Go Outside: It’s Good for Your Depression – and a Whole Lot More

Let me start by acknowledging that I’m really lucky that I can actually type this up. I have a nice house with a big backyard. Not everyone is able to do this. However, if you can, if it’s nice enough, you have the means to do so, and you have the space to do so – please go outside.

When I was younger, I went outside more often. That slowed as I got older, and I couldn’t even really tell you why. I was never a backyard kind of guy. Then we spent ten years in a home with a relatively small backyard (albeit a nice porch) and I didn’t see much of a point of going out. That changed as I did more research. One book in particular sticks with me – I’ve written about it before – The Depression Cure by Dr. Stephen Ilardi. The book argues that depression came from the way we have crafted civilization and that more time outdoors is necessary to address depression. I had other issues with the book, but on this point, I think is absolutely right.

The basic crux is that going outside helps make you feel more relaxed, more at peace, and more connected to others – even if there is no one around. And it’s backed up by some research:

  • One analysis of ten studies found that self-esteem and mood could be improved for people who spent more time outside.
  • People who walked in nature showed lower activity in brain centers associated with rumination, as opposed to those who walked in an urban center.
  • Being close to nature or “greenspace” can reduce stress, symptoms of anxiety, and provide children with ADD or ADHD additional cognitive benefits.
  • Nature is also associated with lower stress levels and higher levels of relaxation.

Alright, fine, going outside is good for your mental health. That probably isn’t really much of a surprise to you. It also helps explain why I’ve spent so much dam money on my backyard of late. But, let’s be clear, there are implications here that go a bit beyond the need to get some fresh air. Let’s go back to my disclaimer at the front of this article: What about people who don’t have a backyard? People who live in a heavily urbanized area and don’t have nearby public parks or nice amenities? People who are physically disabled and thus unable to easily access the benefits of nature?

Well…I mean, let’s be honest, they’re not going to get the benefit that the rest of us will. And that’s deeply unfair.

Of course, the benefits of nature, parks, greenways, and waterways are about more than improving your mood. Studies also show that access to nature can improve your physical health and provide a sense of connection with others. It can also improve your memory, your concentration, and help you lose weight. It’s pretty clear that being able to get outside in a high-quality space is about more than just improving your mood. It can do a lot more, and maybe, if Dr. Ilardi’s theory is to be believed, help people reconnect with something deeply biological within them.

So, if you can, go outside. Also – if you can – let’s all do a better job of advocating for high-quality public spaces that can be accessible to all of us, regardless of our income levels, where we live, or our levels of physical functioning.

The Rise of Telehealth

Telehealth wasn’t new to COVID-19. The concept has been around for decades and applies differently to different areas of medicine. That being said, one of its most positive potential uses has been in the area of mental health, and in that regard, COVID-19 may have pushed us towards telehealth in a big way.

First, check out this USA Today article on the subject. This line stuck with me:

Prior to the pandemic, Blue Cross Blue Shield of Massachusetts received about 200 telehealth claims per day. That number reached up to 40,0000 claims per day from April to May 2020, and the insurer is still receiving about 30,000 claims per day almost a year later, according to spokesperson Amy McHugh.

The article also noted that ” mental health appointments made up about 53% of the 7.5 million telehealth claims processed by Blue Cross Blue Shield of Massachusetts since March 2020.”

This isn’t a surprise, and many of us have had experiences with it. I know I had numerous virtual appointments via telehealth over this pandemic, and I found it every bit as effective as an in-person visit. Maybe even more so – the flexibility that came with it was highly beneficial. I remember having a therapy appointment from my office in Harrisburg!

Of course, it’s not for everyone, but there is unquestionably good news in the area of telehealth. According to a 2020 article from the American Psychological Association, telehealth seems to be working so far. There are even some questions as to whether or not telehealth may be more effective for some groups that are typically less willing to visit a psychiatrists office – like men – as it allows them to get therapy without having to leave their house, thus reducing potential barriers and making it easier for them to overcome self-imposed stigma.

The USA Today article also noted that telehealth can make a therapist more efficient. Said one therapist, “I probably spend somewhere between 2 to 5 minutes per patient moving from one room to another or pausing to document or checking something on their file or handing something off. There are built-in inefficiencies that isn’t time spending with the person… but some of those inefficiencies are taken care of by the fact that everything is electronic.”

