Major Depression in the National Comorbidity Survey–Adolescent Supplement: Prevalence, Correlates, and Treatment

Abstract

Objective To present the 12-month prevalence of DSM-IV major depressive disorder (MDD) and severe MDD, examine sociodemographic correlates and comorbidity, and describe impairment and service utilization. Method Data are from the National Comorbidity Survey-Adolescent Supplement (NCS-A), a nationally representative survey of 10,123 adolescents aged 13 to 18 years that assesses DSM-IV disorders using the Composite International Diagnostic Interview (CIDI) Version 3.0. One parent or surrogate of each participating adolescent was also asked to complete a self-administered questionnaire. Results Lifetime and 12-month prevalence of MDD were 11.0% and 7.5%, respectively. The corresponding rates of severe MDD were 3.0% and 2.3%. The prevalence of MDD increased significantly across adolescence, with markedly greater increases among females than males. Most cases of MDD were associated with psychiatric comorbidity and severe role impairment, and a substantial minority reported suicidality. The prevalence of severe MDD was about a quarter of that of all MDD cases; estimates of impairment and clinical correlates were of 2- to 5-fold greater magnitude for severe versus mild/moderate depression, with markedly higher rates for suicidal thoughts and behaviors. Treatment in any form was received by the majority of adolescents with 12-month DSM-IV MDD (60.4%), but only a minority received treatment that was disorder-specific or from the mental health sector. Conclusion Findings underscore the important public health significance of depression among US adolescents and the urgent need to improve screening and treatment access in this population.

The neuroscience and context of adolescent depression

“…It should be noted that other paediatric mental health disorders have also shown an increasing prevalence in the USA, with a 21.8% increase in attention deficit hyperactivity disorder (ADHD) from 2003-2007 and a nearly four-fold increase in autism spectrum disorders (ASD) during the last decade (1), now reaching a parent-reported prevalence of 6.8% for ADHD and 1.1% for ASD among children between three and 17 years of age (1). Adolescent MDD is often associated with other mental disorders, most frequently with generalised anxiety disorder, behavioural disorders and substance abuse (3). Children and adolescents with ADHD and ASD also show increased risks of comorbid depression (3).…”

“…Adolescent MDD is often associated with other mental disorders, most frequently with generalised anxiety disorder, behavioural disorders and substance abuse (3). Children and adolescents with ADHD and ASD also show increased risks of comorbid depression (3). Assessing comorbidity is important, as MDD may be secondary to the functional limitation of, for example, ADHD or ASD, which will inform the choice of treatment.…”

A Parental Program for the Prevention of Depression in Adolescents

“…Nowadays, mental disorders are considered the leading cause of years lived with disability worldwide, and depression represents 40.5% of this burden (Avenevoli et al 2015). Affecting close to a quarter of all adults during their lifetime (Beardslee et al, 2013;Kessler et al, 2005) depression is also a common, chronic, and impairing disorder with first onset occurring during adolescence (Beardslee et al, 2013;Craighead, Beardslee, Johnson & Keller, in press;Kovacs, 2006).…”

“…In adolescence, is expected that one in five adolescents suffer from depression by the end of high school (Lewinsohn, Hops, Roberts, & Seeley, 1994) and one in eleven suffer from depression by the end of middle school (Garrison, Schluchter, Schoenbach, & Kaplan, 1989). The estimated incidence of depression in adolescence approximates the adult lifetime prevalence rate and the first episode increases substantially between 13 and 18 years of age (Avenevoli et al 2015;Kessler et al, 2005, Kovacs, 2006. Studies in several countries show that depression is a major worldwide phenomenon affecting 3-8% of adolescents (eg, Gladstone, Beardslee, & O'Connor, 2011), and at any point in time, 10 to 19% of adolescents report moderate to high levels of depressive symptoms (Gotlieb, Lewinsohn & Seely, 1995;Nolen-Hoeksema, Girgus, & Seligman, 1986 cited by Gillham et al, 2007).…”

“…Like Gillham and collaborators conclude (2007, p. 324) "treatment and prevention of depressive disorders and symptoms are both important goals". Despite its precocity, chronic course (Costello et al, 2002) and several negative consequences, recent studies in USA suggest that only 1% of youth are treated in an outpatient setting for depression each year (Avenevoli et al 2015). Due to the high personal, familiar, social and economic invalidation that depression causes, adolescence is viewed as a critical developmental period for identifying risk of depression, namely individual, familiar and socioeconomic risk (circumstances that make people vulnerable) and protective factors (facing circumstances that make them resilient) (Anaut, 2005, Schoon, 2006 and implement effective programs to prevent depression in adolescence.…”