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Lydia A. Shrier, MD, MPH; Sion Kim Harris, PhD; William R. Beardslee, MD

Arch Pediatr Adolesc Med. 2002;156:599-606.

Objective  To examine the longitudinal associations between depressive symptoms and self-reported sexually transmitted disease (STD) diagnosis among adolescents.

Setting and Participants  National Longitudinal Study of Adolescent Health data were analyzed for 7th through 12th graders who reported having sexual intercourse between baseline (Wave 1) and 1-year follow-up (Wave 2) in-home interviews (N = 4738 [2232 boys, 2506 girls]). The association between level of depressive symptoms at Wave 1 and self-reported diagnosis of STD between Wave 1 and Wave 2 was explored separately for boys and girls using logistic regression that controlled for age, race/ethnicity, virginity, and history of STD at Wave 1. Alcohol and marijuana use were assessed as potential mediators. The association between interval STD diagnosis and subsequent very high levels of depressive symptoms (predictive of major depression) was also examined separately by sex controlling for demographic characteristics and baseline depressive symptoms.

Main Outcome Measures  Self-reported STD diagnosis and depressive symptoms.

Results  For boys and girls, higher frequency of depressive symptoms at baseline predicted increased risk of being diagnosed as having an STD within 1 year. After adjusting for history of STD, the association was no longer significant for girls. Alcohol and marijuana use did not mediate this association for either sex, although very frequent alcohol use was an independent predictor of STD diagnosis for boys. For boys and girls, being diagnosed as having an STD within 1 year was associated with very high levels of depressive symptoms at the end of that year in both bivariate and multivariate models.

Conclusions  Screening for depressive symptoms in sexually active adolescents, particularly boys, may identify those at risk for STDs. In addition, adolescents who are diagnosed as having STDs should be monitored for depression. These findings suggest that adolescent preventive care needs to include regular, comprehensive assessments of both mental health and STD.

From the Division of Adolescent/Young Adult Medicine, Department of Medicine (Dr Shrier); Clinical Research Core Programs Office (Dr Harris), and Department of Psychiatry (Dr Beardslee), Children's Hospital, Harvard Medical School, Boston, Mass.

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