Life trajectories and social change in mental health: A study of change in general mental health and diagnosed depression in Germany

The prevalence of diagnosed mental disorders has increased in many modern societies, particularly among younger people. This is often attributed to a rise in mental health problems, but empirical evidence supporting this interpretation is limited. An alternative interpretation attributes this increase not to worsening mental health but to a rise in clinical diagnoses for given levels of mental health. The present study evaluated both interpretations by comparing a measure of multidimensional general mental health (Mental Component Scale) with a measure of self-reported diagnosed depression using data from the German Socioeconomic Panel (SOEP) collected between 2002 and 2020 (n = 66,332 individuals, N = 331,868 observations). Based on hierarchical growth curve models, we examined individual change with age and social change across cohorts in both outcome measures. Results on life course trajectories showed that in early and middle adulthood improving general mental health was accompanied by an increasing prevalence of diagnosed depression. Both measures peaked around age 65 to 70 and declined thereafter. An equally sharp contrast between both measures was found for social change across cohorts: cohort improvements in general mental health were accompanied by a rise in diagnosed depression. Age and cohort patterns for both measures were broadly similar for men and women. These results indicate that an increase in the prevalence of diagnosed depression may not imply a decline in general mental health. Possible mechanisms include changes in the stigma of mental disorder, changes in treatment-seeking behavior, and direct positive effects of treatment on general mental health.