significant differences between the two periods. Statistically significant differences between 2012–2013 and 2013–2014 indicate average annual change between 2012 and 2014. All changes discussed in this report are statistically significant at the .05 level of significance.

Estimates are displayed in a U.S. map (Figure 1) and in Table 1. For the estimates displayed in Table 1, states are listed alphabetically. Ninety-five percent confidence intervals are included as a measure of precision for each estimate. To produce the 2013–2014 MDE map (Figure 1), state estimates shown to two decimal places were first rank ordered from lowest to highest and then divided into quintiles (fifths). States with the lowest estimates (i.e., the lowest fifth) are assigned to the bottom quintile and are shown in dark blue. States with the highest estimates are assigned to the top quintile and are shown in dark red. All other states are assigned to one of three quintiles between the lowest and highest quintiles. A supporting table associated with the map (Table S1) provides estimates that are rank ordered from highest to lowest and then divided into quintiles.⁹

When the 2012–2013 national MDE estimate was compared with the 2013–2014 estimate, the nation as a whole experienced a statistically significant increase in the rate of past year MDE among adolescents (9.9 percent in 2012–2013 to 11.0 percent in 2013–2014) (Table 1). On an individual state level, 13 states experienced a statistically significant increase in the rate of adolescent past year MDE. The remaining 37 states and the District of Columbia experienced no change in the percentage of adolescents who had an MDE in the past year.

Addressing adolescents’ mental health needs is fundamental to the future of the nation and each state. The NSDUH data in this report show that depression is a challenge for nearly 2.7 million adolescents in the United States. As shown in Figure 1, adolescent depression occurs in every state. To put this in context, in nearly every state, at least 1 in 10 adolescents had an MDE in the past year.

In addition to understanding the current prevalence of MDE among adolescents, it is also useful to monitor the MDE trends. This issue of The CBHSQ Report finds that past year MDE among adolescents in the United States has become more common in the nation overall and in several states. The short-term trends in adolescent MDE show that the rates of past year MDE have increased between 2012–2013 and 2013–2014 in 13 states and have remained the same in the remaining 37 states and the District of Columbia. This is in contrast to past year MDE rates among adults aged 18 or older where there were no increases between 2012–2013 and 2013–2014.¹¹ Among adults aged 18 or older, 47 states experienced no change in past year MDE between 2012–2013 and 2013–2014, while declines were observed in the remaining 4 states (Michigan, Oklahoma, Texas, and Utah).¹¹ The findings in this report suggest a continuing need for programs to address depression among adolescents.

Highlighting the prevalence of adolescent MDE at the state level may help state and local prevention specialists in their efforts to raise awareness of the signs of adolescent depression, to increase screening for adolescent depression, and to more widely disseminate information on the availability of treatment for adolescents with MDE. Despite the effectiveness of treatment for depression and the variety of treatment options available, nearly two-thirds of adolescents who had past year MDE did not receive treatment for depression in the past year.¹² Resources to help parents, teachers, and caregivers to recognize the signs and symptoms of adolescent depression and to locate mental health services are available from the Substance Abuse and Mental Health Services Administration at https://www.samhsa.gov/children and the U.S. Department of Health and Human Services at http://www.mentalhealth.gov/talk/parents-caregivers/index.html. 

1. Keenan-Miller, D., Hammen, C. L., & Brennan, P. A. (2007). Health outcomes related to early adolescent depression. Journal of Adolescent Health, 41, 256–262.
2. Bhatia, S. K., & Bhatia, S. C. (2007). Childhood and adolescent depression. American Family Physician, 75, 73–80.
3. Kessler, R. C., Amminger, G. P., Aguilar-Gaxiola, S., Alonso, J., Lee, S., & Ustün, T. B. (2007). Age of onset of mental disorders: A review of recent literature. Current Opinion in Psychiatry, 20(4), 359–364.
4. Center for Behavioral Health Statistics and Quality. (2011). The NSDUH Report: Major depressive episode and treatment among adolescents: 2009. Rockville, MD: Substance Abuse and Mental Health Services Administration.
5. Merikangas, K. R., He, J.-P., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., et al. (2010). Lifetime prevalence of mental disorders in U.S. adolescents: Results from the National Comorbidity Survey Replication-Adolescent Supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry, 49(10), 980–989.
6. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
7. All estimates in this report are based on a small area estimation (SAE) methodology in which state-level NSDUH data are combined with local-area county and census block group/tract-level data from the state. This model-based methodology provides more precise estimates of substance use at the state level than those based solely on the sample, particularly for smaller states. The precision of the SAE estimates, particularly for states with smaller sample sizes, can be improved significantly by combining data across 2 years (i.e., 2012 and 2013, 2013 and 2014).
8. The difference in sample sizes between 2012–2013 and 2013–2014 is due to a sample redesign in 2014. For additional information, go to https://www.samhsa.gov/data/.
9. In this report, state estimates are discussed in terms of their observed rankings because they provide useful context. However, a state having a highest or lowest estimate does not imply that the state's estimate is significantly higher or lower than the estimate of the next highest or lowest state. Similarly, the quintiles were not selected to represent statistical differences across quintiles or to correspond to proximity to a target public health threshold for a particular measure. For example, the division of states into quintiles does not indicate that states in the same quintile are statistically similar to each other. Although a nearly equal number of states are contained in each quintile, the size of the intervals (i.e., the difference between the upper and lower limits of each quintile) that define the map boundaries is not necessarily uniform across each quintile. When comparing two state prevalence rates, the method of overlapping confidence intervals is more conservative (i.e., it rejects the null hypothesis of no difference less often) than the standard method based on Z statistics when the null hypothesis is true. Even if confidence intervals for two states overlap, the two estimates may be declared significantly different by the test based on Z statistics. Hence, the method of overlapping confidence intervals is not recommended to test the difference of two state estimates. A detailed description of the method of overlapping confidence intervals and its comparison with the standard methods for testing of a hypothesis is given in the following articles: (a) Schenker, N., & Gentleman, J. F. (2001). On judging the significance of differences by examining the overlap between confidence intervals. American Statistician, 55(3), 182–186. (b) Payton, M. E., Greenstone, M. H., & Schenker, N. (2003). Overlapping confidence intervals or standard error intervals: What do they mean in terms of statistical significance? Journal of Insect Science, 3, 34.
10. The West has 13 states: AK, AZ, CA, CO, HI, ID, MT, NM, NV, OR, UT, WA, and WY. The South has 16 states plus the District of Columbia: AL, AR, DE, FL, GA, KY, LA, MD, MS, NC, OK, SC, TN, TX, VA, and WV. The Northeast has 9 states: CT, MA, ME, NH, NJ, NY, PA, RI, and VT. The Midwest has 12 states: IA, IL, IN, KS, MI, MN, MO, ND, NE, OH, SD, and WI.
11. Tables containing MDE rates for adolescents in 2012 and 2013 and MDE rates for adults in 2013 and 2014 can be obtained at https://www.samhsa.gov/data/.
12. Center for Behavioral Health Statistics and Quality. (2015). Receipt of services for behavioral health problems: Results from the 2014 National Survey on Drug Use and Health. Retrieved from https://www.samhsa.gov/data/

Lipari, R.N., Hughes, A. and Williams, M. State estimates of major depressive episode among adolescents: 2013 and 2014. The CBHSQ Report: July 7, 2016. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, MD.