Depression is a traumatic phase and often a silent illness which is experienced by most of the people over the world, in some point of their life. It is a serious and widespread mental disorder which worsens with time if not treated appropriately and leads to a continuous feeling of unhappiness, loss of interest and frustration, which in turn interferes with everyday life of a person and may last from several weeks to many years.¹

The world has witnessed a drastic increase in prevalence of depression since past four decades. Depression is increasing at an alarming rate of 20 percent annually. The symptoms associated with depression include sleep disturbances (insomnia or oversleeping), appetite disturbances (overeating or not at all eating) which leads to weight gain or weight loss, difficulty in thinking, concentrating and remembering things, feeling restless, constantly pessimist, irritated, agitated and mentally drained off , loss of interest in socializing and previously enjoyed hobbies and trouble in making decisions.¹

United States has highest prevalence of depression in world, which is 9.6 percent. However, Italy has one of the lowest predominance rate of depression in comparison to rest of the world, which happens to be around 3.8 percent.² Why is there such a huge gap in depression rates between these two countries? Such a vast difference in rates of depression between these two countries begs for explanation. As depression is devastating not only for an individual, but also for a family, community and society, it is significant to study the factors inducing such high occurrence of depression in United States. This would in turn result into identification and implementation of measures and initiatives which would mitigate depression in United States. The answer to the above question lies in the fact that there are social, lifestyles, cultural, economic and health care system differences in both the countries, which is later discussed in the paper.

Major causes of depression include genetics, irregular lifestyle, serious illness, experiencing situations like unemployment, death of close ones and conflicts with family/friends, taking too much stress, overambitious attitude and loneliness.³

Mechanism of depression is proved to be related with the brain chemical “serotonin”. Serotonin is a neurotransmitter which allows transmission across routes that connect different brain regions involved in processing emotions.⁴

According to the World Health Organization, approximately 350million people around the world suffer from depression, which is around 5 percent of the world’s total population. In addition, Centre for Disease Control states that, “Depression is the leading cause of disability in United States” and can result into decrease in productivity of a person. Moreover, depression can unfavorably affect the consequences of long-term illnesses like diabetes, asthma, obesity, cancer and cardiovascular diseases. At its worst, depression can result into suicide, with a fact that it has been linked to deaths of approximately 850,000 people every year.⁵

In this paper, the issues, arguments and concerns like incidence of high depression in United States as compared to Italy, reasons why United States has such tremendous prevalence of depression, what makes Italians less likely to get into depression and what measures should be adopted to lessen the occurrence of depression in United States are discussed.

Additionally, this paper will draw upon evidences from international and national government statistics, public health associations like World Health Organization (WHO), National Institute of Mental Health (NIMH), National Alliance on Mental Illness (NAMI), Centers for Disease Control and Prevention (CDC) and American Psychological Association (APA), magazines, newspapers, peer reviewed journals and journals covering cultural differences between United States and Italy.

Higher incidence of depression in United States as compared to Italy

Depression is one of the most common mental disorder in United States which affects 1 in 10 Americans at one point or another. In 2014, around 15.7million adults in United States had at least one major depressive episode in the past year. The estimated annual cost induced by depression in United States due to lost productivity and health care is $8,000,000. “Antidepressants are the third most widely prescribed drugs taken by Americans of all ages and most frequently used by people aged between 18–44years.⁶” More than 60 percent of Americans consuming antidepressant medicines have taken it for 2years or longer, with 14 percent having taken the medicine for 10years or more. “Serious mental illness costs America a loss of $193.2billion per year.⁷” Mental disorders such as depression are the third most common cause of hospitalization in the U.S. for both youth and adults ages 18 to 44. In United States, over 50 percent of students of age 14 and older who suffer from depression are provided with special education drop out which is the highest dropout rate of any disability group. Adults suffering from depression die on average 25years earlier than other Americans. In United States, more than 90 percent of those who die by committing suicide are believed to have depression. Additionally, adults in United States who live with depression, on an average die 25years earlier as compared to others. Although, it is fact that depression can develop at any age, but the median age for its onset is mid-20s in United States. “Approximately 6.7 percent of American adults which comes to be around 14.8million people are living with depression.” As a result, over the period of past 20years, “United States has witnessed a 400 percent escalation in usage of anti-depressants.⁸”