Obviously, COVID pushed us more this way as part of all of our efforts to socially distance. However, major challenges remain in terms of full utilization and effectiveness of telehealth services. First, telehealth is predicated on the idea that someone has the broadband infrastructure and necessary equipment. As this pandemic has shown, that is NOT the case for everyone, particularly among rural Americans or the urban poor. Lacking such equipment means that someone will not be able to get the help they need.

Furthermore, there are insurance barriers. Not all insurance companies cover telehealth, and while states of emergency have knocked down many of these barriers, they haven’t destroyed all. As such, insurance regulations need to be updated in many states. However, this presents a problem in and of itself. For example, in Pennsylvania, the issue has been tripped up due to attempts to limit telehealth services and prevent abortion services from being prescribed or conducted via telehealth. Don’t ask.

The point is this: Telehealth is great, but we’ve got a long way to go.

Let me conclude with this: Did you have a telehealth experience with COVID-19? What was it like? Did you find it to be as effective as an in-person visit? We’d love to hear from you – give us your comments below!

Coming Back To Normal

Ahh, the blog entry I’ve been wanting to write for so, so long.

Slowly but surely…it seems like life may, just may, be returning to normal. We’ve got a long way to go, of course, but there is light at the end of the tunnel that is getting brighter by the moment.

A quick look at the facts. As I type this entry on March 14, the United States is making real progress. Excluding an odd data dump, March 13 set the new one-day record for vaccinations, with 2.9 million people vaccinated. 100 million doses have been administered. 13% of all adults are now fully vaccinated, and about 20% of the population has had at least one dose. It’s not herd immunity, but it’s real progress, and the rate of progress is accelerating.

So, what does all this mean? The increasing rates of vaccines and the relatively steady rates of cases implies that we are starting to get to the point that we can resume normal life. Restrictions on businesses and crowds are starting to be loosened, although some states are obviously taking that way too far. Schools are starting to reopen fully or in more hybrid modes. Of course, thanks to new CDC guidelines, families are getting together again, hanging out with fully vaccinated grandparents for the first time.

On March 9, I had lunch with my Mom. Also, this happened:

My parents and in-laws – both fully vaccinated and post two-weeks – have been over, as per the CDC guidelines. There have been snuggles with the grandkids. A year’s worth of snuggles.

Of course, this is all wonderful news. It is desperately needed and wanted. Life is starting to resume. But, that asks a few questions: What does THAT mean from a mental health perspective? Specifically, what are the dangers of this new moment as life gets back to normal?

A few thoughts. First of all, readjustment will be hard for all of us. Events will resume, as will seeing people. Handshakes may come back…maybe. That’s going to be a challenge. I mean, think about it. For most of us, we’ve avoided crowds or crowded buildings. How will we adjust to being near people again?

Another example: Take events. How are any of us going to get used to being around people again? Will it cause major spikes in anxiety?

What about people who have been able to work from home and be near their kids and pets all the time? How will those individuals adjust to being away from their families again?

For people who are in psychologically vulnerable states to begin with, the readjustment may cause real issues. Keep in mind that being “forced” to stay home with loved ones hasn’t been a big problem for many! As such, it begs the question – how will individuals like this react as they resume “normal” activities? And what about people who suffer from anxiety disorders and OCD? What challenges will they face at this moment? After a year of staying home, how will they adjust to being put into an area where there are germs everywhere – even if they have been fully vaccinated?

It goes without saying that these are questions that we should all be grateful we are able to ask. I want us to get back to normal as soon as possible and to resume the lives that we left behind about a year ago. However, this moment is not without its dangers or its struggles. These are things we should monitor in order to ensure that our transition back to “normal” life goes as smoothly as possible.

Why is it so hard to find a therapist?

If I hear about one issue related to mental health over and over, it’s this: Why can’t I find someone to see me? Why is it so hard to find a therapist? Why can’t I find a bed to help me with my loved one who needs hospitalization? It is, unquestionably, the most frustrating issue in the mental health world – one that I would argue is more frustrating and problematic than general issues like access, affordability, parity, and stigma. Heck, we could solve all of these issues, but if we can’t get people into a therapist, it doesn’t matter.

The reason, roughly, comes down to this: A shortage of practitioners.

There is a well-documented shortage of mental health practitioners. According to available information, the shortage is growing across all fronts, including marriage and family therapists, psychiatrists, psychologists, and more. This shortage is particularly acute in some areas, like poorer states, or more rural states. It also gets worse as you start getting into specific areas of mental health, like geriatric or pediatrics psychology. In my home – the Lehigh Valley, Pennsylvania – we’re actually comparatively in good shape. This may come as a surprise to many people in our area!

