Breaking the Connection Between Depressive Symptoms and Alcohol Use Among Adolescents With a Text-Message Delivered Intervention: A Randomized Controlled Pilot Trial in Primary Care

Adolescent depression is a significant public health problem reflected in increasing rates of major depressive episodes. Depression is also a critical risk for adolescent substance use. Adolescents who have experienced a major depressive episode are approximately twice as likely to engage in heavy drinking compared to those without. Developing strategies to intervene early and reduce adolescent depressive disorders and alcohol use is warranted. We examined the relationship between adolescent depressive symptoms and alcohol use with 69 adolescents enrolled in a preventive randomized controlled pilot trial for substance use risk within a federally qualified health care setting. We also tested a mediation model to determine if a text-delivered intervention reduced alcohol use by reducing depressive symptoms. Participants were randomized to a 4-week, text-delivered stress-and-coping intervention or a waitlist control condition. Participants completed baseline assessments and monthly follow-up surveys for 3 months. Logistic regression showed that adolescents with probable depressive disorder had six times higher odds of alcohol use compared to those with sub-clinical depressive symptoms. Mediation analysis revealed that the intervention reduced alcohol use by reducing depressive symptoms for adolescents with sub-clinical depressive scores. Results support targeting proximal risk factors such as depressive symptoms among adolescents presenting for primary care with text-delivered preventive interventions in order to reduce alcohol use. Incorporating more intensive interventions for adolescents with a broad range of presenting depressive symptoms is recommended.