Screening for Depression in Reproductive Sexual Health Clinics: Potential Identification of At-Risk Young African-American Women

Background: Young women who experience symptoms of depression often are not identified or provided with adequate treatment. Furthermore, little is known about the association between depressive symptoms, other psychological constructs, and sexual risk behavior among African-American female adolescents recruited from sexual health clinics. Method: 701 African American adolescent females (ages 14-20 years) completed self-administered ACASI interviews with measures of psychological functioning, abuse history, substance use, and sexual behaviors prior to participating in an STD/HIV prevention trial. Bivariate analyses examined differences between those with low and high depressive symptoms on the CES-D short form (high = score >7). Results: 41.2% had elevated depressive symptoms. Increased depressive symptoms were associated with: lower self-esteem (p = .001), elevated stress (p = .001), less social support (p = .001), greater impulsivity (p = .001), more frequent use of alcohol (p = .036) and marijuana (p = .069), and history of physical abuse (p = .001), emotional abuse (p = .001), or forced sexual experience (p = .002). Depressed individuals also reported more sexual risk behavior engagement including: greater number of sexual partners (p = .001) and more unprotected sexual encounters during past 90 days (p = .013). Conclusion: Adolescents with elevated depressive symptoms are likely to experience significant psychological distress across multiple domains. Screening for depression in sexual health clinics may help to identify at-risk individuals and provide necessary mental health treatment. Additionally, sexual risk reduction interventions may also benefit from incorporation of content to address the mental health needs of this vulnerable population.