Recent increases in depressive symptoms among US adolescents: trends from 1991 to 2018
Open accessAbstract
Background Mental health problems and mental health related mortality have increased among adolescents, particularly girls. These trends have implications for etiology and prevention and suggest new and emerging risk factors in need of attention. The present study estimated age, period, and cohort effects in depressive symptoms among US nationally representative samples of school attending adolescents from 1991 to 2018.Methods Data are drawn from 1991 to 2018 Monitoring the Future yearly cross-sectional surveys of 8th, 10th, and 12th grade students (N = 1,260,159). Depressive symptoms measured with four questions that had consistent wording and data collection procedures across all 28 years. Age-period-cohort effects estimated using the hierarchical age-period-cohort models.Results Among girls, depressive symptoms decreased from 1991 to 2011, then reversed course, peaking in 2018; these increases reflected primarily period effects, which compared to the mean of all periods showed a gradual increase starting in 2012 and peaked in 2018 (estimate = 1.15, p < 0.01). Cohort effects were minimal, indicating that increases are observed across all age groups. Among boys, trends were similar although the extent of the increase is less marked compared to girls; there was a declining cohort effect among recently born cohorts, suggesting that increases in depressive symptoms among boys are slower for younger boys compared to older boys in recent years. Trends were generally similar by race/ethnicity and parental education, with a positive cohort effect for Hispanic girls born 1999-2004.Conclusions Depressive symptoms are increasing among teens, especially among girls, consistent with increases in depression and suicide. Population variation in psychiatric disorder symptoms highlight the importance of current environmental determinants of psychiatric disorder risk, and provide evidence of emerging risk factors that may be shaping a new and concerning trend in adolescent mental health.
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These findings are consistent with recent increases in depression and suicidal ideation and behaviors among US adolescents.
“These findings are consistent with recent increases in depression and suicidal ideation and behaviors among US adolescents [39–42].”
From Age, period, and cohort effects on suicide death in the United States from 1999 to 2018: moderation by sex, race, and firearm involvement (2021) · cites this paper as [40]
Rates of adolescent-emergent mental health problems (depressive and anxiety disorders, NSSI, and suicidal thoughts and behaviors) have been increasing worldwide, especially over the past decade, and most notably amongst girls.
“Layered atop these well-known developmental trajectories, a series of new findings indicate that rates of these adolescent-emergent mental health problems (depressive and anxiety disorders, NSSI, and suicidal thoughts and behaviors) have been increasing worldwide -- especially over the past decade, and most notably amongst girls.(2,20–23)”
From Puberty Initiates Cascading Relationships Between Neurodevelopmental, Social, and Internalizing Processes Across Adolescence (2021) · cites this paper as [21]
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Self-citationSocial Media Use and Depressive Symptoms-A Longitudinal Study from Early to Late Adolescence
Puukko, K., Hietajärvi, L., Maksniemi, E., Alho, K., & Salmela-Aro, K. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17165921 · Cited by 99 · see citing works
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Adolescents’ Mental Health at School: The Mediating Role of Life Satisfaction
Cavioni, V., Grazzani, I., Ornaghi, V., Agliati, A., & Pepe, A. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.720628 · Cited by 97 · see citing works
Trends in eating disorder risk among U.S. college students, 2013–2021
Daly, M., & Costigan, E. (2022) · Psychiatry Research · doi:10.1016/j.psychres.2022.114882 · Cited by 85 · see citing works
“Affective disorders, which are highly comorbid with EDs (Swinbourne et al., 2012), have also risen most sharply among young females in the US over the past decade (Daly, 2021; Keyes et al., 2019; Twenge et al., 2019).”
BackgroundInfluentialDepression and suicide-risk screening results in pediatric primary care
Kemper, A. R., Hostutler, C. A., Beck, K., Fontanella, C. A., & Bridge, J. A. (2021) · Pediatrics · doi:10.1542/peds.2021-049999 · Cited by 81 · see citing works
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“The burgeoning popularity of smart-phones and social media (SM) over the past fifteen years has garnered growing attention in connection with the nota - ble increase in mental health issues among youth observed globally [14, 22–25].”
