Depression Is Purple, but Unmet Need for Treatment Is Red

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A survey of U.S. adults found that 1 in 4 screened positive for depression with no significant difference in prevalence across political party affiliations; while unmet need for mental health care was high for all groups, there was significantly higher unmet need for mental health treatment among Republicans than Democrats.

Depression in the U.S. is a common experience and is costly to those with poor mental health and those around them: more than 22.5 million adults experienced a depressive episode in 2022 and depression is estimated to cost the U.S. more than $326 billion annually. Depression and anxiety were worsening in the years leading up to the COVID-19 pandemic; the pandemic exposed people to large-scale stressors and exacerbated poor mental health at the population level.

One in Four Adults Screens Positive for Depression

In new research published ahead of print in the Journal of Public Health Management and Practice, we surveyed 2,479 U.S. adults about their political party affiliation, depressive symptoms, and use of mental health care. We found that one in four adults (24.9%) screened positive for depression. There were no significant differences among party affiliations: when adjusted for sex, race and ethnicity, age, education, household income, home ownership, parent status, marital status, health insurance, metropolitan status, region, and self-rated overall health, 25.3% of Democrats, 23.1% of Independents, and 24.8% of Republicans had a positive screen for depression.

Unmet Need Is Highest among Republicans

Among adults who screened positively for depression, we found that just 38% had seen a mental health care provider in the last year, which means that nearly two in three (62%) had treatment needs that were not being met, from which they could have benefitted. Interestingly, we did find a partisan difference among adults with a positive screen: adjusted results showed that Republicans (75.7%) were significantly more likely than Democrats (57.0%) and Independents (59.3%) to have an unmet need for mental health treatment.

As we head into the 2024 election season and beyond, mental health can unite groups across parties. The burden of poor mental health is high in the U.S.; so too is the need for treatment across parties. In divided times, seeking improved mental health and access to health services can unite partisan groups.

Mental Health after the COVID-19 Pandemic

Even as the COVID-19 pandemic has officially ended, U.S. adults’ mental health needs remain high. Continued vigilance is needed to address population-level stressors and implement solutions to improve mental health and access to mental health care.

As a leading cause of disability worldwide, poor mental health is widespread and costly, and its effects can last throughout the life course. Our article in JPHMP was part of the COVID-19 and Life Stressors Impact on Mental Health and Well-Being (CLIMB) study, a longitudinal study that measures trends in mental health to inform policy and public health efforts by understanding how mental health is evolving and the factors that protect it.

Acknowledgements

Dr. C. Ross Hatton, Dr. Brian C. Castrucci, and Dr. Sandro Galea were co-authors on the published article. The author would like to thank the de Beaumont team, particularly Nalini Padmanabhan and Emma Dewhurst, for their partnership in disseminating these findings.

About the Author

Catherine K. Ettman
Dr. Catherine K. Ettman is an Assistant Professor in the Department of Health Policy and Management at the Johns Hopkins University Bloomberg School of Public Health. Her work explores population mental health, assets that shape mental health, and policies across sectors that can reduce health disparities. She is the co-editor of Urban Health (Oxford University Press, 2019) and Migration and Health (University of Chicago Press, 2022). Dr. Ettman received her PhD in Health Services Research at Brown University School of Public Health and studied public policy at Princeton University. She has worked in campaign politics and in academic administrative leadership.
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