Youth Mental Health: Trends in Major Depressive Disorder
The United States is grappling with an unprecedented youth mental health crisis.1 Even before the COVID-19 pandemic, troubling trends were present: Many young people reported feelings of persistent sadness, hopelessness and suicidal thoughts. The pandemic only intensified these trends, disproportionately affecting socially vulnerable communities and racial and ethnic minorities.2 Isolation, school closures, and heightened social stress deepened the struggle, creating a more urgent need to address the mental well-being of young people across America.3
Major Depressive Disorder (MDD) is a serious mental health condition among youth,4 often associated with adverse childhood experiences (ACEs)5—traumatic events that occur in childhood. ACEs are common, affecting almost two-thirds of youth by age 16,6 and ACEs can have mental health and physical health impacts that carry well into adulthood.7 ACEs have also been shown to have a greater impact on children from communities facing social, economic, or geographic barriers.8,9 This includes racial and ethnic minorities, youth of greater social vulnerability, and rural youth. Given these patterns, early detection of MDD is critical and may potentially avert serious downstream effects.
Our study investigates the latest trends in MDD diagnosis and treatment in youth by race/ethnicity, social vulnerability,10 and geographic population density. This analysis spans 2019 to 2023 and is based on the medical claims of more than one million Blue Cross and Blue Shield (BCBS) commercially insured11 youth with MDD between the ages of 6 and 17. Our research shows that MDD prevalence rates are rising, especially among teens ages 15-17, and there are differences in prevalence and treatment rates among socially vulnerable youth10 and also youth from majority Black, Hispanic and Asian/Pacific Islander communities.
Key Findings
MDD prevalence rates in youth spiked during the COVID-19 pandemic and remain significantly elevated.
Key Findings
MDD prevalence rates are lower in socially vulnerable and majority Black, Hispanic, and Asian/Pacific Islander communities.
Key Findings
Socially vulnerable and Black and Hispanic youth are more likely to be diagnosed with MDD for the first time during a crisis event.12
Key Findings
Primary care providers (PCPs) are critical sources of in-community behavioral health services, accounting for 41% of all new MDD diagnoses in youth.
Key Findings
Psychotherapy and prescription treatment rates have risen for youth with MDD, including an increase in telehealth therapy use.
Taking Action
Childhood is a critical period for identifying and addressing mental health concerns
Early diagnosis and treatment for conditions like MDD lay the foundation for improved mental and physical health in later life. Our findings suggest prevalence and treatment of MDD is on the rise, however there are differences in these rates among various groups, and primary care providers are playing a large role in care.
Blue Cross and Blue Shield companies are taking action in communities across the country, partnering with providers and working with policymakers to break down barriers to accessing quality mental health care by:
- Growing our network of providers.
- Continuing to support virtual care and mental health digital solutions.
- Providing training and resources for primary care providers on diagnosing and managing behavioral health conditions.
- Improving care integration of physical and mental health.
- Investing in communities across the country to help all youth get the care they need.
The findings in this report underscore the urgency for taking action to improve youth mental health in America. Learning from this data and acting together is the path toward improving mental health outcomes for youth.
End Notes
- American Academy of Pediatrics. AAP-AACAP_CHA Declaration of a National Emergency in Child and Adolescent Mental Health
- Alihomsi A, Quintero SM, Ponce S, Mendes I, Stewart AL, Napoles AM, and Strassle PD. Racial/Ethnic Disparities in Financial Hardship During the First Year of the Pandemic. Health Equity. 2023 Aug 30;7(1):453-46
- Centers for Disease Control and Prevention Youth Risk Behavior Survey 2013-2023
- US Preventive Services Task Force. Recommendation Statement: Screening for Depression and Suicide Risk in Children and Adolescents. JAMA. 2022;328(15):1534-1542.Doi:10.1001/jama.2022.16946.
- Bomysoad RN, Francis LA. Adverse Childhood Experiences and Mental Health Conditions Among Adolescents. J Adolesc Health. 2020 Dec; 67(6): 868-870. Doi: 10.1016/j.jadolhealth.2020.04.013. Epub 2020 Jun 20. PMID: 32476484.
- Understanding Child Trauma - What is Childhood Trauma? | SAMHSA
- Silva C, P Moreira, DS Moreira, et. Al. Impact of Adverse Childhood Experiences in Young Adults and Adults: A Systematic Literature Review. Pediatr Rep. 2024 Jun 7;16(2): 461-481. Doi: 10.3390/pediatric16020040
- About Adverse Childhood Experiences | Adverse Childhood Experiences (ACEs) | CDC
- American Academy of Pediatrics. Pediatric Collections: Social Determinants of Health – Part 1: Underserved Communities. American Academy of Pediatrics ISBN-13: 978-1-61002-634-5.
- The CDC's Social Vulnerability Index is a measure comprised of 16 American Community Survey variables that encompass socioeconomic status, household characteristics, racial & ethnic minority status, and housing type & transportation. The result is a number that represents the vulnerability of a population in a given area in the event of a disaster. In this report, the SVI measure was converted into quartiles, where Quartile 1 represents the 25% of the population with the lowest SVI scores that are least vulnerable and best equipped to withstand disaster. Quartile 4 represents the 25% of the population with the highest SVI scores that are most vulnerable and least equipped to withstand disaster. Social Vulnerability Index | Place and Health - Geospatial Research, Analysis, and Services Program (GRASP) | ATSDR (2)
- Commercial data comes from the Blue Cross Blue Shield (BCBS) national claims database and includes employer provided and individual insurance policies. This database does not include government insurance policies, such as Medicaid data.
- In this report, a crisis event is defined as an ER visit or inpatient hospitalization associated with a diagnosis related to a mental health condition, self-harm, poisoning, or suicidality.
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