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Depression is feeling severely lonely, sad, and dejected. People may also experience an extreme lack of emotion. It is a common mental disorder.

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Depression often co-occurs with different illnesses or conditions

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Depression often co-occurs with different illnesses or conditions

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25% of cancer patients have had depression.
10 to 27% of stroke patients have depression.
1 in 3 HIV patients may have had depression.

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The annual suicide rate is around 13.42 per 100,000 individuals with an average of 123 suicides per day. Firearms have been accounted for 51% of all suicides. Surprisingly, men commit suicide 3.53 times more often than women.

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If you are in crisis, call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255), available 24 hours a day, 7 days a week. The service is available to anyone. All calls are confidential. http://www.suicidepreventionlifeline.org

Demographics

Crude suicide rate calculations take population size within subgroups in any given year or timeframe into account. They can be a useful tool for understanding the relative proportion of people affected within different demographic groups.

Figure 2 shows the crude rates of suicide within sex and age categories in 2019.

Among females, the suicide rate was highest for those aged 45-64 (9.6 per 100,000).

Among males, the suicide rate was highest for those aged 75 and older (39.9 per 100,000).

Figure 2

Figure 3 shows the crude rates of suicide for race/ethnicity groups in 2019 based on data from the CDC's WISQARS Fatal Injury Data Visualization Tool.

The crude rates of suicide were highest for American Indian, Non-Hispanic males (33.4 per 100,000) and, followed by White, Non-Hispanic males (29.8 per 100,000). Among females the crude rates of suicide were highest for American Indian, Non-Hispanic females (11.1 per 100,000) and White, Non-Hispanic females (8.0 per 100,000).

Figure 3

Suicide Rates by State

Just as state population numbers and age distributions vary, suicide rates can vary widely from state to state. Based on data from the CDC WISQARS Fatal Injury Data Visualization Tool, Figure 4 shows a map of the United States with each state's age-adjusted suicide rate in 2019 indicated by color.

Figure 4

Source: CDC - WISQARS (Web-based Injury Statistics Query and Reporting System) Fatal Injury Mapping
Website: https://wisqars.cdc.gov:8443/cdcMapFramework/mapModuleInterface.jsp Applied Filters: Suicide All Injury Deaths
States: All States
Race: All Races
Ethnicity: All Ethnicities
Sex: All Sexes
Year Range: 2019-2019
Age Range: All Ages

Percent of Suicide Deaths by Method

Figure 5 shows the percentages of suicide deaths by method among females and males in 2019. Among females, the most common methods of suicide were firearm (31.4%), poisoning (30.0%), and suffocation (29.0%). Among males, the most common methods of suicide were firearm (55.6%) followed by suffocation (28.4%).

Figure 5

Figure 6 shows that 4.8% of adults age 18 and older in the United States had serious thoughts about suicide in 2019.

Among adults across all age groups, the prevalence of serious suicidal thoughts was highest among young adults aged 18-25 (11.8%).

The prevalence of serious suicidal thoughts was highest among adults age 18 and older who report having multiple (two or more) race (6.9%).

Figure 6

* Persons of Hispanic origin may be of any race; all other racial/ethnic groups are non-Hispanic.
NH/OPI = Native Hawaiian / Other Pacific Islander / AI/AN = American Indian / Alaskan Native

Figure 7 shows that in 2019, 0.6% of adults age 18 and older in the United States report they attempted suicide in in the past year.

Among adults across all age groups, the prevalence of suicide attempt in the past year was highest among young adults 18-25 years old (1.8%).

Among adults age 18 and older, the prevalence of suicide attempts in the past year was highest among those who report having multiple (two or more) races (1.5%).

Figure 7

* Persons of Hispanic origin may be of any race; all other racial/ethnic groups are non-Hispanic.
NH/OPI = Native Hawaiian / Other Pacific Islander / AI/AN = American Indian / Alaskan Native

Figure 8 shows that in 2019, 12.0 million adults aged 18 or older reported having serious thoughts of suicide, and 1.4 million adults attempted suicide during the past year.

