Mental health, including emotional and behavioral well-being, is an important part of overall health. Untreated depression negatively effects how youth and adults handle stress, relate to others, and make choices. Untreated depression can affect memory function, risk-taking behavior, sleep, and adherence to medical plans for other conditions.

Evidence of the Relationship between Predictor and Related Outcomes

• As of 2017, approximately 17.3 million adults in the US have had at least one major depressive episode. Of adults experiencing at least one major depressive episode, 35 percent did not receive treatment (NIMH, n.d.). Among children ages 6 to 17, the share ever having been diagnosed with either anxiety or depression increased from 5.4 percent in 2003 to 8.4 percent in 2011–12 (Bitsko et al. 2018).
• Research has demonstrated that depressive symptoms may contribute to risk-taking behaviors, particularly among adolescent girls. Seth and colleagues (2011) studied depressive symptoms and risky sexual behavior in adolescent Black girls (i.e., 12 to 19 years old) and found a correlation between (1) depressive symptoms and (2) the lack of condom use during the prior sexual encounter and having multiple sexual partners over a six-month follow-up. They also found that having depressive symptoms also predicted being afraid of communicating about condoms as well as other forms of risky sexual behavior (i.e., having a main partner with concurrent partners and having sex while intoxicated on alcohol or drugs) over a 6- and 12-month follow-up (Seth et al. 2011). Pesa and colleagues (1997) found that adolescent Hispanic girls who reported experiencing depression were significantly more likely to engage in risk-taking behaviors than Hispanic girls who did not report experiencing depression.
• Emerging evidence also suggests that depression and risk-taking behavior are associated with nonadherence to medications, poor treatment outcomes, and death for people with comorbidities (Bender 2006).
• Research by Kizilbash, Vanderploeg, and Curtiss (2002) used the California Verbal Learning Test to examine the effects of depression and anxiety on 3,999 veterans. They found that depressive symptoms negatively affected immediate recall of new information and the total amount of acquisition for new information (but not the rate of acquisition); the retrieval and retention of new information were unaffected. The research also found that when depression was accompanied by anxiety, the prior negative effects were present along with an adverse effect on the retrieval of newly learned information (Kizilbash, Vanderploeg, and Curtiss 2002).
• Untreated depression is associated with hippocampal volume loss. The hippocampus plays a major role in learning and memory (Sheline, Gado, and Kraemer 2003). Compared with a shorter duration of untreated depression, a long duration of untreated depression is associated with less favorable outcomes, such as depression-related disability and patient response to treatment and remission (Ghio et al. 2014, 2015).

How Investments Can Influence the Predictor at State or Local Levels

Enhancing school-based support programs and ensuring access for all can increase the delivery of mental health access to students and teachers in school (Swick and Powers 2018). Mental health services are at a shortage relative to the need. Suggested solutions include addressing socioeconomic factors (e.g., lack of insurance coverage or community resources), provider-specific factors (e.g., high indebtedness combined with low incomes), and the maldistribution of resources (e.g., an ample supply of behavioral health specialists in large cities and a near complete absence in rural areas). Telepsychiatry has become more common and has shown success in addressing the shortage of providers in underserved regions and populations (Butryn et al. 2017). Local governments and organizations can take steps to promote mental health by working to improve the built environment through community connectedness and transportation access. These efforts include increasing greenspace, investing in accessible and high-quality housing, and prioritizing art and culture and community gathering spaces (Habkirk 2013; Paxton, n.d.).

The COVID-19 pandemic has had significant negative impacts on mental health, and considering the impacts of the pandemic will be important to the success of any initiative or policy related to mental health (Bork and Gendelman 2020). Given that Black, Asian, and Hispanic adults have experienced greater pandemic-related stressors and higher rates of COVID-19 infections and death than white adults, and given high-profile events such as the murder of George Floyd by police and the murder of six Asian women in Atlanta, rates of poor mental health among Black, Asian, and Hispanic adults throughout the pandemic have been higher than for white adults, and they had less access to mental health services (Thomeer et al. 2022).

References

The primary reference is marked with an asterisk.

