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Askari MS, Olfson M, Belsky DW, Breslau J, Keyes KM. The Influence of the Great Recession on Adolescent Major Depressive Episodes and Treatment in the United States: An Interrupted Time Series Analysis. J Adolesc Health 2024; 74:51-59. [PMID: 37831049 DOI: 10.1016/j.jadohealth.2023.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 07/22/2023] [Accepted: 08/14/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE In the United States, adolescent depression increased beginning in 2008-2010, coinciding with the Great Recession. We investigated whether this time of changing economic circumstances impacted adolescent depression and treatment. METHODS We analyzed data for adolescents aged 12-17 years from the 2004-2019 National Survey on Drug Use and Health (N = 256,572). Adolescents' past-year major depressive episodes (MDEs) were measured by self-reported symptoms. MDE treatment included seeing a health professional or receiving MDE medication. We tested how MDE and MDE treatment changed from pre-Great Recession (2004 to Fall 2007) to post-Great Recession (Winter 2007-2019) using interrupted time-series segmented regression models, accounting for seasonality and autocorrelation and testing for moderation by household poverty. RESULTS The Great Recession was not associated with an immediate increase in MDE prevalence (β:-0.77 [i.e., quarter-year change in prevalence], 95% confidence interval (CI): -2.23, 0.69). However, the increase in MDE prevalence accelerated following the Great Recession (β: 0.29, 95% CI: 0.13, 0.44). The Great Recession was not associated with immediate or long-term changes in adolescent MDE treatment (immediate β: -2.87, 95% CI: -7.79, 2.04; long-term β: 0.03, 95% CI: -0.46, 0.51). Effects were similar for households by poverty status. DISCUSSION The Great Recession was not associated with increased adolescent depression prevalence, although there was an acceleration in the trend of adolescent MDE following the recession. The prevalence of MDE treatment remained stable. Adolescent depression prevention efforts should be heightened as prevalence increases, including actively engaging caregivers as family supports to alleviate potential negative implications of economic distress for adolescent MDE.
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Affiliation(s)
- Melanie S Askari
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.
| | - Mark Olfson
- Columbia University, New York State Psychiatric Institute, New York, New York
| | - Daniel W Belsky
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | | | - Katherine M Keyes
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
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Szmulewicz A, Öngür D, Shinn AK, Carol EE, Dow J, Yilmaz N, Durning PT, Sastry JM, Hsu J. Impact of the COVID-19 Pandemic on the Employment and Educational Outcomes of Individuals in a First-Episode Psychosis Clinic. Psychiatr Serv 2022; 73:165-171. [PMID: 34189932 DOI: 10.1176/appi.ps.202100114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE A central objective of early psychosis therapy is to restore social functioning (e.g., through employment and education). Employment and educational outcomes during the COVID-19 pandemic were examined in a well-defined cohort of patients receiving care in an early psychosis clinic. METHODS Data were extracted from the electronic health records of 128 patients receiving care at McLean Hospital's first-episode psychosis (FEP) clinic between January 1 and September 21 in 2019 and 2020. Using a generalized linear model with a Gaussian distribution and robust standard errors, the authors compared the average changes in the weekly employment and education proportions before and after COVID-19 lockdowns with the same changes in 2019. RESULTS Employment losses among patients with FEP were greater than among the general population and persisted through the end of follow-up. In 2020, average employment after a stay-at-home order was instituted was 33% lower than before the order compared with the change in employment during the same period in 2019. The effect was stronger among men and those who identified as non-White, were age <21 years, or did not have a college education. Although educational engagement recovered in the fall of 2020, it still remained below the 2019 levels. CONCLUSIONS Employment disruptions were major and persistent among the FEP population, which might affect short- and long-term outcomes. Innovative approaches are needed to help patients transition to remote employment, file unemployment claims, and use online hiring platforms to ameliorate the indirect effects of the COVID-19 pandemic.