Figure 8

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If you are in crisis, call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255), available 24 hours a day, 7 days a week. The service is available to anyone. All calls are confidential. http://www.suicidepreventionlifeline.org Crude suicide rate calculations take population size within subgroups in any given year or timeframe into account.

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An estimate of depressed adults is around 14.8 million people from the ages 18 up. The median age is 32, but more women are depressed than men.

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Not so long ago I had to approach a friend to discuss what appeared to me to be a battle with depression. It was clear to me that this debilitating disorder was affecting both him and the people around him, and that some type of loving intervention was needed. But wow, was this a nerve-wracking conversation to have. And I'm a therapist!

Part of the difficulty was that my friend's symptoms were more about impatience, irritability, and anger than behaviors we typically associate with depression, such as crying, moping, and an inability to get started with any task because everything seems so daunting. And this is often a reason why depression in men can be more difficult to identify than depression in women. Depressed women tend to "act in" ( sleeping too much, crying, overeating, drinking too much, failing to fully function, etc.), while depressed men tend to "act out" with unpleasant behaviors. So a depressed woman might look and act depressed, while a depressed man might just seem like he's being a jerk.

Yes, plenty of men do get depressed with tears and an inability to function, and plenty of women express anger and rage when they're depressed, but as a general rule, depressed women are more obvious about what they're feeling, while men just seem unhappy and angry. And that's what I was experiencing with my friend-a great guy for many years who slowly but steadily became incredibly unpleasant over the course of a year. I know this individual well and felt certain that he was acting out not because he's a jerk, but because he was depressed, so I decided to share this with him. But still, this was not an easy thing to do.

I worried:

What if I'm wrong and he really isn't depressed?

What if he gets angry with me for my "accusation"?

What if trying to intervene costs me an important friendship?

And then I worried the opposite:

What if I'm right and I don't say something and he never gets help?

What if he desperately needs to know that someone cares enough to say something?

What if I don't intervene and I lose an important friendship to suicide?

So yeah, when a person in your life is showing signs of depression, you've got a tough decision to make. Do you take the seemingly easy path and hope things will run their course, or do you step up and try to help? The answer, if you're wondering, is that you absolutely must step up and help.

In many respects, intervening with depression is like intervening with an addiction. First and foremost, you should know that depressed people, especially men, can be deeply in denial about their problem and the negative impact it's having on them and the people around them. They may actually have no conscious knowledge that they look and act depressed. And even if they are consciously aware, they may craft a web of lies that they tell themselves (and others) about why they seem to be struggling. Often, they blame other people, especially those closest to them, for their ongoing bad mood.

This, of course, can make attempts to help them difficult at best. But there are ways to intervene successfully.
Know What You are Dealing With
First and foremost, you must understand the nature of depression, including the signs and symptoms. As stated above, depression can manifest differently in men and women. In general, however, the warning signs are as follows:

Expressing a negative or a hopeless outlook.

Losing interest in previously enjoyable hobbies and activities.

Social and emotional isolation.

Sleeping too much or too little.

Eating too much or too little or poorly (junk food).

Expressing shame, guilt, and feelings of worthlessness.

Talking about death or suicide (even in passing).

Sudden bursts of irritability, agitation, anger, rage, etc.

Blaming others for personal problems.

Feeling trapped.

Unexplained pain and/or physical malaise.

Feeling like a burden.

Increased use of alcohol, drugs, or an addictive behavior (porn, sex, gambling, spending, etc.)

Extreme mood swings.

If you see more than one or two of these warning signs on a consistent basis in a man you care about, you need to initiate a conversation about depression. If you're uncomfortable having this conversation one-on-one, speak with his family and friends and ask them to assist.
Speak Up
You can't help a struggling man if you don't speak up. If you stay silent, the depression will continue, perhaps indefinitely, or until he eventually commits suicide. So you must initiate a conversation, however difficult and anxiety-inducing that might be.

