Depression's got a hold of me:

Transcription

1 Depression's got a hold of me: Gender difference and generational trends in alcohol use and mental health among US adolescents and adults Katherine M. Keyes Associate Professor of Epidemiology Columbia University

2 Topics to be addressed today Psychiatric disorders and suicidality in adolescent girls is increasing At the same time, alcohol and (most) other substance use in adolescence is evidencing a great decline What about adults? A tale of two generations Critical to understanding all of these trends is birth cohort effects

3 Psychiatric disorders and suicidality in adolescent girls are increasing

4

5

6 Major depressive episodes in adolescents and young adults , stratified by sex Percent 10 8 Girls Boys Year Mojtabai R, Olfson M, Han B. National trends in the prevalence and treatment of depression in adolescents and young adults. Pediatrics, 2016.

7 Major depressive episodes in adolescents and adults , stratified by sex Moss S, Keyes K. Is there a mental health crisis in America? Yes, for adolescent girls. Under review.

8 Depressive affect among high school students, 1991 through 2016 Boys Girls 8.9 8th Grade 8th Grade Spline 8.9 8th Grade 8th Grade Spline th Grade 12th Grade 10th Grade Spline 12th Grade Spline th Grade 12th Grade 10th Grade Spline 12th Grade Spline 8.4 Overall Overall Spline 8.4 Overall Overall Spline Depression Mean Scores Depression Mean Score Year Year Keyes KM, Gary D, O Malley P, Schulenberg J. Depressive affect is increasing among US adolescents: trends from Social Psychiatry and Psychiatric Epidemiology, in press.

9 Loneliness, self-derogation, and self-esteem among 12 th grade students, 1991 through 2016 Loneliness Mean, By Sex Self Derogation Mean, By Sex Average Mean Score Average Mean Score Lonely Mean - Male Lonely Mean - Female Self derogation mean - Male Self derogation mean - Female Self Esteem Mean, By Sex Average Mean Score Self Esteem mean - Male Self Esteem mean - Female Keyes KM, Hamilton A, O Malley P, Schulenberg J. Internalizing symptoms among US adolescent girls rapidly increasing: a public health challenge. In preparation.

10 Suicidal behavior among US adolescents, Youth Risk Behavior Survey.

11 Suicide in the United States, Girls and women Boys and men Curtin SC, Warner M, Hedegaard H. Increase in suicide in the United States, NCHS data brief, no 241. Hyattsville, MD: National Center for Health Statistics

12 Why? Some hypotheses

13

14 Orben A, Przybylski AK. The association between adolescent well-being and digital technology use. Nature Human Behavior, 2019.

15 The digital divide and amplification of health disparities Odgers, C. Nature, 2018

16 What about risk factors for adolescent mental health? Historically, alcohol use has been such a risk factor. We would expect, then, that alcohol use should be increasing as well. But alcohol use in adolescence is evidencing a great decline, but differentially by gender

17 Daily use of alcohol in past 30 days Past two-week binge drinking Miech, R. A., Johnston, L. D., O'Malley, P. M., Bachman, J. G., & Schulenberg, J. E., & Patrick, M. E. (2017). Monitoring the Future national survey results on drug use, : Volume I, secondary school students. Ann Arbor: Institute for Social Research, The University of Michigan, 683 pp.

18 NSDUH: Prevalence of binge drinking in the past 30 days among 12- to 20-year-olds, by sex and age group, Chen CM, Yoon Y, Faden VB. Trends in Underage Drinking in the United States NIAAA Surveillance Report #107. March 2017.

19 Frequent binge drinking is also on the decline Jang JB, Patrick ME, Keyes KM, Hamilton AD, Schulenberg JE. Frequent Binge Drinking Among US Adolescents, 1991 to Pediatrics, 2017

20 Why is alcohol use decreasing?

21 Prevention through policy Ross CS, Henehan ER, Jernigan DH. Youth Exposure to Alcohol Advertising in National Magazines in the United States, American Journal of Public Health, 2017.

22 Shifting social norms Cohort-specific disapproval predicts binge drinking (N=967,562) 2 Log odds of binge drinking % 79-83% 74-78% 69-73% 59-63% 54-58% Proportion of cohort disapproving of weekend binge drinking Keyes KM, Schulenberg J, O Malley P, Bachman J, Johnston L, Li G, Hasin DS. Birth cohort effects on adolescent alcohol use: The influence of social norms from JAMA Psychiatry, 2012.