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Affiliation(s)
- Alejandro Szmulewicz
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston (Szmulewicz); Psychotic Disorders Division, McLean Hospital, Belmont, Massachusetts (Öngür, Shinn, Carol, Dow, Yilmaz, Durning); Department of Psychiatry (Öngür, Shinn, Carol) and Department of Health Care Policy (Hsu), Harvard Medical School, Boston; Mongan Institute, Massachusetts General Hospital, Boston (Sastry, Hsu)
| | - Dost Öngür
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston (Szmulewicz); Psychotic Disorders Division, McLean Hospital, Belmont, Massachusetts (Öngür, Shinn, Carol, Dow, Yilmaz, Durning); Department of Psychiatry (Öngür, Shinn, Carol) and Department of Health Care Policy (Hsu), Harvard Medical School, Boston; Mongan Institute, Massachusetts General Hospital, Boston (Sastry, Hsu)
| | - Ann K Shinn
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston (Szmulewicz); Psychotic Disorders Division, McLean Hospital, Belmont, Massachusetts (Öngür, Shinn, Carol, Dow, Yilmaz, Durning); Department of Psychiatry (Öngür, Shinn, Carol) and Department of Health Care Policy (Hsu), Harvard Medical School, Boston; Mongan Institute, Massachusetts General Hospital, Boston (Sastry, Hsu)
| | - Emily E Carol
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston (Szmulewicz); Psychotic Disorders Division, McLean Hospital, Belmont, Massachusetts (Öngür, Shinn, Carol, Dow, Yilmaz, Durning); Department of Psychiatry (Öngür, Shinn, Carol) and Department of Health Care Policy (Hsu), Harvard Medical School, Boston; Mongan Institute, Massachusetts General Hospital, Boston (Sastry, Hsu)
| | - Jacqueline Dow
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston (Szmulewicz); Psychotic Disorders Division, McLean Hospital, Belmont, Massachusetts (Öngür, Shinn, Carol, Dow, Yilmaz, Durning); Department of Psychiatry (Öngür, Shinn, Carol) and Department of Health Care Policy (Hsu), Harvard Medical School, Boston; Mongan Institute, Massachusetts General Hospital, Boston (Sastry, Hsu)
| | - Nergiz Yilmaz
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston (Szmulewicz); Psychotic Disorders Division, McLean Hospital, Belmont, Massachusetts (Öngür, Shinn, Carol, Dow, Yilmaz, Durning); Department of Psychiatry (Öngür, Shinn, Carol) and Department of Health Care Policy (Hsu), Harvard Medical School, Boston; Mongan Institute, Massachusetts General Hospital, Boston (Sastry, Hsu)
| | - Peter T Durning
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston (Szmulewicz); Psychotic Disorders Division, McLean Hospital, Belmont, Massachusetts (Öngür, Shinn, Carol, Dow, Yilmaz, Durning); Department of Psychiatry (Öngür, Shinn, Carol) and Department of Health Care Policy (Hsu), Harvard Medical School, Boston; Mongan Institute, Massachusetts General Hospital, Boston (Sastry, Hsu)
| | - Jayram M Sastry
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston (Szmulewicz); Psychotic Disorders Division, McLean Hospital, Belmont, Massachusetts (Öngür, Shinn, Carol, Dow, Yilmaz, Durning); Department of Psychiatry (Öngür, Shinn, Carol) and Department of Health Care Policy (Hsu), Harvard Medical School, Boston; Mongan Institute, Massachusetts General Hospital, Boston (Sastry, Hsu)
| | - John Hsu
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston (Szmulewicz); Psychotic Disorders Division, McLean Hospital, Belmont, Massachusetts (Öngür, Shinn, Carol, Dow, Yilmaz, Durning); Department of Psychiatry (Öngür, Shinn, Carol) and Department of Health Care Policy (Hsu), Harvard Medical School, Boston; Mongan Institute, Massachusetts General Hospital, Boston (Sastry, Hsu)
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