So, why is there such a shortage? As you can imagine, there are many reasons. The biggest one is reimbursement rates. Simply put, psychiatrists and psychologists are not paid as much by insurance companies or Medicare/Medicaid as other doctors, particularly specialists. This, in turn, leads docs to go into more lucrative fields. That’s not it, of course. In fact, one of my legislative colleagues, Rep. Jeanne McNeill, was able to get a resolution passed that studied the mental health care practitioner shortage in Pennsylvania. That study identified numerous reasons, including regulatory barriers, burnout, parity issues, and information sharing.

What can we do about it? An in-depth analysis is well beyond my ability to address in a blog entry that I usually try not to break 500 words with, but in a nutshell, I think it comes down to investment. Everything above can be addressed with money. Not eliminated, of course. But absolutely addressed.

And, just like that, we’re back at my favorite topic. Everyone says they care about mental health. Great, neat. Can we do something about it? Can we pretend that it actually matters and invest in things like our workforce? In telehealth laws that will ensure that everyone has good access to mental health care, and broadband services to ensure that rural Americans can actually see a doctor no matter where they live? Can we enforce parity laws and ensure that larger insurance companies are meeting their needs when it comes to mental health coverage? Can we get the federal government to expand what they pay for in terms of mental health?

Gah. I’m on my soapbox again. But what I’m saying is accurate! Until the day comes that we actually treat mental health with the seriousness that it deserves, we’re gonna have practitioner shortages. This will limit the number of people that can get the care they deserve.

The Smallest Things Can Make the Biggest Difference

As an elected official, I tend to get captured by big ideas. That’s not a bad thing, obviously. Personally, I think this world needs more big ideas and big plans to tackle big problems, and I wish we had more energy to move in these directions.

That being said, sometimes, big ideas come with little problems. When you hear a big plan to tackle an issue like mental illness or suicide, you think that these are the ONLY things that can tackle depression or suicide. That leads to even more dangerous thoughts: You can’t do anything about it. That’s not true. That’s not true at all.

There is no question that grand gestures and big plans often work, and work well, preventing us from getting into trouble in the first place. But, on an interpersonal level, it is the little things that matter. In fact, more often than not, I’d put money down that it’s the little things that you remember. And, in the long wrong, “little things” is a misnomer. Little things can make a big blessing.

This leads to the obvious question: What are the little things that you can do – that all of us can do – that can save a life or help someone who is struggling feel better?

The Shortest Note: I always got a kick out of this study. In the 1970s, two doctors sent follow up letters to a group of patients who had just been released from the hospital, checking in, expressing concern, and saying that they wanted to stay in touch. Another group didn’t get such letters. The results? Of the group who did get the letters, which came on a regular basis, 1.8% died by suicide within two years. In the group that didn’t? 3.52%.

The conclusion? If the study’s findings are accurate, the smallest thing – the smallest little thing – can help to keep someone alive. This remarkable finding shows that people just want to know someone cares, someone values them, and someone is there if they reach out. Does this mean you can stop a suicide? Not necessarily. But it does mean that regularly checking on someone – letting them know that you value them – can help ease their pain. And yeah, maybe keep them alive.

Call Them By Their Name: The rates of suicide or suicide attempts among the transgender community are hellaciously high: Greater than 50% of transgender male teenagers reported a suicide attempt, with nearly 30% for transgender females. These rates of mental illness and suicide are tied to a few factors, including family rejection, bullying, harassment, or perceived danger. However, there is nothing inherent to being transgender that leads to higher risk of suicide, as transgener individuals who do get the support and acceptance they deserve do not have a higher risk of suicide.

So, what does that support look like? Well, accepting these people for who they are. Puberty blockers reduce the risk of suicide. So does the most simple thing: Calling a person by their chosen name and gender. Calling someone by the name they want reduces their risk of suicide and depression.

Again – it’s the little things.

Ask: There is a misnomer out there – that talking about suicide can implant the idea of suicide in someone’s head. To be clear, this isn’t true. In fact, the opposite is true: Bringing up the subject can save a life. This is because discussing the subject and asking specific questions, such as, “Are you thinking about hurting yourself? Have you been thinking about ending your life? Do you have any plans on it?” can actually check on someone. If done in a caring, compassionate matter, you can tell someone that you are concerned about them, and thus make it clear: You’re here to help. Asking someone if they are in pain or considering suicide will NOT make them more likely to make an attempt. In fact, the opposite may be true.

