Major depressive episodes rising in adolescents, especially minorities

A growing number of adolescents have been facing mental health challenges in recent years. In 2017, more than 13 percent of Americans between the ages of 12 and 17 had been diagnosed with a major depressive episode (MDE), and one study from 2019 found that nearly 20 percent of U.S. high school students reported suicidal thoughts during a one-year period. Major depression can lead to a variety of problems with adolescents’ family and social lives and academic performance.

Researchers have investigated various individual risk factors for MDE, rates of diagnosis and use of mental health services. However, fewer studies have looked into how social involvement may affect MDE rates or explored possible racial and ethnic disparities in MDE rates and mental health service use.

A new study published in the Journal of Affective Disorders attempts to build on what we know about major depression in adolescents. Ping Ma, PhD, assistant professor at the Texas A&M University School of Public Health, doctoral candidate Qiping Fan and others examined MDE in adolescents from 2010 to 2018. Their analysis estimated trends in MDE prevalence over that period, looked into possible racial and ethnic disparities in MDE prevalence and mental health services use, and investigated how factors like social engagement and family structure affect MDE and mental health services use.

Having experienced a major depressive episode can be defined as having five or more of nine symptoms, including depressed mood, loss of interest in daily activities, problems with weight, sleep, energy, concentration or self-worth, or thoughts of death during a period of two weeks or more. MDE can have varying effects on life activities, with some cases causing severe disruption to school, family life and other activities. Participating in school, community and other activities may promote mental health by improving social connections and support. Getting timely help from mental health care service providers can reduce MDE-related negative effects on an adolescent’s life activities.

The researchers used data from the National Survey on Drug Use and Health from 2010 to 2018. This nationally representative dataset included responses from more than 130,000 American adolescents aged 12 to 17. The study looked at weighted percentages of adolescents receiving a major depressive episode diagnoses in the past year, the degree to which the MDE affected life activities like school, chores at home and close relationships with family and friends, and whether the respondents had seen a health professional for their MDE symptoms in the past year. In their analysis, the researchers included data on family structure, participation in youth activities, substance use, and demographic characteristics like age, gender, race and ethnicity.

The analysis found that MDE prevalence in adolescents grew from around 8 percent in 2010 to more than 14 percent in 2018. At the same time, use of mental health services remained low, with only about one-third of adolescents getting help from qualified professionals. The researchers also found that adolescents in racial and ethnic minority populations had higher MDE rates and lower services use than white adolescents. However, their analysis also found an association between participating in school, community or other activities and lower MDE prevalence.

The reasons for the racial and ethnic disparities are unclear. The researchers identified sociodemographic factors, discrimination, cultural perceptions of mental illness and mistrust of the health care system as possible contributing issues; however, there is a need for more research into these disparities. The disparities in MDE diagnosis and services use point to a need for further study and for improving mental health care interventions for more vulnerable populations. Developing a more diverse population of mental health professionals and training providers to be more culturally aware and responsive when working with minority adolescents could lead to improved care. In addition, future interventions that consider gender differences in mental health and service use could be beneficial as this study found differences between male and female MDE prevalence and service use across the board. The researchers also identified a need to improve social support in depressed adolescents.

The findings of this study show increasing trends in major depressive episode prevalence and the need for tailored interventions to increase use of mental health services, especially in vulnerable adolescent populations.

– by George Hale