The Influence of the Great Recession on Adolescent Major Depressive Episodes and Treatment in the United States: An Interrupted Time Series Analysis

• Published in: Journal of adolescent health 2024-01, Vol.74 (1), p.51-59
• Main Authors: Askari, Melanie S., Olfson, Mark, Belsky, Daniel W., Breslau, Joshua, Keyes, Katherine M.
• Format: Article
• Language: English
• Subjects: Adolescent; Adolescent depression; Depressive Disorder, Major - epidemiology; Health Surveys; Humans; Interrupted Time Series Analysis; Poverty; Prevalence; Psychiatric epidemiology; Social epidemiology; Substance-Related Disorders - epidemiology; United States - epidemiology
• ISSN: 1054-139X; 1879-1972
• DOI: 10.1016/j.jadohealth.2023.08.023

In the United States, adolescent depression increased beginning in 2008–2010, coinciding with the Great Recession. We investigated whether this time of changing economic circumstances impacted adolescent depression and treatment. We analyzed data for adolescents aged 12–17 years from the 2004-2019 National Survey on Drug Use and Health (N = 256,572). Adolescents' past-year major depressive episodes (MDEs) were measured by self-reported symptoms. MDE treatment included seeing a health professional or receiving MDE medication. We tested how MDE and MDE treatment changed from pre-Great Recession (2004 to Fall 2007) to post-Great Recession (Winter 2007–2019) using interrupted time-series segmented regression models, accounting for seasonality and autocorrelation and testing for moderation by household poverty. The Great Recession was not associated with an immediate increase in MDE prevalence (β:-0.77 [i.e., quarter-year change in prevalence], 95% confidence interval (CI): −2.23, 0.69). However, the increase in MDE prevalence accelerated following the Great Recession (β: 0.29, 95% CI: 0.13, 0.44). The Great Recession was not associated with immediate or long-term changes in adolescent MDE treatment (immediate β: −2.87, 95% CI: −7.79, 2.04; long-term β: 0.03, 95% CI: −0.46, 0.51). Effects were similar for households by poverty status. The Great Recession was not associated with increased adolescent depression prevalence, although there was an acceleration in the trend of adolescent MDE following the recession. The prevalence of MDE treatment remained stable. Adolescent depression prevention efforts should be heightened as prevalence increases, including actively engaging caregivers as family supports to alleviate potential negative implications of economic distress for adolescent MDE.