Oct 11, 2023 - Health

The U.S. mental health crisis is taking an uneven toll

Illustration of a person sitting hunched over on top of a large 3d "not equal" sign.

Illustration: Gabriella Turrisi/Axios

A trio of new studies paints a grim picture of how overdose deaths, depression and barriers to care are weighing heaviest on disadvantaged and minority groups — and are aligning to widen health disparities as the U.S. emerges from the pandemic.

Why it matters: While behavioral health issues seep into nearly every corner of American life, many experts say interventions have to be built around "precision psychology" that factors social determinants and can predict which subgroups benefit the most.

  • A one-size-fits-all approach could widen gaps in length and quality of life, the experts caution.

The studies reveal just how much the behavioral health crisis is leaving deep faults along racial, educational and generational lines:

Overdose deaths

What they found: Educational attainment was a huge factor in who might die from an overdose from 2000 to 2021, with differences becoming especially stark during the pandemic, a study published last week in JAMA Health Forum found.

  • From 2019 to 2021, the overdose death rate for people who didn't attend college at all increased by 30.6 per 100,000 people, the study found. In contrast, the death rate for people with at least some college increased by only 4.5 per 100,000.
  • In 2021, people without any college experience had overdose death rates nine times higher than people with bachelor's degrees.
  • Researchers noted that as the opioid crisis has transitioned to fentanyl and polysubstance use, overdose deaths have become more prevalent in groups with lower socioeconomic status, potentially widening disparities in life expectancy.
  • "The opioid crisis has increasingly become a crisis disproportionately impacting those without any college education," the study concludes.

Teens with depression

What they found: In 2021, 1 in 5 adolescents had major depressive disorder, but less than half who needed treatment received any, per a study published this week in JAMA Pediatrics.

  • Teenagers of color — particularly Latinos — had the lowest treatment rates.
  • Some of this may be due to the shrinking availability of Spanish-language mental health services while the U.S. Latino population continues to grow.
  • "It is critical to address major depression among adolescents due to the association with suicide, life expectancy, and educational and work achievement and its link to substance use and chronic physical health conditions," the study's authors write.

Adult depression and mortality

What they found: Adults with depression — particularly moderate or severe cases — are at higher risk of dying from cardiovascular disease, ischemic heart disease and other causes, according to a new study in JAMA Network Open.

  • Lifestyle and biological factors may contribute to the link between depression and mortality, but so do social factors "such as poverty, housing instability, lower educational attainment, lower income, and lack of health insurance," the authors write.
  • In 2020, some 21 million U.S. adults (8.4%) had at least one major depressive episode. Researchers noted the onset of cardiovascular disease occurs an average of 7.5 years earlier in adults with mood disorders.

The bottom line: Addressing the root causes of the mental and behavioral health crises will require taking into account a wide array of socioeconomic and health factors, and in many cases will mean tackling much broader societal inequities.

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