the patient needs to get physically present at an official clinic or treatment facility to get the service—which, of course, defeats the purpose entirely as it is exactly people who lack easy access to clinics and treatment facilities that need the service most.
The hope is for Medicare and other insurance carriers to expand or begin coverage for teletherapy for mental health and for burdensome restrictions that limit access to be removed or reconsidered. Lastly, as we move into another election cycle, let's hope the issue of mental health is more front of mind for both the campaigns and the press.
Copyright 2019 Guy Winch
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Todd, M., & Teitler, J. (2018). Darker days? Recent trends in depression disparities among U.S. adults. American Journal of Orthopsychiatry. Advance online publication.