May 11, 2009

Major Depressive Episode and Treatment among Adolescents

Depression involves persistent sadness, discouragement, loss of feelings of self-worth, and loss of interest in usual activities, and each year it affects millions of adolescents. Although many treatment options are available for depression—including psychotherapeutic approaches and medications—many adolescents who need these services may not access them. Increasing parental, caregiver, and teacher awareness of the signs of adolescent depression and ensuring that effective mental health treatment services are easily accessible may help to increase service utilization and improve the current and future well-being of America's adolescents.

The National Survey on Drug Use and Health (NSDUH) includes questions about major depressive episode (MDE) and treatment for depression. MDE is defined using the diagnostic criteria set forth in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), which specifies a period of 2 weeks or longer in which there is either depressed mood or loss of interest or pleasure and at least four other symptoms that reflect a change in functioning, such as problems with sleep, eating, energy, concentration, and self-image. Treatment for depression is defined as seeing or talking to a medical doctor or other professional about depression or using prescription medication in the past year for depression. This issue of The NSDUH Report, which focuses on MDE and treatment for depression among adolescents (i.e., youths aged 12 to 17), uses findings based on 2007 NSDUH data.

An estimated 2.0 million adolescents (8.2 percent) experienced at least one MDE in the past year (Table 1). Females were more likely than males to have experienced past year MDE (11.9 vs. 4.6 percent). Rates were similar across the four geographic regions and did not vary by health insurance coverage. However, the prevalence of MDE was related to the perception of overall health; 15.0 percent of those adolescents who reported that their overall health was fair or poor experienced MDE compared with 5.4 percent of those who reported that their overall health was excellent.

About two fifths (38.9 percent) of adolescents who experienced past year MDE received treatment for depression in the past year (Table 1); this is equivalent to an estimated 781,000 adolescents. Females with past year MDE were more likely than their male counterparts to have received treatment (39.9 vs. 36.7 percent). Adolescents with MDE who lived in the Northeast were more likely to have received treatment than their counterparts in other geographic regions.

Among adolescents with past year MDE, those with no health insurance were much less likely than those with Medicaid/Children's Health Insurance Program (CHIP) coverage or private health insurance to have received treatment (17.2 vs. 42.9 and 40.6 percent, respectively).¹ About half (50.9 percent) of the adolescents with past year MDE who reported that their overall health was fair or poor received treatment for depression compared with 31.7 percent of their counterparts who indicated that their health was excellent.

Among those who received treatment for depression in the past year, 53.2 percent saw or talked to a medical doctor or other professional about depression, but did not take prescription medication for depression (Figure 1). In addition, 40.4 percent saw or talked to a medical doctor or other professional about depression and used prescription medication for depression. The remainder (6.4 percent) took prescription medication for depression, but did not see or talk to a medical doctor or other professional about depression.²

Figure 1. Type of Treatment Received for Depression in the Past Year among Adolescents Who Experienced Past Year Major Depressive Episode (MDE) and Received Treatment for Depression in the Past Year*: 2007

Among those adolescents who saw or talked to a medical doctor or other professional about depression, nearly three fifths (58.8 percent) saw or talked to a counselor (Figure 2). Over one third (36.8 percent) saw or talked to a psychologist, 27.3 percent saw or talked to a psychiatrist or psychotherapist, and 26.6 percent saw or talked to a general practitioner or family doctor.

Figure 2. Type of Professional Seen among Adolescents with Past Year Major Depressive Episode (MDE) Who Saw or Talked to a Medical Doctor or Other Professional about Depression in the Past Year*^,**: 2007

About 1 in 12 American adolescents experienced MDE in the past year. About two fifths of those with MDE received treatment for their depression in the past year, and rates of treatment were particularly low among adolescents who did not have health insurance coverage—with only about 17 percent of these adolescents receiving treatment. These findings highlight the need for increased efforts to raise parental, caregiver, and teacher awareness of the signs of adolescent depression and the availability of treatment options, as well as the need for improving access to treatment among adolescents without health insurance.