Population-Based Analysis of Temporal Trends in the Prevalence of Depressed Mood Among Sexual Minority and Heterosexual Youths From 1999 Through 2017

Depression in adolescence is highly prevalent and associated with negative long-term outcomes.¹ Despite decades of research on treatment for adolescent depression, sexual minority youths remain a particularly at-risk group.² Temporal trends inform progress in addressing the need to eliminate health disparities among sexual minority populations.³ To our knowledge, this study presents the first population-representative analysis of temporal trends in depressed mood among sexual minority and heterosexual youths. An 18-year period is examined.

The Youth Risk Behavior Surveillance System (YRBSS) obtains biannual data representative of students in grades 9 through 12 using a multistage cluster-sample design.⁴ Data were drawn from the Massachusetts YRBSS for calendar years 1999 through 2017. This study did not undergo institutional review board review at any institution but was believed by the authors to be exempt because the dataset used is publicly available for use (https://www.cdc.gov/healthyyouth/data/yrbs/data.htm). These analyses used previously collected data through the YRBSS, a national survey conducted by the US Centers for Disease Control and Prevention, who works with local schools to collect data and obtain parental permission.

Sexual minority status was assessed with 2 items: self-reported sexual identity and same-sex behavior. For sexual identity, respondents were classified as members of sexual minorities if they self-identified as gay, lesbian, bisexual, or unsure. For same-sex behavior, respondents who endorsed having same-sex partners in their lifetime were classified as sexual minority youths. Respondents who reported no sexual partners were excluded from analyses examining sexual behavior. Youths were asked about feeling depressed and/or hopeless in the past year with the question, “During the past 12 months, did you ever feel so sad or hopeless almost every day for 2 weeks or more in a row that you stopped doing some usual activities?”

Depressed mood was stratified by sexual minority status and weighted to obtain population-representative estimates. Join point regression was conducted to quantify annual percentage change with 95% CIs. Trends are presented as linear segments connected at the years (ie, join points) when the slope of the trend changed significantly. A straight line was fitted over the full period based on a simple log linear model if no significant change in trend was observed. Analyses were conducted separately for sexual identity and behavior. A sensitivity analysis was conducted in the first case, excluding respondents unsure of their sexual identity. The percentage of non-Hispanic white youths who completed the survey are presented. These data provide an overview of the racial/ethnic diversity in the YRBSS survey sample, notably that youth who completed the survey between 1999 and 2017 were predominantly non-Hispanic and white.

Join point statistical software (Joinpoint Regression Program version 4.7.0.0 [National Cancer Institute]) was used for analyses of trends using join point models. All P value of .05 or less were considered significant. Data analysis occurred in February 2019.

The unweighted total study population was 33 456 individuals. The percentage of non-Hispanic white youths in the sample ranged from 42.5% among sexual minority youths reporting sexual identity in 2017 to 73.3% among heterosexual youths reporting sexual behavior in 2003 (Table 1).

Table 1 presents depressed mood prevalence rates stratified by sexual identity and behavior. Analyses based on sexual identity (Table 2) revealed heterosexual youths demonstrated a significant decrease in depressed mood from 1999 to 2013 (annual percentage change, −2.31% [95% CI, −3.67% to −0.92%]; P = .01), with no significant change from 2013 to 2017. A significant decline was not observed for sexual minorities from 1999 to 2017. In a sensitivity analysis, the trend for sexual minorities remained nonsignificant. When sexual orientation was based on sexual behavior, a significant decrease in depressed mood was observed for heterosexual youths (annual percentage change, −3.33% [95% CI, −4.93% to −1.70%]; P = .003), but not sexual minority youths, between 1999 and 2009.

Prevalence of depressed mood across all years was high, with especially concerning rates reported in sexual minority youths across the study period. The current study found evidence of a decline in depressed mood among heterosexual youths over time, while depressed mood rates among sexual minority peers have remained largely unchanged in nearly 2 decades. These findings collectively suggest that disparities in rates of feeling depressed in sexual minority youths populations have not improved over the last 18 years.

Limitations of this study include its reliance on a single-item measure of depressed mood. Additionally, as the current study drew from the Massachusetts YRBSS, the degree to which current findings generalize to other populations awaits future research.

Research studies across pediatric health care disciplines that prioritize screening of sexual minority youths for depression are needed. These findings lend urgency to the need for studies evaluating effectiveness of existing treatments for adolescent depression in this population⁵ and support the importance of identifying and testing the effectiveness of tailored intervention components targeting the specific needs of sexual minority youths.⁶ Addressing mental health disparities remains a priority in research and clinical practice, and there is much opportunity for progress in addressing this public health concern.

Accepted for Publication: May 7, 2019.

Corresponding Author: Alexandra H. Bettis, PhD, Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Bradley Hospital, 1011 Veterans Memorial Pkwy, East Providence, RI 02915 (alexandra_bettis@brown.edu).

Published Online: October 21, 2019. doi:10.1001/jamapediatrics.2019.3804

Author Contributions: Drs Bettis and Liu had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: All authors.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: All authors.

Supervision: Liu.

Conflict of Interest Disclosures: Dr Liu reported grants from American Psychological Foundation and the US National Institutes of Mental Health during the conduct of the study. Dr Bettis reported grants from the US National Institutes of Mental Health during the conduct of the study. No other disclosures were reported.

Funding/Support: This study was supported in part by the National Institute of Mental Health of the National Institutes of Health (grants R01MH101138, R01MH115905, R21MH112055, and T32MH019927), as well as by the American Psychological Foundation Wayne F. Placek Grant.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies.