Correlates of depressive symptoms among at-risk youth presenting to the emergency department.

OBJECTIVE The study's objective was to identify correlates of depressive symptoms among at-risk youth in an urban emergency department (ED). METHOD A systematic sample of adolescents (ages 14-18) in the ED were recruited as part of a larger study. Participants reporting past-year alcohol use and peer aggression self-administered a survey assessing: demographics, depressive symptoms and risk/protective factors. Logistic regression identified factors associated with depressive symptoms. RESULTS Among 624 adolescents (88% response rate) meeting eligibility criteria, 22.8% (n=142) screened positive for depressive symptoms. In logistic regression, depressive symptoms were positively associated with female gender [odds ratio (OR): 2.84, 95% confidence interval (CI): 1.78-4.51], poor academic performance (OR: 1.57, 95% CI: 1.01-2.44), binge drinking (OR: 1.88, 95% CI: 1.21-2.91), community violence exposure (OR: 2.25, 95% CI: 1.59-3.18) and dating violence (OR: 2.14, 95% CI: 1.36-3.38) and were negatively associated with same-sex mentorship (OR: 0.52, 95% CI: 0.29-0.91) and older age (OR: 0.55, 95% CI 0.34-0.89). Including gender interaction terms did not significantly change findings. CONCLUSIONS Screening and intervention approaches for youth in the urban ED should address the co-occurrence of depressive symptoms with peer and dating violence, alcohol and nonmarijuana illicit drug use.

[1]  E. Datner,et al.  Depression, acute stress and behavioral risk factors in violently injured adolescents. , 2007, General hospital psychiatry.

[2]  J. Fortenberry,et al.  Comparability of a computer-assisted versus written method for collecting health behavior information from adolescent patients. , 1999, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[3]  J. Klein,et al.  Health-compromising behaviors: why do adolescents smoke or drink?: identifying underlying risk and protective factors. , 2000, Archives of pediatrics & adolescent medicine.

[4]  A. Browne,et al.  What girls need: recommendations for preventing violence among urban girls in the US. , 2005, Social science & medicine.

[5]  D. Finkelhor,et al.  Psychiatric Diagnosis as a Risk Marker for Victimization in a National Sample of Children , 2009, Journal of interpersonal violence.

[6]  Kathrin Pietsch,et al.  SCREENING FOR DEPRESSION IN ADOLESCENTS: VALIDITY OF THE PATIENT HEALTH QUESTIONNAIRE IN PEDIATRIC CARE , 2012, Depression and anxiety.

[7]  S. Catlin,et al.  Lethality of firearms relative to other suicide methods: a population based study , 2003, Journal of epidemiology and community health.

[8]  K. Ball,et al.  Physical activity correlates in young women with depressive symptoms: a qualitative study , 2010, The international journal of behavioral nutrition and physical activity.

[9]  K. Bauman,et al.  Risk and protective factors distinguishing profiles of adolescent peer and dating violence perpetration. , 2011, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[10]  M. Irwin,et al.  Screening for depression in the older adult: criterion validity of the 10-item Center for Epidemiological Studies Depression Scale (CES-D) , 1999, Archives of internal medicine.

[11]  M. Zimmerman,et al.  Adolescent resilience: a framework for understanding healthy development in the face of risk. , 2005, Annual review of public health.

[12]  M. Ireland,et al.  Predictors of future fight-related injury among adolescents. , 2004, Pediatrics.

[13]  S. M. Rogers,et al.  Adolescent sexual behavior, drug use, and violence: increased reporting with computer survey technology. , 1998, Science.

[14]  B. Druss,et al.  Racial/ethnic differences in mental health service use among adolescents with major depression. , 2011, Journal of the American Academy of Child and Adolescent Psychiatry.

[15]  David Finkelhor,et al.  The effect of lifetime victimization on the mental health of children and adolescents. , 2006, Social science & medicine.

[16]  Janet B W Williams,et al.  Diagnostic and Statistical Manual of Mental Disorders , 2013 .

[17]  M. Zimmerman,et al.  Brief Motivational Interviewing Intervention for Peer Violence and Alcohol Use in Teens: One-Year Follow-up , 2012, Pediatrics.

[18]  L. Abramson,et al.  Development of gender differences in depression: an elaborated cognitive vulnerability-transactional stress theory. , 2001, Psychological bulletin.

[19]  K. Rhodes.  Mood disorders in the emergency department: the challenge of linking patients to appropriate services. , 2008, General hospital psychiatry.

[20]  L. Radloff.  The use of the Center for Epidemiologic Studies Depression Scale in adolescents and young adults , 1991, Journal of youth and adolescence.