The best way to go about this is to use the "addiction intervention" model of telling him that you love him and care about him, and you are worried for his safety and wellbeing. Next, you can say that you think he is suffering from depression. Then you should list the signs of depression that you have seen him exhibit. If you're worried about suicide, be direct: Ask him, "Are you thinking about killing yourself?"

Be prepared for any response-anger, fear, crying, resignation, desperation, and just about any other emotion you can think of. Whatever the response, be willing to sit there and to let him get it out. Listen with patience and compassion. Make sure he knows you care and want to help. Do not leave until you feel certain he is not a danger to himself or anyone else.

Most of all, you need to let him know that help is available, so he doesn't have to always feel this way. Ideally, you will steer him to both a medical doctor and a certified psychotherapist who specializes in depression and related issues. Clergy members can also help, as can friends, family, and support groups for men dealing with depression.

If he is willing to listen, you can educate him about treatments for depression, which include:

Individual therapy, where he can explore thoughts, feelings, and behaviors, and develop coping skills to help manage depression.

Group therapy, with the same basic goals as individual therapy, but with added support from others who are also fighting depression.

Medications (antidepressants and mood stabilizers) can help a depressed individual manage the symptoms (though they don't "cure" depression).

Support groups for men with depression provide confidential spaces for depressed men to share openly and honestly and to support one another.

Eating healthier, developing healthy sleep habits, and exercising regularly are helpful in combatting depression.

If a depressed man says that he is suicidal, you need to immediately call 911 or take him to the nearest Emergency Room.

Resources you can share with a depressed man include:

I Don't Want to Talk About It: Overcoming the Secret Legacy of Male Depression, by Terrence Real.

American Foundation for Suicide Prevention: This site provides information on finding support for people at risk of suicide.

American Psychological Association: This site offers, among other things, the latest information about depression, anxiety, and related conditions.

American Psychiatric Association: This is the professional organization for psychiatrists, with links to resources about mental health problems, information about medications, and more.

Anxiety and Depression Association of America: This site offers facts about depression and its symptoms, plus information on finding treatment, getting support, and more.

Brain and Behavior Research Foundation: This site offers, among other things, information about depression, anxiety, and related conditions.

Crisis Text Line: Anyone in an immediate mental health crisis can text a specialist with this service, 24/7/365. Text HOME to 741741 to speak to a trained crisis counselor.

Depression and Bipolar Support Alliance: This is a self-help organization for depression, anxiety, and bipolar disorder.

Drug News: Information about prescription medications, warnings about products, patient stories, and possible side effects.

Mental Health America: This is a mental health nonprofit with information about various disorders and a large list of resources.

National Association of Mental Illness: Provides education and support about mental health disorders, including depression.

National Center for Complementary and Integrative Health: Provides information about medications and alternative and holistic therapies, including herbs and supplements.

National Institute of Mental Health: The largest mental health organization in the world, NIMH offers detailed information on depression and related disorders.

National Suicide Prevention Lifeline: This site offers a free, 24-hour suicide prevention hotline. 1.800.273.8255. This is a nationwide service. The website offers a wide variety of resources.

For specific information about healthfully helping a troubled man, I recommend my recently released book, Prodependence: Moving Beyond Codependency. The book is written primarily for family members of addicts, but the principles apply equally to depression.

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Not so long ago I had to approach a friend to discuss what appeared to me to be a battle with depression. It was clear to me that this debilitating disorder was affecting both him and the people around him, and that some type of loving intervention was needed.

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The treatment for depression is therapy but most people with depression don't get treated for it because the treatment costs too much, they don't want people to find out, it's too far, they feel they can handle it on their own, or they don't have time for it.

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Major depressive disorder is a mental disorder characterized by affective symptoms (e.g., depressed mood), cognitive symptoms (e.g., difficulty with concentration), and somatic symptoms (e.g., appetite/weight changes). Not all depressed individuals who feel they require treatment for depression receive it. What are some barriers to receiving treatment for depression?

