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Age, sex and race/ethnicity disparities in the prevalence of major depressive symptoms: A population-based study of US adults.

Qinghua Fan,Yi Guo,Zhongjian Liu,Gang Wang,Haibo Wang

Published 2025 in Journal of Affective Disorders

ABSTRACT

BACKGROUND This study examined temporal trends in major depressive symptoms (MDS) prevalence among US adults and identified associated risk factors during the COVID-19 pandemic. METHODS Using National Health and Nutrition Examination Survey (NHANES) data from 2011 to 2023, we conducted a cross-sectional analysis across three periods: non-pandemic, pre-pandemic, and trans-pandemic. Complex survey weights and multivariable logistic regression models were applied to estimate odds ratios (ORs) for MDS risk factors. RESULTS Among 23,558 participants (weighted population = 185,795,118), MDS prevalence increased significantly during the trans-pandemic period, representing a 1.67-fold increase (adjusted OR 1.67, 95 % CI 1.39-2.01, P < 0.001). Young adults aged 20-39 years experienced the most pronounced increase, with males showing a 2.79-fold increase (OR 2.79, 95 % CI 1.85-4.21) and females a 2.19-fold increase (OR 2.19, 95 % CI 1.56-3.08). Asian participants consistently showed the lowest MDS prevalence (3.1 %-5.4 %). Significant trans-pandemic risk factors included female sex (OR 1.41, 95 % CI 1.07-1.87), low income (PIR < 1.30: OR 1.91, 95 % CI 1.11-3.29), non-employment (OR 1.51, 95 % CI 1.00-2.28), and never married status (OR 1.98, 95 % CI 1.31-2.98). Protective factors included never smoking (OR 0.67, 95 % CI 0.46-0.99), regular sunshine exposure (OR 0.61, 95 % CI 0.44-0.86), and adequate sleep duration (7-8 h: OR 0.60, 95 % CI 0.44-0.82; ≥8 h: OR 0.63, 95 % CI 0.45-0.90). CONCLUSIONS COVID-19 significantly impacted MDS prevalence, with young adults particularly vulnerable. Findings highlight the need for targeted mental health interventions and lifestyle modifications.

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