BOSTON – Adolescent boys and girls with symptoms of depression are more likely than their nondepressed peers to engage in high-risk sexual behavior, results of a recent study have shown.
These findings fuel arguments in favor of expanding depression prevention, screening, and treatment efforts in this vulnerable population, Jocelyn A. Lehrer, Sc.D., said at the annual meeting of the Society for Adolescent Medicine.
The results were based on home interview data from a sample of 4,152 sexually active, unmarried high school students who participated in Waves I and II of the National Longitudinal Study of Adolescent Health at 1-year intervals between 1995 and 1996.
Dr. Lehrer of the University of California, San Francisco, and her colleagues at the Harvard School of Public Health and Children's Hospital Boston examined associations between baseline depressive symptoms (measured as both trichotomous and continuous variables) and sexual risk behaviors over the course of the year between the first and second interviews.
The researchers conducted separate analyses for boys and girls and adjusted for demographic variables, religious practices, same-sex attraction and behaviors, sexual intercourse before age 10, and baseline sexual risk behaviors.
Depressive symptoms were assessed using a 19-item modified Center for Epidemiological Studies-Depression Scale. Among the sexual risk behaviors examined were condom nonuse, birth control nonuse, and substance use–all at last sexual encounter–as well as participation with multiple sexual partners.
“In the adjusted models for both the boys and the girls, adolescents with high levels of depressive symptoms at baseline were significantly more likely than those with low or no symptom levels [to have engaged in] at least one of the sexual risk behaviors over the course of the year,” Dr. Lehrer said.
Among boys, high levels of depressive symptoms predicted condom nonuse, birth control nonuse, and substance use in both the trichotomous (low, moderate, and high symptom levels) and continuous depression measure analyses, she said.
Among girls, analysis with the continuous depression measure showed significant associations between depressive symptoms and condom nonuse, birth control nonuse, participation with three or more sexual partners, and any other sexual risk behavior. In the parallel analysis with the trichotomous depression measures, moderate depressive symptoms predicted substance use at last sexual encounter. No link was seen between high depressive symptom levels and individual sexual risk behaviors, Dr. Lehrer said.
“The findings of this study suggest that elevated depressive symptom levels during adolescence may, at the very least, serve as a red flag for an increased likelihood of sexual risk behaviors,” Dr. Lehrer said.
“This has important implications both for depression screening and sexual health counseling by primary care providers and mental health providers.”
Additionally, because of the increased risk of STDs associated with sexual risk behaviors, the content of population-based STD and HIV prevention programs should include educational information on the signs and symptoms of depression and resources for getting help, Dr. Lehrer said.