Depression and role impairment among adolescents in primary care clinics

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 eft'ect of having a general medical conditions 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 ernphasize the importance of primary care clinicians' attention to depression and role limitations. (c) 2005 Society for Adolescent Medicine. All rights reserved.