Rate of Illness Rises Dramatically : Studies Find Depression Epidemic in Young Adults

The rate of mental depression in the United States has risen dramatically over the last 30 years, according to a growing number of researchers who say that recent data has convinced them that the disorder is now epidemic among young adults.

People born in the last 30 years face three to 10 times the risk of major depression than their grandparents faced, researchers say. Depression is also striking earlier: The average age at the first bout has dropped in that time span from the early 30s to the early 20s.

Those startling figures--in part, from federally financed studies--have inspired a flurry of theorizing about what underlies the malaise. Some blame the rise of individualism; some blame the Baby Boom. One researcher implicates the cult of female thinness.

“There seems to be something about modern life that creates fertile soil for depression,” said Martin E. P. Seligman, a professor of psychology at the University of Pennsylvania who is writing a book about what some have called “the Age of Melancholy.”

If the figures are confirmed--some experts remain unconvinced--they could influence treatment as well as theories of depression. Some hope that the trend might shed light on depression’s causes and the relative contributions of environment and heredity.

But the trend also has implications for public health. Increases in depression could be contributing to the documented rise in alcoholism and drug abuse. Depression can also contribute to physical illness and have a crippling effect on productivity.

“Depression now strikes people in their most productive years,” said Dr. Robert Hirschfeld of the National Institute of Mental Health, which has embarked on a campaign to raise public awareness of the causes of and treatments for depression.

“It strikes when they’re parents of young children, when they’re in the midst of developing their careers,” said Hirschfeld, the institute’s chief of mood, anxiety and personality disorders research.

Depression, one of the most common mental disorders, affects 9.4 million Americans during any six-month period, according to the American Psychiatric Assn. Without treatment, symptoms can last for weeks or even years. Appropriate treatment, through therapy or medication, is said to help over 80% of sufferers.

Clinical depression is a more intense and prolonged experience of what many people think of as being gloomy or blue. Its diagnosis is based on a combination of symptoms experienced nearly daily over weeks. One of the most important is low mood, which, unlike simple unhappiness, may be unconnected to any tragedy or other external event in a person’s life.

Also present must be at least four of the following: eating disturbances, fatigue, feelings of worthlessness, loss of interest or pleasure, insomnia or hypersomnia, restlessness or irritability, poor concentration and thoughts of death or suicide.

The data cited by Seligman, Hirschfeld and others comes in part from two large, federally financed research projects that were conducted over the last 10 years to examine the epidemiology of various mental disorders.

Many of the data have been published, but only recently have Seligman and others begun calling public attention to the statistics.

The first of the studies involved 9,500 adults nationwide. Each was asked in interviews if they had ever experienced the symptoms of depression.

Confound Accepted Wisdom

To the researchers’ surprise, their findings confounded the accepted wisdom that one’s lifetime chance of depression increases with age--an idea based on the assumption that the longer one lives, the more opportunities one has to become depressed.

Instead, they found that people aged 20 to 25 had a 5% to 6% chance of having had at least one major depression. Those aged 25 to 44 had an 8% to 9% chance. But people born around 1925 had only a 4% chance and those born before World War I had a 1% chance.

The second study involved people at higher risk of depression--2,289 close relatives of people diagnosed as having major mood disorders such as manic depression.

The researchers found a major increase in the prevalence of depression from one generation to the next: By age 30, only 3% of those born before 1910 had experienced depression--compared to nearly 60% of those born around 1950.

The studies found that depression striking at younger ages. While people born before World War II encountered, on the average, their first bout in their mid-30s; people born in the 1950s were first encountering major depression in their mid-20s.

Other statistics that researchers say point to an increase in misery nationwide includes data from smaller studies of depression as well as federal statistics tracking increases in drug abuse, alcoholism, suicide and other violent deaths.

There are many theories on what might lie behind the trends.

Among the factors being considered are genetic forces, because heredity is believed to play a role in some forms of depression. However, most researchers believe that environmental forces are a more probable cause.

