Depression and role impairment among adolescents in primary care clinics

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.

doi:10.1016/j.jadohealth.2004.11.123

« Previous Next »Journal of Adolescent Health
Volume 37, Issue 6 , Pages 477-483, December 2005

Depression and role impairment among adolescents in primary care clinics

Joan Rosenbaum Asarnow, Ph.D.
- University of California, Los Angeles School of Medicine, Los Angeles, California, USA
- Corresponding author. Tel.: 310-825-0408; fax: 310-206-4446. (J.R. Asarnow)
Lisa H. Jaycox, Ph.D.
- RAND, Santa Monica, California, USA
Naihua Duan, Ph.D.
- University of California, Los Angeles School of Medicine, Los Angeles, California, USA
Anne P. LaBorde, Ph.D., Psy.D.
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA
Margaret M. Rea, Ph.D.
- University of California, Davis, School of Medicine, Sacramento, California, USA
Lingqi Tang, Ph.D.
- University of California, Los Angeles School of Medicine, Los Angeles, California, USA
Martin Anderson, M.D., M.P.H.
- University of California, Los Angeles School of Medicine, Los Angeles, California, USA
Pamela Murray, M.D., M.H.P.
- Children’s Hospital Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
Christopher Landon, M.D.
- Ventura County Medical Center, Landon Pediatrics, Ventura, California, USA
Beth Tang, M.A.
- University of California, Los Angeles School of Medicine, Los Angeles, California, USA
Diana P. Huizar, B.A.
- University of California, Los Angeles School of Medicine, Los Angeles, California, USA
Kenneth B. Wells, M.D., M.P.H.
- University of California, Los Angeles School of Medicine, Los Angeles, California, USA
- RAND, Santa Monica, California, USA

Received 3 March 2004; received in revised form 4 November 2004

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords: Depression , Adolescence , Impairment