23 Declines in alcohol use are part of a broader decline in many kind of problem behaviors, but the declines are more apparent among boys

24 Past month cigarette use, 12 th grade, Miech, R. A., Johnston, L. D., O'Malley, P. M., Bachman, J. G., & Schulenberg, J. E., & Patrick, M. E. (2017). Monitoring the Future national survey results on drug use, : Volume I, secondary school students. Ann Arbor: Institute for Social Research, The University of Michigan, 683 pp.

25 Keyes KM, Gary DS, Beardslee J, Prins SJ, O Malley PM, Rutherford C, Schulenberg J. Age, period, and cohort effects in conduct problems among American adolescents from 1991 though American Journal of Epidemiology, 2017 Conduct problems and juvenile arrests, Boys Girls Overall Conduct Problem Mean Scores Arrest Rates Overall Conduct Problem Mean Scores Conduct Problems All Arrest Rates Arrest Rates Year Groups Year Groups

26 Evenings out per week, by grade, 1991 through 2015 Boys Girls Evenings Out Mean Scores Evenings Out Mean Scores th Graders 10th Graders 12th Graders Year Year Keyes KM, Gary DS, Beardslee J, Prins SJ, O Malley PM, Rutherford C, Schulenberg J. Age, period, and cohort effects in conduct problems among American adolescents from 1991 though American Journal of Epidemiology, 2017

27 Extending adolescence and shifting life strategies

28 What about marijuana use?

29 Miech, R. A., Johnston, L. D., O'Malley, P. M., Bachman, J. G., & Schulenberg, J. E., & Patrick, M. E. (2017). Monitoring the Future national survey results on drug use, : Volume I, secondary school students. Ann Arbor: Institute for Social Research, The University of Michigan, 683 pp.

30 Frequent marijuana use is increasing Hamilton AD, Jang JB, Patrick ME, Schulenberg JE, Keyes KM. Age, Period, and Cohort effects on Frequent Heavy Marijuana Use Among US Adolescents, 1991 to Under review.

31 Why isn t marijuana use decreasing?

32 Shifting medical marijuana laws are not associated with state-specific adolescent marijuana use Sarvet A, Wall MM, Fink DS, Greene E, Le A, Boustead AE, Pacula RL, Keyes KM, Cerda M, Galea S, Hasin DS. Medical marijuana laws and adolescent marijuana use in the United States: a systematic review and meta-analysis. Addiction, 2018.

33 The influence of cigarette smoking and alcohol Prevalence of marijuana use stratified by cigarette and alcohol use Miech R, Johnston L, O Malley PM. Prevalence and Attitudes Regarding Marijuana Use Among Adolescents Over the Past Decade. Pediatrics, 2017.

34 Tranquilizers Narcotics Amphetamines Miech R, Keyes KM, O Malley P, Johnstone L. The Great Decline in Adolescent Cigarette Smoking Since 2000: Consequences for Drug Use among Adolescents. Under review.

35 Keyes KM, Hamilton A, Kandel DB. Birth Cohorts Analysis of Adolescent Cigarette Smoking and Subsequent Marijuana and Cocaine Use. American Journal of Public Health, 2016.

36 What about adults? A tale of two generations

37 Depression increasing among low-ses American adults: gender differences understudied Goldman N, Glei D, Weinstein M. Declining mental health among disadvantaged Americans. PNAS, 2018.

38 Major depressive episodes in adolescents and adults , stratified by sex Moss S, Keyes K. Is there a mental health crisis in America? Yes, for adolescent girls. Under review.

39 Suicide in the United States, Girls and women Boys and men Curtin SC, Warner M, Hedegaard H. Increase in suicide in the United States, NCHS data brief, no 241. Hyattsville, MD: National Center for Health Statistics

40 Total per capita ethanol consumption, United States, Haughwout SP, Slater ME. Apparent per capita alcohol consumption: national, state, and regional trends, Surveillance Report #108, April 2017.

