NCHS Data Brief ■ No. 172 ■ December 2014

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Depression in the U.S. Household Population, 2009–2012

Laura A. Pratt, Ph.D., and Debra J. Brody, M.P.H.

Key findings 

Data from the National 

Health and Nutrition 

Examination Survey, 

2009–2012

• During 2009–2012, 7.6% of 

Americans aged 12 and over 

had depression (moderate or 

severe depressive symptoms in 

the past 2 weeks). Depression 

was more prevalent among 

females and persons aged 

40–59.

• About 3% of Americans 

aged 12 and over had severe 

depressive symptoms, while 

almost 78% had no symptoms.

• Persons living below the 

poverty level were nearly 

21⁄2 times more likely to have 

depression than those at or 

above the poverty level.

• Almost 43% of persons with 

severe depressive symptoms 

reported serious difficulties 

in work, home, and social 

activities.

• Of those with severe 

symptoms, 35% reported 

having contact with a mental 

health professional in the past 

year.

Depression is a serious medical illness with mood, cognitive, and physical 

symptoms (1). Depression is associated with higher rates of chronic disease, 

increased health care utilization, and impaired functioning (2,3). Rates of 

treatment remain low, and the treatment received is often inadequate (4). 

This data brief examines both depression and depressive symptom severity 

in the past 2 weeks from a symptom-based questionnaire, by demographic 

characteristics, functioning difficulties, and recent contact with a mental 

health professional. Severity is categorized as severe, moderate, mild, or no 

depressive symptoms. Current depression is defined as severe or moderate 

symptoms; no depression is defined as mild or no symptoms. 

Keywords: NHANES • depressive symptoms • mental health

In 2009–2012, 7.6% of Americans aged 12 and over had 

depression (moderate or severe depressive symptoms in the 

past 2 weeks).

Figure 1. Percentage of persons aged 12 and over with depression, by age and sex:

United States, 2009–2012

1

Males have significantly lower rates than females overall and in every age group.

2

Significantly different from 40–59. 3Significantly different from 18–39. 4Significantly different from 60 and over.

NOTES: Depression is defined as having moderate to severe depressive symptoms. Access data table for Figure 1 at: 

http://www.cdc.gov/nchs/data/databriefs/db172_table.pdf#1. 

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2009–2012. Percent

7.6

5.72

7.42,4

9.84

5.6 5.4 1

4.01–3

5.81,4

7.21,4

3.41

9.5

7.42

9.32,4

12.34

7.1

0

2

4

6

8

10

12

14

All ages 12–17 18–39 40–59 60 and over

Total Male Female
NCHS Data Brief ■ No. 172 ■ December 2014

■  2  ■

• Females had higher rates of depression than males in every age group (Figure 1).

• The rate of depression increased by age, from 5.7% among youth aged 12–17 to 9.8% 

among adults aged 40–59, but adults aged 60 and over had a significantly lower rate of 

depression (5.4%) than those aged 18–39 and 40–59. 

• The highest rate of depression, 12.3%, was found in women aged 40–59.

• The lowest rates of depression were for males aged 12–17 (4.0%) and 60 and over (3.4%).

Approximately 3% of all Americans aged 12 and over had severe 

depressive symptoms, while almost 78% had no depressive symptoms. 

• Non-Hispanic black persons had a higher rate of severe depressive symptoms (4.1%) than 

non-Hispanic white persons (2.6%) (Figure 2).

• Non-Hispanic black persons and Hispanic persons had higher rates of mild and moderate 

depressive symptoms than non-Hispanic white persons. Non-Hispanic white persons were 

more likely to have no depressive symptoms (78.5%) than either non-Hispanic black 

persons (73.2%) or Hispanic persons (73.9%).

Percent

Figure 2. Percentage of persons aged 12 and over by depressive symptom severity and race and Hispanic origin:

United States, 2009–2012

1

Significant linear trend.

2

Significantly different from non-Hispanic black. 

3

Significantly different from Hispanic.

4

Includes race and ethnicity groups not shown separately.

NOTE: Access data table for Figure 2 at: http://www.cdc.gov/nchs/data/databriefs/db172_table.pdf#2.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2009–2012.

