Major depression diagnoses are on the rise, especially among adolescents and millennials, according to a new study by Blue Cross Blue Shield that evaluated medical claims data. Dr. Robert Pierattini, chair of Psychiatry at the UVM Medical Center, comments on the study and explains what it means.
What did the study examine?
Robert Pierattini: This report prepared uses insurance claims data to estimate the prevalence of Major Depressive Disorder among BCBS subscribers. It also comments on the association of Major Depression with other health conditions, leading to poor health outcomes. It quantifies the higher healthcare costs for patients with Major Depression.
One of the most interesting findings is that the diagnosis of Major Depression has increased by 33 percent since 2013. Adolescents saw a 63 percent increase.
Why are the findings significant?
Robert Pierattini: The adult findings are consistent with many other studies over a long period of time. Depression is very common, associated with many other medical problems, and causes enormous disability.
For example, a famous series of epidemiologic studies called the Epidemiologic Catchment Area Study found the one month prevalence of Major Depression in adults to be about 2.3 percent, the six month prevalence to be 3.0 percent, and the lifetime prevalence to be 5.9 percent. When we add a diagnosis of dysthymia (chronic mild depression), the six month prevalence of these two serious depressions is 6.3 percent.
Disability is well-studied. The World Health Organization reports that neuropsychiatric disorders are the leading cause of disability in the United States. WHO also reports that depression is the leading cause of disability among all neuropsychiatric disorders.
The Blue Cross Blue Shield report is more evidence that depression is very common, causes enormous disability, and is a huge cost to society.
The study finds the depression rate even higher among teens, specifically, teenage girls. Why is this?
Robert Pierattini: I think it’s safe to say that no one is sure. There are lots of indicators that mental health problems are an increasing concern with young people. SAMSHA reports that:
- 46.3 percent of children age 13-18 have a mental health disorder of some kind.
- 21.4 percent have a serious mental disorder.
Suicide rates among teens have increased substantially since 2005. Teenage girls appear to be at even higher risk.
Many people have speculated about the causes, including social life via electronic devices, social media, the effects of cyberbullying, changes in parenting style, the role of the family, and even economic downturns. Clinicians think that all of these factors have created a new level of stress and pressure for young people.
What are the health impacts of depression?
Robert Pierattini: In the Blue Cross Blue Shield report, people diagnosed with Major Depression were 30 percent less healthy than people without the diagnosis. Most of the impact resulted from other medical conditions that tend to co-occur with depression. The report emphasizes that claims data cannot tell us whether depression tends to make people sick with other conditions or whether multiple health problems tends to cause depression.
Why might there be higher rates of depression in New England?
Robert Pierattini: It is very important when interpreting the report to remember that Blue Cross Blue Shield was counting the number of diagnoses submitted by health care providers on insurance claims forms. This is a different method from community surveys, which look at all people in the community, not just those with commercial insurance, and not just those who seek medical attention.
Whether a person has a diagnosis on a claim depends on whether he or she sees a doctor, whether the doctor screens for depression, whether the doctor is familiar with the diagnosis, and whether the doctor includes the diagnosis on a claim.
It is possible that the actual rate of depression is not higher in New England or Vermont, but rather that people in our region have better access to health care. The advanced Medical Home model for primary care in Vermont may increase the detection of Major Depression among Vermonters. Or, Vermonters may have less fear of seeking help for depression and disclosing their symptoms.
This report itself cannot explain why depression diagnoses are more prevalent in New England. Although the rates in the report might cause worry at first glance, there are a number of explanations that we would welcome as good news.
What are the signs of depression?
Robert Pierattini: Depression usually includes a depressed mood, a feeling of “feeling down.”
Or, a person might notice that things are not fun or interesting in the way they have been in the past. There is often a disturbance in sleep, poor concentration, low energy, and negative feelings (hopelessness, helplessness, or pessimism). It affects appetite. There may be thoughts of death or thoughts of suicide.
If I feel depressed, what do I do?
Robert Pierattini: They should talk to the person and encourage an evaluation to find the cause of the problem. Many healthcare providers are trained to evaluate depression. And most primary care providers in Vermont are very knowledgeable about the assessment and treatment of depression.
This is a treatable condition. Most people can be helped significantly, and many people have a complete response to treatment.
What should people do if they have thoughts of suicide?
Robert Pierattini: If a person is tempted to harm himself or herself, he or she should seek help immediately. This might include visiting the emergency department if harm is imminent. Even if there is no temptation right now to act on thoughts of suicide, the presence of frequent suicidal thoughts increases the risk of eventual harm.