Major depressive disorder (MDD) is a leading contributor to the global burden of disease and commonly develops during adolescence. The COVID-19 pandemic was linked to significant increases in depressive symptoms among youth, but less is known about whether these increases have continued in recent years.

Using the first four consecutive years of methodologically comparable national data since the pandemic, we examined changes in past-year major depressive episode (MDE) among U.S. adolescents aged 12–17 years from 2021 to 2024 and evaluated demographic and substance use factors.

We analyzed pooled, cross-sectional data from the 2021–2024 National Survey on Drug Use and Health (NSDUH), a nationally representative survey of non-institutionalized U.S. residents. The sample included 43,828 adolescents aged 12–17 years. Past-year MDE was assessed using DSM-5–based criteria. Survey-weighted logistic regression models estimated changes over time and adjusted associations with age, sex, race/ethnicity, and past-year tobacco, alcohol, and marijuana use. Predicted prevalences and 95% confidence intervals were calculated using post-estimation margins.

The prevalence of past-year MDE decreased from 20.5% in 2021 to 14.8% in 2024, reflecting a 38.5% relative reduction. Adjusted models showed decreasing odds of MDE over time. Girls had significantly higher odds of MDE compared to boys, and older adolescents were at greatest risk. Compared with non-Hispanic White adolescents, non-Hispanic Black/African American, non-Hispanic Asian, and non-Hispanic Native Hawaiian/Other Pacific Islander adolescents had lower odds of MDE, while non-Hispanic multiracial adolescents had higher odds. Alcohol and marijuana use were linked to increased odds of MDE.

Past-year MDE among U.S. adolescents declined from 2021 to 2024, indicating partial recovery following pandemic-related increases. Despite overall improvements, ongoing disparities based on sex, age, race/ethnicity, and substance use highlight the continued need for targeted adolescent mental health prevention and early intervention efforts.

Depression

Youth

Prevention

Psychiatric epidemiology

© 2026 The Authors. Published by Elsevier Ltd.