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Askari MS, Belsky DW, Olfson M, Breslau J, Mojtabai R, Kajeepeta S, Bruzelius E, Keyes KM. An integrative literature review of birth cohort and time period trends in adolescent depression in the United States. Soc Psychiatry Psychiatr Epidemiol 2024; 59:899-915. [PMID: 37428192 DOI: 10.1007/s00127-023-02527-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 06/27/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE The aim of this literature review is to examine evidence of time trends and birth cohort effects in depressive disorders and symptoms among US adolescents in peer-reviewed articles from January 2004 to April 2022. METHODS We conducted an integrative systematic literature review. Three reviewers participated at different stages of article review. Of the 2234 articles identified in three databases (Pubmed, ProQuest Central, Ebscohost), 10 met inclusion criteria (i.e., adolescent aged United States populations, included information about birth cohort and survey year, focused on depressive symptoms/disorders). RESULTS All 10 articles observed increases in depressive symptoms and disorders in adolescents across recent survey years with increases observed between 1991 and 2020. Of the 3 articles that assessed birth cohort trends, birth cohort trends were less prominent than time period trends. Proposed explanations for increases included social media, economic-related reasons, changes in mental health screening and diagnosis, declining mental health stigma, increased treatment, and, in more recent years, the COVID-19 pandemic. CONCLUSIONS Multiple cross-sectional surveys and cohort studies documented rising prevalence of depressive symptoms and disorder among adolescents from 1991 to 2020. Mechanisms driving this increase are still unknown. Research to identify these mechanisms is needed to inform depression screening and intervention efforts for adolescents.
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Affiliation(s)
- Melanie S Askari
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY, 10032, USA.
| | - Daniel W Belsky
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY, 10032, USA
| | - Mark Olfson
- New York State Psychiatric Institute, Columbia University, 1051 Riverside Dr, New York, NY, 10032, USA
| | - Joshua Breslau
- RAND Corporation, 4570 Fifth Ave #600, Pittsburgh, PA, 15213, USA
| | - Ramin Mojtabai
- Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Hampton House 797, Baltimore, MD, 21205, USA
| | - Sandhya Kajeepeta
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY, 10032, USA
| | - Emilie Bruzelius
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY, 10032, USA
| | - Katherine M Keyes
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY, 10032, USA
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Keyes K, Hamilton A, Finsaas M, Kreski N. Childhood internalizing, externalizing and attention symptoms predict changes in social and nonsocial screen time. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02669-3. [PMID: 38684513 DOI: 10.1007/s00127-024-02669-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 04/17/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND While accumulating research has tested the hypothesis that screen time causes psychiatric symptoms in children, less attention has been paid to the hypothesis that children with psychiatric symptoms change their patterns of screen time and digital media use. We aimed to test whether children with psychiatric symptoms subsequently change their patterns of screen time and digital media use. METHODS N = 9,066 children primarily aged 9-10 in the Adolescent Brain Cognitive Development Study at baseline and 1-year later. Psychiatric symptoms included internalizing, attention, and externalizing symptoms. Screen time was measured as ordinally defined weekday and weekend time on social and nonsocial [e.g., YouTube] digital media). Models assessed psychiatric symptoms as predictors of screen time, and screen time as predictors of psychiatric symptoms, controlled for baseline measures of each, sex, age, race/ethnicity, and income. RESULTS Children with psychiatric symptoms spent more time on non-social media one year later compared with peers. Considering total psychiatric problems, clinical levels of problems predicted higher levels of weekday (OR = 1.22, 95% CI 1.22-1.23) and weekend (OR = 1.10, 95% CI 1.09-1.11) nonsocial screen time. For nearly all analyses of psychiatric symptoms predicting screen time, associations were highest for a non-social screen time outcome rather than a social screen time outcome (Highest OR = 1.65, 95% CI 1.63-1.67, clinical rule breaking predicting weekday nonsocial screen time). Comparable magnitude associations were observed for social and nonsocial media use predicting future psychiatric symptoms, suggesting bidirectionality. CONCLUSION Children with psychiatric symptoms have different subsequent media use patterns, including higher rates of subsequent nonsocial engagement. Ensuring that ongoing data collection and analysis efforts attend to temporality and transitions in the relation between media use and psychiatric symptoms will accelerate progress in the field.