I need to be clear about something: Not stopping someone from dying by suicide is never someone’s fault. Suicide is a complex, complicated process that almost always involves multiple factors. It’s never just one thing, and it’s virtually impossible for it to be your fault. However, while stopping suicide may not be our fault, it is something we should all take responsibility for. Thankfully, you don’t have to be a doctor. You don’t need formal training. The smallest measures of kindness and compassion can save a life.

The debate about in-person vs. virtual school misses the point

As a parent – and as a policy-maker – it seems as if everything we do these days is related to COVID. How will we recover? How can we ensure that everyone is getting the vaccine who deserves it? How can we deal with the devastating economic and unemployment effects? How soon can we (safely) get kids back into school?

Of course, the mental health impacts of COVID are damning as well, and much of that blame – at least for our kids – has been thrown at the feet of virtual learning. There is a lot of truth in that, of course. Evidence is clear that the mental health of our kids are, on the whole, suffering, with a rise noted in self-reported rates of depression and visits to the emergency room. Some are quick to cite the idea that this is a direct result of the fact that millions of kids are in some sort of virtual learning environment now, either full-time or on a hybrid schedule.

That being said, I really, truly believe that much of this debate misses the point. Why? Because – even for kids who are in school – they’re not getting their usual experience.

If you are in the real world in any capacity, you know it: Everything is different. Wear your mask. Wash your hands. STAY MORE THAN SIX FEET AWAY FROM ME. And if you are someone who was prone to anxiety, you are nervous every time you go out, because you can, quite literally, contract a deadly disease at any moment.

Okay, fine. Now, take all those fears and all those changes, and apply them to school. What do you get? A recipe for disaster. Take this article from Wisconsin Public Radio that details the struggles of kids in the pandemic. It notes, correctly, that zoom school makes it harder for kids to get the help they need and limits social interactions and the desperately needed personal connections. But, it also notes that in-person school is not a panacea:

With the broad disruption wrought by COVID-19, though, simply bringing students back into classrooms doesn’t resolve their mental health concerns.

In the Lake Mills district, where Kisten [a school psychologist] works, students have been mostly attending school in person since the start of the year.

“There’s a lot of grief right now, but the students don’t really have the right words to express that, or they don’t even know what it is that they’re feeling,” she said.

Other evidence has buttressed this point: Kids’ mental health is suffering regardless of where they are in school.

I don’t want to miss the point: Zoom and electronic learning is a cause for mental illness. There’s no question about it. However, even among those who are in school, things aren’t normal. And this is hurting the mental health of our kids.

The debate about whether or not kids should be in school or virtual misses the point entirely. We should be concentrating on SAFELY getting all of our kids back into school, then providing them with the mental health supports that they need in order to thrive. Even kids who are in school are reporting difficulties right now. Real-life or virtual, they’re in pain.

Our Role as Parents

As I type this…damnit to hell, I was about to write something sweet about my kids, but I swear to God, my son just screamed “OW!” at the top of his lungs. I’m not sure what happened, but he’s…oh, for God’s sake, he’s upside-down now, playing on the couch. Kids are weird. 

Well, at least I got cute pictures:

IMG_0532

Kids are weird. Yup. Also, here’s my daughter, because as any parent of multiples knows, if you include one kids, you HAVE TO INCLUDE THE OTHER LEST YOU EXPOSE YOURSELF TO ACCUSATIONS OF FAVORITISM. And yes, she was in motion. She’s always in freakin motion. 

Anyway, the kiddos have been on my mind lately. No reason – they’re wonderful, and Brenna and I are very blessed. They spent about two months doing virtual school but have been able to get back to face to face. We’ve sent them to a Jewish Day School in the area for years but pulled them virtual when we were uncomfortable with the COVID numbers. 

Our experience has been blessed. Our kids are physically and emotionally healthy. That is very unlike students profiled in this Morning Call article, who have suffered mightily during the pandemic. And that is nothing compared to the issues faced by students in Las Vegas. Nevada has long been a suicide hotspot, having the 11th highest suicide ratings – and that was before the pandemic. Now? Suicides are so bad that schools are reopening as part of an effort to clamp down on a rash of suicides.

