Study: Mental Health Issues Increasingly Seen in Young Americans
-Rising psychological distress, depression, and suicidal thoughts in this group may be partly due to digital media, study suggests
by Zeena Nackerdien, CME Writer, MedPage TodayMarch 20, 2019
CME Author: Zeena Nackerdien
Study Authors: Jean M. Twenge, A. Bell Cooper, et al.
Target Audience and Goal Statement: Psychiatrists, psychologists, pediatricians, family physicians, internists
The goal was to learn if there was an overall increase in mood disorders in recent years in the U.S. or whether trends reflected a generational shift in serious psychological distress, major depression, and suicide-related outcomes.
What were the trends in psychological distress, past-year major depressive episodes (MDEs), and suicide-related outcomes (suicidal ideation, plans, attempts, and deaths by suicide) from 2005 to 2017 as determined by data drawn from the National Survey on Drug Use and Health (NSDUH)?
Could the hypothesis be confirmed that there would be an increase in the prevalence of psychological distress, past-year MDEs, and suicide-related outcomes in recent years, and that this increase would be driven by cohort effects?
Were there any discernible trends in mood disorder indicators and suicide-related outcomes as a function of gender, race/ethnicity, and income?
Study Synopsis and Perspective:
Depression has increased in the U.S. over recent years, with the fastest rise in youth and young adults, according to health insurance data. Certain aspects of digital media, such as the introduction of smartphones and social media, have also been linked to a higher likelihood of major depressive disorder, specifically among millennials.
While studies have documented trends in mood disorders and suicide-related outcomes among adolescents since 2010, it was not clear if the recent rise in those phenomena was restricted to all age groups. More precisely, it was not clear if trends in mood disorder indicators and suicide-related outcomes were due to age, time period, or birth cohort -- three different processes that can cause changes over time. Since earlier onset of depression predicts chronicity, recurrence, and severity of episodes throughout life, there was a need to examine mood disorder indicators and suicide-related outcomes across all ages.
For the new study, Jean Twenge, PhD, of San Diego State University, and colleagues drew data from the NSDUH (n=611,880) – a nationally representative sample of Americans ages ≥12 years – to assess age, period, and cohort trends in mood disorders and suicide-related outcomes since the mid-2000s. The researchers analyzed data by individual years, although they sometimes referred to generations such as baby boomers (born 1946–1964), Generation X (1965–1979), millennials (1980 –1994), and iGen (1995–2012).
In total, 212,913 adolescents (ages 12-17) responded from 2005 to 2017 and 398,967 adults (≥18) responded from 2008 to 2017. These groups were similar in terms of sex (51% vs 52% female), race, and ethnicity, with over 50% of both samples being non-Hispanic white, almost 15% non-Hispanic black, and 15% Hispanic in both groups.
A slightly higher percentage of the older group had family incomes <$49,999 compared with the adolescent group (55% vs 46%). A respondent was deemed to have experienced an MDE in the past year if he or she reported five of the nine criteria for MDE in the standard nomenclature, where at least one of the criteria is a depressed mood or loss of interest or pleasure in daily activities.
From 2005 through 2017, the rates of MDEs in the last year arced upwards for teens by 52% (from 8.7% to 13.2%). A similar trend was observed for young adults ages 18 to 25 from 2009 through 2017 (from 8.1% to 13.2%). From 2008 through 2017, there was a 71% increase in serious psychological distress in the previous 30 days (from 7.1% to 13.1%).
During the same period, the rate of young adults with suicidal thoughts or suicide-related outcomes rose by 47% (from 7% to 10.3%). The researchers did not observe significantly similar trends for older adults over the same time periods, and from 2008 to 2017 there was actually a slight decline in serious psychological distress in the last month among adults ages 65 and older.
Cohort increases in MDEs, serious psychological distress, suicidal thoughts, suicide plans, suicide attempts, and suicide-related outcomes were larger for women than men, the analysis found. The cohort increase in psychological distress was largest among Hispanic Americans and smallest among black Americans.