[21]  K. Merikangas,et al.  Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication--Adolescent Supplement (NCS-A). , 2010, Journal of the American Academy of Child and Adolescent Psychiatry.

[22]  J. Eckenrode,et al.  Longitudinal Associations Between Teen Dating Violence Victimization and Adverse Health Outcomes , 2013, Pediatrics.

[23]  Leonard J. Paulozzi,et al.  Vital signs: overdoses of prescription opioid pain relievers---United States, 1999--2008. , 2011, MMWR. Morbidity and mortality weekly report.

[24]  D. Kivlahan,et al.  The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. , 1998, Archives of internal medicine.

[25]  D. Paunesku,et al.  Protective and vulnerability factors predicting new-onset depressive episode in a representative of U.S. adolescents. , 2008, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[26]  J. Elhai,et al.  Poly-victimization and risk of posttraumatic, depressive, and substance use disorders and involvement in delinquency in a national sample of adolescents. , 2010, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[27]  Christy K. Scott,et al.  The Cannabis Youth Treatment (CYT) experiment: rationale, study design and analysis plans. , 2002, Addiction.

[28]  M. Zimmerman,et al.  Rates and correlates of violent behaviors among adolescents treated in an urban emergency department. , 2009, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[29]  Kelly N. Graves.  Not Always Sugar and Spice: Expanding Theoretical and Functional Explanations for Why Females Aggress , 2007 .

[30]  D. Sugarman,et al.  The Revised Conflict Tactics Scales (CTS2) , 1996 .

[31]  B. Buchan,et al.  Cannabis use: consistency and validity of self-report, on-site urine testing and laboratory testing. , 2002, Addiction.

[32]  N. Ialongo,et al.  Longitudinal associations between community violence exposure and suicidality. , 2008, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[33]  R. Kessler,et al.  Epidemiology of DSM‐III‐R major depression and minor depression among adolescents and young adults in the national comorbidity survey , 1998, Depression and anxiety.

[34]  J. Mercy,et al.  Centers for Disease Control and Prevention's Expert Panel on Protective Factors for Youth Violence Perpetration: background and overview. , 2012, American journal of preventive medicine.

[35]  A. Bagnell,et al.  Factorial Validity of the Center for Epidemiological Studies Depression 10 in Adolescents , 2010, Issues in mental health nursing.

[36]  R. Iachan,et al.  Linking dating violence, peer violence, and suicidal behaviors among high-risk youth. , 2008, American journal of preventive medicine.

[37]  D L Patrick,et al.  Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). , 1994, American journal of preventive medicine.

[38]  N. Ialongo,et al.  Community Violence, Protective Factors, and Adolescent Mental Health: A Profile Analysis , 2010, Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53.

[39]  Esther Calvete,et al.  Gender Differences in Cognitive Vulnerability to Depression and Behavior Problems in Adolescents , 2005, Journal of abnormal child psychology.

[40]  C. King,et al.  Social and Interpersonal Factors Relating to Adolescent Suicidality: A Review of the Literature , 2008, Archives of suicide research : official journal of the International Academy for Suicide Research.

[41]  B. Baltes,et al.  Community violence: A meta-analysis on the effect of exposure and mental health outcomes of children and adolescents , 2009, Development and Psychopathology.

[42]  L. O'donnell,et al.  Aggressive behaviors in early adolescence and subsequent suicidality among urban youths. , 2005, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[43]  T. Simon,et al.  Clustering of Adolescent Dating Violence, Peer Violence, and Suicidal Behavior , 2008, Journal of interpersonal violence.

[44]  R. Spitzer,et al.  The PHQ-9: validity of a brief depression severity measure. , 2001, Journal of general internal medicine.

[45]  C Raymond Bingham,et al.  Three-month follow-up of brief computerized and therapist interventions for alcohol and violence among teens. , 2009, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[46]  C. Slovis,et al.  Alcohol on Campus: Alcohol‐Related Emergencies in Undergraduate college Students , 1998, Southern medical journal.

[47]  P. Martinez,et al.  The NIMH community violence project: I. Children as victims of and witnesses to violence. , 1993, Psychiatry.

[48]  R Jessor,et al.  Risk behavior in adolescence: a psychosocial framework for understanding and action. , 1991, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[49]  S. Budman,et al.  Connecting to Young Adults: An Online Social Network Survey of Beliefs and Attitudes Associated With Prescription Opioid Misuse Among College Students , 2011, Substance use & misuse.

[50]  Julie Gilchrist,et al.  "Choking game" awareness and participation among 8th graders--Oregon, 2008. , 2010, MMWR. Morbidity and mortality weekly report.

[51]  Mark Olfson,et al.  Service utilization for lifetime mental disorders in U.S. adolescents: results of the National Comorbidity Survey-Adolescent Supplement (NCS-A). , 2011, Journal of the American Academy of Child and Adolescent Psychiatry.