These numbers are brutal. My wife and I are lucky, and while I like to think that we’re good parents, I’m not dumb enough to think that our kids’ health doesn’t have a heaping dose of luck in it. But…I don’t want to understate the role that parents play in terms of their kids’ mental health.

Sometimes, it’s the little things, but they can be so, so meaningful for kids with certain challenges or issues. For example, take transgender kids. According to studies, suicide rates amongst transgender adults are absurdly high: One study shows that more than half of all transgender people attempt suicide. But there’s good news: Parents who are accepting and supportive of their kids can help reduce these suicide and depression risks. This involves promising unconditional love, support, and using chosen names and pronouns.

Of course, there are a million little ways that this is the case, and your kid doesn’t have to be transgender. According to a 2017 study on suicide and parental involvement, parental involvement and support can have a “significant” influence on reducing suicide. The connection is not a question – it makes perfect sense. Kids grave the love and support of their parents, and that support can help  keep them alive.

Because of my own history, I regularly worry about my kids’ mental health. I regularly think about that nightmare scenario. The only way I comfort myself at those moments is by reminding myself there are some things I can do. Loving my kids – unconditionally – and supporting them – that’s about it. That’s all any of us can ask for, and that’s all any of us can do. 

Keep that in mind in your worst moments as a parent. You matter deeply to them, even when you think you don’t.

An Alternative Perspective on the Madness in Washington, D.C.

Like many of you, I watched the events of this past Wednesday with unmitigated shock, horror, fear, and disgust. Armed terrorists – potentially with help from inside of the building – stormed the temple of our democracy. Spurred on by the words of a malignant, craven madman, they forced a massive lockdown of the building, came within feet of some of our most important leaders, and genuinely and truly sought the death of hundreds and a violent overthrow of our government. What happened on Wednesday is unfathomable. It should never happen again.

The political, legal, and financial reckoning of this event are just beginning, I fear. This was really a 9/11-like day, and it is exceptionally fortunate that only five died, including at least one brave police officer. Hopefully, this day will spurn the changes in our society and security that will ensure such madness never occurs again. Maybe it was like the poison needing to get expunged from the body.

I have had many thoughts as both a passionate American and an elected official, and I have been tweeting like crazy about it. I have some political thoughts – mainly that anyone who participated in this election fraud nonsense shares the blame – but that’s not what I want to talk about today. This is a mental health blog, after all, and I want to discuss the major mental health impacts of the event. To be clear, they are there. Participants and reporters and reporting PTSD-like symptoms:

Millions of Americans are more fearful than ever of what comes next.

Standard disclaimer: I’m not a therapist, just a guy with more experience than I care to think about at seeing them. But I do have some thoughts. The best way to get through this – the only way to get through this – is to try your best to change your perspective.

The day was filled with horror. It was also filled with unimaginable bravery. For example, take the good work of Capitol Police Officer Eugene Goodman:

There’s a full video, but here’s what happens here is nothing short of life-saving. Officer Goodman is the only member the Capitol Police force present at 2:14pm. The direction he is looking leads towards the entrance of the U.S. Senate, where Senators still were, while police frantically tried to seal the doors to the Chamber. That happened at 2:15pm – meaning that Office Goodman is the only thing that stands between the mob and the Senate. Officer Goodman looks towards the Senate entrance and sees it is unguarded. So, he verbally engages with the mob, shoves one of them, and retreats…to his right. Dragging the mob away from the Senate, and potentially saving lives.

The entire wild video is here:

And this says nothing of the countless other people – ordinary citizens and elected officials – who rose about the call of duty. Like the quick-thinking aides who grabbed the electoral votes and made a run for it before the mob could get them. Like Congressman Andy Kim (D-NJ), who stopped to help officers clean up the debris. Or like Congressman Jason Crow (D-CO), who can be seen comforting Congresswoman Susan Wild (D-PA) in this now infamous picture:

Congressman Crow was prepared to fight off the terrorists…with his pen.

Now, let me be clear. This ain’t pollyannic. The day’s events were ugly. There must be justice before there can be unity. Our country faces dark days.

But I would encourage you to take a modified version of the Mr. Rogers approach to the day’s events when trying to process it. Mr. Rogers famously called for people to “look for the helpers.” Go beyond that. Look for the ordinary citizens who rose above the call of duty that day, who risked their lives to save others. Don’t look for those who sank beneath history. Look for those who rose to meet the moment. Evil may be loud. But there’s still more good than bad. Use that perspective to motivate you for the days ahead.

New Years Resolutions Are Stupid

First, and most importantly: HAPPY NEW YEAR, my friends! It has to get better? Right?

::ducks as flaming murder hornets covered in plague and looking like Carol Baskin fly my way::

Anywho, we’re now at the start of a new and hopefully better yeah. 2021 – like every new year – means new beginnings, a chance to make a better year and a better you. So, that means it’s time for New Years Resolutions, right? Time to pledge to lose weight, get in shape, learn that 8th language, whatever.

Please…don’t do that. Don’t make a resolution. Just make the change.

32 pounds and eight and a half years ago, I was sitting on the couch with my wife. I was complaining about my wife. I weighed way, way too much. My pants were tighter. The scale was making me sad. I was only 29 but I felt much older. After a disappointing trip to the scale, I turned to my wife and complained. Finally, she said the magic words to me:

“So, what are you going to do about it?”

It was the only question that mattered. And she was right, of course. I downloaded the LiveStrong app, began counting calories, and got myself into shape. It obviously wasn’t easy, but I’m now 37 and in the best shape of my life.

For purposes of this story, here’s the important point: It wasn’t New Years. It wasn’t a resolution. I just felt lousy and decided to make a change. No, of course it isn’t that easy. But New Year’s resolutions typically suck. In my mind, it’s a deferral. “After New Years, I’m gonna get into shape.” Why wait? Why not just start doing something about it now?

This has always just been my personal belief, but as it turns out, I’m not wrong! Mental health organizations have previously warned that, since so many New Year’s resolutions fail, they can be bad for mental health, triggering feelings of inadequacy or failure. There can be so much pressure from New Year’s resolutions that it can actually put us into a bit of a depression!

According to other writings, this comes from unrealistic expectations that New Years Resolutions often engender. According to that article, most resolutions don’t even make it past January. This, in turn, can lead to fears of failure. A better approach? Make a bunch of little goals that are more realistic, centered around a larger goal. This gives you an obtainable target, one that you then feel better about when you hit. Then you move to the next one.

Yeah, this wasn’t a strictly mental health blog, per se. But it is one that can be a major source of stress for some. And, more to the point, I think it’s really important that we keep a sense of agency about ourselves and our lives. You don’t have to wait for the new year to make that change. To quote my wife, “What are you gonna do about it?”

The Connection Between Physical Appearance & Depression

I caught a post on Reddit and it got me thinking about the broader connections between physical appearance – well, really, more like self-perceived physical appearance – and depression. The results, as you can probably imagine, are not particularly pretty.

First, the study in question. A new survey shows that there is a strong correlation between rates of depression and perceived physical appearance. According to the study, 61% of people suffer from some form of body dissatisfaction. Strikingly, a study found that body dissatisfaction at the age of 14 was related to increased risk of depression as a teenager gets older. Those risks varied, but could increase depression risks by 50% – 285%. Interestingly enough, the severity of the depression was higher in women than in men, somewhat counterintuitively. The study does not that increasing body satisfaction can potentially reduce depression in teenagers.

As usual, standard disclaimer: Correlation does not equal causation, and it is very difficult to determine whether or not the body dissatisfaction causes the depression, if the reverse is true, or if there is another factor that makes these levels of depression and body dissatisfaction occur.

However, this obviously isn’t the first piece of research that makes a direction connection between body dissatisfaction and depression, and many other studies have made this connection in the past.

So, what do we do here? Of course, increasing body satisfaction is an obvious solution, but…good luck with that. I still sort of hate the way I look and I’m 37. I mean, really. How many people like the way they look?

I’m starting to veer into an area that I’ve done in the past, but again, I’d point out that this is yet another example of broader cultural connections making a big input on our mental state. Indeed, I would love to see more research on this topic. The above study, for example, took place in the United Kingdom. Other studies, like this one from Singapore, have made similar findings. This begs the question: How severe is this connection in America? Given the cultural and financial value we tend to place on issues of looks in America, I’d bet that the connections are very strong. But…what about countries that don’t culturally emphasize physical appearance the way that we do? Do they have the same level of connection between body satisfaction and depression?

I’d bet no. And if I’m right about that guess, this is even further proof: Issues of mental illness simply cannot be separated from broader cultural and societal priorities.