In addition to draining more than $83 billion from the U.S. economy each
year, depression affects 19 million Americans and is the leading cause of
disability, according to a report issued in February by the Depression and
Bipolar Support Alliance (DBSA) investigating the personal, societal, and
economic impact of depression
The report, "The State of Depression in America," declared that
although more people than ever are seeking help for depression, and
antidepressant use is widespread, "less than 22 percent of individuals
diagnosed with depression receive adequate treatment for their
The report cited problems related to a poorly funded mental health care
system, inadequate reimbursement for services, a lack of mental health
professionals, and stigma as some of the major barriers to proper care.
The report was supported by an unrestricted educational grant from Wyeth
"The state of depression in America now is a national tragedy,"
said DBSA President Lydia Lewis. "Most of this impact is preventable
because depression is treatable."
Lewis appeared with a panel of depression experts, mental health advocates,
and lawmakers at a press conference in Washington, D.C., in February to
announce the report's findings and to describe recommendations to improve
access to depression treatment (see box).
To compile the data for the report, researchers from Booz Allen Hamilton
Inc. conducted literature reviews and interviewed mental health professionals,
consumers, pharmaceutical manufacturers, employers, and researchers to get a
solid understanding of the impact of depression from various perspectives.
From the interviews, researchers learned about the need for "quality
metrics" to track depression outcomes, implementation of chronic-care
models, and the benefits of peer support, which is not funded or supported by
health plans or providers.FIG1
Madhukar Trivedi, M.D., tells attendees that mental health clinicians
treating patients with depression should help them to achieve "full
recovery," not just symptom reduction.
Photo by John Harrington, courtesy of DBSA
According to the report, depression's direct and indirect costs are $83.1
billion each year. Direct costs include those associated with the diagnosis
and treatment of people with depression, and indirect costs are associated
with the economic loss to employers attributed to absent or underproductive
Depression is also thought to be a factor in the vast majority of the
30,000 suicides and 730,000 suicide attempts that occur each year in the
United States, the report noted.
"Those who are depressed deserve a better deal," declared Ellen
Frank, Ph.D., chair of DBSA's Scientific Advisory Board and a professor of
psychiatry and psychology at the University of Pittsburgh School of Medicine.
One of the main barriers to recovery for people with depression, Frank said,
is a "failed mental health system that is crisis oriented and reactive
rather than focused on prevention and wellness" and that "offers a
woman who is about to take her own life crisis counseling or hospitalization
instead of outpatient treatment months earlier."
Frank is also director of the Depression and Manic Depression Prevention
Program at Western Psychiatric Institute and Clinic in Pittsburgh.
Frank pointed out that only 57 percent of those with major depression
reported receiving any treatment last year, and access to care is especially
problematic in rural areas and areas populated by ethnic minorities,"
where the growing number of patients with depression has far outpaced
the availability of psychiatrists and other health care
A well-known legislator, mental health advocate, and consumer identified
stigma as a culprit in the shortcomings of insurance reimbursement for mental
Were it not for the stigma and misinformation that surround mental
illnesses such as depression, treatment for mental disorders would be covered
at parity with treatment for other types of medical problems, explained Rep.
Patrick Kennedy (D-R.I.).
"We don't have equal coverage for diseases of the brain,"
Kennedy said. "I'm going to be fighting this year to deliver fair access
to mental health care by passing the Paul Wellstone parity bill."
He also decried the new Medicare prescription drug program, which"
seems as if it was designed specifically to force our seriously
mentally ill friends and family off their medications."
Madhukar Trivedi, M.D., who was also on the panel, emphasized that the goal
of treatment should not be limited to improvement of symptoms, but full
recovery from depression, which requires a holistic understanding of the
patient. In terms of treatment, "one size does not fit all," he
Trivedi is a professor of psychiatry and director of the Mood Disorders
Research Program and Clinic at the University of Texas Southwestern Medical
Center in Dallas. He is also co-principal investigator of the Sequenced
Treatment and Alternatives to Relieve Depression (STAR*D) study.
While conducting research, he has found that of patients who receive
adequate treatment for depression, only about 30 percent achieve remission
from depression initially.
"As clinicians and study investigators like myself continue, our goal
is to find better modes of treatment to get patients to recovery, so they can
lead happy and productive lives."
"The State of Depression in America" is posted at<www.dbsalliance.org/stateofdepression1.html>.▪