[52]  R. Maio,et al.  Violence and substance use as risk factors for depressive symptoms among adolescents in an urban emergency department. , 2007, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[53]  E. Shenassa,et al.  Brief screening for adolescent depressive symptoms in the emergency department. , 2008, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[54]  Nancy P Barnett,et al.  Alcohol use disorders identification test: factor structure in an adolescent emergency department sample. , 2002, Alcoholism, clinical and experimental research.

[55]  L. Watson,et al.  Depression and termination of pregnancy (induced abortion) in a national cohort of young Australian women: the confounding effect of women's experience of violence , 2008, BMC public health.

[56]  W. Katon,et al.  Association between posttraumatic stress and depressive symptoms and functional outcomes in adolescents followed up longitudinally after injury hospitalization. , 2008, Archives of pediatrics & adolescent medicine.

[57]  A. Kilbourne,et al.  Clinical importance of HIV and depressive symptoms among veterans with HIV infection , 2002, Journal of General Internal Medicine.

[58]  I. Seiffge-Krenke.  Causal links between stressful events, coping style, and adolescent symptomatology. , 2000, Journal of adolescence.

[59]  H. Resnick,et al.  Violence and risk of PTSD, major depression, substance abuse/dependence, and comorbidity: results from the National Survey of Adolescents. , 2003, Journal of consulting and clinical psychology.

[60]  Martha W. Waller,et al.  Adolescent depression and suicide risk: association with sex and drug behavior. , 2004, American journal of preventive medicine.

[61]  E. Frank,et al.  Adolescent onset of the gender difference in lifetime rates of major depression: a theoretical model. , 2000, Archives of general psychiatry.

[62]  M. Zimmerman,et al.  The overlap of youth violence among aggressive adolescents with past-year alcohol use-A latent class analysis: aggression and victimization in peer and dating violence in an inner city emergency department sample. , 2013, Journal of studies on alcohol and drugs.

[63]  H. Juon,et al.  Childhood, adolescent, and young adult predictors of suicidal behaviors: a prospective study of African Americans. , 1997, Journal of child psychology and psychiatry, and allied disciplines.

[64]  T. Simon,et al.  The Role of Families and Care Givers as Risk and Protective Factors in Preventing Youth Violence , 2000, Clinical child and family psychology review.

[65]  Nimesh Patel,et al.  Surveillance for violent deaths--National Violent Death Reporting System, 16 States, 2007. , 2010, Morbidity and mortality weekly report. Surveillance summaries.

[66]  D. Cole,et al.  Testing Reciprocal Longitudinal Relations Between Peer Victimization and Depressive Symptoms in Young Adolescents , 2012, Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53.

[67]  T. Harford,et al.  A Typology of Violence Against Self and Others and Its Associations With Drinking and Other Drug Use Among High School Students in a U.S. General Population Survey , 2012, Journal of child & adolescent substance abuse.

[68]  Gitanjali Saluja,et al.  Prevalence of and risk factors for depressive symptoms among young adolescents. , 2004, Archives of pediatrics & adolescent medicine.

[69]  A. Amstadter,et al.  Exposure to interpersonal violence and risk for PTSD, depression, delinquency, and binge drinking among adolescents: data from the NSA-R. , 2012, Journal of traumatic stress.

[70]  L R Muenz,et al.  Marijuana use among HIV-positive and high-risk adolescents: a comparison of self-report through audio computer-assisted self-administered interviewing and urinalysis. , 2000, American journal of epidemiology.

[71]  T. Schwenk.  Screening for depression in primary care. , 2000 .

[72]  Beth E. Molnar,et al.  THE IMPACT OF EXPOSURE TO INTERPERSONAL VIOLENCE ON GENDER DIFFERENCES IN ADOLESCENT‐ONSET MAJOR DEPRESSION: RESULTS FROM THE NATIONAL COMORBIDITY SURVEY REPLICATION (NCS‐R) , 2012, Depression and anxiety.

[73]  F. Barg,et al.  Patients' and Caregivers' Beliefs About Depression Screening and Referral in the Emergency Department , 2009, Pediatric emergency care.

[74]  E. Vittinghoff,et al.  The Influence of Depressive Symptoms on Clinician–Patient Communication Among Patients With Type 2 Diabetes , 2008, Medical care.

[75]  M. Krohn,et al.  The Self-Report Method for Measuring Delinquency and Crime , 2000 .

[76]  F. Barg,et al.  Adolescent Depression: Views of Health Care Providers in a Pediatric Emergency Department , 2010, Pediatric emergency care.

