Diagnoses of depression and anxiety in teenage people have increased during the Covid-19 pandemic

Novel research reveals a dramatic boost in depression and anxiety diagnoses among American youth during the pandemic, calling for a re-evaluation of mental health services for at-risk teenage people.

Test: Depression and anxiety among children and teenage adults in the United States. Image source: Overearth / Shutterstock

In a recent study published in the journal JAMA network opena group of researchers assessed the incidence, prevalence, and temporal changes of clinically diagnosed depression and anxiety among children, adolescents, and teenage adults from 2017 to 2021, identifying related disparities.

Background

Depression and anxiety are major mental health challenges that affect millions of children in the United States, with an estimated annual societal cost of $247 billion. Research indicates an increasing incidence of these disorders, but knowledge about clinically diagnosed cases, especially during the coronavirus disease (COVID-19) pandemic, is restricted. It is worth noting that clinical diagnosis rates are often lower than self-reported rates from surveys. It is critical to understand disparities and long-term effects, as well as to explore the causes underlying this boost in youth mental health. Further research is needed to fill these gaps and improve interventions for depression and anxiety in children and adolescents, especially in the context of the impact of the pandemic on mental health.

About the study

This population-based cohort study included members aged 5 to 22 years enrolled in Kaiser Permanente Southern California (KPSC) from 2017 to 2021. A total of 1,703,090 unique members were identified, representing approximately 1 million calendar year members. Data for this study were provided by Kaiser Permanente’s extensive electronic medical record (EMR) system, which was approved by the KPSC Institutional Review Boards. Due to the minimal risk, individual participant consent was waived.

Diagnosis of depression was based on clinical encounters with International Statistical Classification of Diseases, Tenth Revision (ICD-10) codes corresponding to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for major depressive disorder (MDD) and dysthymia. Anxiety diagnoses were identified using ICD-10 codes for generalized anxiety disorder, panic disorder, social phobia, and other phobia-related conditions. Both inpatient and outpatient records were analyzed, and previous research has confirmed that these codes are used to identify depression and anxiety.

Subgroup analysis was performed based on age, gender, race, ethnicity, weight, household income, and history of comorbidities. Incidence and prevalence rates were calculated and trends over time were assessed using Poisson regression, including comparisons before and during the Covid-19 pandemic.

Research results

The study surveyed over 1.1 million members aged 5 to 22 in each year from 2017 to 2021, for a total of 1,703,090 unique participants. The average age was 14 years, with approximately 30% aged 5 to 10.9 years, 16% aged 11 to 13.9 years, 22% aged 14 to 17.9 years, and 31 % aged 18 to 22.9 years. Approximately 51% of participants were men and 49% were women. Over the years, the racial and ethnic composition was consistent: approximately 50% Latino, 8% non-Hispanic black, 8% non-Hispanic Asian, 23% non-Hispanic white, and the remainder identified as other groups. Additional demographic information was also included, such as household income and health insurance status.

The prevalence of depression increased significantly from 1.35% in 2017 to 2.10% in 2021, an boost of 55.6%. Rates were consistently highest among older age groups (14–22 years), women and those with higher income, obesity or comorbidities. Body weight status, especially obesity, was one of the most vital factors influencing the incidence of depression. It is worth noting that growth during the Covid-19 pandemic was higher (1.97%) than before the pandemic (1.56%), although the annual growth rate during the pandemic was not significantly greater than pre-pandemic trends. The prevalence of depression also increased, from 2.55% in 2017 to 4.08% in 2021. Subgroup analysis reflected incidence trends, with a noticeable boost among those aged 18 to 22 and those aged from 14 to 17 years aged.

The prevalence of anxiety without depression also increased, from 1.77% in 2017 to 2.32% in 2021, an boost of 31.1%. Similar to depression, the prevalence of anxiety without depression was highest among older age groups, women, and non-Hispanic whites. Weight status, especially being underweight, was a key factor influencing anxiety levels without depression. The prevalence of anxiety without depression increased from 3.13% in 2017 to 4.22% in 2021, with a significant boost during the pandemic compared to pre-pandemic years. For both depression and anxiety, the main factors influencing outcomes were weight status and age, along with gender, race and ethnicity, and comorbidities.

Conclusions

Overall, the study found a significant boost in the incidence of clinically diagnosed depression and non-depressed anxiety from 2017 to 2021, with higher rates occurring during the Covid-19 pandemic. Although depression cases increased during the pandemic, the annual rate of boost was similar to pre-pandemic trends. Depression was more common in older adolescents, women, American Indian or Alaska Natives, non-Hispanic whites, or people of different races, and in people with higher income, obesity, or comorbidities. Anxiety levels without depression were also higher in underweight people. The findings underscore the need for targeted mental health interventions, especially as the pandemic has exacerbated rising trends in youth mental health problems.