Original article
Depression and role impairment among adolescents in primary care clinics

https://doi.org/10.1016/j.jadohealth.2004.11.123Get rights and content

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.

Section snippets

Methods

This first article reports findings from the initial eligibility screening for Youth Partners in Care (YPIC), an effectiveness trial of a quality improvement intervention aimed at increasing access to evidence-based treatments for adolescent depression through primary care. Other publications will focus on the smaller sample enrolled in the intervention phase of the project.

Results

Patients were diverse in age, ethnicity, and gender; and these demographic variables varied by site. As shown in Table 1, the sample ranged in age from 13 to 21 years inclusive, with a mean age of 16.89 years (SD 2.00). A large number of ethnic minority youth were included. Over half of the patients identified themselves as Latino or Hispanic, 74% considered themselves to belong to a non-Caucasian ethnic group, with another 13% reporting mixed ethnicity (Table 1). The overall rate of probable

Discussion

We found that in a large, ethnically diverse sample of adolescents representative of those visiting their health clinics, depression was uniquely associated with clinically meaningful and statistically significant decrements in school and work productivity, and in educational attainment. These findings were confirmed using two indicators of depression (probable depressive disorder and a dimensional measure of depressive symptoms), and with and without controlling for medical conditions.

Acknowledgments

The study was supported by a grant from the Agency for Healthcare Research and Quality (grant HS09908). Dr. Wells was supported in part by grant MH546230 from the National Institute of Mental Health. We thank all of the health care providers, staff, administrators, and patients at the participating sites, which include: Kaiser Permanente Los Angeles Medical Center, Children’s Hospital Pittsburgh, Western Psychiatric Institute & Clinics, UCLA Medical Center, Venice Family Clinic, and Ventura

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    Copyright © 2005 Society for Adolescent Medicine. Published by Elsevier Inc. All rights reserved.