Correlation between wealth and depression

SAMHSA’s National Helpline | SAMHSA

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  • SAMHSA’s National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.

    Also visit the online treatment locator.

SAMHSA’s National Helpline, 1-800-662-HELP (4357) (also known as the Treatment Referral Routing Service), or TTY: 1-800-487-4889 is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations.

Also visit the online treatment locator, or send your zip code via text message: 435748 (HELP4U) to find help near you. Read more about the HELP4U text messaging service.

The service is open 24/7, 365 days a year.

English and Spanish are available if you select the option to speak with a national representative. Currently, the 435748 (HELP4U) text messaging service is only available in English.

In 2020, the Helpline received 833,598 calls. This is a 27 percent increase from 2019, when the Helpline received a total of 656,953 calls for the year.

The referral service is free of charge. If you have no insurance or are underinsured, we will refer you to your state office, which is responsible for state-funded treatment programs. In addition, we can often refer you to facilities that charge on a sliding fee scale or accept Medicare or Medicaid. If you have health insurance, you are encouraged to contact your insurer for a list of participating health care providers and facilities.

The service is confidential. We will not ask you for any personal information. We may ask for your zip code or other pertinent geographic information in order to track calls being routed to other offices or to accurately identify the local resources appropriate to your needs.

No, we do not provide counseling. Trained information specialists answer calls, transfer callers to state services or other appropriate intake centers in their states, and connect them with local assistance and support.

  • Suggested Resources

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    For additional resources, please visit the SAMHSA Store.

Last Updated: 08/30/2022

Alcohol, Tobacco, and Other Drugs

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Misusing alcohol, tobacco, and other drugs can have both immediate and long-term health effects.

The misuse and abuse of alcohol, tobacco, illicit drugs, and prescription medications affect the health and well-being of millions of Americans. SAMHSA’s 2020 National Survey on Drug Use and Health reports that approximately 19.3 million people aged 18 or older had a substance use disorder in the past year.



  • In 2020, 50.0% of people aged 12 or older (or 138.5 million people) used alcohol in the past month (i.e., current alcohol users) (2020 NSDUH)
  • Among the 138.5 million people who were current alcohol users, 61. 6 million people (or 44.4%) were classified as binge drinkers and 17.7 million people (28.8% of current binge drinkers and 12.8% of current alcohol users) were classified as heavy drinkers (2020 NSDUH)
  • The percentage of people who were past month binge alcohol users was highest among young adults aged 18 to 25 (31.4%) compared with 22.9% of adults aged 26 or older and 4.1% of adolescents aged 12 to 17 (2020 NSDUH)
  • The 2019 National Survey on Drug Use and Health reports that 139.7 million Americans age 12 or older were past month alcohol users, 65.8 million people were binge drinkers in the past month, and 16 million were heavy drinkers in the past month
  • About 2.3 million adolescents aged 12 to 17 in 2019 drank alcohol in the past month, and 1.2 million of these adolescents binge drank in that period (2019 NSDUH)
  • Approximately 14.5 million people age 12 or older had an alcohol use disorder (2019 NSDUH)
  • Excessive alcohol use can increase a person’s risk of stroke, liver cirrhosis, alcoholic hepatitis, cancer, and other serious health conditions
  • Excessive alcohol use can also lead to risk-taking behavior, including driving while impaired. The Centers for Disease Control and Prevention reports that 29 people in the United States die in motor vehicle crashes that involve an alcohol-impaired driver daily


  • STOP Underage Drinking interagency portal - Interagency Coordinating Committee on the Prevention of Underage Drinking
  • Interagency Coordinating Committee on the Prevention of Underage Drinking
  • Talk. They Hear You.
  • Underage Drinking: Myths vs. Facts
  • Talking with your College-Bound Young Adult About Alcohol

Relevant links:

  • National Association of State Alcohol and Drug Abuse Directors
  • Department of Transportation Office of Drug & Alcohol Policy & Compliance
  • Alcohol Policy Information Systems Database (APIS)
  • National Institute on Alcohol Abuse and Alcoholism