On the other hand, in Italy, the depression rate is only 3.8 percent. Although Italy has witnessed an increased prescription of antidepressants over past few years, it has been assumed that the rise is associated with an early treatment of depression and hence, reducing the chances of worsening of incidences of depression over time. Furthermore, a striking decrease in hospital admissions has been observed over past few years in Italy, which reflects a reduction in the predominance of depression. A plausible description of the noticed drop in hospital admissions for depression over past few years in Italy is that depression became well diagnosed there, and hence better treated. It is most likely that the recognized boost in antidepressant prescribing reveals improved efforts in perceiving depression, and hence an immediate and more effective treatment. Furthermore, an observed downward trend in suicidal rates in Italy, is probably a result of decline in the onset of depression which is an outcome of the development of an integrated and community-based mental healthcare system. Also, the fact that antidepressants are used for anxiety disorders as well, explains the observed antidepressant overprescribing in Italy.⁹

Factors driving high rates of depression in United States

United States has witnessed a drastic rise in depression rates as compared to what it was during 1980’s. A study conducted by San Diego State University psychology professor Jean M. Twenge indicates that among 6.9million adolescents and adults analyzed throughout the country, “38 percent were reported to be more likely to have trouble remembering, 74 percent were found to be more likely to have trouble sleeping and twice as were likely to have seen a mental health care professional.¹⁰ The above mentioned results are miserable consequences of the escalating depression. Hence, in order to improve the current scenario, it is necessary to recognize and study the factors which trigger depression.

Firstly, stress plays a significant aspect in provoking depression. Stress about obsession for money and finances seems to have a compelling and noteworthy influence on American’s lives. Americans link happiness with wealth. The fact that money is at the peak position in priority list of an American cannot be argued. Money plays a powerful role in creating stress for the majority of Americans. 64 percent of Americans have acknowledged money to be a dominant source of stress in their life. “Nearly three quarters (72 percent) of Americans admit feeling stressed about money at least some point of the time and nearly one quarter (22 percent) say that they undergo through extreme stress about money most or all of the time.¹¹” “Twenty-nine percent of Americans have reported a hike in their stress level during past year and 42 percent of them have admitted that they are not doing enough in order to manage their stress.¹¹”

Additionally, people in United States devote very less time for relaxation. “United States is the most overworked developed country around the globe.¹²” Approximately, 134 nations have regulations which set the utmost length of the work week, unlike United States. In every nation (except Canada and Japan), workers get somewhat 20 paid vacation days. In Finland and France, workers get an entire month off, every year, which is paid. However, United States is the only industrialized country left in the world which has no legally assigned annual leave (as illustrated in Figure 1). “Americans work 499 more hours than French workers, 260 more hours than British workers, and 137 more hours than Japanese workers, per year.” For most Americans, more work leads to more stress and a lower quality of life.

Figure 1 Illustration of no Paid Holidays and Paid Vacations in United States.¹²

Secondly, irregular lifestyle also plays a prominent role in inducing depression. Irregular lifestyle includes improper food habits, fluctuating sleep patterns and hardly doing any exercise. Americans are believed to have very poor eating habits. People in United States do not consume enough fruits and vegetables. Instead, they consume unhealthy, highly processed, low nutritional and densely caloric food. For instance, unhealthy dishes like pizza, nachos, pastas and burgers are eaten more than fresh fruits and vegetables.¹³ “McDonald's is considered to be the heart and soul of America’s food culture”. The reason assumed for such eating habit is because, “Frozen pizza is less expensive in comparison to brown rice and vegetables”. Furthermore, around 10billion donuts are eaten in the United States each year. Somewhat 1 in 4 people in United States consume some form of junk food every day. People in United States eat 31 percent more packaged food than fresh food. Moreover, “Americans waste 10 percent of their extra income on junk food each year.¹⁴” “Processed junk food is scientifically linked to induce depression”, according to a research conducted by a University College London team. They found out that people who frequently eat processed meat, fried food, high-fat dairy products, desserts and refined grains are 58 percent more prone to get into depression. On the contrary, “people who consume a diet which is rich in whole foods such as vegetables, fruits and protein are 26 percent less inclined to be depressed.¹⁵”

Additionally, “Exercise decreases and prevents depression”, according to the Mayo Clinic. A study conducted by Harvard University has confirmed that regular exercise advantageous for treating depression. Tragically, “80 percent of Americans do not exercise regularly”, according to the Center for Disease Control.¹⁵

