Reducing health risk behaviors and improving depression in adolescents: A randomized controlled trial in primary care clinics

• Main Authors: Anderson, M. (Author), Asarnow, J.R (Author), Avina, C. (Author), Bai, S. (Author), D'Amico, E.J (Author), Fitzpatrick, O.M (Author), LaBorde, A.P (Author), Shoptaw, S. (Author), Zeledon, L.R (Author)
• Format: Article
• Language: English
• Published: Oxford University Press 2018
• Subjects: Adolescence; adolescent; Adolescent; adolescent behavior; Adolescent Behavior; controlled study; depression; Depression; Depressive Disorder; drug dependence; female; Female; follow up; Follow-Up Studies; health promotion; Health Promotion; Health risk behaviors; Health Risk Behaviors; high risk behavior; human; Humans; Integrated care; Intervention; male; Male; obesity; Obesity; prevention and control; Primary care; primary health care; Primary Health Care; procedures; Prospective Studies; prospective study; psychology; randomized controlled trial; smoking; Smoking; Substance-Related Disorders; unsafe sex; Unsafe Sex
• Online Access: View Fulltext in Publisher

 Objective: Primary care (PC) is a major service delivery setting that can provide preventive behavioral health care to youths. To explore the hypothesis that reducing health risk behaviors (HRBs) would lower depressive symptoms, and that health risk and depression can be efficiently targeted together in PC, this study (1) evaluates an intervention designed to reduce HRBs among adolescent PC patients with depressive symptoms and (2) examines prospective links between HRBs and depressive symptoms. Method: A Randomized controlled trial was conducted comparing a behavioral health intervention with enhanced Usual PC (UCþ). Participants were 187 adolescents (ages 13-18 years) with past-year depression, assessed at baseline, 6 months, and 12 months. Primary outcome was the Health Risk Behavior Index (HRBI), a composite score indexing smoking, substance use, unsafe sex, and obesity risk. Secondary/exploratory outcomes were an index of the first three most correlated behaviors (HRBI-S), each HRB, depressive symptoms, and satisfaction with mental health care. Results: Outcomes were similar at 6 and 12 months, with no significant between-group differences. HRBI, HRBI-S, and depressive symptoms decreased, and satisfaction with mental health care increased across time in both groups. HRBI, HRBI-S, and smoking predicted later severe depression. Conversely, severe depression predicted later HRBI-S and substance use. Conclusions: UCþ and the behavioral health intervention yielded similar benefits in reducing HRBs and depressive symptoms. Findings underscore the bidirectional links between depression and HRBs, supporting the importance of monitoring for HRBs and depression in PC to allow for effective intervention in both areas. © The Author(s) 2018. Published by Oxford University Press on behalf of the Society of Pediatric Psychology.