In a recent paper, published in the August issue of Psychiatric Services, Chekroud and colleagues examine reasons people diagnosed with depression do not obtain treatment-even though they acknowledge the need for it. A model to identify such individuals is also discussed.

Study of barriers to getting treatment for depression

Less than half of American adults with a mental illness receive treatment. According to 2014 data, for instance, only 19 of 44 million American adults with a mental illness obtained mental health treatment.

The current study investigated barriers to receiving treatment for depression in those diagnosed with depression the previous year.

Data were obtained from the 2008-2014 National Survey on Drug Use and Health. The sample consisted of 20,785 individuals who had been diagnosed with major depression. Most were aged 18-49 years, and White (77 percent). Half had private health insurance.

Participants who acknowledged the need for treatment but received none (30 percent of the sample), were provided a list of 15 potential justifications. They were asked: "Which of these statements explains why you did not get the mental health treatment or counseling you needed?"

Over half of participants chose only one statement-while 18 percent chose two, 12 percent chose three, etc.

Top reasons for not getting treatment for depression

The list of 15 reasons, and endorsement rate for each, is presented below (ordered from lowest to highest, based on endorsement rate):

1. Had no transportation or treatment too far (5.8 percent)

2. Didn't want others to find out (6.5 percent)

3. Health insurance didn't cover it (6.5 percent)

4. Concern about effect on job (8.1 percent)

5. Didn't think I needed it at that time (8.6 percent)

6. Concern about confidentiality (9.7 percent)

7. Didn't think treatment would help (10.9 percent)

8. Concerned about opinion of neighbors (11 percent)

9. Not enough health insurance coverage (11.7 percent)

10. Didn't have time/too busy (14.2 percent)

11. Thought I might be committed or forced to take meds (15.2 percent)

12. Some other reason (15.3 percent)

13. Didn't know where to go for service (16.7 percent)

14. Thought I could handle without treatment (22.2 percent)

15. Couldn't afford cost (47.7 percent)

Overall, more than half of participants cited financial factors for not receiving treatment ( therapy or medications).

These financial concerns may reflect mistaken assumptions. As Chekroud et al. observe, "some generic antidepressants cost less than $10 per month (free under Medicare Part D and Medicaid and the Children's Health Insurance Program)."

Some statements that depressed individuals endorsed could also reflect symptoms of depression; for example, it is understandable why a person with depression would endorse the pessimistic belief that treatments for depression will not work.

Results of this study also provided support for the researchers' model, which identified 72 percent of people who acknowledged needing treatment but did not initiate it. In addition, the model predicted 10 of 15 explanations given as barriers to receiving treatment.

The most predictive factor for not getting treatment was suicidal ideation. People who had been seriously considering killing themselves (e.g., making suicide plans) were less likely to seek treatment.

How to reduce barriers to receiving treatment for depression?

The next step in this line of research is determining how to minimize barriers.

Because low energy and a lack of motivation are essential features of depression, "aggressive outreach may be required to encourage some individuals to begin and remain in care...and thus better targeting of patients in need of encouragement may make outreach cost-effective."

The public needs to be informed that treatment-at least pharmacological treatment (medications)-is not necessarily expensive; cheaper options are available.

In conclusion, both practical and psychological barriers to treatment need to be addressed. Practical barriers include cost concerns (whether real or assumed), availability of transportation, not knowing where to go for treatment, etc. Psychological barriers include obstacles such as worries about stigmatization and doubts about the effectiveness of treatment. Addressing both barriers will increase the likelihood that millions of depressed Americans will receive needed treatment for depression.

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15 Reasons Why People with Depression Don't Get Treatment

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Major depressive disorder is a mental disorder characterized by affective symptoms (e.g., depressed mood), cognitive symptoms (e.g., difficulty with concentration), and somatic symptoms (e.g., appetite/weight changes). Not all depressed individuals who feel they require treatment for depression receive it. What are some barriers to receiving treatment for depression?