Variation in Adolescent Depression Rates: A Review of Findings Using the Patient Health Questionnaire (PHQ) Across School Contexts and Years
Rates of adolescent depression and anxiety have increased over the past two decades, but the onset of the COVID-19 pandemic and related disruptions and school closures led to even higher levels of reports of mental health concerns. However, understanding the extent of the problem is difficult because reported rates of depression vary significantly depending on the measure used, from a low of 5.7% to a high of 42%. Data is also limited for some groups of students (e.g., American Indian/Alaska Native).
Using data from student responses to the Patient Health Questionnaire (PHQ) depression measure over multiple years in three districts, we explored how rates of reported symptoms of depression varied by: (a) context (i.e., rural vs. urban), (b) year, (c) student characteristics, and (d) the shorter 2-item or longer 9-item PHQ measure. Our findings have potential implications for policymakers and school mental health professionals as they identify and support students experiencing depression.
Key findings
Overall, our findings were consistent with national reports that indicate high levels of adolescent depression. Across data sets and over time, at least 34% of students reported symptoms. Students in the rural district reported lower rates of symptoms of depression than in the urban district, but both reported higher rates after the start of the COVID-19 pandemic compared to just before. Rates of depression vary considerably by student characteristics. Students who identify as girls or LGBTQ+ reported higher rates of depression than those who do not. Students who identify as multiracial had higher rates of depression than those who identify as Black/African American, Hispanic/Latinx, or White. Finally, we observed discrepancies between the PHQ-2 and the PHQ-9’s ability to identify a consistent set of students with symptoms of depression. Both the short and longer versions may miss some students, which may be driven by differences in the depression symptoms included in each measure. If resources allow, the PHQ-9 may be a better measure of depression for adolescents, but the PHQ-2 produces mostly comparable results.