  • In 2020, 20.7% of people aged 12 or older (or 57. 3 million people) used nicotine products (i.e., used tobacco products or vaped nicotine) in the past month (2020 NSDUH)
  • Among past month users of nicotine products, nearly two thirds of adolescents aged 12 to 17 (63.1%) vaped nicotine but did not use tobacco products. In contrast, 88.9% of past month nicotine product users aged 26 or older used only tobacco products (2020 NSDUH)
  • Data from the 2019 NSDUH reports that 58.1 million people were current (i.e., past month) tobacco users. Specifically, 45.9 million people aged 12 or older in 2019 were past month cigarette smokers (2019 NSDUH)
  • Tobacco use is the leading cause of preventable death, often leading to lung cancer, respiratory disorders, heart disease, stroke, and other serious illnesses. The CDC reports that cigarette smoking causes more than 480,000 deaths each year in the United States
  • The CDC’s Office on Smoking and Health reports that more than 16 million Americans are living with a disease caused by smoking cigarettes

Electronic cigarette (e-cigarette) use data:

  • Data from the Centers for Disease Control and Prevention’s 2020 National Youth Tobacco Survey.  Among both middle and high school students, current use of e-cigarettes declined from 2019 to 2020, reversing previous trends and returning current e-cigarette use to levels similar to those observed in 2018
  • E-cigarettes are not safe for youth, young adults, or pregnant women, especially because they contain nicotine and other chemicals


  • Tips for Teens: Tobacco
  • Tips for Teens: E-cigarettes
  • Implementing Tobacco Cessation Programs in Substance Use Disorder Treatment Settings
  • Synar Amendment Program


  • Truth Initiative
  • FDA Center for Tobacco Products
  • CDC Office on Smoking and Health
  • National Institute on Drug Abuse: Tobacco, Nicotine, and E-Cigarettes
  • National Institute on Drug Abuse: E-Cigarettes



  • Among people aged 12 or older in 2020, 3.4% (or 9.5 million people) misused opioids in the past year. Among the 9.5 million people who misused opioids in the past year, 9.3 million people misused prescription pain relievers and 902,000 people used heroin (2020 NSDUH)
  • An estimated 745,000 people had used heroin in the past year, based on 2019 NSDUH data
  • In 2019, there were 10.1 million people age 12 or older who misused opioids in the past year. The vast majority of people misused prescription pain relievers (2019 NSDUH)
  • An estimated 1.6 million people aged 12 or older had an opioid use disorder based on 2019 NSDUH data
  • Opioid use, specifically injection drug use, is a risk factor for contracting HIV, Hepatitis B, and Hepatitis C. The CDC reports that people who inject drugs accounted for 9 percent of HIV diagnoses in the United States in 2016
  • According to the Centers for Disease Control and Prevention’s Understanding the Epidemic, an average of 128 Americans die every day from an opioid overdose


  • Medication-Assisted Treatment
  • Opioid Overdose Prevention Toolkit
  • TIP 63: Medications for Opioid Use Disorder
  • Use of Medication-Assisted Treatment for Opioid Use Disorder in Criminal Justice Settings
  • Opioid Use Disorder and Pregnancy
  • Clinical Guidance for Treating Pregnant and Parenting Women With Opioid Use Disorder and Their Infants
  • The Facts about Buprenorphine for Treatment of Opioid Addiction
  • Pregnancy Planning for Women Being Treated for Opioid Use Disorder
  • Tips for Teens: Opioids
  • Rural Opioid Technical Assistance Grants
  • Tribal Opioid Response Grants
  • Provider’s Clinical Support System - Medication Assisted Treatment Grant Program


  • National Institute on Drug Abuse: Opioids
  • National Institute on Drug Abuse: Heroin
  • HHS Prevent Opioid Abuse
  • Community Anti-Drug Coalitions of America
  • Addiction Technology Transfer Center (ATTC) Network
  • Prevention Technology Transfer Center (PTTC) Network