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Affiliation(s)
- Katherine Keyes
- Mailman School of Public Health, Department of Epidemiology, Columbia University, 722 West 168th St., Room 724, New York, NY, 10032, USA.
| | - Ava Hamilton
- Mailman School of Public Health, Department of Epidemiology, Columbia University, 722 West 168th St., Room 724, New York, NY, 10032, USA
| | - Megan Finsaas
- Mailman School of Public Health, Department of Epidemiology, Columbia University, 722 West 168th St., Room 724, New York, NY, 10032, USA
| | - Noah Kreski
- Mailman School of Public Health, Department of Epidemiology, Columbia University, 722 West 168th St., Room 724, New York, NY, 10032, USA
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Keyes KM, Platt JM. Annual Research Review: Sex, gender, and internalizing conditions among adolescents in the 21st century - trends, causes, consequences. J Child Psychol Psychiatry 2024; 65:384-407. [PMID: 37458091 DOI: 10.1111/jcpp.13864] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 07/18/2023]
Abstract
Internalizing conditions of psychopathology include depressive and anxiety disorders; they most often onset in adolescence, are relatively common, and contribute to significant population morbidity and mortality. In this research review, we present the evidence that internalizing conditions, including depression and anxiety, as well as psychological distress, suicidal thoughts and self-harm, and fatal suicide, are considerably increasing in adolescent populations across many countries. Evidence indicates that increases are currently greatest in female adolescents. We present an epidemiological framework for evaluating the causes of these increases, and synthesize research on whether several established risk factors (e.g., age of pubertal transition and stressful life events) and novel risk factors (e.g., digital technology and social media) meet conditions necessary to be plausible causes of increases in adolescent internalizing conditions. We conclude that there are a multitude of potential causes of increases in adolescent internalizing conditions, outline evidence gaps including the lack of research on nonbinary and gender nonconforming populations, and recommend necessary prevention and intervention foci from a clinical and public health perspective.
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Affiliation(s)
- Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jonathan M Platt
- College of Public Health, University of Iowa, Iowa City, IA, USA
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Kreski NT, Chen Q, Olfson M, Cerdá M, Hasin DS, Martins SS, Mauro PM, Keyes KM. Time use and associations with internalizing symptoms from 1991 to 2019 among US adolescents. SSM Popul Health 2022; 19:101181. [PMID: 35968043 PMCID: PMC9365953 DOI: 10.1016/j.ssmph.2022.101181] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Adolescent time use in recent cohorts is distinguished by large-scale changes, including shifts in parental monitoring, supervision, and adolescent activity patterns, that together may provide a more complete perspective on changing patterns of mental health than can be captured by single risk factors. Methods To determine whether patterns of adolescent time use explain recent increases in depressive and other internalizing symptoms, we first conducted latent profile analyses of 465,839 adolescents, grades 8/10, from annual, cross-sectional Monitoring the Future surveys, years:1991-2019, using twenty-one variables (e.g., frequency of attending parties) to identify groups based on patterns of time use. Most of the sample was female (51.0%), non-Hispanic white (58.8%), and in grade 8 (52.2%); mean age: 14.60 years (95% CI: 14.57, 14.64). We subsequently examined differences in depressive and other internalizing symptoms between these time use groups over time with survey-weighted logistic regressions producing odds ratios. Results Analyses derived six groups: part time workers, full time workers, and four groups based on levels of social activities (Low, medium, and high levels, with "High Social" split between those engaged in sports, academics, and community service and those who were not). Internalizing symptoms were predicted by lower socialization, low engagement in activities like sports, academics, and community service, and time spent at a paid job. Adolescents decreasingly engaged in social activities over time, though shifts in time use patterns did not account for much of the overall increase in depressive symptoms. Conclusion Shifts in adolescent time use do not explain increases in depressive and other internalizing symptoms, which increased across different patterns of time use. Levels of internalizing symptoms were highest among those with low socialization, low recreational engagement, and those working substantial hours. Encouraging socialization, engagement in recreational activities, and providing mental health resources for isolated adolescents may reduce internalizing symptom trends.
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Affiliation(s)
- Noah T Kreski
- Columbia University, Mailman School of Public Health, Department of Epidemiology, 722 West 168th St, Room 733, New York, NY, 10032, USA
| | - Qixuan Chen
- Columbia University, Mailman School of Public Health, Department of Biostatistics, 722 West 168th Street, Room 644, New York, NY, 10032, USA
| | - Mark Olfson
- Columbia University, Mailman School of Public Health, Department of Epidemiology, New York State Psychiatric Institute, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, Department of Psychiatry, 1051 Riverside Dr, New York, NY, 10032, Box 24, USA
| | - Magdalena Cerdá
- New York University Grossman School of Medicine, Department of Population Health, 180 Madison Avenue 4-16, New York, NY, 10016, USA
| | - Deborah S Hasin
- Columbia University, Mailman School of Public Health, Department of Epidemiology, New York State Psychiatric Institute, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, Department of Psychiatry, 722 West 168th Street, Room 228F, New York, NY, 10032, USA
| | - Silvia S Martins
- Columbia University, Mailman School of Public Health, Department of Epidemiology, 722 West 168th Street, 5th Floor, Room 509, New York, NY, 10032, United States
| | - Pia M Mauro
- Columbia University, Mailman School of Public Health, Department of Epidemiology, 722 West 168th Street, Room 507, New York, NY, 10032, USA
| | - Katherine M Keyes
- Columbia University, Mailman School of Public Health, Department of Epidemiology, 722 West 168th Street, Room 724, New York, NY, 10032, USA
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