Thirdly, making yourself lonely and socially isolated, triggers depression. In General Social Survey (GSS) conducted by the National Science Foundation (NSF), it was reported that remarkable numbers of American’s are lonely. In the survey, more than a quarter of the participants said that they do not have anyone with whom they can share their personal concerns, problems or happiness. Unfortunately, the researchers observed a rise in “social isolation” in addition to a noteworthy decline in social connection with family and close friends.¹⁶ Moreover, the concept of fragile families, which is practiced in United States makes people, precisely children, unstable, lonelier and hence more depressed. Additionally, having meals with family and friends makes an individual less prone to get alienated. Unfortunately, Americans hardly eat together anymore. On an average, “an American consumes 1 in every 5 meals in car and majority of American families eat a single meal together which is less than five days a week.¹⁷” Eating with friends and family serves as a medium to catch up and talk with them, which makes a person happy.

Lastly, USA TODAY reported that more than half a million Americans suffering from depression find it difficult to get an appropriate and timely treatment, because states in America tend to save money by cutting back the provision of community mental health services intended to keep people healthy and arrangement of the hospital care required to aid them to recover after a trauma. NIMH estimates that, “Nearly 40 percent of adults suffering from depression are untreated, which results in a total loss of $444billion to the country.” Only in few hospitals, patients suffering from depression get personal rooms, rest elsewhere; they are made to be on their own in corridors surrounded by lights, crises and noise.¹⁸

Why depression rates are low in Italy?

Italy has one of the lowest rates of depression in the world, which is 3.8 percent. Such low depression rate indicates that there is a better mental healthcare system in Italy, Italians practice healthy food habits, take less amount of stress, and love to spend quality time with their friends and family.

Firstly, in Italy, the most significant aspect is to enjoy life by spending time with family and friends. Even the working hours are less and the holidays provided to employees are more, as compared to United States. “An average Italian does not work for more than 8hours a day.¹⁹” Additionally, workers get paid holidays which are not less than 4weeks per year, unlike United States where there is no legally assigned annual leave. Italian employers provide their workers more time period for rest, as compared to American employers. Hence, work related stress among Italians is low since they do not live with a hectic schedule, like people in United States do. “The Italian way of lifestyle comprises of a leisurely approach towards work”.²⁰ For instance, they prefer driving back to home for having lunch, rather than to have it at their workplace. Moreover, “Italians devote 1 to 2 hours to have lunch and most businesses shut down for 2hours during the day.²¹” According to Italians, dinner is a chance to relax, laugh, talk and share with family and friends, which makes them unlikely to get isolated, lonely and hence depressed.

Moreover, “Italians are so healthy, that their traditional food habits are likely to match numerous guidelines for healthy eating laid down by experts.²²” Italian diet consists of lots of fresh fruits, vegetables, salad, natural foods like beans, nuts and rice. They consume processed food like pasta drenched in full-fat creamy sauce less frequently and in low amounts, unlike United States. Full-fat dairy products like meat and eggs are generally consumed in less amounts. Overall, food in Italy tends to be simple, healthy and home-made instead of the processed convenience food which fill fridges in United States very often.²² It has been identified that diet rich in processed food, lacks in vital nutrition which makes our mind to function, which explains low depression rates in Italy as compared to United States.

Secondly, in an international poll conducted by Reader’s Digest and published by CNN, it was revealed that money tends to be the main source of stress among people in most of the countries. According to the survey, Italy is among the countries, where people are reported to care least about money. Instead their priorities are more concerned with their family and friends.²³ They consider their friends and family to be their true wealth and are satisfied with what they have. Furthermore, Italians seek happiness, passion, serenity and relaxation from their lives and make conscious efforts to live and share every moment with their loved ones. Hence, their demands are not materialistic and their lifestyle is not hectic, stressful and work alcoholic, like Americans. Therefore, they are very less prone to suffer from mental disturbances.

Thirdly, “Italians are seduced by nature.²⁴” They love to be one with the nature instead of getting themselves confined within their homes. UK based mental health charity, “Mind” has found out that 90 percent of the people have revealed compelling and note-worthy emotional boost by spending time close to the nature. Hence, Italians usually do not undergo through the incidences of feeling emotionally down.

