This week, Gallup published a poll showing US depression rates for the first quarter of 2026. Over 19% of adults report that they have depression or are being treated for it, a comparable rate to the prior quarter but nearly double where the figure stood in 2015.

Since 2015, when Gallup began to track this measure, the US has seen a period of greatly expanded access to mental healthcare. When the Affordable Care Act took effect in 2010, up to 37 million previously uninsured Americans, 29% of whom had preexisting behavioural health disorders, gained access to mental-health service coverage. Today, coverage has continued to increase, with marketplace enrolment doubling between 2020 and 2025.

That presents a paradox: if the problem is primarily clinical, treatment expansion should reflect a decrease in this trend. Why, then, are Americans still so depressed?

Rates of reported depression are high because many people are, in fact, unhappy. At least 19% of them consider that unhappiness through a clinical lens, regardless of whether they meet diagnostic thresholds. However, most don’t. In 2010, research found that most non-psychiatrist physicians — from whom adults largely receive mental healthcare — didn’t use clinical criteria to diagnose. Unsurprisingly, in 2013, Johns Hopkins University found that over 60% of adults with diagnosed depression did not meet the 12-month criteria. Later that year, diagnostic thresholds were practically broadened by new DSM definitions, and the rate of non-threshold diagnoses dropped to between 26% and 45%. Formally, clinical depression now includes hopelessness and bereavement, with more diagnostic ambiguity and physician discretion, while symptoms are only required for a two-week period.

All that is not to suggest that Americans’ depression isn’t real. It’s to clarify that what’s primarily measured by Gallup — and, more generally, what’s meant by the classification “depression” — is ordinary unhappiness. The World Health Organization’s description of depression supports that: it is “common” and “involves a depressed mood or loss of pleasure or interest in activities for long periods of time”.

Classification is easy to dismiss as a wonky researcher’s preference. But it has real implications for society. Based on Gallup data and rising depression rates reported elsewhere, it has not been effective to consider this phenomenon known as “depression” a clinical problem with a clinical solution.

Consider an alternative categorisation: loneliness. Gallup shows a direct association between depression and loneliness, which is also reflected in other data. Depression is treated as a clinical problem, while loneliness is understood as a social problem. The two concepts, in practice, are hard to disentangle and may largely represent the same experience. In the Johns Hopkins study mentioned above, six of seven participants with clinician-identified depression aged 65 or older did not meet depression criteria. This is striking, because loneliness is a well-recognised problem among the elderly.

If unhappiness has nothing to do with cognitive malfunctioning, there’s a downside to calling it depression. The clinical label obscures the need for non-clinical solutions, which is precisely what appears to have happened. High rates of depression and anxiety over the past decade have raised concerns about a “mental health crisis” and caused politicians to double down on public-health interventions.

Depression is not polio: it can’t be cured with a vaccine and a public awareness campaign. A policy response that focuses exclusively on expanding clinical services will always fall short when the problem can’t be fixed by therapists or pills, no matter how many.

Americans are sad, lonely, and disconnected. In seeking to fix that state of affairs, it’s easier to point out what hasn’t worked than to say what should be done. But acknowledging the categorisation failure is a legitimate re-direction: medicalisation, the approach we’ve tried, routes people away from social structures such as neighbourhoods, churches, families and friends. All of that is needed for civic revival, and perhaps less unhappiness.