Bender, Bruce G. 2006. “Risk Taking, Depression, Adherence, and Symptom Control in Adolescents and Young Adults with Asthma.” American Journal of Respiratory and Critical Care Medicine 173 (9): 953–57.

Bitsko, Rebecca H., Joseph R. Holbrook, Reem M. Ghandour, Stephen J. Blumberg, Susanna N. Visser, Ruth Perou, and John T. Walkup. 2018. “Epidemiology and Impact of Healthcare Provider Diagnosed Anxiety and Depression among US Children.” Journal of Developmental and Behavioral Pediatrics 93 (5): 395–403.

Bork, Rachel H., and Moriah Gendelman. “Supporting a Nation in Crisis: Solutions for Local Leaders to Improve Mental Health and Well-Being During and Post-COVID-19.” Bethesda, MD:

de Beaumont Foundation. August 2020.

Butryn, Tracy, Leah Bryant, Christine Marchionni, and Farhad Sholevar. 2017 “The Shortage of Psychiatrists and Other Mental Health Providers: Causes, Current State, and Potential Solutions.” International Journal of Academic Medicine 3 (1): 5–9.

Ghio, Lucio, Simona Gotelli, Alice Cervetti, Matteo Respino, Werner Natta, Maurizio Marcenaro, Gianluca Serafini, Marco Vaggi, Mario Amore, and Martino Belvederi Murri. 2015. “Duration of Untreated Depression Influences Clinical Outcomes and Disability.” Journal of Affective Disorders 175 (1): 224–28.

Ghio, Lucio, Simona Gotelli, Maurizio Marcenaro, Mario Amore, and Werner Natta. 2014. “Duration of Untreated Illness and Outcomes in Unipolar Depression: A Systematic Review and Meta-analysis.” Journal of Affective Disorders152–154: 45–51.

Habkirk, A. 2013. “How Do Local Governments Improve Health and Community Well–Being.” Available from BC Healthy Communities Society and Healthy Families BC PlanH website: http://planh. ca/tools-resources/action-guides/how-dolocal-governments-improve-health-and-community-well-being.

* Kizilbash, Ali H., Rodney D. Vanderploeg, and Glenn Curtiss. 2002. “The Effects of Depression and Anxiety on Memory Performance.” Archives of Clinical Neuropsychology 17 (1): 57–67.

Paxton, Cassidy. n.d. “Four Ways Local Governments Can Support Mental Health through Community Design.” Victoria, Canada: BC Healthy Communities.

Pesa, Jacqueline A., Joan E. Cowdery, R. Carl Westerfield, and M. Wang. 1997. “Self-Reported Depression and Risk-Taking Behaviors among Hispanic Adolescents.” Psychological Reports 81 (1): 235–43.

Seth, Puja, Shilpa N. Patel, Jessica M. Sales, Ralph J. DiClemente, Gina M. Wingood, and Eve S. Rose. 2011. “The Impact of Depressive Symptomatology on Risky Sexual Behavior and Sexual Communication among African American Female Adolescents.” Psychology, Health & Medicine 16 (3): 346–56.

Sheline, Yvette I., Mokhtar H. Gado, and Helena C. Kraemer. 2003. “Untreated Depression and Hippocampal Volume Loss.” American Journal of Psychiatry 160 (8): 1516–18.

Swick, Danielle, and Joelle D. Powers. 2018. “Increasing Access to Care by Delivering Mental Health Services in Schools: The School-Based Support Program.” Social Community Journal 28 (1): 129–44.

Thomeer, Mieke Beth, Myles D. Moody, and Jenjira Yahirun. 2022. “Racial and Ethnic Disparities in Mental Health and Mental Health Care During the COVID -19 Pandemic.” Journal of Racial Ethnic Health Disparities.

NIMH (National Institute of Mental Health). n.d. “Major Depression.” Accessed May 13, 2022.

*Vandivere, Sharon, Elizabeth C. Hair, Christina Theokas, Kevin Cleveland, Michelle McNamara, and Astrid Atienza. 2006. “How Housing Affects Child Well-Being.” Coral Gables, FL: Funders’ Network for Smart Growth and Livable Communities.