Journal of Adolescent Health 70 (2022) 496e499
www.jahonline.org
Adolescent health brief
Prevalence of Depression Among Adolescents in the U.S. From
2009 to 2019: Analysis of Trends by Sex, Race/Ethnicity, and
Income
Michael Daly, Ph.D. *
Department of Psychology, Maynooth University, Co. Kildare, Ireland
Article history: Received June 24, 2021; Accepted August 26, 2021
Keywords: Major depressive disorder; Mood disorders; Depression; Prevalence trends; Sociodemographic characteristics
See Related Editorial on p.354
A B S T R A C T
IMPLICATIONS AND
CONTRIBUTION
Purpose: Major depression is a leading cause of disability and represents a significant health
concern for adolescents. Evidence of temporal trends in adolescent depression stratified by soci-
This study provides na-
odemographic characteristics is needed. tionally representative
Methods: This study drew on 11 years of the National Survey on Drug Use and Health (N ¼ evidence that the preva-
167,783), a nationally representative survey of adolescents aged 12e17 years conducted between lence of major depressive
2009 and 2019. episode doubled among
Results: The prevalence of past-year major depressive episode (MDE) increased by 7.7 percentage adolescent girls over an
points from 8.1% to 15.8% between 2009 and 2019. MDE increased by 12 percentage points from 11-year period from 2009
11.4% to 23.4% among girls. The gender difference in the prevalence of MDE increased from 6.4% to to 2019. Identifying the
14.8% between 2009 and 2019. Black participants experienced a comparatively small increase in causes of this increase and
depression (4.1%). enhancing mental health
Conclusions: Since 2009 there has been a sharp and sustained increase in depression among promotion, prevention,
adolescent girls in the U.S. This concerning trend highlights the critical importance of directing and intervention efforts
prevention and intervention efforts toward this group. targeting adolescent girls
Ó 2021 Society for Adolescent Health and Medicine. Published by Elsevier Inc. This is an open will now be crucial.
access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Depression is a leading cause of impairment and disability depression reported by U.S. adolescents since 2010 [5,6]. Although
globally [1] and major contributor to suicidal behavior [2]. The national trends in depression have been documented, reliable up-
prevalence of fatal suicide among U.S. adolescents and young to-date estimates of trends among key subpopulations are
adults increased by 57.4% between 2007 and 2018 [3]. This trend needed. To address this gap, this study drew on nationally
has been attributed to a range of potential causes including representative data to estimate temporal trends in the prevalence
increased prevalence of anxiety and depressive disorders over this of past-year major depressive episode (MDE) across sex, race/
period [4]. Of particular concern is a rise in the prevalence of major ethnicity, and household income groups between 2009 and 2019.
Conflicts of interest: No conflicts of interest reported. Methods
Data Availability: The data that support the study findings can be accessed from
the Substance Abuse and Mental Health Data Archive (https://www.datafiles.
Study population
samhsa.gov/).
* Address correspondence to: Michael Daly, Ph.D., Department of Psychology,
Maynooth University, 1.1.7 Education House, Maynooth, Ireland. Participants were 167,783 adolescents aged 12e17 years who
E-mail address:
[email protected]. took part in the 2009e2019 waves of the National Survey on
1054-139X/Ó 2021 Society for Adolescent Health and Medicine. Published by Elsevier Inc. This is an open access article under the CC BY license (http://
creativecommons.org/licenses/by/4.0/).
https://doi.org/10.1016/j.jadohealth.2021.08.026
M. Daly / Journal of Adolescent Health 70 (2022) 496e499 497
Drug Use and Health (NSDUH), administered using computer- of MDE between 2009 and 2019, with statistical significance
assisted interviewing methods [7]. The NSDUH is an annual defined as two-sided, p < .05. Interactions between survey year
cross-sectional survey of the U.S. population with a high and demographic characteristics were tested to identify whether
response rate (70% for those aged 12e17 across the years changes in the prevalence of MDE from 2009 to 2019 differed as a
examined) [7]. Each year the NSDUH utilizes a stratified, multi- function of participant sex, race/ethnicity, household income,
stage area probability sampling method to select participants and age groups. All analyses incorporated sampling weights
and provide nationally representative estimates for noninstitu- taking into account the NSDUH’s complex survey sampling
tionalized individuals aged 12 and older [8]. This study involved design to generate nationally representative estimates.
secondary analysis of anonymized microdata files and did not
require institutional approval from the Maynooth University Results
Social Research Ethics Sub-Committee.
