The Great Recession of 2008 to mid-2009 put some of the most depressed and anxious Americans in a tailspin and threw their treatment into chaos, according to a new study published in the journal Psychiatric Services. Those who reported being the most miserable were, unsurprisingly, more likely to be poor and uninsured and often couldn't afford to continue the treatment they needed more than ever.
To reach this bleak conclusion, researchers from NYU Langone Medical Center compared data from the National Health Interview Survey between 2006 and 2014. NHIS is an annual study from the Centers for Disease Control and Prevention that has estimated the prevalence of health conditions and access to treatment since 1957.
They looked at 207,000 adults who took the NHIS survey and completed a six-item questionnaire measuring the frequency of depression and anxiety symptoms. The answers stack up to create a score from 0 to 24; a score of 13 or higher means the person isn't just more likely to be depressed and anxious but is experiencing what psychologists call "serious psychological distress," or SPD. SPD combines feelings of sadness, worthlessness, and restlessness that are strong enough to affect a person's physical well-being and researchers use it to estimate the prevalence of serious mental illness in a community. The authors determined that 3.4 percent of American adults ages 18 to 64, or about 8.3 million people, met this miserable threshold. There are five seriously distressed women in the US for every three men, and SPD was more common in people of color than in white people.
Their study is believed to be the first such analysis in more than a decade. Previous survey estimates put the SPD figure at 3 percent or less, so that increase in and of itself is bad news. But it gets worse.
Those with SPD are poorer than average, less likely to have a college education, and they also have higher rates of heart and kidney disease, says lead study investigator Judith Weissman, an epidemiologist at NYU Langone Medical Center. These correlations between SPD and other shitty circumstances can be reinforced in cycles: Mental illness can impact a person's ability to work and earn, and those who face unemployment and low wages naturally have a fuel for their anguish, she adds.
"People with serious psychological distress did not recover from the recession," Weissman says. "It tipped some of them over the edge and they didn't have the resilience to get back."
The researchers also looked at access to mental health services among the severely distressed and how they used healthcare. This population was 10 percent more likely, all other factors considered, to not have enough money for medication and they were also more likely to be uninsured, experience delays in care, and have their place of care change. These rates were higher than those of people struggling with serious medical conditions of the non-psychological kind.
These issues are partially due to a lack of insurance and monetary resources, but also because navigating mental healthcare options can be difficult for people who have a lot of other issues on their plate. "[I]f you do have access and you have mental illness, your utilization patterns are often quite different," Weissman says. Plus, some rural areas don't have enough psychiatrists and counselors to meet the need, even for those who do have health insurance, she adds. Perhaps not coincidentally, suicide rates are notably increasing in rural areas.
Healthcare access for people with SPD worsened from 2006 to 2014, according to the study. The number of people who said they experienced delays in getting psychological help increased from 9.5 percent to 10.5 percent. About 8.7 percent of these people said they couldn't afford psychiatric medication in 2006 compared to 9.9 percent in 2014. People with SPD who didn't have health insurance that covers visits to psychiatrists or counselors increased from 9 percent to 9.5 percent.
You may be wondering why these numbers increased even though the Affordable Care Act was passed in 2010 and required insurance plans to cover mental health treatment, but Weissman offers some context. The law lowered in the uninsured rate from 16 percent in 2010 to 8.6 percent in 2016 and helped to expand coverage to 21 million people, but the law wasn't fully implemented until 2014, the last year in this study.
"I think we need to check back in a few years," said Weissman. "This [study] will offer us a baseline to view it."
Her theory is that the main factor in the worsening plight of Americans with serious psychological distress was the recession. They're generally more vulnerable and "lack the resources, internally and externally, to recover."
Recessions, she adds, are serious mental health catastrophes. "If you look at mining or manufacturing towns, where the jobs are gone and the economic providers can no longer earn a living, there is not just a loss of money but a loss of role and loss of community."
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Update 4/18/17: A previous version of this story said researchers used a score of 10 or higher on a psychological distress scale to determine which respondents could be classified as experiencing serious psychological distress. It has been changed to 13.