Risk Factors for Adult Depression in the United States

Depression is one of the leading disorders in the United States for the adult population. While the disease itself is often characterized as elusive and difficult to diagnose, often due to degrees of severity, the factors are relatively commonplace. Generalized factors are made up of environmental, biological and psychological elements. However, there are a few specific factors increasing the risk of depression such as financial hardship, the lack of inclusiveness present within the American healthcare system for the treatment of depression and the presence of sleep problems observed by the Center for Disease Control. Since depression afflicts a significant portion of the adult population, it is important to analyze and understand the factors that contribute to it.

Unfortunately for adults stricken with depression, most of the factors associated with the disorder are not alterable through a simple change in the environment. However, a few changes can be made to lessen the risk of developing depression. According to Dr. Jim Haggerty, depression in an environmental context is primarily centered on alcohol and tobacco usage. In terms of severity, alcohol is the biggest environmental risk factor associated with depression. “Depression and alcoholism is often seen in the same patients at the same time…has serious implications on treatment outcome” (Haggerty, par 6). What makes alcohol a danger to people prone to or existing with depression is the fact that it is a depressant. Commonly, depression precedes the consumption of alcohol but it is well established that alcohol makes existing depression worse. Tobacco usage is less documented but is still considered an important environmental factor. Like alcohol, tobacco is a mood-altering drug. In the context of depression, increasing the use of tobacco may provide temporary relief but often, a person cannot reduce their intake without experiencing negative mood changes (Haggerty, par 15). In addition to environmental factors, biological and psychological elements further illuminate the nature of depression in American adults.

In terms of biology, depression is well-grounded. According to the latest report for the Center for Disease Control, several of the risk factors associated with depression are biologically based or out of an individual’s control, translating into an increased risk for depression. “Persons 45-64 years of age, women, blacks, Hispanics, non-Hispanic persons of other races or multiple races…” ("An Estimated 1 in 10 U.S. Adults Report Depression," par 5). The mechanism behind these biological factors is not well understood, however, it is believed that sometimes ethnic or cultural differences can play a role, particularly in the African American community. “You have to look out for cultural and ethnical differences because some people are unwilling to admit weaknesses in themselves…” (McLane, par 17). It is easy to see how culture and medicine can and do often collide presenting a schism for the person experiencing depression. Sometimes, making the decision to accept help and treatment conflicts with existing cultural norms which can create more stress and depression, keeping the person in mental instability and strife. Often coinciding with biology are the psychological factors associated with depression.

Psychological factors often involve thought patterns but these factors can also extend into past and current life traumas. According to the Mayo Clinic, psychological factors related to ways of thinking often plague older adults. “…often wanting to stay at home, rather than going out to socialize or doing new things. Suicidal thinking or feelings, especially in older men” (Mayo Clinic Staff, par 5). The vicious cycle of psychological prongs within depression is sometimes very hard to identify. Fortunately, the cyclical nature of depression can be broken through therapies such as Cognitive-Behavioral, especially since depression commonly appears in conjunction with other mental illnesses.

A longitudinal study conducted on adults with the help of the U.S. Preventative Services Task Force (USPSTF) explains the increased risk for depression through preexisting mental illnesses. The study, consisting of multiple screenings of adults with depression, found a connection between preexisting psychological problems such as substance abuse with depression ("Screening for Depression in Adults: U.S. Preventive Services Task Force Recommendation Statement" 785). This is further evidence that depression commonly occurs alongside or in part because of other mental problems. Another one of these factors is the occurrences of past and present life traumas.

While depression tends to strike adults prone to several risk factor categories, sometimes major psychological life events in isolation can trigger the onset of depression. “Early childhood trauma…linked to increased risk for adult depression” (Haggerty, par 2). Further, stress should not be disregarded as a leading psychological risk factor for depression. “Negative life events…are associated with increased depression. Research shows that chronic stresses are also linked to depression” (Haggerty, par 3). Obviously, trauma and stress can work together to create depression for certain adults. One area of stress that has been linked successfully to depression is financial hardship.

In American adults, the stressor of financial hardship can be explained through the example of the 2008 stock market crash. An article published in USA Today explained the mass panic of Americans surrounding the collapse of the economy. “Seventy-three percent said U.S. financial troubles will get worse before they get better. They expect their taxes to go up, and many worry about affording retirement or maintaining their standard of living” (Fetterman 01b). In terms of depression, sudden financial troubles can be a traumatic life-changing event for certain individuals. While financial hardship is an example of a sudden trigger, the ongoing holes present in the American healthcare system regarding mental illness, including depression, contains a severe risk factor for not only establishing depression but contributing to the worsening of existing depression.

In America, depression has become a significant mental struggle for the adult demographic. “According to the National Institute of Mental Health, 21 million adults in the United States suffer from some type of depression…” (Moore, par 5). Due to the sheer number of cases, it is troubling that America’s healthcare system is floundering regarding the treatment of depression. The healthcare system has become an unexpected risk factor for mental illness in general.