Cohen, Z. P., Cosgrove, K. T., DeVille, D. C., Akeman, E., Singh, M. K., White, E. J., Stewart, J. L., Aupperle, R. L., Paulus, M. P., & Kirlić, N. (2021) · Frontiers in Pediatrics · doi:10.3389/fped.2021.622608 · Cited by 78 · see citing works
Adolescent development and growing divides in the digital age
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Historical language records reveal a surge of cognitive distortions in recent decades
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Dynamics of adolescents’ smartphone use and well-being are positive but ephemeral
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Is the US Gender Gap in Depression Changing Over Time? A Meta-Regression
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Self-citationCourtney, D. B., Watson, P., Krause, K. R., Chan, B. W. C., Bennett, K., Gunlicks-Stoessel, M., Rodak, T., Neprily, K., Zentner, T., & Szatmari, P. (2022) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.46331 · Cited by 63 · see citing works
What is needed to eradicate the depression epidemic, and why
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Secular trends in mental health problems among young people in Norway: a review and meta-analysis
Potrebny, T., Nilsen, S. A., Bakken, A., von Soest, T., Kvaløy, K., Samdal, O., Sivertsen, B., Aase, H., & Bang, L. (2024) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-024-02371-4 · Cited by 66 · see citing works
“The findings for males are more mixed, however, with certain studies identifying increases over time [39, 42, 44] and others finding more stable or decreasing trends [37, 38, 41].”
Askari, M. S., Rutherford, C. G., Mauro, P. M., Kreski, N. T., & Keyes, K. M. (2021) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-021-02189-4 · Cited by 68 · see citing works
Self-citationSutcliffe, K., Ball, J., Clark, T. C., Archer, D. J., Peiris-John, R. J., Crengle, S. M., & Fleming, T. M. (2022) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/00048674221138503 · Cited by 63 · see citing works
Girls, mental health and academic achievement: a qualitative systematic review
Stentiford, L., Koutsouris, G., & Allan, A. (2021) · Educational Review · doi:10.1080/00131911.2021.2007052 · Cited by 71 · see citing works
“This resonates with research from other countries that indicates that girls are likely to display greater prevalence of mental health difficulties such as anxiety and depression (e.g. Beattie et al., 2019; Keyes et al., 2019).”
ResultAdolescent social media use and well-being: a systematic review and thematic meta-synthesis
Shankleman, M., Hammond, L., & Jones, F. W. (2021) · Adolescent Research Review · doi:10.1007/s40894-021-00154-5 · Cited by 61 · see citing works
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Hickingbotham, M. R., Wong, C., & Bowling, A. B. (2021) · Translational Behavioral Medicine · doi:10.1093/tbm/ibab085 · Cited by 59 · see citing works
Weissman, D. G., Rodman, A. M., Rosen, M. L., Kasparek, S. W., Mayes, M., Sheridan, M. A., Lengua, L. J., Meltzoff, A. N., & McLaughlin, K. A. (2021) · Biological Psychiatry Global Open Science · doi:10.1016/j.bpsgos.2021.06.001 · Cited by 62 · see citing works
“The COVID-19 pandemic has produced sudden and unprecedented changes in the lives of adolescents that have introduced many novel stressors and exacerbated risk for anxiety and depression (7 – 11), which were already on the rise among adolescents in the United States (51).”
InfluentialSuicide assessment and treatment in pediatric primary care settings
Sisler, S. M., Schapiro, N. A., Nakaishi, M., & Steinbuchel, P. H. (2020) · Journal of Child and Adolescent Psychiatric Nursing · doi:10.1111/jcap.12282 · Cited by 56 · see citing works
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Declines in non‐digital social interaction among Americans, 2003–2017
Twenge, J. M., & Spitzberg, B. H. (2020) · Journal of Applied Social Psychology · doi:10.1111/jasp.12665 · Cited by 56 · see citing works
Martínez-Alés, G., Pamplin, J. R., Rutherford, C., Gimbrone, C., Kandula, S., Olfson, M., Gould, M. S., Shaman, J., & Keyes, K. M. (2021) · Molecular Psychiatry · doi:10.1038/s41380-021-01078-1 · Cited by 52 · see citing works
Self-citationSteinsbekk, S., Nesi, J. L., & Wichstrøm, L. (2023) · Computers in Human Behavior · doi:10.1016/j.chb.2023.107859 · Cited by 57 · see citing works
“During this period, the prevalence of emotional problems in youth has increased (Keyes, Gary, O’Malley, Hamilton, & Schulenberg, 2019; Lebrun-Harris, Ghandour, Kogan, & Warren, 2022; Mojtabai, Olfson, & Han, 2016; Parodi et al., 2022; Platt, Bates, Jager, McLaughlin, & Keyes, 2021; Shorey, Ng, &…”
BackgroundMartínez‐Alés, G., Hernández‐Calle, D., Khauli, N., & Keyes, K. M. (2020) · Current topics in behavioral neurosciences · doi:10.1007/7854_2020_158 · Cited by 54 · see citing works
“…approaches (Kessler et al. 2019), can be enhanced by partnering with broader conceptual models to include multiple levels of organization and capture the social, economic, and political settings where suicide, as a complex process, unfolds across the life course (Martínez-Alés and Keyes 2019).”
