Depression Diagnoses Up 33% (Up 47% Among Millennials): Why There Is An Upside
Bruce Y. Lee Senior Contributor
What's the bright side to the report just released by the Blue Cross Blue Shield Association. In the movie Life of Brian, Eric Idle once sang "always look on the bright side of life," followed by lots of whistling. But is there a silver lining to the report just released by the Blue Cross Blue Shield Association (BCBSA) entitled Major Depression: The Impact on Overall Health that showed steady increases in depression diagnoses from 2013 to 2016?
At first glance, there seems nothing but bad news. An analysis of insurance claims data from over 41 million Blue Cross Blue Shield commercially insured members yielded the following curves:
These look like escalators going up. As you can see at the right edge of this graph, in 2016, 6.0% of female members and 2.8% of male members (for a total of 4.4%, which is over 9 million members) had a diagnosis code for major depression. This represented a 33% increase since 2013 (hence the big red upward arrow that says 33%).
Of all the age groups, the rise was highest among teens from 12 to 17 years old (increasing by 63% from 1.6 to 2.6%) followed by Millennials (ages 18 to 34), increasing by 47% from 3.0% to 4.4%. But before you blame Millennials and younger folks for the rise in depression diagnoses, because it may seem so easy to blame Millenials for everything ("oh, it's raining today, darn Millennials"), realize that other older age groups experienced substantial rises as well (increases of 26% and 23% for those 35-49 and 50-64 years in age.)
This is one map that doesn't follow a clear "Blue States" and "Red States" pattern. As shown by the brown color, Rhode Island (6.4%), Maine (6.1%), and Utah (6.0%) had the highest overall rates. Hawaii (2.1%) in dark blue had the lowest. Both the highest Millennial (6.8%) and adolescent (4.6%) rates were highest in Utah while Hawaii had the lowest (1.8% and 1.1%, respectively).
So far, not very good news. The findings from this report add to the growing evidence that depression has been rising in the United States since at least the early 2000's, if not before then. For example, a study published in Psychological Medicine found that the prevalence of depression increased from 6.6% to 7.3% between the years 2005 and 2015 with an even greater increase (8.7% to 12.7%) among those ages 12 to 17. As BCBSA Chief Medical Officer Trent Haywood, MD, JD, explained, "Various studies and measures all suggest that there is an underlying trend that depression has been and continues to be a growing problem."
Here's more not-good-news. This isn't a simple "fix it with a song" problem. Broken and worsening systems may be contributing to this rise in depression. Haywood mentioned that "increasing social isolation, utilization of social media, competition between people, divorce rates, and other issues" may be helping fuel the upward trends. Yes, folks, it's a systems problem. A review article in the Journal of Affective Disorders also cited growing income and social inequality as contributing factors and that "modern populations are increasingly overfed, malnourished, sedentary, sunlight-deficient, sleep-deprived, and socially-isolated." In other words, people are becoming more and more like sleep-deprived potatoes that are buried in the ground and use social media to yell at each other.
So where's the sunshine on these seeming cloudy days? Well, keep in mind that this study measured the number of people who received major depression diagnoses (as indicated by insurance codes used for major depression) and not the actual number of people who had major depression. This is an important distinction. If you were suffering from major depression, you would not have been counted if you did not revealed your symptoms to a doctor or other relevant health care personnel and that person did not indicate in your insurance billing records that you had major depression. Studies, such as one published in JAMA Internal Medicine, have shown that a large percentage of people who have depression symptoms don't ever seek help and get proper treatment. Therefore, could the increase in depression diagnoses in part represent a greater percentage of people seeking medical attention for depression?
Perhaps. Recent years have seen depression become more "mainstream." Celebrities such as Beyoncé, Miley Cyrus, Lady Gaga, Kristen Bell, and The Rock have openly discussed their struggles with depression. As I mentioned recently for Forbes, NBA star DeMar DeRozan even filmed a mental health public service announcement that is airing this month during the NBA playoffs. Reports like the Blue Cross Blue Shield one may be raising awareness and could be decreasing stigma connected with depression. After all, it is saying that if you have been diagnosed with depression, you are among at least 9 million other people. As Haywood emphasized, "our findings raise awareness so that there is an opportunity to intervene."
It's also quite notable that a major insurer like BCBSA is recognizing depression as an important growing problem. Our current health care system doesn't always make it easy for depression to be detected and recognized. Nowadays doctors are often too busy and too overwhelmed to spend enough time with patients to find out how their lives are going. As I have detailed before for Forbes, fifteen minutes is barely enough time to take a "more involved" toilet visit and wash your hands properly (which you should always do after using the toilet). How can it be long enough to really talk to a patient? And here's a shocker, our health care system can be quite reactive rather than proactive, waiting for something to boil over or blow up before it is addressed. As Haywood explained, "there needs to be more active rather than passive management of lifestyles, social media, and social relationships. Sleep hygiene, nutrition, and fitness are often unrecognized issues." The BCBSA report also found that members who had a depression diagnosis also had over twice the average annual healthcare spending ($10,673) of those who did not ($4,283). So depression is costing everyone moolah. It's time for the health care system to extend more into the community and help address the systems that may be contributing to depression.
Thus, the BCBSA report is not all "this is bad, this is bad, this is bad, and it's getting badder." It could be that more people are seeking help for their depression. The report also further raises awareness and shows that a major insurer recognizes depression as an important problem and that it's worth more than just a whistle.
My ongoing exploration into therapy related topics.