title: Depression and role impairment among adolescents in primary care clinics.
abstract: OBJECTIVE
  To evaluate the association between depression and role impairment in a primary care sample, with and without controlling for the effects of general medical conditions.
  
  
  METHODS
  Cross-sectional survey of consecutive primary care patients, ages 13-21 years (n = 3471), drawn from six sites including public health, managed care, and academic health center clinics. We assessed probable depressive disorder, depressive symptoms, and common medical problems using youth self-report on a brief screening questionnaire. Main outcome measures were two indicators of role impairment: (a) decrement in productivity/role activity, defined as not in school or working full time; and (b) low educational attainment, defined as more than 2 years behind in school or > or = 20 years of age and failed to complete high school.
  
  
  RESULTS
  Adolescents screening positive for probable depressive disorder had elevated rates of productivity/role activity decrements (19% vs. 13%; OR 1.69; 95% confidence interval [CI] 1.39-2.06; p < 0.001) and low educational attainment (20% vs. 15%; OR 1.47; 95% CI 1.21-1.78; p < 0.001). Probable depressive disorder made a unique contribution to the prediction of these impairment indicators after adjusting for the effect of having a general medical condition; controlling for depression, the presence of a general medical condition did not contribute to role impairment.
  
  
  CONCLUSIONS
  Adolescent primary care patients screening positive for depression are at increased risk for impairment in school/work productivity and educational attainment. These findings emphasize the importance of primary care clinicians' attention to depression and role limitations.
authors.affiliation: University of California, Los Angeles School of Medicine, Los Angeles, California, USA. jasarnow@mednet.ucla.edu
authors.forename: Joan Rosenbaum
authors.initials: JR
authors.lastname: Asarnow
authors.forename: Lisa H
authors.initials: LH
authors.lastname: Jaycox
authors.forename: Naihua
authors.initials: N
authors.lastname: Duan
authors.forename: Anne P
authors.initials: AP
authors.lastname: LaBorde
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Rea
authors.forename: Lingqi
authors.initials: L
authors.lastname: Tang
authors.forename: Martin
authors.initials: M
authors.lastname: Anderson
authors.forename: Pamela
authors.initials: P
authors.lastname: Murray
authors.forename: Christopher
authors.initials: C
authors.lastname: Landon
authors.forename: Beth
authors.initials: B
authors.lastname: Tang
authors.forename: Diana P
authors.initials: DP
authors.lastname: Huizar
authors.forename: Kenneth B
authors.initials: KB
authors.lastname: Wells
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000209:etiology / Q000523:psychology*; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D011320:Primary Health Care / Q000706:statistics & numerical data; D012307:Risk Factors; D012380:Role