Depressive symptoms rising faster in US teens who do not engage in risk behaviors

Key takeaways:

• Depressive symptoms increased in high school students from 28.4% in 2007 to 42.3% in 2021.
• The largest increases occurred among girls and non-Hispanic white students.

An increase in depressive symptoms was observed among U.S. teenagers without, rather than with, behavioral risk factors, underscoring the need for greater screening in this population, data show.

“Over the last decade, national survey data has revealed a sharp rise in depressive symptoms among U.S. adolescents,” Tanner J. Bommersbach, MD, MPH, child and adolescent psychiatrist and assistant professor at the University of Wisconsin School of Medicine and Public Health, told Healio regarding the research presented in The Lancet Regional Health Americas. “Yet, surprisingly little is known about what is driving this increase and which adolescents are most affected.”

Bommersbach and colleagues sought to examine the reasons for this steady increase and to estimate nationwide trends in depressive symptoms among high school-aged students with and without health-risk behaviors.

Their cross-sectional study included 119,654 individuals (50.1% girls) attending grades 9 through 12 in both public and private schools, whose publicly available data were taken from the biennial Youth Risk Behavior Survey between 2007 and 2021.

Depressive symptoms were defined as reported feelings of sadness or hopelessness almost every day for 2 consecutive weeks or more over the past year, which negatively impacted usual activities. The survey also named 24 health-risk behaviors across five categories (violence, substance use, sexual, physical exertion and weight related), including recent additions of school and online bullying.

Further, the researchers classified the survey respondents into low-, medium- and high-risk groups based on the number of reported health-risk behaviors, with overlap if multiple risk behaviors were reported.

Lastly, they estimated national trends of depressive symptoms by both demographics and presence of health-risk behaviors, reporting biennial average percent change (BAPC) with 95% confidence intervals.

School response rates ranged from a low of 73% in 2021 to a high of 81% in 2009; student response rates ranged from a 2021 low of 79% to a 2009 high of 88%; overall response rates ranged from 58% (2021) to 71% (2009).

Results showed that depressive symptoms rose as much or more from 2007 to 2021 among students engaging in few or no risk behaviors as students who did engage in such behaviors, with the trend observed for both boys and girls.

The researchers reported the largest increases in depressive symptoms occurred among girls (BAPC: 3.3%; 95% CI, 2.9%–3.8%) and non-Hispanic white students (BAPC: 3.6%; 95% CI, 3%–4.1%), while symptoms increased overall from 28.4% in 2007 to 42.3% in 2021, with a BAPC of 3% (95% CI, 2.6%–3.4%).

Bommersbach and colleagues also reported that depressive symptoms increased more among students who engaged in one or more risk category (BAPC = 4.6%; 95% CI, 3.6%–5.7%) compared with those who engaged in four to five risk categories (BAPC = 2.9%; 95% CI, 2.4–3.3%). Data further showed that presence of depressive symptoms indicated a general trend toward decreasing engagement in risk behaviors.

“The fact that we found that depressive symptoms have actually been rising faster among adolescents with few or no behavioral risk factors, compared to adolescents with multiple risks, suggests that many students with depressive symptoms are likely being missed by current targeted screening practices,” Bommersbach said. “These results underscore the potential value of universal screening for depression in primary care and school settings.”