Depression and role impairment among adolescents in primary care clinics

• Published in: Journal of adolescent health Vol. 37; no. 6; pp. 477 - 483
• Main Authors: Asarnow, Joan Rosenbaum, Jaycox, Lisa H., Duan, Naihua, LaBorde, Anne P., Rea, Margaret M., Tang, Lingqi, Anderson, Martin, Murray, Pamela, Landon, Christopher, Tang, Beth, Huizar, Diana P., Wells, Kenneth B.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-12-2005; Elsevier Science
• Subjects: Academic achievement; Adolescence; Adolescent; Adolescents; Adult; Adult and adolescent clinical studies; Biological and medical sciences; Cross-Sectional Studies; Depression; Depressive Disorder - etiology; Depressive Disorder - psychology; Educational Status; Female; Humans; Impairment; Male; Medical sciences; Mood disorders; Primary Health Care - statistics & numerical data; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Risk Factors; Role; Screening; United States; North America; America; Adolescence; Depression; Impairment; Human; Mood disorder; Social environment; Productivity; Occupational adjustment; Prevalence; School adaptation; Primary health care; Mental health; Social adjustment; Symptomatology; Decrease; Cross sectional study; Adolescent; Social role; Predictive factor; Comparative study; Public health
• ISSN: 1054-139X; 1879-1972
• DOI: 10.1016/j.jadohealth.2004.11.123

To evaluate the association between depression and role impairment in a primary care sample, with and without controlling for the effects of general medical conditions.
Cross-sectional survey of consecutive primary care patients, ages 13–21 years (
n = 3471), drawn from six sites including public health, managed care, and academic health center clinics. We assessed probable depressive disorder, depressive symptoms, and common medical problems using youth self-report on a brief screening questionnaire. Main outcome measures were two indicators of role impairment: (a) decrement in productivity/role activity, defined as not in school or working full time; and (b) low educational attainment, defined as more than 2 years behind in school or ≥ 20 years of age and failed to complete high school.
Adolescents screening positive for probable depressive disorder had elevated rates of productivity/role activity decrements (19% vs. 13%; OR 1.69; 95% confidence interval [CI] 1.39–2.06;
p < 0.001) and low educational attainment (20% vs. 15%; OR 1.47; 95% CI 1.21–1.78;
p < 0.001). Probable depressive disorder made a unique contribution to the prediction of these impairment indicators after adjusting for the effect of having a general medical condition; controlling for depression, the presence of a general medical condition did not contribute to role impairment.
Adolescent primary care patients screening positive for depression are at increased risk for impairment in school/work productivity and educational attainment. These findings emphasize the importance of primary care clinicians’ attention to depression and role limitations.