Finally, the researchers reported, the biggest increases in psychological distress and suicidal ideation were observed in respondents with the highest family incomes, while increases of adult major depressive disorder and suicide attempts were greater in lower-income families.
Twenge and co-authors cautioned against overinterpreting the suicide ideation result, however, as few respondents reported their thoughts about suicide or attempted suicides. However, since each later generation had increased thoughts of suicide, it appears this increase was due to the cohort as well, the researchers explained.
Study limitations, the team said, included the cross-sectional design and the fact that only single-item assessments of suicide ideation or attempts were included. In addition, suicide-related outcomes were not analyzed for adolescents, and assessment of adolescents also did not include irritability as a criterion for MDE, potentially resulting in an underestimate of the true prevalence of past-year MDEs among adolescents.
Source Reference: Journal of Abnormal Psychology, March 14, 2019; DOI: 10.1037/abn0000410
Study Highlights: Explanation of Findings
From the mid-2000s to 2017, there were increases in mood disorder indicators, suicide-related outcomes, and rates of deaths by suicide, mainly driven by increases among adolescents and adults ages 18 to 25, the study showed.
"More U.S. adolescents and young adults in the late 2010s, versus the mid-2000s, experienced serious psychological distress, major depression or suicidal thoughts, and more attempted suicide," Twenge said in a statement. "These trends are weak or non-existent among adults 26 years and over, suggesting a generational shift in mood disorders instead of an overall increase across all ages."
Mood disorder indicators were more pronounced among women, in keeping with prior evidence that showed a larger increase in depression since 2011 among adolescent girls compared with boys. Most indicators rose over the study period, with generally larger increases observed for white Americans. Moreover, with the exception of MDE and suicide attempts, increases in mood disorder indicators were largest among Americans with the highest total family income. The demographic profile of largest increases in mood disorder among higher-socioeconomic-status white women and girls was consistent with other evidence from the literature, the researchers noted.
Overall, the team said, the results consistently showed increases in mood disorder indicators and suicide-related outcomes from those born in the early 1980s to those born in the late 1990s. Individuals born in the 1990s (i.e., late millennials and early iGen) appeared to be experiencing mood order indicators and suicide-related outcomes at a higher rate than those born in the 1980s, even when the time period and age were taken into account, the researchers stated.
These trends could be explained by the introduction of smartphones in the developmental stages of more recent generations, said Twenge, who is also the author of a 2018 book about iGen: "iGen: Why Today's Super-Connected Kids are Growing Up Less Rebellious, More Tolerant, Less Happy -- and Completely Unprepared for Adulthood."
"When you think of how lives have changed from 2010 to 2017, a clear answer is that over time, people started spending more time on phones and on social media, less time face-to-face with their friends, and less time sleeping," she told MedPage Today. "As we know from other studies, spending more time with screens, less time sleeping, and less time face-to-face with friends is not a good formula for mental health."
Twenge speculated that youth might be more susceptible to some of the effects of digital media because it was such an integral part of their development early on. She also noted that the findings by her group do contrast with other theories that the increase could be attributed to today's teens being more open about their mental health, or more willing to seek help, since the current study asked about symptoms and behaviors instead of inpatient or clinical data regarding specific disorders.
"I think it's possible the change in social lives of young people has been more pronounced in the age of the smartphone," Twenge said. "Older people may already have an established social network, and the change in how they use their social time may not be as extensive as it has been for teens and young adults."
"Getting your first smartphone at 12 is fundamentally different than getting your first smartphone at 30," she added.
However, other experts hold different views, contending that "screen time has a minimal psychological effect on adolescents." One alternative view is that "the use of social media actually helped children forge social bonds, especially when kid-safe public spaces are limited."
"These results suggest a need for more research to understand how digital communication versus face-to-face interaction influences mood disorders and suicide-related outcomes and to develop specialized interventions for younger age groups," Twenge said.