October 6, 2011

The Economy's Depression Epidemic

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Joseph V. Madia, MD By:

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How unemployment and foreclosures are creating a mental health crisis in America

The American Dream of a good job, home ownership and creating a better life for our children has long been the dream of many. But has that dream been shattered over the past few years of an economic recession?

The recession has taken not only a toll on America's economic health, but our mental health as well. With it has come job losses and rising unemployment, massive home foreclosures, and a loss of faith in prosperity for the future—and all of these have contributed to a widespread national depression that has reached troubling heights.

About nine percent of Americans are clinically depressed, according to data released from the Centers for Disease Control and Prevention (CDC) in 2010. Compared to 2002, which showed a 6.6 percent rate, severe depression has risen significantly. And millions more, who haven't yet reached clinical depression, are falling into despair and depressive states that they weren't dealing with several years ago.

This week, October 2-8, is Mental Health Awareness Week and October 6 is National Depression Screening Day, offering an optimal time to look at today's epidemic.

"Given the situation with the economy and staggering unemployment rate, depression is likely to also increase," says Russell J. Ricci, MD.

The Toll of Unemployment

Many times, losing a job creates much more than a financial crisis. "Depression can arise independent of reality with feelings of hopelessness and helplessness," Ricci says. "It can also follow the real loss of job, home, and health care." Mental Health America reports that individuals who are unemployed are four times as likely to report symptoms consistent with severe mental illness.

“The depth and length of the recession’s toll on the unemployed has caused them first to question and now to disbelieve one of the fundamental tenets of the American credo—that people have it in their power to succeed if they work hard enough," said Cliff Zukin, co-author of a study on the impact of joblessness at the John J. Heldrich Center for Workforce Development at Rutgers University.

Fourteen million Americans are unemployed, and of those three-fourths have been out of work for more than six months and fully half of them, unemployed for more than two years. For older workers, the recession has wreaked havoc on their retirement plans. The Rutgers survey documented the dramatic erosion in the quality of life for millions of Americans, as they exhaust their financial reserves and continue to come up short in job prospects, leaving them feeling hopeless and powerless.

Researchers at the Heldrich Center interviewed more than 1,200 unemployed workers from August 2009 through November 2010 and found that only 30 percent felt hopeful about an economic recovery. More than half (58 percent) were pessimistic about finding a job in the near future and three out of five said the economic situation has had a major impact on their families.

“Well over half of the unemployed have been looking for a job for over a year, and are pessimistic about their chances of getting a new job in the next year. They face a situation not of their own making and have exhausted all ideas of what to do next to get work and take care of their families. The climate is one of pessimism, tinged with resignation," said Carl Van Horn, director of the Heldrich Center and a co-author of the study. Van Horn calls the crisis a "silent mental health epidemic."

Compromised Health Care, Isolation and Suicide Risk

With continued unemployment comes bigger problems. Many people lose their health insurance, and as isolation and depression set it they cannot afford to seek professional help. They struggle with paying their bills and hundreds of thousands have lost their homes. The emotional devastation creates high levels of stress and anxiety that can lead to conflicts within the family and alcohol or substance abuse-or worse.

CDC data shows that suicide rates rise and fall in connection with the economy. A study released in April 2011 was the first to examine the relationship between age-specific suicide rates and business cycles, finding a strong association between the rise and fall of business strength with suicide among people 25-64 years old—the prime working ages.

The U.S. suicide rate saw its largest increase during the Great Depression of 1929-1933, surging to an all-time high of 22.1 percent in 1932. The suicide rate has gone up every time the economy has failed into a recession since, including recently. The American Foundation for Suicide Prevention reports that the suicide rate rose from 11.5 per 100,000 in 2007 to 11.8 in 2008-an increase of 2.6 percent. Particularly, the rate for every age group between 35 and 74 increased; the suicide rate for the 45-54 age group (18.7) is the highest it's been since 1977.

James Mercy of the CDC says that knowing suicides increase during economic recessions underscores the need for additional suicide prevention measures during times of economic downturns. Feijun Luo, lead author of the CDC study, says that economic downturns can disrupt entire communities. "Economic problems can impact how people feel about themselves and their futures as well as their relationships with family and friends."

Foreclosures and Health

Alongside the unemployment rise during the recession has come the foreclosure crisis. Foreclosure notices were filed against a record 2.9 million properties in 2010, and it affects physical and mental health as well as credit reports and the financial toll.

The National Bureau of Economic Research found that more than one-third of homeowners simply living in high-foreclosure states (New Jersey, Arizona, California and Florida) had symptoms of major depression. There were significantly more suicide attempts in high-foreclosure neighborhoods and for every 100 foreclosures, there was a 12 percent increase in anxiety-related visits to the emergency room and hospitalizations. There was also an increase for physical health conditions that are stress-related.

In an Op-Ed piece to the New York Times, university professors Craig E. Pollack (Johns Hopkins) and Julia F. Lynch (University of Pennsylvania) state that mental health care should be part of the comprehensive approach to foreclosure prevention. Nonprofit mortgage counselors are trained to find a financial resolution, but have by necessity also become crisis counselors. In a national survey of 395 mortgage counselors in January 2011, 37 percent reported working with at least one homeowner in the past month who was considering suicide.

"Studies of unemployed people have shown that treating depression can improve the chances of landing a new job," wrote Pollack and Lynch. "If we can’t help them stay in their homes, the least we can do is help them stay alive."

The Changing Family

Even for people not as severely affected or at risk of suicide, the Great Recession may have altered our plans for family. In 2010, the U.S. fertility rate fell to below two births per woman, a decrease of more than 10 percent since 2007.

Sam Sturgeon of Social Trends Institute found that although most Americans still believe that two or more children is ideal, many are putting off having children due to the economic climate. More than one million babies will have been postponed or foregone from 2008 to 2011, especially among couples who already have a child.

“Childbearing is partly an economic decision and clearly many couples feel like they cannot afford an additional child,” said Sturgeon.

For those emotionally impacted by the recession, in one way or another, Ricci advises getting the support of friends, colleagues and community rather than isolating oneself. "Whether the depression comes from biochemical causes or a real assessment of the economic community where one lives, the challenge is to get help and get moving. Doing nothing rarely helps, while getting support and education can be a life saver." 

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Reviewed by: 
Joseph V. Madia, MD
Review Date: 
October 6, 2011

Last Updated:
July 11, 2013