Researchers aren’t certain why adolescent depression rates are on the rise, but they do know that treatment rates are not growing along with increased prevalence, according to a new report.
Depression is increasing among teenagers and young adults, but researchers aren’t sure why. What is certain is that treatment is not growing at the same rate as prevalence.
A recent study published in Pediatrics revealed that the prevalence of major depressive episodes (MDEs) over a 12-month period increased in adolescents from 8.7% in 2005 to 11.3% by 2014. There was a similar jump in prevalence among young adults, rising from 8.8% to 9.6%. Even after adjustment for substance abuse disorders and socioeconomic status, the investigators say the rise in depression in the 12-years to 20-years age group was “significant.”
The risk of depression rises sharply as children enter the adolescent years, according to the report, and MDEs are more common in young adults who were unemployed or employed only part time, or who had family incomes below $20,000 per year. For teenagers, prevalence rose with the presence of additional factors, such as age, income, and substance abuse disorders. Girls also had a higher chance of experiencing an MDE, growing from 13.1% in 2004 to 17.3% by 2014 compared with 4.5% in boys in 2004 to 5.7% by 2014.
“This aligns with past studies that also found a larger increase in depressive symptoms in girls than boys in more recent years, and recent data on trends in suicide in the United States that identified a greater increase among adolescent girls and young women. Adolescent girls may have been exposed to a greater degree to depression risk factors in recent years. For example, cyberbullying may have increased more dramatically among girls than boys,” the study notes. “As compared with adolescent boys, adolescent girls also now use mobile phones with texting applications more frequently and intensively and problematic mobile phone use among young people has been linked to depressed mood. Interestingly, the sex differences in trends were not consistent across age groups, as the prevalence of depression followed similar temporal trends in young men and women.”
Prevalence was also higher among non-Hispanic whites than in minority groups, according to the report.
Mark Olfson, MD, MPH, professor of psychiatry at Columbia University Medical Center in New York, New York, research psychiatrist at the New York State Psychiatric Institute, and one of the study authors, says the study findings highlight the problem of undertreated depression in young people.
“The recent national increase in depression among young people, most of whom receive no treatment for their symptoms, underscores the importance of improving the detection and treatment of depression in pediatric primary care,” Olfson says. “Using standardized depression screening tools, such as the Patient Health Questionnaire for Adolescents, may improve identification and triage of young people with depression. Follow-up assessments are also important to confirm the diagnosis.”
Despite the increases in prevalence, there was little change in the number of teenagers and young adults that received treatment for depression.
“In view of the growing prevalence of MDE in these age groups, stable treatment rates translate into a growing number of untreated depressed adolescents. These trends suggest that little progress has been made in narrowing the mental health treatment gap for adolescent depression,” the researchers say. “This lack of progress may reflect lingering reluctance on the part of providers to diagnose and treat depression in the wake of the US Food and Drug Administration’s black box warning regarding the use of antidepressants.”
Numbers did increase, however, within the overall treatment rate in regard to the number of individuals receiving care from a specialty mental health care center and in those receiving prescription medication for depression.
The study offers a few hypotheses for why these increases are occurring, but the researchers admit that the data aren’t certain. The report draws a correlation between the economic downturn that occurred during the study period and the increasing rates of adolescent depression, but also noted that there was not a significant increase during these years in adult depression rates.
In terms of treatment, the use of specialty mental health centers and the use of antidepressant medication increased during the study period, particularly after 2011. The researchers correlate this to the wider adoption of the medical home model under the Affordable Care Act and the enactment of parity legislation to enhance access to mental health services.
Olfson doesn’t have an explanation for the increase in adolescent depression, but says there may be several factors in play.
“We do not know why adolescent depression is increasing in the United States. Some possible explanations include changing adolescent communication patterns including the rise of social media with its risks for cyberbullying, changing family communication patterns, rising academic strain, and increasing family economic insecurity,” he says. “It is also possible that changing public attitudes have resulted in young people being more forthcoming about their depressive symptoms. At this point, however, we simply do not know what factors are contributing to the national increase in adolescent depression.”
Olfson says he hopes the study will bring attention to the problem and help support the need for a broad range of interventions in this patient population. “Beyond screening and follow-up assessments, brief supportive counseling is often sufficient for children and adolescents with mild symptoms of depressions,” he says. “Providing families with education about depression and treatment options is also helpful. For moderate and severe depression, psychotherapy and serotonin reuptake inhibitors are generally recommended, with symptom severity and prior treatment response being key factors in treatment selection.”
Pediatricians should discuss symptoms of depression with parents, including less obvious signs such as difficulty focusing on homework; changes in eating and sleeping pattern; and irritability or withdrawal from activities and relationships.
Ms Zimlich is a freelance writer in Cleveland, Ohio. She writes regularly for Contemporary Pediatrics and sister publications Managed Healthcare Executive and Medical Economics.