Girls Aged 16 to 17 Years at Highest Risk for Depression Symptoms

Among adolescents with depression, outcomes were relatively consistent across symptom subtypes but varied as a function of identity, according to study findings published in Journal of Affective Disorders.

Researchers from The University of Illinois Urbana-Champaign sourced data for this study from the National Survey on Drug Use and Health (NSDUH) collected between 2009 and 2017. Adolescents (N=145,499) were evaluated for trends in depression outcomes on the basis of personal identity.

Adolescents were aged 12 to 13 years (31.7%), 14 to 15 years (33.9%), and 16 to 17 years (34.5%); 49% were girls; 56.3% were White, 19.8% were Hispanic, 13.4% were Black, 3.5% were Asian, 1.5% were Native American or Alaskan Native, and 0.5% were Hawaiian or Pacific Islander. Among the participants, 56% lived in a household with income 200% above the poverty line, 22.7% with income within 100% to 199% of the poverty line, and 21.4% with income at the poverty line.

Overall, 15.0% of adolescents reported lifetime depressed mood, 9.6% reported depressed mood during the past 12 months, 15.9% reported lifetime anhedonia, and 9.6% reported anhedonia during the past 12 months. Among individuals with some symptoms of depression, 75% experienced both depressed mood and anhedonia, 15% experienced anhedonia alone, and 10% experienced depressed mood alone.

A null 2-level mixed model with depression outcomes nested within identity explained a significant proportion of the variance of identity (P <.001). This finding suggested that depression outcomes varied across identities.

In the multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA), gender (all P <.001), ethnicity (all P <.001), and age (all P <.001) were significant predictors for all depression outcomes. Poverty was also significant for lifetime depressed mood (P <.001), depressed mood during the past 12 months (P =.009), lifetime anhedonia (P <.001), and anhedonia during the past 12 months (P =.02).

On the basis of these predictors, the researchers constructed identity profiles for the adolescents most at risk for depression outcomes. The top 5 profiles were all girls aged 16 to 17 years, multiracial or White ethnicities, and were within all economic statuses, although more of the at-risk profiles were impoverished.

Altogether, 15% of the variance in depressive symptoms and 6% of the variance in anhedonia was attributable to identity.

The study may have been limited by its assessment of poverty, which is a multifaceted construct not easily categorized by a single, simple variable.

Study authors concluded, “Depression prevention protocols continue to demonstrate small, transient effects on the aggregate. In response, some suggest a shift away from universal to secondary prevention programs based on dynamic risk factors (eg, cognitive vulnerabilities), targeting specific symptoms (eg, anhedonia) or updating curriculums to better address societal risks (eg, social media). That our study found an overwhelming amount of depression variance is still explained by age and gender may suggest that it is critical for depression prevention strategies to better incorporate a female and late adolescent perspective, as well.”