Regional trends in adolescent depressive symptoms and loneliness across the United States from 1977 to 2024

Objective To investigate regional trends in depressive symptoms and loneliness among US adolescents. Method Using Monitoring the Future data, linear regression models examined whether year, census region, and their interaction predicted annually ascertained depressive symptoms (Model 1: 1989-2010; Model 2: 2011-2024) and loneliness scores (Model 1: 1977-2010; Model 2: 2011-2024), controlling for urbanicity and race/ethnicity. Additional analyses stratified by sex. Results Mean depressive symptom and loneliness scores decreased pre-2011 and increased post-2011 across all regions. The steepest increases in depressive symptoms post-2011 occurred in the South and West compared to the Northeast ( B =0.08, SE=0.03, P <.001 and B =0.08, SE=0.03, P =.021, respectively). Trends in loneliness converged across region in 2011 and increased similarly across all regions post-2011. Increases in both outcomes post-2011 were faster among female respondents; however, there was minimal regional heterogeneity relative to sex. Conclusions Regional trends should be considered when monitoring US adolescent mental health rates to help identify emerging patterns and allocate resources more effectively when addressing the youth mental health crisis. Concentrated increases in depressive symptoms in the South and West of the US indicate additional prevention and intervention resources are needed.