Why So Many Young Adults with Depression Don’t Get Treatment

DYoung adults are more affected by epression than any other group of adult. An estimated 7.5% Americans experience at least one episode of major depression every year. These episodes are characterized by sadness that persists, a decreased interest or desire to do things, feelings of hopelessness and emptiness lasting for at least 2 weeks. The National Institute of Mental Health (NIH) found that 17% of those aged 18 to 25 had suffered from major depression in 2020. Most cases of major depression are signs and symptoms of severe clinical depression.

That’s an even bigger problem than it seems, because a study published May 10 in JAMA Network OpenIt was also found that many of these youth are not receiving treatment. Between 2011 and 2019, 53% young adults with a history of major depression in the last year didn’t receive treatment. The main reason young adults avoided treatment was because of cost.

The research was led by Wenhua Lu (a professor at the City University of New York School of Medicine) and used data from an annual survey of 70,000 Americans. The survey asks participants a wide range of questions, such as whether they have received treatment or why.

Over the nine-year period they were studying, Lu and her colleagues found that more than 21,000 young adults had suffered from at least one major depressive episode—and more than 11,000 said they did not receive any mental health treatment. There were a variety of reasons that respondents didn’t want to seek treatment. In addition to cost—which topped the list every year the researchers studied, with an average of 51% of people citing it as the number-one reason—many also feared being committed to a mental-health facility, having to take medication, people finding out, or job repercussions. Others said they didn’t have time to see a provider or doubted that treatment would help.

The seventh most common reason for not receiving treatment was lack of insurance. However, it was also the fastest-growing category. It jumped from 7.2% to 15.8% in 2011 and was now the number seven.

Neglecting to treat depression is dangerous, regardless of the reason. Untreated depression can lead to serious mental health problems and even suicide. The NIH reports that suicide attempts among all adults are at their highest, with 18-25-year-olds being the deadliest, followed by homicides, accidents, and other causes of death. Lu states that substance abuse can increase in young people suffering from depression. “The effort to self-medicate with drugs and alcohol is very high,” she says.

Continue reading: Suicide Is Preventable. It’s finally happening in hospitals and doctors

Lu’s study only tracked people through 2019, but other research shows that the COVID-19 pandemic has led to greater stressors and a spike in depression across all age groups. A study by Boston University School of Public Health was published in Lancet Regional HealthThe self-reported levels of depression among those aged 18 years and over jumped from 8.5% in 2019, to 27.8% for 2020, to an alarming 32.8% for 2021. The sample group was much smaller—just 1,470 participants—than in the large national survey that Lu used, and the survey participants may have been suffering as much from the transient stressors of the pandemic as they were from the chronic pain of clinical depression. Results were also not separated by age. However, it is clear that the epidemic has made many people feel worse.

“In general, we are expecting a rise in depression during COVID,” says Lu. “So there is a still-higher need for improving treatment access for young adults.”

One positive aspect of health care in times like the pandemic was that telehealth became more popular. Studies have shown it to be equally effective in managing depression than in person therapy. And while cost and insurance coverage are still barriers to treatment, telehealth is typically cheaper than in-office care—plus, it takes less time, since commutes to and from a provider’s office are eliminated. “Telehealth is a promising option for young adults to improve their access to mental health services,” Lu says.

To make both in-person and telehealth more affordable, some solutions include finding a therapist who offers sliding scales based on a person’s ability to pay, or seeking out the services of free community health-care clinics. A further expansion of Medicaid could help to reduce the insurance problems. Lu states that 39 states and District of Columbia have expanded Medicaid eligibility since 2014. However, more work is needed to do so, Lu adds. “We need more efforts to further expand Medicaid and to enroll those people who are already eligible so that they can use the services that they need.”

The ACA’s provision allowing young people to remain on their parents’ insurance until they are 26—and have aged out of the highest-risk group for depression—can help ameliorate both the cost and insurance problems, too. Lu sees the need to expand access and outreach to mental health services at college campuses, as students make up a large portion of Americans between 18-25.

Finally, Lu urges young adults suffering from depression to take the first steps toward treatment by using an option closest to home—and one that doesn’t cost a thing. “If I could speak to these young adults directly,” she says, “I would encourage them to reach out to their families and friends, who can help them seek professional services as needed.”

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Send an email to Jeffrey Kluger at


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