National trends in depressive symptoms, antidepressant use, and mental health consultations among US adults, 2005–2020

Objectives

Depression significantly contributes to the global disease burden. This study aims to monitor national trends in depressive symptoms, antidepressant use and mental health consultations among American adults and identify key subgroups that require attention.

Study design

Serial cross-sectional analysis.

Methods

This study utilized data from the National Health and Nutrition Examination Survey during 2005–2020. Adults over 18 were included, using the PHQ-9 to screen for depressive symptoms. Excluding 4461 participants with missing PHQ-9 values, 39,467 adults were analyzed. Temporal trends were evaluated using the Joinpoint regression program.

Results

The prevalence of depressive symptoms increased from 21.6 % to 25.1 % (P for trend = 0.009) between 2005 and 2020, particularly among females and non-Hispanic whites. In pharmacotherapy, 26.7 % of depressed individuals reported taking any antidepressants, with usage rates of 21.7 % for mild and 36.7 % for clinically relevant symptoms. After adjusting for covariates, overall antidepressant use increased from 25.4 % to 30.8 % (P for trend = 0.044). Compared with 2005–2008, antidepressant use among individuals with PHQ-9 ≥5 and ≥ 10 increased by 5.2 % and 8.8 %, respectively, while mental health professional consultation rates rose by 8.0 % and 12.2 %, respectively.

Conclusions

The estimated prevalence of depressive symptoms significantly increased. Antidepressant use remained relatively stable, but it may relatively higher among those with mild depressive symptoms. After adjusting for covariates, antidepressant use increased significantly among those with depressive symptoms. Compared with 2005–2008, rates of antidepressant use and mental health consultations among individuals with depressive symptoms increased significantly. Urgent implementation of intervention strategies across multiple domains is warranted.