Recent increases in depressive symptoms among US adolescents: trends from 1991 to 2018
Mental health problems and mental health related mortality have increased among adolescents, particularly girls. These trends have implications for etiology and prevention and suggest new and emerging risk factors in need of attention. The present study estimated age, period, and cohort effects in depressive symptoms among US nationally representative samples of school attending adolescents from 1991 to 2018.
Data are drawn from 1991 to 2018 Monitoring the Future yearly cross-sectional surveys of 8th, 10th, and 12th grade students (N = 1,260,159). Depressive symptoms measured with four questions that had consistent wording and data collection procedures across all 28 years. Age–period–cohort effects estimated using the hierarchical age–period–cohort models.
Among girls, depressive symptoms decreased from 1991 to 2011, then reversed course, peaking in 2018; these increases reflected primarily period effects, which compared to the mean of all periods showed a gradual increase starting in 2012 and peaked in 2018 (estimate = 1.15, p < 0.01). Cohort effects were minimal, indicating that increases are observed across all age groups. Among boys, trends were similar although the extent of the increase is less marked compared to girls; there was a declining cohort effect among recently born cohorts, suggesting that increases in depressive symptoms among boys are slower for younger boys compared to older boys in recent years. Trends were generally similar by race/ethnicity and parental education, with a positive cohort effect for Hispanic girls born 1999–2004.
Depressive symptoms are increasing among teens, especially among girls, consistent with increases in depression and suicide. Population variation in psychiatric disorder symptoms highlight the importance of current environmental determinants of psychiatric disorder risk, and provide evidence of emerging risk factors that may be shaping a new and concerning trend in adolescent mental health.
KeywordsDepression Age–period–cohort Adolescent Suicide Time trend
Monitoring the Future study is funded by National Institute on Drug Abuse Grant R01001411.
Compliance with ethical standards
Conflict of interest
The authors report no conflicts of interest and have no financial relationships with commercial interests.
- 2.Costello EJ, Erkanli A, Angold A (2006) Is there an epidemic of child or adolescent depression? J Child Psychol Psychiatry 47(12):1263–1271Google Scholar
- 4.Substance Abuse and Mental Health Services Administration (2017) Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. Rockville, MD Cent Behav Heal Stat Qual Subst Abus Ment Heal Serv Adm. https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2016/NSDUH-FFR1-2016.htm. Accessed 23 Mar 2019
- 5.Curtin SC, Warner M, Hedegaard H (2016) Increases in suicide in the United States, 1999–2014. NCHS data brief, no 241. National Center for Health Statistics, Hyattsville, MDGoogle Scholar
- 6.CDC (2016) Trends in the prevalence of suicide–related behavior national YRBS: 1991–2015. https://www.cdc.gov/healthyyouth/data/yrbs/pdf/trends/2015_us_suicide_trend_yrbs.pdf. Accessed 23 Mar 2019
- 9.Marcus SC, Olfson M (2010) National trends in the treatment for depression from 1998 to 2007. Arch Gen Psychiatry 67(12):1265–1273. https://doi.org/10.1001/archgenpsychiatry.2010.151 CrossRefGoogle Scholar
- 13.Klerman GL, Lavori PW, Rice J et al (1985) Birth-cohort trends in rates of major depressive disorder among relatives of patients with affective disorder. Arch Gen Psychiatry 42(7):689–693. https://doi.org/10.1001/archpsyc.1985.01790300057007 CrossRefGoogle Scholar
- 32.Miech RA, Johnston LD, O’Malley PM, Bachman JG, Schulenberg JE, Patrick ME (2018) Monitoring the future national survey results on drug use, 1975–2017: volume I, secondary school students. The University of Michigan Institute for Social Research, Ann Arbor, MI. http://monitoringthefuture.org/pubs.html#monographs. Accessed 6 Aug 2018
- 37.Merikangas KR, He JP, Burstein M et al (2010) Lifetime prevalence of mental disorders in US adolescents: results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry 49(10):980–989. https://doi.org/10.1016/j.jaac.2010.05.017 CrossRefGoogle Scholar
- 39.Dohrenwend BP, Shrout PE, Egri G, Mendelsohn FS (1980) Nonspecific psychological distress and other dimensions of psychopathology: measures for use in the general population. Arch Gen Psychiatry. https://doi.org/10.1001/archpsyc.1980.01780240027003 Google Scholar
- 40.Miech R, Johnston LD, O’Malley PM, Bachman JG, Schulenberg J (2016) Monitoring the future national survey results on drug use, 1975–2015, secondary school students. Ann Arbor Inst Soc Res Univ Michigan 1:636Google Scholar
- 41.Bachman JG, Johnston LD, O’Malley PM, Schulenberg J, Miech R (2015) The monitoring the future project after four decades: design and procedures. Institute for Social Research, University of Michigan, Ann Arbor, MIGoogle Scholar
- 45.Schulenberg J, Zarrett N (2006) Mental health during emerging adulthood: continuity and discontinuity in courses, causes, and functions. In: Arnett JJ, Tanner JL (eds) Emerging adults in America: coming of age in the 21st century. American Psychological Association, Washington, pp 135–172CrossRefGoogle Scholar
- 46.American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders: DSM-5. American Psychiatric Association. https://doi.org/10.1176/appi.books.9780890425596.744053
- 48.Yang Y, Land K (2013) Mixed effects models: hierarchical APC-cross-classified random effects models (HAPC-CCREM), Part II: Advanced analyses. In: Yang Y, Land K (eds) Age-period-cohort analysis: new models, methods and empirical applications. Chapman & Hall/CRC Interdisciplinary Statistics, Boca Raton, pp 231–284CrossRefGoogle Scholar
- 49.Yang Y, Land KC (2006) A mixed models approach to age-period-cohort analysis of repeated cross-section surveys: trends in verbal test scores. In: Stolzenberg RM (ed) Sociological methodology, vol 36. Blackwell Publishing, BostonGoogle Scholar
- 51.CDC (2016) Trends in the prevalence of alcohol use national YRBS: 1991–2015. https://www.cdc.gov/healthyyouth/data/yrbs/pdf/trends/2015_us_alcohol_trend_yrbs.pdf. Accessed 5 Oct 2017
- 52.CDC (2016) Trends in the prevalence of marijuana, cocaine, and other illegal drug use national YRBS: 1991–2015. https://www.cdc.gov/healthyyouth/data/yrbs/pdf/trends/2015_us_drug_trend_yrbs.pdf. Accessed 6 Oct 2017
- 57.Twenge JM (2017) Have smartphones destroyed a generation? The Atlantic. https://www.theatlantic.com/magazine/archive/2017/09/has-the-smartphone-destroyed-a-generation/534198/. Accessed 23 Mar 2019
- 65.Elder GH (1999) Children of the great depression: social change in life experience. Westview, BoulderGoogle Scholar
- 68.WHO (2008) The global burden of disease: 2004 update, Table A2: burden of disease in DALYs by cause, sex and income group in WHO regions, estimates for 2004. The World Health Organization, Geneva. http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_AnnexA.pdf. Accessed 23 Mar 2019