41 Onset of alcohol use in two birth cohorts in the US Survival probability Birth cohort (Men) Birth cohort (Women) Birth cohort (Men) Birth cohort (Women) Time (years) Keyes KM, Martins S, Blanco C, Hasin DS. Telescoping and gender differences in alcohol dependence: new evidence from two national surveys. American Journal of Psychiatry, 2010.

42 Time from first use to alcohol dependence in two birth cohorts in the US Survival probability Birth cohort (Men) Birth cohort (Women) Birth cohort (Men) Birth cohort (Women) Time (years) Keyes KM, Martins S, Blanco C, Hasin DS. Telescoping and gender differences in alcohol dependence: new evidence from two national surveys. American Journal of Psychiatry, 2010.

43 Changes in binge drinking by gender from in the US Dwyer-Lindgren L, Flaxman AD, Ng, M. Hansen GM, Murray CJL, Mokdad AH. Drinking Patterns in US Counties from 2002 to American Journal of Public Health, 2014

44 Gender-Specific Prevalence (%) of Binge Drinking, NSDUH 2002 to 2012 Men Women Precent to Percent to Year Year White A, Castle I, Chen CM, Shirley M, Roach D, Hingson R. Converging Patterns of Alcohol Use and Related Outcomes Among Females and Males in the United States, 2002 to Alcoholism: Clinical and Experimental Research, 2015.

45 Gender-Specific Prevalence (%) of Binge Drinking, meta-analytic estimate across six national datasets Grucza RA, Sher KJ, Kerr WC, Krauss MJ, Lui, CK, McDowell YE, Hartz S, Virdi G, Bierut LJ. Trends in adult alcohol use and binge drinking in the early 21 st -Century US: A Meta-analysis of 6 National Survey Series. Alcoholism: Clinical and Experimental Research, 2018.

46 Critical to understanding both of these trends is birth cohort effects

47 Glen Elder: Children of the Great Depression Our birth cohort brings interdependent lives Socialization across the life course Timing Context Agency Competition Constraints Opportunities Elder, Glen H., Jr Children of the Great Depression: Social change in life experience. Chicago, IL: University of Chicago Press.

48 What history has taught us Cohort effects are elusive yet important to uncover changes in etiologically important exposures Mortality rates Peptic ulcer Most forms of cancer Tuberculosis Smoking-related diseases Obesity

49 Death rates in Great Britain and Sweden, Kermack WO, McKendrick AG, McKinlay, PR. Death-rates in Great Britain and Sweden. Some general regularities and their significance. Lancet, 1934.

50

51 Cohort effects in substance use and mental health: gender differences

52 Murphy J. Trends in depression and anxiety: men and women. Acta Psychiatr. Scand., 1986

53 Keyes KM, Nicholson R, Kinley J, Raposo S, Stein M, Goldner E, Sareen J. Age, period, and cohort effects in psychological distress in the United States and Canada. American Journal of Epidemiology, 2014.

54 Cohort effects in alcohol use: millennial women at highest risk, but not approximating males

55 Keyes KM, Miech R. Age, period, and cohort effects in heavy episodic drinking in the US from Drug and Alcohol Dependence, 2013.

56 Keyes KM, Li G, Hasin D. Birth cohort effects and gender differences in alcohol epidemiology: a review and synthesis. Alcoholism: Clinical and Experimental Research, Keyes KM, Li G, Hasin DS. Birth cohort effects and gender differences in alcohol epidemiology: a review and synthesis. Alcoholism: Clinical and Experimental Research, 2011.

57 What is the continuity between declining adolescent rates of alcohol use and rising adult rates?

58 Lower adolescent rates portend faster acceleration though adulthood Jager J, Keyes KM, Schulenberg JE. Historical variation in young adult binge drinking trajectories and its link to historical variation in social roles and minimum legal drinking age. Developmental Psychology, 2015.

59 Acknowledgements NIAAA: R01 AA (PI: Keyes and Jager) NIAAA: R21 AA (PI: Keyes and Cerda) NIAAA: K01 AA (PI: Keyes) FONDECYT: Regular (PI: Calvo) NIDA: R01 DA (PI: Miech) Columbia University Center for Injury Epidemiology and Prevention Columbia University Department of Epidemiology Society and Health Research Center at Universidad Mayor, Santiago, Chile