A recent population-based study has found a significant increase in depressive symptoms among U.S. high school students over the past 15 years. The largest increases were observed among females and non-Hispanic White students.
The study researchers analyzed data from the Youth Risk Behavior Survey from 2007 to 2021 and included responses from 119,654 students. Depressive symptoms—defined as feeling sad or hopeless almost every day for at least 2 weeks, leading to disruptions in usual activities—increased from 28.4% in 2007 to 42.3% in 2021, with a biennial average percent change (BAPC) of 3% (95% confidence interval [CI] = 2.6–3.4%). The increase was highest among females (BAPC = 3.3% [95% CI = 2.9–3.8%]) and non-Hispanic White students (BAPC = 3.6% [95% CI = 3.0–4.1%]).
The researchers evaluated 24 health-risk behaviors across five categories: violence, substance use, sexual activity, physical/sedentary activity, and weight-related behaviors. Certain behaviors, including cannabis use, high-risk screen time, shorter sleep duration, and unhealthy weight perception, were linked to disproportionately larger increases in depressive symptoms. Students engaging in one or fewer risk categories saw a greater increase in depressive symptoms (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%], P = .037).
"We demonstrate how rising rates of depressive symptoms among high school students have not been confined to students with established behavioral risk factors and have increased more among students with few or no behavioral risks," wrote Tanner J. Bommersbach of the Department of Psychiatry, University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin, with colleagues in their article published in The Lancet Regional Health – Americas. Therefore, the investigators continued, "targeted screening practices are likely to miss many adolescents experiencing depressive symptoms."
They suggested universal screening in primary care, as well as in schools, for "adolescents who might otherwise go undetected." They also reaffirmed groups such as "Hispanic students, sexual minorities, students impacted by violence, especially bullying and forced sexual intercourse, and students using substances" who remain at increased risk for depression.
"Clinical and population-based strategies to reduce adolescent depression are incomplete without prevention and intervention efforts targeted at these high-risk groups," the researchers wrote.
Clinical diagnoses of depression could not be ascertained in the study and the research was limited by a single item used to assess depression symptoms. Other limitations included generalizability to adolescents who are not enrolled in school or who do not speak English, self-reporting and other potential biases, and other confounding factors that could not be assessed.
The study was not funded, and no conflicts of interest were reported.