77.21

73.91 73.21

78.51–3

15.3 16.7 17.1

14.62,3

4.7 5.7 5.6 4.32,3

2.9 3.7 4.1 2.62

0

20

40

60

80

100

Total

4 Hispanic Non-Hispanic black Non-Hispanic white

No symptoms Mild Moderate Severe
NCHS Data Brief ■ No. 172 ■ December 2014

■  3  ■

Poor persons were more than twice as likely to have depression as persons 

living at or above the poverty level.

• More than 15% of persons living below the federal poverty level had depression compared 

with 6.2% of persons living at or above the poverty level (Figure 3).

• No significant differences were observed in rates of depression by race and Hispanic origin 

among persons living below the poverty level or among those living at or above the poverty 

level.

Percent

Figure 3. Percentage of persons aged 12 and over with depression, by poverty status and race and Hispanic origin: 

United States, 2009–2012

1

Significantly higher than “at or above poverty level.” 2

Includes race and ethnicity groups not shown separately.

NOTES: Depression is defined as moderate to severe depressive symptoms. The poverty level is set by the U.S. Department of Health and Human Services

and is based on family income and family size. Access data table for Figure 3 at: http://www.cdc.gov/nchs/data/databriefs/db172_table.pdf#3.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2009–2012.

15.41

13.41

16.41 16.51

6.2

7.6 7.3

5.9

0

5

10

15

20

Total

2 Hispanic Non-Hispanic black Non-Hispanic white

Below poverty level At or above poverty level
NCHS Data Brief ■ No. 172 ■ December 2014

■  4  ■

Nearly 90% of persons with severe depressive symptoms reported difficulty 

with work, home, or social activities related to their symptoms.

• Rates of any difficulty with work, home, or social activities related to depressive symptoms 

increased as the severity of those symptoms increased, from 45.7% among persons with 

mild depressive symptoms to 88.0% among those with severe depressive symptoms

(Figure 4).

• Rates of serious difficulty with work, home, or social activities related to depressive 

symptoms also increased as symptom severity increased, from 3.9% among persons with 

mild depressive symptoms to 15.8% among persons with moderate symptoms, and 42.8% 

among those with severe symptoms.

Figure 4. Percentage of persons aged 12 and over reporting difficulty with work, home, or social activities due to 

depressive symptoms, by severity: United States, 2009–2012

1

Significant linear trend for “serious difficulty” and “any difficulty.”

NOTES: “Any difficulty” (percentage above the bar in each category) is the sum of the percentages for “some difficulty” and “serious difficulty.” Access data table

for Figure 4 at: http://www.cdc.gov/nchs/data/databriefs/db172_table.pdf#4.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2009–2012.

3.91

15.8

42.8

41.8

58.0

45.2

0

20

40

60

80

100

Some

difficulty

Serious

difficulty

45.71

73.8

88.0

Moderate Severe

Depressive symptoms

Mild

Percent
NCHS Data Brief ■ No. 172 ■ December 2014

■  5  ■

Just over one-third (35.3%) of persons with severe depressive symptoms 

reported having seen a mental health professional in the past year.

• Rates of seeing a mental health professional increased as severity of depressive symptoms 

increased in all race and Hispanic origin groups (Figure 5).

• Less than 20% of all Americans with moderate depressive symptoms reported having seen 

a mental health professional in the past year. About 5% of persons with no depressive 

symptoms and 13% of persons with mild symptoms have also seen a mental health 

professional in the past year.

• Hispanic persons with mild depressive symptoms were less likely to have seen a mental 

health professional than non-Hispanic black or non-Hispanic white persons with the same 

level of symptoms.

• Among persons with moderate or severe depressive symptoms, no significant differences 

were observed in the rate of seeing a mental health professional by race and Hispanic origin.

Percent

Figure 5. Percentage of those aged 12 and over who contacted a mental health professional in past 12 months, by 

depressive symptom severity and race and Hispanic origin: United States, 2009–2012

1

Significant linear trend.

2

Significantly less than non-Hispanic black and non-Hispanic white.

3

Significantly less than non-Hispanic white.

4

Includes race and ethnicity groups not shown separately.

NOTE: Access data table for Figure 5 at: http://www.cdc.gov/nchs/data/databriefs/db172_table.pdf#5.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2009–2012.

