Advertisement

Depression and role impairment among adolescents in primary care clinics

      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

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Adolescent Health
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Murray C.J.
        • Lopex A.D.
        The Global Burden of Disease. The Harvard School of Public Health on behalf of the World Health Organization and the World Bank, Boston, MA1996
        • Lewinsohn P.
        Depression in adolescents.
        in: Gotlib I. Hammen C. Handbook of Depression. Guilford Press, New York, NY2002: 541-553
        • Kessler R.C.
        Epidemiology of depression.
        in: Gotlib I. Hammen C. Handbook of Depression. Guilford Press, New York, NY2002: 23-42
        • Centers for Disease Control
        Youth risk behavior surveillance—United States. 2001 (Available from: www.cdc.gov/mmwr/preview/mmwrhtml/ss5104a1.htm.)
        • Shaffer D.
        • Pfeffer C.
        • et al.
        • American Academy of Child and Adolescent Psychiatry
        Practice Parameters for the Assessment and Treatment of Children and Adolescents with Suicidal Behavior. AACAP Communications Department, Washington, DC2000
        • Weissman M.
        • Wolk S.
        • Goldstein R.
        • et al.
        Depressed adolescents grown up.
        JAMA. 1999; 281: 1707-1713
        • Lewinsohn P.M.
        • Rohde P.
        • Seeley J.R.
        Natural course of adolescent major depressive disorder: I. Continuity into young adulthood.
        J Am Acad Child Adolesc Psychiatry. 1999; 38: 56-63
        • Katon W.
        • Von Korff M.
        • Lin E.
        • et al.
        Collaborative management to achieve treatment guidelines. Impact on depression in primary care.
        JAMA. 1995; 273: 1026-1031
        • Von Korff M.
        • Gruman J.
        • Schaefer J.
        • et al.
        Collaborative management of chronic illness.
        Ann Intern Med. 1997; 127: 1097-1102
        • Wells K.B.
        • Sherbourne C.D.
        • Schoenbaum M.
        • et al.
        Impact of disseminating quality improvement programs for depression in managed primary care.
        JAMA. 2000; 283: 212-220
        • U.S. Department of Health and Human Services
        Mental Health. U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, Natonal Institute of Health, National Institute of Mental Health, Rockville, MD1999
      1. National Institute of Mental Health. (July 9 2002): The strategic plan for mood disorders research. [cited 2002 Jul 9]. Available from: http://www.nimh.nih.gov/strategic/stplan_mooddisorders.cfm.

        • World Health Organization
        Mental Health Ministerial Round Tables.
        Fifty-fourth World Health Assembly. 2001
        • Ziv A.
        • Boulet J.R.
        • Slap G.B.
        Utilization of physician offices by adolescents in the United States.
        Pediatrics. 1999; 104: 35-42
        • Kramer T.
        • Garralda M.
        Psychiatric disorders in adolescents in primary care.
        Br J Psychiatry. 1998; 173: 508-513
        • Daniels D.
        • Moos R.
        Assessing life stressors and social resources among adolescents.
        J Pediatr. 1990; 5: 268-289
        • Lewinsohn P.M.
        • Seeley J.R.
        • Hibbard J.
        • Rohde P.
        • Sack W.H.
        Cross-sectional and prospective relationships between physical morbidity and depression in older adolescents.
        J Am Acad Child Adolesc Psychiatry. 1996; 35: 1120-1129
        • Lewinsohn P.M.
        • Gotlib I.H.
        • Seeley J.R.
        Depression-related psychosocial variables.
        J Abnorm Psychol. 1997; 106: 365-375
        • Lewinsohn P.M.
        • Rohde P.
        • Seeley J.R.
        • Klein D.N.
        • Gotlib I.H.
        Psychosocial characteristics of young adults who have experienced and recovered from major depressive disorder during adolescence.
        J Abnorm Psychol. 2003; 112: 353-363
        • World Health Organization
        Composite International Diagnostic Interview (CIDI) Core Version. 2.1 Interviewer’s Manual. 1997 (Geneva)
        • Burnam M.A.
        • Wells K.B.
        • Leake B.
        • Landsverk J.
        Development of a brief screening instrument for detecting depressive disorders.
        Med Care. 1988; 26: 775-789
        • Radloff L.S.
        The CES-D scale.
        Appl Psychol Meas. 1977; 1: 385-401
        • Clarke G.N.
        • Hawkins W.
        • Murphy M.
        • et al.
        Targeted prevention of unipolar depressive disorder in an at-risk sample of high school adolescents.
        J Am Acad Child Adolesc Psychiatry. 1995; 34: 312-321
        • Moos R.H.
        • Moos B.S.
        Life Stressors and Social Resources Inventory. Stanford University Center for Health Care Evaluation, Palo Alto, CA1992
        • Wells K.
        • Sherbourne C.
        Functioning and utility for current health of patients with depression or chronic medical conditions in managed, primary care practices.
        Arch Gen Psychiatry. 1999; 56: 897-904
        • StataCorp
        Stata Statistical Software, Release 7.0 edn. Stata Corporation, College Station, TX2001
        • Hosmer D.W.
        • Lemeshow S.
        Applied Logistic Regression, 2nd edn. Wiley, New York2000
        • Asarnow J.
        • Jaycox L.H.
        • Tompson M.C.
        Depression in youth.
        J Clin Child Psychol. 2001; 30: 33-47
        • Mufson L.
        • Weissman M.M.
        • Moreau D.
        • et al.
        Efficacy of interpersonal psychotherapy for depressed adolescents.
        Arch Gen Psychiatry. 1999; 56: 573-579
        • Rosello J.
        • Bernal G.
        Treatment of depression in Puerto Rican adolescents.
        J Consult Clin Psychol. 1999; 67: 734-745
        • Irwin Jr, C.E.
        • Burg S.J.
        • Uhler C.
        America’s adolescents.
        J Adolesc Health. 2002; 31: 91-121
        • Shafer M.
        • Tebb K.
        • Pantell R.
        • et al.
        Effect of a clinical practice improvement intervention on chlamydial screening among adolescent girls.
        JAMA. 2002; 288: 2846-2852
        • Bordley W.C.
        • Margolis P.A.
        • Stuart J.
        • et al.
        Improving preventative service through office systems.
        Pediatrics. 2001; 108: E41
        • Heinrich P.
        • Homer C.J.
        Improving the care of children with asthma in pediatric practice: the HIPPO project. Helping Improve Pediatric Practice Outcomes.
        Pediatr Ann. 1999; 28: 64-72
        • Asarnow J.R.
        • Jaycox L.H.
        • Duan N.
        • et al.
        Effectiveness of a quality improvement intervention for adolescent depression in primary care clinics.
        JAMA. 2005; 293: 311-319