Depression Diagnoses More Common Among Younger, Female Americans

Credit: Unsplash / Sasha Freemind

Nearly 1 in 5 US adults reported having ever been diagnosed with depression as of 2020, according to new data from the Centers for Disease Control and Prevention (CDC).¹

In a new analysis of the 2020 Behavioral Risk Factor Surveillance System (BRFSS) data for national-, state- and county-levels of depression prevalence, a team of CDC investigators reported notable differences in the burden of depression in US adults based on their region, age, sex, ethnicity and education.

The study, led by Benjamin Lee, MPH, of the division of population health at the CDC’s National Center for Chronic Disease Prevention and Health Promotion as well as the Oak Ridge Institute for Science and Education, provides a clearer estimation to which populations are at increased risk of depression and would therefore benefit from preventive care plans, mental health services, and/or substance abuse resource allocation.

Lee and colleagues reviewed the BRFSS, an ongoing, randomized survey of US adults aged ≥18 years old by landline and cell phone. Their analysis was designed to provide estimates and 95% confidence intervals (CIs) for national, state and county levels of depression, weighted by age, sex, race or ethnicity and education.

The 2020 BRFFS included the question, “Has a doctor, nurse, or other health professional ever told you that you had a depressive disorder, including depression, major depression, dysthymia, or minor depression?” Lee and colleagues defined depression as a “yes” response to said question. A rate of 98.9% of all 392,746 survey respondents provided an answer to the question regarding depression.

Investigators reported that 74,830 survey respondents confirmed having ever been diagnosed with depression; the weighted prevalence was 18.4% of all adults (95% CI, 18.1 – 18.6), or approximately 47.0 million US adults.

Among age groups, younger age was positively correlated with increased prevalence of depression diagnoses; 21.5% (95% CI, 20.6 – 22.5) of adults aged 18 – 24 had been previously diagnosed, as had 19.9% (95% CI, 19.5 – 20.4) of those aged 25 – 44 years old. Investigators estimated 23.8 million US adults aged 18 – 44 years old had been diagnosed with depression, versus 23.2 million of those aged ≥45 years old.

Based on sex, women were nearly twice as likely as men to be diagnosed with depression; 23.4% (95% CI, 22.9 – 23.8) versus 13.1% (12.8 – 13.4). An estimated 30.7 million US women had been diagnosed with depression as of 2020.

The race and ethnicity groups with the greatest prevalence of depression among their US adult populations were non-Hispanic multiracial (28.5%; 95% CI, 26.3 – 30.8), American Indian / Alaska Native (23.3%; 95% CI, 21.1 – 25.7), and non-Hispanic White (20.6%; 95% CI, 20.3 – 20.9). An estimated 32.2 million non-Hispanic White US adults had been diagnosed with depression.

US adults with less than high school education completion or technical college/some college completion reported a 21.0% prevalence of depression in 2020.

The following states had the highest prevalence of depression among their adults in 2020:

• West Virginia (26.4%; 95% CI, 25.0 – 27.8)
• Kentucky (24.2%; [95% CI, 22.5 – 26.0)
• Tennessee (24.1% ;95% CI, 22.4 – 25.8)

The following states had the lowest prevalence of depression among their adults in 2020:

• Hawaii (12.7%; 95% CI, 11.8 – 13.7)
• California (14.1%; 95% CI, 12.8 – 15.5)
• Illinois (14.7% 95% CI, 13.2 – 16.4)

Lee and colleagues noted that previously similar reports had shown similar differences in the prevalence of depression among these subpopulations. The considerably greater prevalence of depression among the Appalachian and southern Mississippi Valley regions are both somewhat explained by, and conducive to, other health concerns in the populations.

“Depression is a comorbidity for many chronic diseases, including diabetes, arthritis, and cardiovascular diseases,” they wrote. “These diseases also occur in higher concentrations in states within the Appalachian region, suggesting that geographic variation in the prevalence of depression might partially reflect patterns of other chronic diseases.”

The implementation of the region-level depression prevalence data may help guide targeted efforts from local public health practitioners to address community-level mental health awareness and care.

“Population-level efforts to address prevention, treatment, and management of depression include tailored and targeted programs to address demographic and geographic disparities,” investigators wrote. “CDC provides information about mental health resources and programs, including those focused on specific populations (e.g., children, older adults, and those with chronic conditions).”

Though the assessment was limited by a trio of components including the subjective nature of survey data, the limitation of data collection beyond phone calls, and the potentially imprecise estimates from county-level data, Lee and colleagues believe their analysis provides a clear snapshot of estimated depression prevalence throughout the US.

“These estimates can help decision-makers guide resource allocation to areas where the need is greatest, which might include consideration of evidence-based interventions and practices such as those recommended by the Community Preventive Services Task Force and the Substance Abuse and Mental Health Services Administration,” they concluded.

References

1. ^{Lee B, Wang Y, Carlson SA, et al. National, State-Level, and County-Level Prevalence Estimates of Adults Aged ≥18 Years Self-Reporting a Lifetime Diagnosis of Depression — United States, 2020. MMWR Morb Mortal Wkly Rep 2023;72:644–650. DOI: http://dx.doi.org/10.15585/mmwr.mm7224a1}