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Dinkel -

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Depression, the most commonly experienced mental illness, affects more than 264 million people and is one of the leading causes of disability worldwide [1]. Depression, or major depressive disorder, is characterized by depressed mood and often accompanies other symptoms such as lack of interest, fatigue, feelings of worthlessness, impaired thinking, psychomotor agitation or slowing, thoughts of being better off dead and/or of suicide [2]. According to the 2018 National Survey of Drug Use and Health (NSDUH), 17.7 million or 7.7% of U.S. adults met the criteria for having a major depressive episode in the past year [3]. The prevalence of depression is closely related to socioeconomic factors and prevalence increases as family income level decreases. For example, 19.8% of women aged 20 years and older living below the federal poverty level (FPL) experience depression compared to only 4.8% of those living at or above 400% of the FPL [4]. Despite the availability of safe and effective treatments, many adults diagnosed with depressive disorders do not receive treatment [5]. Of the 17.7 million adults (≥ 18 years) meeting criteria for a major depressive disorder in the past year, only 64.8% reported having received treatment for depression [3]. There are disparities in receipt of treatment for mental health care, particularly among racial and ethnic minority groups. Only about 30% of African American and Hispanic adults (≤18 years) with any mental illness receive treatment, compared to 43.3% of the overall U.S. population [3]. Further, for those with lower education, the odds of receiving treatment declined (women) or remained stable (men) between 2005 and 2014 [6].


This is an Accepted Manuscript of an article published by Elsevier in General Hospital Psychiatry on February 8, 2021, available online:

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General Hospital Psychiatry



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Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

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