In November of 2014, the U.S. government's Substance Abuse and Mental Health Services Administration (SAMHSA) issued a press release titled "Nearly One in Five Adult Americans Experienced Mental Illness in 2013." This brief press release provides a snapshot of the number of Americans who are suicidal, depressed, and mentally ill, and it bemoans how many Americans are not in treatment. However, excluded from SAMHSA's press release -- yet included in the lengthy results of SAMHSA's national survey -- are economic, age, gender, and other demographic correlates of serious mental illness, depression, and suicidality (serious suicidal thoughts, plans, or attempts). It is these demographic correlates that have political implications.
These lengthy results, for example, include extensive evidence that involvement in the criminal justice system (such as being on parole or probation) is highly correlated with suicidality, depression, and serious mental illness. Yet Americans are not told that preventing unnecessary involvement with the criminal justice system -- for example, marijuana legalization and drug use decriminalization -- could well prove to be a more powerful antidote to suicidality, depression, and serious mental illness than medical treatment.
Also, the survey results provide extensive evidence that unemployment and poverty are highly associated with suicidality, depression, and serious mental illness. While correlation is not the equivalent of causation, it makes more sense to be further examining variables that actually are associated with suicidality, depression, and serious mental illness rather than focusing on variables such as chemical imbalances which are not even correlates (see Psychiatric Times, 2011). These results raise questions such as: Does unemployment and poverty cause depression, or does depression make it more likely for unemployment and poverty, or are both true?
And the survey results also provide extensive evidence that younger Americans are more depressed than older Americans, that women are more likely to be depressed than men, and that Native Americans and biracial Americans are more likely to be depressed than other ethnic/racial groups. Again, while correlation is not the equivalent of causation, depression obviously cannot cause one to become young, female, or Native American. More rationally, researchers should be asking what is it about American society that is so depressing, especially for young people, women, and Native Americans?
These recent SAMHSA survey results provide a golden opportunity for a scientific and societal shift to reconsider what about American society and culture is resulting in emotional suffering and self-destructive behaviors, especially for certain groups. Below is a summary of some of the key statistics in these buried SAMHSA survey results.
Summary of Buried SAMHSA Survey Results
Involvement with the Criminal Justice System: In 2013, the percentage of American adults with serious suicidal thoughts: 10.7 percent for those on parole or a supervised release from jail in the past 12 months, 9.2 percent among those who were on probation, and 3.9 percent for those not involved in the criminal justice system. The percentage for adults with any mental illness: if on probation was 32.3 percent, if on parole or supervised release, 36.5 percent, double the percentage of adults not involved in the criminal justice system (18.3 percent). The percentage of adults with serious mental illness: if on probation was 9.4 percent, if on parole or supervised release was 13.9 percent, more than triple for those not involved in the criminal justice system (4.1 percent).
Unemployment: Among American adults in 2013, the unemployed were more likely than those who were employed full time: to have serious thoughts of suicide (7.0 vs. 3.0 percent), make suicide plans (2.3 vs. 0.7 percent), or attempt suicide (1.4 vs. 0.3 percent). The percentage of adults with any mental illness: for the unemployed was 22.8 percent, for part-time employed was 20.3 percent, and for full-time employed was 15.4 percent. Among adults with serious mental illness: the percentage for the unemployed was 6.6 percent, for part-time employed was 4.8 percent, and for those full-time employed was 2.7 percent. Among those adults having a major depression episode: the percentage for the unemployed was 9.5 percent, for part-time employed was 7.8 percent, and for full-time employed was 5.3 percent.
Family Income: Among American adults in 2013, serious suicidal thoughts occurred in: 6.6 percent of those from family incomes below the Federal poverty level, 4.7 percent of those with family incomes between 100 and 199 percent of the Federal poverty level, and 3.1 percent of those with annual family incomes at 200 percent or more of the Federal poverty level. Among American adults, the percentage with serious mental illness: for those with a family income that was below the Federal poverty level was 7.7 percent, for those with a family income at 100 to 199 percent of the Federal poverty level was 5.1 percent, and for those with a family income at 200 percent or more of the Federal poverty level was 3.2 percent.
Age: No suicidality results were reported for Americans under 18, however, among American adults having serious suicidal thoughts, the percentage: for those aged 18 to 25 was 7.4 percent, for those aged 26 to 49 was 4.0 percent, and for those aged 50 or older was 2.7 percent. And among adults who made suicide plans in the past year: the percentage for those aged 18 to 25 was 2.5 percent, for those aged 26 to 49 was 1.3 percent, and for those aged 50 or older was 0.6 percent. The percentage of Americans having a major depressive episode in 2013: for those aged 12 to 17 was 10.7 percent, for those aged 18 to 25 was 8.7 percent, for those aged 26 to 49 was 7.6 percent, and for those aged 50 or older was 5.1 percent.
Gender: In 2013, adult women were more likely than adult men to have: any mental illness (22.3 vs. 14.4 percent), a serious mental illness (4.9 vs. 3.5 percent), a major depressive episode (8.1 vs. 5.1 percent), and suicidal thoughts (4.0 vs. 3.8 percent). Among American ages 12 to 17, females were more likely than males to have a major depressive episode (16.2 vs. 5.3 percent) and a major depressive episode with severe impairment (12.0 vs. 3.5 percent).
Ethnicity/Race: In 2013, the percentages of adults aged 18 or older having serious thoughts of suicide in the past year were: 2.9 percent among blacks, 3.3 percent among Asians, 3.6 percent among Hispanics, 4.1 percent among whites, 4.6 percent among Native Hawaiians or Other Pacific Islanders, 4.8 percent among American Indians or Alaska Natives, and 7.9 percent among adults reporting two or more races. The percentages of adults with a major depressive episode: 1.6 percent among Native Hawaiians or Other Pacific Islanders, 4.0 percent among Asians, 4.6 percent among blacks, 5.8 percent among Hispanics, 7.3 percent among whites, 8.9 percent among American Indians or Alaska Natives, and 11.4 percent among adults reporting two or more races.
The SAMHSA press release states that among American adults in 2013: 10 million American adults (4.2 percent) experienced a serious mental illness, 15.7 million adults (6.7 percent) experienced a major depressive episode, and states that "major depressive episodes affected approximately one in ten (2.6 million) youth between the ages of 12 to 17." The press release then laments how many Americans with mental illnesses are not receiving treatment.
While these statistics in the SAMHSA press release are troubling, the devil is in the details of the actual lengthy SAMHSA survey results. These results make clear that suicidality, depression, and mental illness are highly correlated with involvement in the criminal justice system, unemployment, and poverty, and occur in greater frequency among young people, women, and Native Americans.
Shouldn't researchers be examining American societal and cultural variables that are making so many of us depressed and suicidal? At the very least, don't we as a society want to know what exactly is making physically healthier teenagers and young adults more depressed than senior citizens?
~ Bruce E. Levine serves as Assistant Secretary of Health in the Green Shadow Cabinet.