Additionally, appropriate, desirable and satisfying emotional support from friends and family plays a vital and effective role in recovering from depression. “Depression digs a pit of hopelessness and despair inside the person witnessing it. With the loved ones nearby, the pit does not appear to be as frightening.²⁵” Family is considered to be extremely valuable in lives of Italians. Italians frequently organize family gatherings and enjoy spending time with their friends and family.²⁶ The family structure in Italy, still follows the concept of extended family where Italians in their mid-thirties or even older are likely to be raised by their grandparents as much as their parents, and most of them consider cousins as their siblings.²⁷ Italian society is more cohesive and less divided society in comparison to United States. "Children in Italian society are raised to remain close to their family even upon adulthood”, unlike United States where the concept and practice of nuclear families is prevalent and children no longer remain closed and attached to their families, upon entering into their adulthood.

Lastly, Italy has an established community-based mental health system. Since depression should be recovered with the aid of others or with the help of mental health-care professionals, the model of community-based mental health care system has proved to lessen prevalence of depression in Italy. At this point of time, many American states are in a despair because of achieving unsuccessful outcomes for efforts made to move depression patients out of the mental asylums and heal them back in the local community. However, Italy has made this approach possible and successful. Since early 1970’s, “Italy remarkably decreased the capacity of its mental hospitals and created many neighborhood clinics in order to provide services to patients living in their homes, in small groups in apartments or at the clinic itself, which is open throughout the day and maintains a handful of beds for use in emergencies.” On the contrary, in New York City, for instance, thousands of depressed people roam around the streets, where they are susceptible to encounter thieves and robbers, crooked and deceitful landlords and the complexities of urban life.²⁸

However, under the community mental health-care system in Italy, all citizens have an approach to unlimited health care, access to general health services is usually for free of charge, medicines for major mental disorders are generally provided for free of charge, patients are offered with one on one meetings with the psychiatrist and domestic care activities are organized for severely depressed patients.²⁹ Moreover, patients are treated with dignity and are not socially isolated, which makes them to overcome depression.

Overall, this paper summarizes the facts, reasons and arguments which support the claim that United States has one of the highest prevalence of mental depression around the globe, in comparison to Italy, which is the nation witnessing one of the lowest rates of depression in the world. The arguments discussed in this paper are essential and crucial ones, since depression is devastating not only for an individual, but also for a family and a society. Studying and understanding the factors which trigger depression is significant in order to undertake initiatives and measures to control and mitigate depression. By adopting the “Italian model of lifestyle and culture”, we can lessen the prevalence of depression in United States, thereby, indirectly increasing the productivity in United States. The lifestyle, culture, priorities, notions, social and healthcare system are the major differences between both the countries, which explain such huge gap in depression rates among them. The facts and information mentioned in this paper have been obtained from various magazines, newspapers like USA Today and CNN, e-books, international and national government statistics, peer reviewed journals, journals covering social, cultural and lifestyle variations among United States and Italy and public health associations like NIMH, WHO, CDC, NAMI and APA.³⁰ Moreover, the causes, mechanism, symptoms and outcomes of depression and the reasons for current depression rates in both the countries have also been discussed.

To put in a nutshell, depression has been linked to critical and hazardous outcomes which comprise of long-term and irreversible illnesses like cancer, obesity, diabetes, asthma, cardiovascular diseases and suicide, at its worst.³¹ Therefore, it is essential and necessary to identify and implement measures to control and mitigate depression in United States. The ideal initiatives which would help in curbing depression in United States are to subsidize farmers market, subsidize cost of transportation of fruits and vegetables and improving the quality of lunch in schools. This would substantially reduce their cost and result into inclination of people, particularly kids and teenagers towards consumption of healthy food. Additionally, we should develop Drive thru centers of fresh and healthy foods and shut down those of fast foods like Mc Donald’s. Moreover, companies sponsoring Fitbit watches and organizing various activities to motivate their employees to remain fit, should be provided tax incentives by the government.

However, it is very difficult and challenging to transform an entire culture and lifestyle of a nation. Hence, the more realistic approaches to this alarming issue include creating awareness among people by organizing public health campaigns, where they should be educated regarding miserable consequences of depression and motivated to stay healthy by avoiding fast food and exercise regularly.³² Furthermore, companies should be encouraged to provide their employees greater flexibility of work hours and more vacation time, which would reduce stress levels among them. Additionally, the concept of community mental health care system, which is adopted in Italy, should be implemented in United States. This would lead to proper diagnosis and timely treatment of depressed patients in terms of provision of supportive care. Moreover, family bonding and support have proven to be significant aspects in helping a person to easily recover from depression. Hence, families should be encouraged to spend quality time together by having at least one meal together. Food is the bonding of a family. “The family that eats together, stays together”.

None.

Author declares there are no conflicts of interest.

None.

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