Aetna 2004 Annual Report Download - page 16

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Understanding Depression
and Disparities
ANNELLE B. PRIMM, M.D., M.P.H.
Director, Minority and National Affairs,
American Psychiatric Association, and Associate
Professor of Psychiatry, Johns Hopkins School of Medicine
In many ways, depression is the stealth mental illness in our
nation. Although it does not have the dramatic manifestations
of schizophrenia, it has a massive effect on the people and the
economy of this country. It is estimated that depression affects
over 6 percent of Americans at any one time, and at least
16.6 percent of the population experiences depression in their
lifetime. Depression costs the nation over $43 billion annually
through absenteeism, reduced job productivity, related health
care costs, premature death and suicide. But the tragedy is, while
effective treatments are available, depression is often unrecognized,
undiagnosed and untreated.
Much more than temporary sadness triggered by a life incident,
depression is a disease that can cause prolonged suffering through
its effect on the brain. A depressed individual can experience sadness, anxiety, irritability and low
self-esteem. Negative effects on sleep pattern, energy level, motivation and quality of life are common.
Similar to chronic diseases, episodes of depression can come and go many times during the life
cycle. People with heart disease, diabetes, cancer and HIV/AIDS have higher-than-average rates of
depression. When depression accompanies these diseases, it can contribute to poor outcomes.
Depression is an equal-opportunity illness that strikes individuals of all racial and ethnic groups
and economic classes. However, depression is associated with gender, ethnic and racial disparities in
prevalence, help seeking, diagnosis and treatment. Women have depression at twice the rate of men.
And while African Americans, Hispanics, American Indians and Asian Americans have rates of
depression similar to whites, they are less likely to be diagnosed or treated. Some of the reasons for
disparities in depression treatment among underserved groups include the extreme shame and stigma
associated with mental illness, lesser access to mental health services, and health care practitioners’
lack of familiarity with the culturally mediated expressions of depression. Also, cultural traditions
among these groups include “toughing out” feelings of depression or turning to spiritual leaders
and extended family members instead of health and mental health professionals. Clearly, we need to
develop culturally tailored public education and specialized training among health care practitioners
to reverse these disparities.
In a competitive global economy, this nation cannot afford the lost productivity and lower quality
of life caused by untreated depression. We as a nation must do better to use our resources for screening
and providing accurate diagnosis and appropriate treatment of depression for all of our citizens.
Depression is an equal-
opportunity illness
that strikes individuals
of all racial and
ethnic groups and
economic classes.