A comprehensive analysis of data spanning fifteen years reveals that depression symptoms have increased among college students in the United States, with the most severe rises occurring after 2016. The findings indicate that while distress is growing across the board, the escalation is particularly steep for women, racial minorities, and students facing financial difficulties. These results were published in the Journal of Affective Disorders.
Mental health professionals recognize depression as a debilitating condition that can severely impact daily functioning. Rates of the disorder have been climbing for decades, with young adults showing some of the highest prevalence.
While the general increase in diagnosis rates is well-documented, less is understood about how specific symptoms manifest and change over time within different groups. Some theories suggest that exposure to stress varies by demographic, potentially altering how depression presents itself.
Past research has debated whether cultural background or social status influences the expression of distress. Some scholars propose that individuals from minority groups or lower socioeconomic backgrounds may express depression through physical symptoms, such as fatigue or sleep issues.
Others suggest that Western cultures are more likely to manifest distress through emotional or cognitive symptoms, like guilt or hopelessness. The authors of this new study aimed to clarify these distinctions by analyzing trends at the level of individual symptoms rather than just overall diagnosis scores.
“The motivation for this study was an interest in understanding if the increase in prevalence of youth depression over the past two decades, which is a known phenomenon for which we don’t have definite answers, was also reflected in college students,” explained study author Carol Vidal, an associate professor at Johns Hopkins Medicine and author of Status and Social Comparisons Among Adolescents.
“I am a pediatric psychiatrist and personally had an experience with one of my patients a few years ago who made me think about looking at item level changes. This young patient had presented to us for depression initially, but after treatment, her depression improved in our clinical assessment and by her report, but she continued to have elevated PHQ-9 scores.”
PHQ-9, or the Patient Health Questionnaire-9, is a screening tool that asks participants to rate how often they have been bothered by nine specific problems over the past two weeks. The items cover a range of experiences, including low interest in activities, feelings of failure, trouble concentrating, and thoughts of self-harm. Responses are rated on a scale from zero to three.
“When looking closely at her repeated PHQ-9s, her therapist and I saw that those scores were driven mostly by sleep, appetite, and concentration problems, but her mood was much better and she did not present anhedonia, which are core symptoms of depression,” Vidal said.
“We thought maybe the increase in depression at the population level was driven by certain items and decided to explore PHQ-9 changes over time by item. We also wanted to see if the global increases in youth depression were driven by increases in certain demographic groups.”
For their new study, the researchers utilized data from the Healthy Minds Study. This is a large, nationally representative survey of undergraduate and graduate students. The dataset included responses from approximately 560,000 students across 450 colleges and universities collected between 2007 and 2022. The primary measure used was the PHQ-9.
The researchers used statistical models to estimate the trends of depression symptoms over time. They examined how these trends interacted with sex, race, ethnicity, and self-reported financial stress. The analysis focused on identifying which specific symptoms were rising the fastest and which groups were most affected.
The analysis showed that average scores for every single item on the PHQ-9 increased from 2007 to 2022. The total depression scores remained relatively stable from 2007 to 2015 but began a meaningful ascent starting in 2016. By 2022, the average student score was approaching the threshold for moderate depression.
“The main findings are that depression increased for all PHQ-9 items between 2007 and 2022, but that the most meaningful increase was after 2016. I was surprised to find the steep increase after 2016. Other epidemiological studies find steeper increases starting in 2012,” Vidal told PsyPost.
The specific symptoms that saw the largest growth were alarming. The most dramatic increase was in suicidal ideation, defined as thoughts of being better off dead or hurting oneself. This specific symptom increased by 153.9 percent over the study period.
Other symptoms also showed sharp rises. Psychomotor agitation, which involves moving or speaking slowly or being fidgety and restless, increased by 79.6 percent. Trouble concentrating on things like reading or watching television rose by 77.7 percent. Feelings of worthlessness increased by 66 percent.
When breaking the data down by sex, clear disparities emerged. Women and intersex students reported steeper annual increases in nearly every symptom compared to men. Intersex students showed the most rapid growth in fatigue, psychomotor changes, and suicidal ideation. While men also experienced increases, the rate of change was slower.
The study also revealed nuanced differences regarding race and ethnicity. For several physical symptoms, White students showed flat or declining trends, while other racial groups reported increases. For instance, sleep problems remained stable among White students but rose among all other groups. The steepest rise in sleep disturbances was observed among Hispanic students.
Similar patterns appeared for symptoms like fatigue and appetite changes. White students did not show aggregate increases in fatigue, yet every other racial group did. This suggests that the burden of physical symptoms of depression is growing disproportionately among racial and ethnic minority students.
However, cognitive symptoms showed more uniformity. Feelings of worthlessness and depressed mood increased at similar rates across all racial and ethnic groups. Most notably, suicidal ideation increased across all groups without significant differences in the rate of growth by race. This indicates that the most severe indicator of distress is rising universally, regardless of racial background.
Financial stress also proved to be a powerful predictor of worsening mental health. The researchers categorized students based on whether they found their financial situation to be stressful. Students who reported that their finances were “always stressful” had higher levels of all depression symptoms.
Furthermore, financially stressed students experienced faster yearly increases in symptoms compared to those who reported their finances were never stressful. This was particularly true for symptoms like poor appetite, feelings of worthlessness, and suicidal ideation. The gap between financially secure and financially stressed students appears to be widening over time.
“Students experiencing financial stress had higher levels of all symptoms of depression and faster yearly increases compared to those without financial stress, which is important to consider in an environment of economic uncertainty,” Vidal said.
The sharp increase in suicidal ideation is a major concern highlighted by the data. Although the absolute mean scores for this item remain lower than for common symptoms like fatigue, the rate of change is much faster. This suggests a need for targeted suicide prevention strategies on college campuses that go beyond general mental health support.
The findings challenge the idea that depression trends are monolithic. The variation in symptom trajectories suggests that different groups are experiencing the rising tide of mental health issues in distinct ways. The consistent pattern of higher increases among women and racial minority groups points to widening disparities in mental health burdens.
“I’d like to point out that popular explanations about depression causes tend to be simplistic (i.e., social media) and that we don’t really know well if other factors like economic or political changes, or even things a decrease in stigma, are also contributors,” Vidal told PsyPost.
One limitation of the study is that it relied on cross-sectional data. This means different students were surveyed each year, rather than tracking the same individuals over time. The results reflect population-level changes but cannot confirm individual trajectories of illness.
Additionally, the data is self-reported. This introduces the possibility that changes in how people perceive or report mental health issues could influence the results. For example, a decrease in stigma might lead to more students being willing to admit to symptoms they previously would have hidden.
The study focused exclusively on college students. The experiences of young adults who do not attend college may differ. However, given the large proportion of young adults who attend higher education institutions, the findings have broad relevance for this age group.
Future research aims to investigate the macro-level and environmental causes of these trends. Understanding the role of economic instability, political climate, and other societal factors is a priority for the researchers. They hope to move beyond simplistic explanations to identify the structural drivers of youth distress.
“The changes we are seeing put many youth in the clinically meaningful threshold for depression,” Vidal noted. “Prevention and promotion of mental health involving peers and other individuals who are more accessible to youth can help with having less people get to that level of severity, and at the same time, interventions with professionals for those students in need for higher level services need to be made available on campus.”
The study, “Fifteen-year trends in depression symptoms by sex, race, and financial stress among U.S. College Students,” was authored by Carol Vidal, Jenny Owens, Phillip Sullivan, and Flavius Lilly.