  • The percentage of people who used marijuana in the past year was highest among young adults aged 18 to 25 (34. 5%) compared with 16.3% of adults aged 26 or older and 10.1% of adolescents aged 12 to 17 (2020 NSDUH)
  • 2019 NSDUH data indicates that 48.2 million Americans aged 12 or older, 17.5 percent of the population, used marijuana in the past year
  • Approximately 4.8 million people aged 12 or older in 2019 had a marijuana use disorder in the past year (2019 NSDUH)
  • Marijuana can impair judgment and distort perception in the short term and can lead to memory impairment in the long term
  • Marijuana can have significant health effects on youth and pregnant women.


  • Know the Risks of Marijuana
  • Marijuana and Pregnancy
  • Tips for Teens: Marijuana

Relevant links:

  • National Institute on Drug Abuse: Marijuana
  • Addiction Technology Transfer Centers on Marijuana
  • CDC Marijuana and Public Health

Emerging Trends in Substance Misuse:

  • Methamphetamine—In 2019, NSDUH data show that approximately 2 million people used methamphetamine in the past year. Approximately 1 million people had a methamphetamine use disorder, which was higher than the percentage in 2016, but similar to the percentages in 2015 and 2018. The National Institute on Drug Abuse Data shows that overdose death rates involving methamphetamine have quadrupled from 2011 to 2017. Frequent meth use is associated with mood disturbances, hallucinations, and paranoia.
  • Cocaine—In 2019, NSDUH data show an estimated 5.5 million people aged 12 or older were past users of cocaine, including about 778,000 users of crack. The CDC reports that overdose deaths involving have increased by one-third from 2016 to 2017. In the short term, cocaine use can result in increased blood pressure, restlessness, and irritability. In the long term, severe medical complications of cocaine use include heart attacks, seizures, and abdominal pain.
  • Kratom—In 2019, NSDUH data show that about 825,000 people had used Kratom in the past month. Kratom is a tropical plant that grows naturally in Southeast Asia with leaves that can have psychotropic effects by affecting opioid brain receptors. It is currently unregulated and has risk of abuse and dependence. The National Institute on Drug Abuse reports that health effects of Kratom can include nausea, itching, seizures, and hallucinations.


  • Tips for Teens: Methamphetamine
  • Tips for Teens: Cocaine
  • National Institute on Drug Abuse

More SAMHSA publications on substance use prevention and treatment.

Last Updated: 04/27/2022

Statistics are inexorable: the better people live, the sadder they are

Harvard and WHO conducted the first global epidemic study of depression. It turned out that Indians are more likely than others to suffer from chronic bad mood, the Chinese and Japanese are not too sad about their lack of education, and the Ukrainians are the most inconsolable widows in the world.

Depression, more specifically major depressive disorder (MDD), or clinical depression, which implies a whole range of symptoms that distinguish this serious pathology from just a bad mood, affects 121 million people in the world. And these are only the recorded cases that compiled the WHO statistics. It is more difficult to judge the real epidemic situation due to imperfect methods of counting and medical diagnostics, which differ even within a group of countries with a developed healthcare system.

Clinical depression not only reduces the quality of life and causes temporary disability, but in the most severe cases can be fatal.

Thus, due to clinical depression, up to 850 thousand suicides are committed annually. And again, these are only statistically accounted cases of suicides committed against the background of clinically confirmed MDD.

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Although some comparative statistics describing the distribution of this disease in various regions and countries have already been accumulated, a global epidemic study of depression, unlike other popular human ailments, has not yet been conducted. Harvard University's Global Mental Health Research Initiative Group , in collaboration with WHO, filled this gap with the first global monitoring of clinical depression.

Data collection and post-processing took a total of ten years. WHO-approved survey methods were used to interview 89,000 people in 18 countries.

All respondents were divided into age groups. In addition to age, marital status (both present and past), income level, education level, whether a person lives alone or in a family were also taken into account.

A commonly accepted standard questionnaire was used to identify clinical depression (current or past). A case of MDD was recorded in the presence of five out of nine significant signs of clinical depression: persistent low mood, loss of interest in life, decreased energy, loss of a sense of pleasure, low self-esteem, guilt, loss of appetite, sleep disturbance, impaired concentration.

The results of the monitoring, published in the journal BMC Medical , confirmed the thesis, which was previously largely controversial, that

there is a stable positive relationship between the prevalence of depression and the standard of living of the population.

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In relatively high-income countries, 28% of the population has MDD symptoms, and in middle- and low-income countries (this group includes Brazil, Colombia, India, China, Lebanon, Mexico, South Africa and Ukraine ) in 20%.

The French (32%), the Dutch (33%) and the Americans (30%) were the most depressed among the wealthy nations. The least prone to depression are the Chinese (12%). The share of depressed individuals in nations with a modest income level would be even smaller, but the group portrait of the cheerful poor people was spoiled by unexpectedly gloomy Indians, who showed a world record for propensity for MDD (36%) and outstripped even the Dutch, who lead in bad mood among the rich.

Israelis, Italians and Japanese look the least gloomy among prosperous nations (22% of depressives each).

Ukrainians and South Africans (17%) demonstrated equally low propensity for persistently bad mood.

In comparison, Brazilians (27%), Colombians (22%) and Mexicans (19%) - southerners with a similar temperament - look rather gloomy.

Regardless of nationality and income level, women suffer from depression twice as often as men. But the age of the sick person already depends on the place of residence: in countries with lower income levels, people begin to suffer from depression two years earlier than in prosperous ones. At the same time, depression in rich countries is experienced by people, as a rule, more severely, and memories of experienced depression are more stable.

Divorce is strongly associated with depression in seven out of ten developed and four out of eight developing countries surveyed.

In the second group of countries, the Japanese, Chinese and Ukrainians are the most worried about divorce. Widowhood is among the less powerful triggers of depression, but not in Ukraine, where widows are eight times more likely to be depressed than married women.

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In high-income countries, there is a significant increase in depression among single people and among those who have separated from their sexual partner. In less affluent countries, the divorced, as well as widowers and widows, suffer the most from depression. It is also customary for wealthier people to get depressed more often if a bachelor shares a home with other people. The less wealthy are not inclined to become depressed about this, which is logical: in developed countries it is easier to survive alone, and if a bachelor lives in the same apartment with his parents, this only increases his feeling of loneliness and reduces self-esteem.

In non-Asian countries, a significant association between low education and depression was found only in Israel, USA, Mexico and Ukraine.

In Asia, the situation is more complicated. An uneducated Indian is 14 times more prone to MDD than an educated one. But in Japan and China, an inverse relationship was recorded: the less educated suffer less from depression. In general, the study did not establish a connection between depression, the level of education and the standard of living of the population. As you can see, both in China and in more prosperous Japan, the uneducated feel equally great. Rather, it is not the level of economic development of the country that matters here, but cultural and mental attitudes, which are more similar among the Japanese and the Chinese than among the Japanese, Chinese and Indians.

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The authors of the Global Depression Study did not attempt to explain why the epidemic rate of MDD is higher in higher-income countries. The hypothesis that they cautiously put forward at the end of the article (the high disparity in the level of incomes of the population within developed societies) looks unconvincing, since

The income gap among certain groups of the population is observed everywhere - both in rich countries and in poor ones.

Most likely, the general level of economic development of the nation matters: it is clear that the achievement of high economic indicators occurs against the backdrop of more intense competition and the resulting costs of mental and physical resources, which is fraught with more intense stress. Therefore, the high level of depression in developed countries is not a consequence of social stratification, but of intense competition. This is the payment of the nation for the wealth acquired by labor as such.

Russia did not participate in the survey, but judging by the number of our citizens who, according to sociological surveys, want to leave for permanent residence in countries that are very unfavorable in terms of the incidence of MDD, in terms of chronically bad mood they could easily outdo the Indians, who have there is still a chance to be happier in future lives.

