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Am Fam Physician. 2002;66(8):1532-1535

Several studies have found an association between mental health problems in adolescents and the incidence of sexually transmitted diseases (STDs). Adolescents may attempt to cope with depression through risky sexual behaviors. Persons with depression, especially males, tend to divert their attention from depressive symptoms to neutral or pleasant activities such as sexual intercourse. Many studies have examined the connection between mental illnesses and risky sexual behavior but have focused mainly on specialized populations, such as homeless persons and runaways. Shrier and colleagues examined the longitudinal association between depressive symptoms and self-reported STDs in adolescents.

The study consisted of an in-home interview of students in grades 7 through 12. The sample was randomly selected from 80 high schools and 52 associated feeder schools. Approximately one year later, the students completed a second in-home interview. Adolescents who were included in the data analysis consistently reported having sexual intercourse at least once between the initial interview and the follow-up interview. Depressive symptoms were identified using a modified version of the Center for Epidemiologic Studies Depression Scale. During the initial and follow-up interviews, participants were asked if they had ever been diagnosed with an STD. The correlation between self-reported STDs and depressive symptoms was the main outcome measured.

A higher frequency of depressive symptoms at baseline predicted an increased risk of being diagnosed with an STD within one year for persons of both genders. The use of alcohol and marijuana did not alter this association. Frequent alcohol use was an independent predictor of STD diagnosis in males. Being diagnosed with an STD within one year was associated with very high levels of depressive symptoms when bivariate and multivariate analyses were used.

The authors conclude that screening sexually active adolescents for depressive symptoms may identify those at risk for STDs. In addition, adolescents who are diagnosed with an STD should be evaluated for depression. The results of this study suggest that comprehensive screening for STDs and mental health disorders should be a regular part of preventive health care for adolescents.

editor's note: The association between depression and some of the common adolescent issues is becoming apparent as more studies explore these relationships. In the study by Shrier and colleagues, depressive symptoms clearly correlate with STDs and vice versa. This finding adds to the information about a link between depressive symptoms and increased risky sexual behaviors. The theme is that when risky behaviors or STDs are identified, patients also should be screened to determine the presence or absence of depression. The next step is to determine if treatment of depression can reduce these risky behaviors and the incidence of STDs.—k.e.m.

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