Depression affects adolescents in every part of the United States. Depression has been shown to affect adolescents' physical, emotional, and social development. Adolescents who suffer from depression are at increased risk for substance use, high-risk sexual behaviors, problems at school, problems with peer and family relationships, and suicide attempts.1,2 Like many mental disorders, depression can emerge during adolescence,3 and the prevalence of major depressive episode (MDE) generally increases with age through the adolescent years.4 Studies have shown that there is nearly a twofold increase in mood disorders from the 13- and 14-year-old age group to the 17- and 18-year-old age group.5 Because adolescent depression is a problem in every American community, this report provides state-level information on the prevalence of depression among adolescents. This information can inform policymakers’ and prevention specialists’ efforts to develop effective education, treatment, and prevention programs in their communities.
The National Survey on Drug Use and Health (NSDUH) provides up-to-date estimates of MDE and treatment for depression among adolescents. NSDUH asks adolescents aged 12 to 17 about past year symptoms to determine whether they had MDE in the past year. MDE is defined using the diagnostic criteria from the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders.6 Adolescents were assessed as having MDE if they had a period of 2 weeks or longer during which they had either depressed mood or loss of interest or pleasure in usual activities, as well as at least four other symptoms that reflect a change in functioning, such as problems with sleep, eating, energy, concentration, and self-worth.
This issue of The CBHSQ Report uses data from NSDUH to present state (including the District of Columbia) estimates of past year MDE among adolescents aged 12 to 17.7 Findings in this report are annual averages based on combined 2013–2014 NSDUH data from 39,600 adolescent respondents. Comparisons are made with combined 2012–2013 data to examine changes over time; 2012–2013 data are based on information obtained from 45,000 adolescents aged 12 to 17.8 The inclusion of a common year (i.e., 2013) in these comparisons increases the precision of the estimates and the ability to detect statistically
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
The combined 2013–2014 data indicate that across the United States, about 1 in 9 (11.0 percent) or 2.7 million of the 24.9 million adolescents in the nation had an MDE in the past year. Rates of adolescent past year MDE ranged from 8.7 percent in the District of Columbia to 14.6 percent in Oregon (Figure 1).
Of the 10 states with the highest rates of past year MDE among adolescents, 4 were in the West (Oregon, Arizona, Utah, and Washington), 3 were in the Northeast (Rhode Island, Maine, and New Hampshire), 2 were in the Midwest (Wisconsin and Indiana), and 1 was in the South (Virginia).10 Of the 10 states with the lowest rates of past year MDE among adolescents, 4 were in the South (Tennessee, Georgia, Kentucky, and the District of Columbia), 3 were in the West (Alaska, New Mexico, and Hawaii), 2 were in the Midwest (North Dakota and South Dakota), and 1 was in the Northeast (Connecticut).
Figure 1. Major depressive episode in the past year among adolescents aged 12 to 17, by state: percentages, annual averages, 2013–2014
Table 1. Major depressive episode in the past year among adolescents aged 12 to 17, by state: percentages, annual averages, combined 2012–2013 and combined 2013–2014
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.
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.
Table S1. Major depressive episode in the past year among adolescents aged 12 to 17, by quintile group and size of state estimate: percentages, annual averages, 2013–2014