Adolescents in Primary Care with Sub-Threshold Depressed Mood Screened for Participation in a Depression Prevention Study: Co-Morbidity and Factors Associated with Depressive Symptoms.

Purpose: Adolescents in primary care with sub-threshold depression symptoms may be candidates for early intervention to prevent onset of full major depressive disorder. Little is known about this population.

Method: We screened consecutive adolescents (ages 14-21) in 13 primary care sites for presence of depression symptoms for "at least a few days" or "nearly every day" in the last two weeks for possible enrollment in a primary care/Internet-based depression prevention intervention (CATCH-IT). We report illness severity, prevalence of self-harm ideation, prevalence correlates (automatic negative thoughts, generalized self-efficacy, perceived social support from family and friends) and co-occurring symptoms of other mental disorders with depressed mood.

Results: Twenty-one percent (N=293) of those screened reported a core symptom of depressive disorder of which 83 enrolled in the study and were analyzed. The sample was 40% ethnic minority with a mean zip code household income of $40,249 (SD=$14,500). Reporting at least one symptom of another mental disorder was common for anxiety (48%, N=40), substance abuse (31%, N=15), conduct disorder (71%, N=53), as were self-harm ideation (16%, N=12) and reporting school impairment (100%, N=83). Prevalence correlates for current depressive symptoms included low self-efficacy, automatic negative thoughts, perceived low peer acceptance, and school impairment.

Conclusions: Adolescents with sub-threshold depressed mood have frequent co-morbid symptoms that may need to be considered in developing prevention interventions. Early intervention targets to reduce depressed mood include pessimistic thinking, low self-efficacy, low peer acceptance, and school impairment.