BackgroundSelf-citationPerceived consequences and worries among youth in Norway during the COVID-19 pandemic lockdown
Lehmann, S., Skogen, J. C., Haug, E., Mæland, S., Fadnes, L. T., Sandal, G. M., Hysing, M., & Bjørknes, R. (2021) · Scandinavian Journal of Public Health · doi:10.1177/1403494821993714 · Cited by 51 · see citing works
Riehm, K. E., Mojtabai, R., Adams, L. B., Krueger, E. A., Mattingly, D. T., Nestadt, P. S., & Leventhal, A. M. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.32131 · Cited by 50 · see citing works
Zhang, X., Yue, H., Hao, X., Liu, X., & Bao, H. (2023) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2023.102199 · Cited by 50 · see citing works
Melcher, J., Lavoie, J., Hays, R., D’Mello, R., Rauseo-Ricupero, N., Camacho, E., Rodriguez-Villa, E., Wisniewski, H., Lagan, S., Vaidyam, A. N., et al. (2021) · Journal of American College Health · doi:10.1080/07448481.2021.1905650 · Cited by 49 · see citing works
“increase in mental health problems among adolescents has actually been trending upward since 2012.(2) Now, during the”
BackgroundDecline of depressive symptoms in Europe: differential trends across the lifespan
Beller, J., Regidor, E., Lostao, L., Miething, A., Kröger, C. B., Safieddine, B., Tetzlaff, F., Sperlich, S., & Geyer, S. (2020) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-020-01979-6 · Cited by 51 · see citing works
Gagné, T., Schoon, I., McMunn, A., & Sacker, A. (2021) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-021-02194-7 · Cited by 47 · see citing works
Armitage, J. M., Collishaw, S., & Sellers, R. (2024) · Discover Social Science and Health · doi:10.1007/s44155-024-00076-2 · Cited by 57 · see citing works
Woodward, M. J., McGettrick, C. R., Dick, O. G., Ali, M., & Teeters, J. B. (2025) · Journal of Technology in Behavioral Science · doi:10.1007/s41347-024-00474-y · Cited by 49 · see citing works
“From 2012 to 2018, depressive symptoms steadily increased in U.S. adolescents (Keyes et al., 2019), and from 2005 to 2014 the 12-month prevalence of major depressive episodes increased by 2.6% in adolescents and 0.8% in young adults (Mojtabai et al., 2016).”