5.2

3.32 4.6

6.0

13.0

9.13

11.6

13.9

19.6

17.1

19.2

20.9

35.31

27.81

33.61

37.01

0

10

20

30

40

Total

4 Hispanic Non-Hispanic black Non-Hispanic white

No symptoms Mild Moderate Severe
NCHS Data Brief ■ No. 172 ■ December 2014

■  6  ■

Summary

During 2009–2012, 7.6% of Americans aged 12 and over had depression (defined as having 

moderate or severe depressive symptoms in the past 2 weeks). Depression was more prevalent 

among females than males and among adults aged 40–59 than those of other age groups. Rates of 

any depressive symptoms were lower among non-Hispanic white persons than among Hispanic 

and non-Hispanic black persons. Once poverty was taken into account, however, rates of 

depression did not differ significantly by race or Hispanic origin. 

Persons with mild depressive symptoms, as well as those with moderate or severe depressive 

symptoms, reported difficulties with work, home, and social activities related to their symptoms. 

Numerous studies have also shown that persons with depression have more functional limitations 

than those without depression (3,5).

Studies have shown that the most effective treatment for depression, especially for severe 

depression, is a combination of medication and therapy (6–8). Although medication can be 

prescribed by a primary care physician, therapy is generally provided by a mental health 

professional. These data demonstrate that among those having severe depressive symptoms, only 

35% reported seeing a mental health professional in the past year.

Definitions

Depressive symptoms: Categorized in three groups—mood, cognitive, and physical symptoms. 

Mood symptoms include depressed, sad, or irritable mood; loss of interest in usual activities; 

inability to experience pleasure; feelings of guilt or worthlessness; and thoughts of death or 

suicide. Cognitive symptoms include inability to concentrate and difficulty in making decisions. 

Physical symptoms include fatigue, lack of energy, feeling either restless or slow, and changes in 

sleep, appetite, and activity levels (1). 

Depression: Measured by the National Health and Nutrition Examination Survey (NHANES) 

using the Patient Health Questionnaire (PHQ–9), a nine-item screening instrument that asks 

about the frequency of symptoms of depression over the past 2 weeks (9). Response categories 

of “not at all,” “several days,” “more than half the days,” and “nearly every day” receive a score 

of 0–3. A total score of 0–27 is then calculated. Depression is a PHQ–9 score of 10 or higher, a 

well-validated cut point commonly used in clinical studies that measure depression (9). Severely 

depressed persons may have disproportionately chosen not to participate in the survey or health 

examination, which included administration of the PHQ–9; therefore, the prevalence estimates 

in this report may slightly underestimate the actual prevalence of depression. In addition, people 

being successfully treated for depression would not be identified as depressed by the PHQ–9. 

Depression symptom severity: Determined by various cut points using the total score from 

the PHQ–9 screening instrument (9). PHQ–9 scores can be classified as: 0–4 (no or minimal 

depressive symptoms), 5–9 (mild), 10–14 (moderate), 15–19 (moderately severe), and 20–27 

(severe). In this report, scores of 15 and higher are referred to as severe depressive symptoms. 

Difficulties related to depression: Defined by responses to the question, “How difficult have these 

problems made it for you to do your work, take care of things at home, or get along with other 

people?” Only persons with a score of 1 or more on PHQ–9 symptom questions are asked the 
NCHS Data Brief ■ No. 172 ■ December 2014

■  7  ■

difficulties question. Responses were scored from 0 (not at all difficult) to 3 (extremely difficult). 

A score of 1 or more is defined as any difficulty. A score of 2 or 3 suggests moderate to severe 

difficulties.

Contact with a mental health professional: Determined by responses to the question, “During the 

past 12 months, have you seen or talked to a mental health professional such as a psychologist, 

psychiatrist, psychiatric nurse, or clinical social worker about your health?” The data do not 

indicate whether persons who contacted a mental health professional actually began treatment for 

depression. Respondents also are not asked about mental health treatment received from primary 

care providers.

Poverty status: Determined using an index calculated by dividing family income by U.S. 

Department of Health and Human Services poverty guidelines specific to the survey year. These 

guidelines are issued each year for determining financial eligibility for certain federal programs. 

Poverty guidelines vary by family size and geographic location; a family income-to-poverty ratio 

of less than 1 is the cut point for below poverty level.