Poverty, perfectionism and the struggle for social status – News – IQ Research and Education Portal – National Research University Higher School of Economics

According to the World Health Organization, 5% of adults in the world suffer from depression. In the most severe cases, it can lead to suicide. However, until now, this mental disorder is often not taken seriously - as requiring treatment and prevention. At the same time, depression can be treated at all stages, and knowledge about its nature and causes can help in the prevention and prevention of the development of this disease. About what factors, according to recent scientific research, contribute to depression, and how it can manifest itself among modern people living in a digital world - in a selection from IQ.HSE.

Poverty, especially in childhood, contributes to depression

In international studies, much attention is paid to the socio-psychological processes associated with social inequality. For example, one of the scientific papers analyzes the relationship between poverty, social inequality and depression. It shows that depression can be linked to experiences of poverty—particularly those experienced in childhood. At the same time, the level of depression is higher in communities with high levels of income inequality.

Russian studies also testify to the connection between poverty and adverse effects on the psyche. Thus, scientists from the National Research University Higher School of Economics and the World Bank have shown that the existing risks of poverty are associated with lower subjective well-being and life satisfaction in almost all population groups in Russia.

Impostor syndrome is dangerous for mental health

Impostor syndrome, as proved by the Higher School of Economics, contributes to the transition from perfectionism to psychological distress. This syndrome occurs among people in various professions. To a greater extent, women are subject to it, who today often succeed in business and politics. As a rule, a person suffering from maladaptive perfectionism (inflated, unattainable demands on himself) is focused on what was not done or was done poorly, and is afraid of being exposed.

The results of the study suggest that imposter syndrome fully mediates the relationship between perfectionism and anxiety, and partly between perfectionism and depression. Therefore, manifestations of the impostor syndrome are a problem that needs to be worked on in order to prevent depression.

Depression can be a consequence of the struggle for social status

Events associated with the loss of social status can lead to the development of a depressive state. A lot of research has been devoted to this. Much depends on how a person experiences the upheavals associated with status conflicts. Thus, a conscious cessation of the obviously useless struggle for status can contribute to recovery.

At the same time, intentional self-abasement carries the maximum risk of depression. “The social strategy of self-deprecation avoids the attacks of a stronger one at the cost of developing depressive symptoms,” she writes in her book Good Bad Feelings. Why Evolution Allows Anxiety, Depression, and Other Mental Disorders by physician and scientist Randolph Nessie. As one example, he cites the downplaying by spouses of their own accomplishments and merits—even in their own eyes—in order to save the marriage.

Despondency loses ground in retirement

But there is also good news — at an older age, the level of depression can decrease, despite retirement, children leaving the family, the loss of habitual social roles, activities, etc. A study by scientists from the Higher School of Economics showed that after 65 years of age, the rates of apathy and depression are lower, while the level of subjective experience of happiness is higher.

The authors note that the decrease in negative characteristics can be explained by the so-called "emotional paradox of the aging brain." Its essence is that older people react less emotionally to negative stimuli, are able to more successfully ignore emotional stimuli, and remember more positive information.

These results are consistent with previous scientific data. So a large international study with the participation of respondents from 145 countries of the world confirmed U a figurative form of the relationship between age and the subjective experience of happiness. It turned out that its lowest level is typical for people aged closer to 50 years, or rather, at 48 years old. Further, this figure gradually increases.

Depression leaves digital footprints

In recent years, scientists have become interested in the question of whether it is possible to predict the psychological state of people by analyzing their profiles in social networks. Most of the research in this area has been carried out by foreign experts. But there are also works carried out in Russia - for example, on the data of the social network VKontakte (now VK ).

It turned out that signs of depression in VKontakte/ VK users may not be obvious things. For example, a subscription to a large number of "interesting" pages and publics or a large number of "friends" may indicate that the user belongs to a group with severe depression. This is explained by the fact that in this way a depressed person can compensate for reduced communicative and social activity.

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