InfluentialSocial connection as a key target for youth mental health
Birrell, L., Werner‐Seidler, A., Davidson, L., Andrews, J. L., & Slade, T. N. (2025) · Mental Health & Prevention · doi:10.1016/j.mhp.2025.200395 · Cited by 43 · see citing works
Lifetime prevalence and treatment of mental disorders in Saudi youth and adolescents
Altwaijri, Y. A., Kazdin, A. E., Al‐Subaie, A., Alhabeeb, A. A., Hyder, S., Bilal, L., Naseem, M. T., & Devol, E. B. (2023) · Scientific Reports · doi:10.1038/s41598-023-33005-5 · Cited by 42 · see citing works
Myhr, A., Anthun, K. S., Lillefjell, M., & Sund, E. R. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.01472 · Cited by 43 · see citing works
Gimbrone, C., Bates, L. M., Prins, S. J., & Keyes, K. M. (2021) · SSM - Mental Health · doi:10.1016/j.ssmmh.2021.100043 · Cited by 41 · see citing works
Self-citationKeyes, K. M., Hamilton, A. D., Patrick, M. E., & Schulenberg, J. E. (2019) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2019.08.026 · Cited by 39 · see citing works
Self-citationNature-based interventions for vulnerable youth: a scoping review
Overbey, T. A., Diekmann, F., & Lekies, K. S. (2021) · International Journal of Environmental Health Research · doi:10.1080/09603123.2021.1998390 · Cited by 45 · see citing works
“…about high levels of adolescents and young adults struggling with mental health problems, adjustment difficulties, problem behavior, disengagement, or disaffection (e.g. Olfson et al. 2015; Coley et al. 2018; Keyes et al. 2019; Murray et al. 2019; Mojtabai and Olfson 2020; Cybulski et al. 2021).”
BackgroundCurran, T., Ito‐Jaeger, S., Vallejos, E. P., & Crawford, P. (2023) · Journal of Mental Health · doi:10.1080/09638237.2023.2182412 · Cited by 40 · see citing works
“In the United States, cohort studies of young people between 1976 and 2017 show marked increases in loneliness after 2011 (Twenge et al., 2019), anxiety (Duffy et al., 2019), depressed mood (Keyes et al., 2019), self-harm (Mercado et al., 2017), and suicidal ideation (J. M. Twenge et al., 2019).”
BackgroundGlobal Well-Being and Mental Health in the Internet Age
Vuorre, M., & Przybylski, A. K. (2023) · Clinical Psychological Science · doi:10.1177/21677026231207791 · Cited by 39 · see citing works
“These results align with other results that tend to be mixed or find few changes over time (Bor et al., 2014; Collishaw, 2015; Cosma et al., 2020; Keyes et al., 2019).”
McAllister, C., Hisler, G. C., Blake, A. B., Twenge, J. M., Farley, E., & Hamilton, J. L. (2021) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-021-00832-x · Cited by 38 · see citing works
Associations between screen time and internalizing disorder diagnoses among 9- to 10-year-olds
Roberston, L., Twenge, J. M., Joiner, T. E., & Cummins, K. M. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.05.071 · Cited by 37 · see citing works
Beller, J. (2022) · European Journal of Ageing · doi:10.1007/s10433-022-00732-z · Cited by 40 · see citing works
Barker, K. M., Dunn, E. C., Richmond, T. K., Ahmed, S., Hawrilenko, M. J., & Evans, C. R. (2020) · SSM - Population Health · doi:10.1016/j.ssmph.2020.100661 · Cited by 36 · see citing works
Assessing adult ADHD: New research and perspectives
Lovett, B. J., & Harrison, A. G. (2021) · Journal of Clinical and Experimental Neuropsychology · doi:10.1080/13803395.2021.1950640 · Cited by 35 · see citing works
Martínez‐Alés, G., & Keyes, K. M. (2019) · Current Psychiatry Reports · doi:10.1007/s11920-019-1080-6 · Cited by 37 · see citing works
Self-citationSubstance Use, Suicidal Thoughts, and Psychiatric Comorbidities Among High School Students
Tervo‐Clemmens, B., Gilman, J. M., Evins, A. E., Bentley, K. H., Nock, M. K., Smoller, J. W., & Schuster, R. M. (2024) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/jamapediatrics.2023.6263 · Cited by 35 · see citing works
Lifestyle habits and depressive symptoms in Norwegian adolescents: a national cross-sectional study
Kleppang, A. L., Haugland, S. H., Bakken, A., & Stea, T. H. (2021) · BMC Public Health · doi:10.1186/s12889-021-10846-1 · Cited by 35 · see citing works
