Depression During Development

By Katherine Keyes
February 26, 2020

Adolescence is tough and has been for every generation. But adolescence is also a developmental period with a high risk of onset of psychiatric disorders. Among the most prevalent is depression, a disorder characterized by sadness, anxiety, trouble with appetite and sleep, feelings of worthless, and suicidal behavior. While adolescent depression prevalence was relatively stable for about 50 years, accumulating evidence indicates that depression and suicide have increased among US adolescents in the past decade in a historically unprecedented way.

We contributed to this literature in a new study that reports on data from Monitoring the Future, which includes a yearly, nationally-representative survey of school-attending teens. Since 1991, identical questions about depressive symptoms have been asked. We assessed not only whether symptoms were increasing or decreasing over time among all adolescents, but we also tracked whether adolescents who were born in certain years have particularly accelerated changes in depressive symptoms across time.

We documented that depressive symptoms have been rapidly increasing across time and that this increase began occurring around 2012. These increases were not substantially different in any particular birth cohort, indicating that all adolescent cohorts, regardless of age at the time of the survey, are reporting more depressive symptoms than adolescents in any other time in the last 25 years. These increases are faster among girls.

Our results are consistent with other studies. Nationally-representative US adolescent survey data have documented increases in suicidal thoughts and reported attempts, as well as major depressive episodes and psychological distress. Records of hospitalization for self-injury have doubled from 2007 to 2015, and for suicide death, vital statistics indicate 12.7% annual increases for girls and 7.1% annual increases for boys from 2007 through 2016.

The consistency of findings across data sources, outcomes, self-report, and administrative records indicates that these increases are real. Strong epidemiological studies are needed to elucidate causes of the increases, including reasons for a faster increase among girls.

Why are adolescents today experiencing more mental health problems than previous generations? Parents and non-parents alike are concerned that teens spend too much time on smartphones and social media, which may engender mental health problems due to cyberbullying, envy, and negative self-worth through comparison, isolation from face-to-face interaction, and disrupted sleep, among other potential mechanisms. And certainly, smartphone and social media use skyrocketed in the past decade, coinciding with the increase in depressive symptoms and suicidality.

But, correlating two variables measured across time can be tricky. If digital technology is responsible for the increases in depressive symptoms, we would expect higher depressive symptoms among those who use it more. While some studies show associations, the validity and strength of the association remains highly questionable. A conservative read of the literature certainly indicates that smartphones are not the magic bullet that entirely describes the increase. And given that many teens find solidarity and resources online for coping with marginalization and with their mental health, smartphones may be the future of mental health delivery to improve population mental health.

If phones aren’t the whole story, what is driving mental health trends in the US? The social and environmental landscape for today’s teens is different in many ways. The Sandy Hook shootings of 26 people, including 20 children, in 2012 led to a culture shift in schools. Active shooter and lockdown drills occurred in 95% of US primary and secondary schools by 2015-2016, and measures purportedly for ‘school safety’ (e.g. metal detectors, cameras, locked doors, etc.) have increased in frequency with concomitant student reports of fear and anxiety, and feeling less safe.

Teens are increasingly exposed to a fractured political environment and report high levels of anxiety about global issues such as climate change. Their parents have mounting debt and middle-class wage erosion, increasingly working in precarious and unprotected labor markets. More people in the US died of drug overdose by 2017 than during the height of HIV, car crash, and gun death epidemics in the US, with deaths a tip of the iceberg of drug use disorders and harm, leading to collateral damage to millions of families. Adolescents who have minority and undocumented status are particularly targeted for victimization and trauma, especially adolescent girls.

The ways in which each new cohort of young people entering and exiting adolescence, both in the US and elsewhere, experience the world anew and face new challenges and consequences is a complex phenomenon. While excessive smartphone and social media use may be concerning to parents, they are not a sufficient explanation for the troubling trends in adolescent mental health. We owe it to the coming generation to think deeply about the ways in which alleviating inequities and improving well-being can be achieved for all.

Originally posted via Public Health Post