Environmental causes could conceivably include biological factors--a change in diet, a virus, a hypothetical “Agent Blue,” as one researcher put it. Or, the causes could be psychosocial--resulting from historical, cultural or economic changes.

Dr. Gerald Klerman, former administrator of the federal Alcohol, Drug Abuse and Mental Health Administration and the first to detail the apparent rise in depression, points to the work of Richard Easterlin, an economist at USC.

Klerman and Easterlin trace the increase in mental distress to the Baby Boom, that bulge in the birthrate between 1945 and the early 1960s, which left people born during that period facing relatively low earnings and relatively high unemployment.

To compensate and fulfill their material aspirations, many Baby Boomers have stayed single, married late, remained childless or become dual-career parents. As Easterlin put it recently, they have “placed themselves in conflict with what families should be like.”

Sacrifice Happiness

“On the one hand, the adjustments they make do succeed in raising their income,” Easterlin said in an interview. They end up sacrificing the happiness that goes along with having a family life.

“You might say that in the United States we’ve come to value consumption and well-being over transmission of values or even wealth across generations,” said Klerman, now a professor of psychiatry at Cornell University Medical Center. “There’s a gap between expectations and fulfillment. And women are particularly vulnerable.”

The higher incidence of depression among women--two to four times the rate among men, researchers say--prompted the American Psychological Assn. this year to form a 30-member task force to explore the problem.

Ellen McGrath, a clinical psychologist heading the task force, believes that women have experienced greater social change than men. They find themselves torn by a traditional past, a liberated present and future, changes in divorce laws and new economic responsibilities.

“What you tend to find is that no matter what choice a woman has made to balance her life, she doesn’t feel that it’s the right choice,” McGrath said. “It’s a symptom of our age that no matter what we choose, it’s not quite right among women.”

Other theories cite the geographic mobility of Americans; perhaps women react more strongly to separation and loss than do men. Another researcher suggests that women may be more ruminative than men, dwelling on, and thus exacerbating, their depression.

A final theory, developed by a colleague of Seligman’s at the University of Pennsylvania, blames what Seligman called “the malignant pursuit of thinness” at a time when improved nutrition makes it almost impossible for most women to meet the prevailing ideal.

“You can diet and diet and diet and fail, which is helplessness and depression,” Seligman said. “(Or) you can succeed; one of the well-known side effects of starvation is depression.”

Seligman traces “the epidemic of depression” to historical and cultural occurrences, which, he contends, have exalted the individual and weakened the institutions that traditionally served as buffers against personal failure.

Those developments include the rise in personal wealth and the proliferation of customized products on the market, Seligman argues. Americans over the last 30 years have become preoccupied with pleasing themselves, encouraged daily to exercise individual choice.

Seligman calls this spirit “the California self--an exalted entity whose pleasures and pains, whose successes and failures occupy center stage.” He contrasts it to the Yankee self of earlier generations, which he says acknowledged few feelings, if experiencing them at all.

Meanwhile, the political assassinations of the 1960s, the Vietnam War and Watergate corroded faith in the nation; the role of religion in people’s lives dwindled; the divorce rate rose, and the size and importance of families shrank.

The waning of those institutions has left many people with nowhere to turn for help and consolation in times of failure, Seligman suggests.

“Where can one turn now for identity, for satisfaction and for hope?” Seligman asked, laying out his theory at an American Psychological Assn. meeting last August. “To a very small and frail unit indeed: the self.”

Some researchers, however, remain to be convinced that the increase is real.

The data, they say, may be misleading. The statistics may simply reflect a society that is increasingly “psychologically minded.” The young may report more depression than the old because they are more inclined to think and speak in psychological terms.

Age differences may also reflect limitations of memory: Older people may not remember depression in the distant past, researchers acknowledged. In addition, professional attitudes and diagnoses have changed; what is diagnosed as depression now may not have been before.

“Things like selective memory can perhaps explain a portion of the increase--that, in fact, it’s not as much as it appears,” said Allan Horwitz, chairman of the sociology department at Rutgers University. “But I don’t think they can explain nearly all of it.”