Fleming, T. M., Ball, J., Bavin, L. M., Rodriguez, C. R., Peiris-John, R. J., Crengle, S. M., Sutcliffe, K., Lewycka, S. O., Archer, D. J., & Clark, T. C. (2022) · Journal of the Royal Society of New Zealand · doi:10.1080/03036758.2022.2072349 · Cited by 35 · see citing works
Opie, J. E., Vuong, A. T., Welsh, E. T., Gray, R. J., Pearce, N., Marchionda, S., Mutch, R., & Khalil, H. (2024) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-024-00469-4 · Cited by 35 · see citing works
MicroRNA regulation of prefrontal cortex development and psychiatric risk in adolescence
Morgunova, A., & Flores, C. (2021) · Seminars in Cell and Developmental Biology · doi:10.1016/j.semcdb.2021.04.011 · Cited by 33 · see citing works
Structural sexism and Women's alcohol use in the United States, 1988–2016
McKetta, S. C., Prins, S. J., Hasin, D. S., Patrick, M. E., & Keyes, K. M. (2022) · Social Science & Medicine · doi:10.1016/j.socscimed.2022.114976 · Cited by 34 · see citing works
Self-citationFoundational Nutrition: Implications for Human Health
Townsend, J. R., Kirby, T. O., Marshall, T. M., Church, D. D., Jajtner, A. R., & Esposito, R. (2023) · Nutrients · doi:10.3390/nu15132837 · Cited by 43 · see citing works
Garcia-Carachure, I., Flores‐Ramirez, F. J., Castillo, S. A., Themann, A., Arenivar, M. A., Preciado-Piña, J., Zavala, A. R., Lobo, M. K., & Iñiguez, S. D. (2020) · Neuropsychopharmacology · doi:10.1038/s41386-020-0654-7 · Cited by 32 · see citing works
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“Depression, a highly prevalent mental health disorder among adolescents, is a growing crisis within the US (1, 2).”
BackgroundMethodInfluentialOlfati, M., Samea, F., Faghihroohi, S., Balajoo, S. M., Küppers, V., Genon, S., Patil, K. R., Eickhoff, S. B., & Tahmasian, M. (2024) · EBioMedicine · doi:10.1016/j.ebiom.2024.105313 · Cited by 31 · see citing works
Soft Drink Consumption and Mental Health in Adolescents: A Longitudinal Examination
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“Implications for prevention are especially relevant now as recent studies using the MTF dataset have found both boredom and DA to be increasing in adolescents over the past decade (Weybright et al. 2020; Keyes et al. 2019).”
BackgroundSelf-citationIs adolescent internet use a risk factor for the development of depression symptoms or vice-versa?
Fitzpatrick, C., Lemieux, A., Smith, J., West, G. L., Bohbot, V. D., & Asbridge, M. (2023) · Psychological Medicine · doi:10.1017/s0033291723000284 · Cited by 30 · see citing works
“Over the span of the last decade, depression and suicide rates have climbed significantly among youth, particularly for girls (Hedegaard, Curtin, & Warner, 2021; Keyes, Gary, O ’ Malley, Hamilton, & Schulenberg, 2019; Lin et al, 2016).”
BackgroundAWAKE BRUXISM PREVALENCE ACROSS POPULATIONS: A SYSTEMATIC REVIEW AND META-ANALYSIS
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- Authors
- Keyes, K. M., Gary, D., O’Malley, P. M., Hamilton, A., & Schulenberg, J.
- Affiliations
- Universidad Mayor (CL)
- Columbia University (US)
- University of Michigan (US)
- Corresponding author
- Keyes, Katherine M.
- Venue
- Social Psychiatry and Psychiatric Epidemiology
- Published
- 2019-03-30
- Volume
- 54
- Issue
- 8
- Pages
- 987-996
- ISSN
- 0933-7954 (ISSN-L)
- 1433-9285
- PMC
- PMC7015269
- OpenAlex
- W2926589548
- Cited by
- 465
- References
- 65
- Citations by year
- 2026: 39 · 2025: 78 · 2024: 90 · 2023: 79 · 2022: 69 · 2021: 64 · 2020: 39 · 2019: 7
- FWCI
- 52.26
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Social Psychiatry and Psychiatric Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Drug Abuse (R01001411)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Keywords
- depressive symptoms, adolescent mental health, age-period-cohort effects, sex differences, girls, boys, cohort effects, period effects, Latino youth, race and ethnicity, parental education, suicide, environmental risk factors
- MeSH terms
- Adolescent, Cross-Sectional Studies, Depression, Ethnicity, Female, Hispanic or Latino, Humans, Male, Mental Health, Risk Factors, Students, Suicide, United States
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