In the NSDUH, the prevalence of MDE increased significantly
Past-year depression from 8.1% (95% confidence interval [CI] 7.5e8.7) in 2009 to 15.8%
(95% CI 15.2e16.5) in 2019, an increase of 7.7 percentage points
The presence of MDE in the past year was assessed using a (95% CI 6.8e8.6) (Table 1, Figure 1A). Depression levels increased
structured interview based on DSM-5 criteria and adapted from by 3.2 percentage points (95% CI 2.3e4.1) from 2009 to 2014 and
the depression module of the National Comorbidity Survey- by 4.5 percentage points (95% CI 3.5e5.5) from 2014 to 2019.
Adolescent which used modified version of the World Health Statistically significant increases in the prevalence of MDE
Organization Composite International Diagnostic Interview were observed across all demographic groups examined
[7,9,10]. Past-year MDE was defined as present when a partici- (Table 1). Depression levels among female participants increased
pant reported 5 of nine symptom criteria for MDE (e.g., prob- by 12 percentage points (95% CI 10.4e13.5) between 2009 and
lems with sleeping, eating, fatigue/loss of energy, feelings of 2019, from 11.4% to 23.4%. This increase was 8.3 percentage
worthlessness, recurrent thoughts of death of suicidal ideation) points (95% CI 6.2e10.4) larger than the increase experienced by
in the same 2-week period in the past year, where 1 of the males over the same period (3.7%, 95% CI 2.5e4.8) (Figure 1B).
criteria was either depressed mood or loss of interest or pleasure The gender difference in adolescent depression levels increased
in daily activities during this period [7]. from 6.4 percentage points (95% CI 5.4e7.5) in 2009 to 14.8
percentage points (95% CI 12.9e16.6) in 2019. Both males and
Demographics females experienced statistically significant increases in
depression from 2009 to 2019 across all age, race/ethnicity, and
Participants reported their age in years (coded as 12e14, 15e income groups examined, as shown in Table S1. Female partici-
17), sex (male, female), and race/ethnicity (categorized as non- pants experienced a significantly larger increase in depression
Hispanic white, non-Hispanic black, Hispanic, and other race/ than male participants in each age, income, and race/ethnicity
ethnicity). Household income was classified as either less than group except for black participants where the change in
$50,000 per annum or greater than or equal to $50,000 per depression did not differ significantly between males and fe-
annum. males (Table S1).
Black participants experienced a 4.1 percentage point (95% CI
Statistical analysis 1.7e6.5) increase in the prevalence of MDE which was smaller
than the increase experienced by white (3.3% lower increase,
Logistic regression analysis with cluster robust standard er- 95% CI 6.1 to .6), Hispanic (5.6%, 95% CI 9.1 to 2.1), and
rors followed by the Stata margins postestimation command was other race/ethnicity participants (5.1%, 95% CI 9.4 to .7).