Data sources and methods

NHANES, conducted by the Centers for Disease Control and Prevention’s (CDC) National 

Center for Health Statistics (NCHS), is a continuous cross-sectional survey of the civilian 

noninstitutionalized U.S. population designed to assess the health and nutrition of Americans. 

NHANES does not include persons living in institutions, where rates of depression are higher 

than in the community-dwelling population. Survey participants are asked to complete a 

household interview and an examination in a mobile examination center (MEC) that includes 

a private interview. The question about contact with a mental health professional is asked in 

the household interview, and the PHQ–9 depression symptom questions are asked in the MEC. 

For youths aged 12–15, a proxy respondent, usually a parent, answers the questions in the 

household interview. During the private interview in the MEC, participants aged 12 and over 

answer questions for themselves. Questions related to depression are administered in English and 

Spanish.

NHANES sample examination weights, which account for the differential probabilities of 

selection, nonresponse, and noncoverage, were used for all analyses. Standard errors of the 

percentages were estimated using Taylor series linearization, a method that incorporates the 

sample design and sample weights.

Differences between subgroups were evaluated using the univariate t statistic. All significance 

tests were two-sided using p < 0.05 as the level of significance. All comparisons reported in the 

text are statistically significant unless otherwise indicated. To test for linear trends (Figures 2, 

4, and 5), the null hypothesis of a nonlinear trend was examined using orthogonal polynomials. 

Data analyses were performed using SAS version 9.1 (SAS Institute, Cary, N.C.) and SUDAAN 

version 9.0 (RTI International, Research Triangle Park, N.C.).

About the authors

Laura A. Pratt is with CDC’s NCHS Office of Analysis and Epidemiology; Debra J. Brody is with 

NCHS Division of Health and Nutrition Examination Surveys.
NCHS Data Brief ■ No. 172 ■ December 2014

References

1. American Psychiatric Association. Diagnostic and Statistical Manual of

Mental Disorders (DSM–5). 5th ed. Arlington, VA. 2013.

2. Katon WJ. Clinical and health services relationships between major

depression, depressive symptoms, and general medical illness. Biol 

Psychiatry 54(3):216–26. 2003.

3. Wells KB, Stewart A, Hays RD, Burnam MA, Rogers W, Daniels M,

et al. The functioning and well-being of depressed patients: Results from the 

Medical Outcomes Study. JAMA 262(7):914–9. 1989.

4. Wang PS, Lane M, Olfson M, Pincus HA, Wells KB, Kessler RC.

Twelve-month use of mental health services in the United States: Results 

from the National Comorbidity Survey Replication. Arch Gen Psychiatry 

62(6):629–40. 2005.

5. Broadhead WE, Blazer DG, George LK, Tse CK. Depression, disability

days, and days lost from work in a prospective epidemiologic survey. JAMA 

264(19):2524–8. 1990.

6. March J, Silva S, Curry J, Wells K, Fairbank J, Burns B, et al. The

Treatment for Adolescents With Depression Study (TADS): Outcomes over

1 year of naturalistic follow-up. Am J Psychiatry 166(10):1141–9. 2009.

7. Thase ME, Greenhouse JB, Frank E, Reynolds CF, Pilkonis PA,

Hurley K, et al. Treatment of major depression with psychotherapy or 

psychotherapy–pharmacotherapy combinations. Arch Gen Psychiatry 

54(11):1009–15. 1997.

8. Pampallona S, Bollini P, Tibaldi G, Kupelnick B, Munizza C. Combined

pharmacotherapy and psychological treatment for depression: A systematic 

review. Arch Gen Psychiatry 61(7):714–9. 2004.

9. Kroenke K, Spitzer RL, Williams JBW. The PHQ–9: Validity of a brief

depression severity measure. J Gen Intern Med 16(9):606–13. 2001.

Suggested citation

Pratt LA, Brody DJ. Depression in the U.S. 

household population, 2009–2012. NCHS 

data brief, no 172. Hyattsville, MD: National 

Center for Health Statistics. 2014.

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Charles J. Rothwell, M.S., M.B.A., Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Office of Analysis and Epidemiology

Irma E. Arispe, Ph.D., Director

Division of Health and Nutrition 

Examination Surveys

Kathryn S. Porter, M.D., M.S., Director

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