[77]  L. Zun,et al.  Who Are the Young Victims of Violence? , 2005, Pediatric emergency care.

[78]  D. Fergusson,et al.  Cannabis use and psychosocial adjustment in adolescence and young adulthood. , 2002, Addiction.

[79]  Cris M. Sullivan,et al.  Relationships Between Physical and Non-Physical Forms of Intimate Partner Violence and Depression among Urban Minority Adolescent Females. , 2011, Child and adolescent mental health.

[80]  D. Finkelhor,et al.  Psychological distress as a risk factor for re-victimization in children. , 2010, Child abuse & neglect.

[81]  S. Southwick,et al.  Clinical and functional correlates of posttraumatic stress disorder in urban adolescent girls at a primary care clinic. , 2000, Journal of the American Academy of Child and Adolescent Psychiatry.

[82]  K. Grant,et al.  A Prospective Comparison of Moderating Relationships among Stressors, Hopelessness, and Internalizing Symptoms in Low-Income Urban Youth with Asthma , 2012, Journal of Urban Health.

[83]  M. Boulton,et al.  Twenty years' research on peer victimization and psychosocial maladjustment: a meta-analytic review of cross-sectional studies. , 2000, Journal of child psychology and psychiatry, and allied disciplines.

[84]  D S Metzger,et al.  Randomized controlled trial of audio computer-assisted self-interviewing: utility and acceptability in longitudinal studies. HIVNET Vaccine Preparedness Study Protocol Team. , 2000, American journal of epidemiology.

[85]  J. Richters.  The NIMH community violence project , 1993 .

[86]  J. Cairney,et al.  Emergence of gender differences in depression during adolescence: national panel results from three countries. , 2002, Journal of the American Academy of Child and Adolescent Psychiatry.

[87]  K. Wilson,et al.  Adolescents Who Use the Emergency Department as Their Usual Source of Care , 2000 .

[88]  J. Billy,et al.  Assessment of factors affecting the validity of self-reported health-risk behavior among adolescents: evidence from the scientific literature. , 2003, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[89]  F. Barg,et al.  Feasibility and effects of a Web-based adolescent psychiatric assessment administered by clinical staff in the pediatric emergency department. , 2010, Archives of pediatrics & adolescent medicine.

[90]  H. Frey.  Suicide in the home in relation to gun ownership. , 1992, The New England journal of medicine.

[91]  J. Garber.  Depression in children and adolescents: linking risk research and prevention. , 2006, American journal of preventive medicine.

[92]  J. Fargo,et al.  Screening for Hazardous/Harmful Drinking and Depressive Symptoms in an At‐Risk Emergency Department Population , 2009 .

[93]  J. Seeley,et al.  Screening for depression prevention: identifying adolescent girls at high risk for future depression. , 2009, Journal of abnormal psychology.

[94]  M. Zimmerman,et al.  Sex differences in characteristics of adolescents presenting to the emergency department with acute assault-related injury. , 2011, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[95]  C. McDonald,et al.  Youth's Strategies for Staying Safe and Coping with the Stress of Living in Violent Communities. , 2010, Journal of community psychology.

[96]  Development and validation of the Conflict in Adolescent Dating Relationships Inventory. , 2001 .

[97]  N. Ialongo,et al.  Contextual Stress and Health Risk Behaviors Among African American Adolescents , 2011, Journal of youth and adolescence.

[98]  P. Lewinsohn,et al.  Adolescent psychopathology: I. Prevalence and incidence of depression and other DSM-III-R disorders in high school students. , 1993, Journal of abnormal psychology.

[99]  Thomas F. Babor,et al.  Alcohol Use Disorders Identification Test , 1995 .

[100]  C. Ziegler,et al.  Outcome of exposure to community violence in female adolescents. , 2010, Journal of pediatric and adolescent gynecology.

[101]  S. Mace,et al.  Children's Mental Health Emergencies-Part 1: Challenges in Care: Definition of the Problem, Barriers to Care, Screening, Advocacy, and Resources , 2008, Pediatric emergency care.

[102]  G. Patton,et al.  Association of adolescent symptoms of depression and anxiety with alcohol use disorders in young adulthood: findings from the Victorian Adolescent Health Cohort Study , 2011, The Medical journal of Australia.

[103]  F. Verhulst,et al.  Gender differences in the development and adult outcome of co-occurring depression and delinquency in adolescence. , 2011, Journal of abnormal psychology.

[104]  M. Zimmerman,et al.  Effects of a brief intervention for reducing violence and alcohol misuse among adolescents: a randomized controlled trial. , 2010, JAMA.

[105]  P. Chedraui,et al.  Depressive Symptoms and Resilience among Pregnant Adolescents: A Case-Control Study , 2011, Obstetrics and gynecology international.