used to estimate percentage-point differences in the prevalence Depression trends for black and white/Hispanic/other race/
Table 1
Estimated changes in the prevalence of past-year MDE among U.S. adolescents from 2009 to 2019 by sociodemographic characteristics
Demographic characteristic 2009 survey wave (N ¼ 17,162) 2019 survey wave (N ¼ 12,950) Change in depression Percentage
% (95% CI)a increaseb
% of sample Depression % (95% CI)a % of sample Depression % (95% CI)a
Overall sample e 8.1 (7.5e8.7) e 15.8 (15.2e16.5) 7.7 (6.8e8.6) 95.1%
Age 12e14 46.8 5.4 (4.7e6.2) 49.6 12.2 (11.2e13.3) 6.8 (5.5e8.0) 126.0%
Age 15e17 53.2 10.5 (9.5e11.4) 50.4 19.4 (18.1e20.7) 8.9 (7.4e10.5) 84.8%
Male 51.2 5.0 (4.3e5.6) 51.1 8.6 (7.6e9.6) 3.7 (2.5e4.8) 74.0%
Female 48.8 11.4 (10.5e12.3) 48.9 23.4 (22.1e24.7) 12.0 (10.4e13.5) 105.3%
White 58.6 8.3 (7.6e9.0) 51.7 15.8 (14.8e16.7) 7.5 (6.3e8.7) 90.4%
Hispanic 19.5 8.1 (6.5e9.8) 24.8 17.8 (16.0e19.6) 9.7 (7.3e12.1) 119.8%
Black 15.0 7.4 (5.9e8.9) 13.4 11.5 (9.6e13.5) 4.1 (1.7e6.5) 55.4%
Other race/ethnicityc 7.0 7.9 (5.9e9.9) 10.1 17.1 (14.3e19.8) 9.2 (5.8e12.6) 116.5%
Income <$50,000 46.4 8.0 (7.1e9.0) 40.0 15.5 (14.2e16.8) 7.5 (5.9e9.1) 93.8%
Income $50,000 53.6 8.2 (7.5e8.9) 60.0 16.0 (15.1e17.0) 7.9 (6.7e9.1) 96.3%
a
Estimates are from marginal effects calculated after logistic regression with cluster robust standard errors. All estimates of change in depression are statistically
significant at the p < .001 level.
b
Percentage change in depression levels relative to 2009 levels defined as: [Percentage point change in depression from 2009 to 2019 100]/[Percentage with
depression in 2009].
c
Race/ethnicity was self-reported. The other race/ethnicity group includes Asian, American Indian/Alaska Native, Native Hawaiian and Other Pacific Island, and other
non-Hispanic multiracial groups which were combined due to small group sizes.
498 M. Daly / Journal of Adolescent Health 70 (2022) 496e499
Figure 1. Trends in the prevalence of past-year MDE from 2009 to 2019 in the (A) overall NSDUH sample, for (B) males and females, and (C) nonblack and black race/
ethnicity groups. Note: NSDUH graphs are derived from logistic regression analysis of 167,783 participants. 95% confidence intervals are presented.
ethnicity participants is shown in Figure 1C. The magnitude of [11] and forecasts adverse health and socioeconomic conse-
the increase in the prevalence of MDE between 2009 and 2019 quences throughout life [9,12].
did not differ significantly by household income or participant In the current study, the gender disparity in depression more
age. than doubled (from 6.4 to 14.8 percentage points) between 2009
and 2019 driven by a substantial rise in the prevalence of MDE
among females over this period. This finding extends existing
Discussion evidence that has found significant though less pronounced in-
creases in internalizing problems [13,14] and depressive symp-
This study of over 160,000 adolescents aged 12e17 years toms [15] among adolescent girls since the beginning of the 21st
drew on nationally representative data to show that the preva- century. Potential reasons for this increase are manifold and
lence of MDE approximately doubled between 2009 and 2019 include increases in bullying and victimization [16] and use of
(from 8.1% to 15.8%). This prolonged rise in MDE is concerning social media and technology [17] which may have been more
because adolescent depression tends to persist into adulthood impactful for girls than boys. In addition, reduced sleep quality
M. Daly / Journal of Adolescent Health 70 (2022) 496e499 499
and quantity [18], the long-term impact of the Great Recession, [5] Weinberger AH, Gbedemah M, Martinez AM, et al. Trends in depression
prevalence in the USA from 2005 to 2015: Widening disparities in
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vulnerable groups. Psychol Med 2018;48:1308e15.
the rise in depression. [6] Twenge JM, Cooper AB, Joiner TE, et al. Age, period, and cohort trends in
The current study is limited in its reliance on self-reports of mood disorder indicators and suicide-related outcomes in a nationally
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Supplementary data related to this article can be found at
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