Since the passage of the Affordable Care Act by the United States government, improvements have been made to physical healthcare and mental healthcare as well. Unfortunately, “…a new study shows only half of psychiatrists accept insurance. That means access to care for the millions of people with depression…and other mental health issues may be limited to those who can pay for treatment out of their own pockets…” (Kennedy 07a). While it is important to note that psychiatrists are not always needed to reduce the effect of risk factors associated with depression (other mental health professionals commonly accept insurance), some individuals need the services of psychiatrists in order to overcome or regulate their own depression. The future looks bleak regarding change for psychiatrists to accept insurance plans. “However, nothing in the law requires psychiatrists to take insurance, and after years of low rates, administrative hassles, extra steps not required of other physicians and a plethora of patients willing to pay cash, many psychiatrists have simply opted out of insurance programs” (Kennedy 07a). As long as people are willing to forgo the benefits of insurance and pay the full costs out of pocket, it is likely the psychiatry sector of the American healthcare system will continue to be a risk factor for depression. In addition to problems within the healthcare system, sleep problems have been identified as a risk factor for depression.

A recent study conducted by the U.S. Centers for Disease Control and Prevention examined over 9,000 men and women in a longitudinal study of how sleep impacts the risk of depression occurring. The study focused on the specific sleep problem of apnea and found a positive correlation between individuals with sleep apnea and a significantly increased risk of developing depression. “Among those with a diagnosis of obstructive sleep apnea, depression was more than twice as common among men and more than five times as common among women, compared with those who did not have the condition” ("Poor Sleep Linked to Depression," G12). In terms of less severe sleep disturbances, such as momentary cessation of breathing, depression was also found to be more common. In essence, the study supports the idea of sleep problems being correlated with an increased risk of developing depression in both men and women. Further, the sleep study explains how the makeup of depression is commonly associated with more than one factor. In this case, biological factors are gender (women) and sleep problems. Sometimes, biological, psychological and environmental factors can work together to contribute to the start and continuation of depression.

In the majority of depression cases, multiple factors are present, each contributing differently to the overall experience of depression. This is especially true regarding older adults, considering the different categorical factors have more time to evolve throughout life. In its entirety, certain risk factors increase while others decrease with the age of individuals prone to or living with depression. Psychotherapy for Depression in Older Adults explains through the developmental stress model:

Psychological vulnerability to depression is thought to decrease in later life as older adults become more adept at coping with stressors. Genetic risk for depression also appears to be less prominent in late life. Other types of biological vulnerability, however, became more frequent, including age-associated neurobiological changes that may predispose to depression. Although stressors are present at all stages of life, certain stressors increase in frequency in late life, including bereavement, caregiving responsibilities, and illness related disability. (Qualls and Knight 31-32)

In its entirety, the factors contributing to depression are a mixed bag of severity as related to age. Therefore, it should be recognized that risk factors not only change over time but an individual’s ability to cope with the variety of risk factors changes as well. Through this understanding, depression and dealing with the risk factors should be dealt with in a customized fashion, taking all facets of a person’s life into consideration.

Due to the significant prevalence of depression as well as its degrees, the risk factors contributing to it are variable and vast. Environmental, psychological and biological factors can be experienced in isolation though it is more common for them to occur collectively. These factors also have the tendency to change over time, presenting different perceptions of depression from those experiencing it. While generalized factors help to create a blueprint for understanding the likelihood of developing depression, more specific factors help to explain the individualized occurrences. Overall, depression is a disease consisting of a multifaceted set of risk factors that can occur at any time.

Works Cited

"An Estimated 1 in 10 U.S. Adults Report Depression." Centers for Disease Control and Prevention. Division of Adult and Community Health, 2011. Web. 15 Mar. 2014.

Fetterman, Mindy. "Americans Gloomier, For Now." USA Today 29 Sept. 2008, Money sec.: 01b. Academic Search Premier. Web. 15 Mar. 2014.

Haggerty, Jim. "Risk Factors for Depression." PsychCentral Learn. Share. Grow. Psych Central, 2006. Web. 15 Mar. 2014.

Kennedy, Kelly. "Access to Mental Care Still Lags." USA Today 30 Dec. 2013, News sec.: 07a. Academic Search Premier. Web. 15 Mar. 2014.

Mayo Clinic Staff. "Depression (major Depressive Disorder)." Mayo Clinic. Mayo Foundation for Medical Education and Research, 21 Feb. 2014. Web. 12 Mar. 2014.

McLane, Lauren. "Experts: Depression Can Strike at Any Time." The Sentinel [Carlisle] 01 May 2011: n. pag. Newspaper Source Plus. Web. 15 Mar. 2014.

Moore, Janet. "St. Jude to Broaden Depression Clinical Trial." Star Tribune [Minneapolis] 12 July 2011: n. pag. Newspaper Source Plus. Web. 15 Mar. 2014.

"Poor Sleep Linked to Depression." Hamilton Spectator 05 Apr. 2012, GO sec.: G12. Newspaper Source Plus. Web. 15 Mar. 2014.

Qualls, Sarah H., and Bob G. Knight. Psychotherapy for Depression in Older Adults. Hoboken: Wiley, 2006. Print.

"Screening for Depression in Adults: U.S. Preventive Services Task Force Recommendation Statement." Annals of Internal Medicine 151.11 (2009): 784-92. Academic Search Premier. Web. 15 Mar. 2014.