Time trends in adolescent diagnoses of major depressive disorder and co-occurring psychiatric conditions in electronic health records

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Background: Major depressive disorder (MDD) is highly prevalent in youth and generally characterised by psychiatric comorbidities. Secular trends in co-occurring diagnoses remain unclear, especially in healthcare settings.Methods: We used large-scale electronic health records data from a major healthcare system in Massachusetts to examine the prevalence of MDD diagnoses and co-occurring psychiatric conditions during adolescence (12-18 years; n = 133 753). Patterns of diagnostic co-occurrence were then examined across four generations (birth years spanning 1985 to 2002) and by sex. Using a phenome-wide association analysis, we explored which of 67 psychiatric conditions were associated with adolescent MDD diagnosis in earlier versus recent generations.Results: The prevalence of adolescent MDD diagnosis increased over time (8.9% to 11.4%). Over 60% with an MDD diagnosis had co-occurring psychiatric diagnoses, especially neurodevelopmental and anxiety disorders. Co-occurring diagnoses generally increased over time, especially for anxiety disorders (14% to 50%) and suicidal behaviours (6% to 23%), across both sexes. Male adolescents showed increased co-occurring substance use disorders (11% to 18%). Eight comorbidities interacted with generation, showing stronger associations with MDD diagnosis in earlier (e.g., conduct disorder) versus more recent (e.g., suicidal ideation and behaviours) generations.Conclusion: Diagnostic comorbidities are common among adolescents diagnosed with MDD, with prominent increases in co-occurring anxiety and suicidal diagnoses over time. This implies the need to carefully assess psychiatric complexity in adolescents in clinical and research settings, apply transdiagnostic approaches to address co-occurring presentations, and further investigate potential causes for generational increases.

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