- Email: [email protected]
Health Status of Adolescents Who Report Psychosomatic Symptoms in Comparison to Those Who are Chronically Ill
Abstracts / 46 (2010) S17–S81
S47
identified (sometimes known as somatoform disorders or complex medico-psycho-social presentations). The Clinic offers multi-disciplinary treatment, taking a rehabilitative approach that aims to improve the adolescent’s day-to-day functioning. As part of this process, the team attempts to help families to gradually draw a link between somatic and psychological aspects of their condition. The purpose of this study was to (a) examine how family health beliefs change over the course of treatment, and (b) explore whether changes in health beliefs impact on improvements in adolescent functioning. Its strengths include a prospective design with a 12-month follow-up, which is rarely achieved in research with this population. Methods: 50 adolescents and their parents were recruited to the study, 40 of whom were female. They were aged between 12 and 17 years (M ¼ 14.4, SD ¼ 1.32). 36% met criteria for Chronic Fatigue Syndrome, and the remaining 64% received a DSM-IV diagnosis of one of the Somatoform Disorders. Participants and their parents completed questionnaires measuring physical and psychosocial functioning and illness perceptions at recruitment, 4 months into treatment, and 12 months later. Multivariate analyses of variance (MANOVAs) were conducted to examine how adolescent functioning and family health beliefs changed over the 12-month period. Further, multiple-regression analyses were conducted to determine whether changes in health beliefs influenced functional improvements. Results: There were significant improvements in adolescent physical and psychosocial functioning over the course of treatment (F [4,28] ¼ 10.00, p < .001, Wilk’s Lambda ¼ .412, partial eta squared ¼ .588). Parent health beliefs also changed significantly over this time period (for mothers, F [10, 21] ¼ 3.34, p ¼ .01, Wilk’s Lambda ¼ .4, partial eta squared ¼ .614; for fathers, F [10,12] ¼ 2.76, p ¼ .050, Wilk’s Lambda ¼ .3, partial eta squared ¼ .697). However, adolescent health beliefs were less amenable to change (F(10, 20) ¼ 1.43, p ¼ .237, Wilk’s Lambda ¼ .6, partial eta squared ¼ .417). A significant model emerged when changes in adolescent functioning were predicted by changes in mother’s health beliefs (F [5, 27] ¼ 3.108, p ¼ .024). This model accounted for 24.8% of the variance in adolescent psychosocial functioning. Conclusions: This study provides support for a family-based approach to adolescents with complex-medico-psycho-social conditions. It illustrates that parental health beliefs may be a more important therapeutic target than those of the adolescent. Sources of Support: This study was supported in part by a grant from the Medical Foundation of the University of Sydney.
quences for people living with HIV as people with PTSD are more likely to engage in substance abuse and less likely to adhere to antiretroviral therapy compared to people without PTSD. Surprisingly, however, relatively little attention has been paid to this area in the adolescent population. A better understanding of PTSD and PTSD-HIV in HIV positive adolescents can help the development of interventions that will target mental health, adherence and overall quality of life of adolescents living with HIV. Methods: Ninety three HIV positive adolescents were screened for mental health issues as part of routine care in an HIV Adolescent Medicine clinic in a large metropolitan city. Participants were between the ages of 14 and 24 (mean 19.3) and were 47 % (n ¼ 44) male and 53% (n ¼ 49) female. The brief mental health screening instrument utilized in the clinic, adapted from the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire, screens for anxiety, PTSD, HIV-PTSD, panic, depression, substance abuse, psychosis and cognition. Adolescents are routinely screened at least once per year and appropriate referrals are initiated for comprehensive assessment and treatment as clinically indicated. Results: Nine-three HIV positive adolescents were screened for mental health issues. Seventy-three percent of the adolescents were positive for some mental health concern, with 44% scoring positive in two or more areas. The most commonly identified issues were depression and anxiety. Specifically, 43% of the adolescents were positive for generalized anxiety, 30% for depression and 25% for some type of PTSD, including 11% HIV-PTSD. Additionally, 25% were positive for substance abuse, 16% for cognition and 6% for psychosis. Among adolescents who were positive for some type of PTSD, 9 were positive for PTSD only, 6 for PTSDHIV only and 4 were positive for both PTSD and PTSD-HIV. Adolescents with PTSD were more likely to also endorse symptoms of generalized anxiety, (63% vs 42%), depression (42% vs. 27%) panic (21% vs. 9%) and cognition (26% vs. 14%) when compared to adolescents without PTSD. Conclusions: HIV positive adolescents in our clinic report experiencing high levels of depression, generalized anxiety and PTSD, including PTSD related to their HIV diagnosis. Adolescents with PTSD were more likely to also endorse symptoms of generalized anxiety, depression, panic and cognition difficulties when compared to adolescents without PTSD. Our results indicate the need for additional research in this area that can inform the development of specific interventions tailored for HIV positive adolescents with PTSD symptoms. Sources of Support: None.
67.
68.
PREVALENCE OF PTSD SYMPTOMS IN ADOLESCENTS LIVING WITH HIV Lourdes Illa, MD1, Gustavo Benejam, PsyD.1, Onelia Lage, MD2, Lawrence Friedman, MD2, Hanna Major-Wilson, MSN1, Donna Maturo, MSN1, Debra Latson-McEwen1. 1University of Miami; 2University of Miami Miller School of Medicine
HEALTH STATUS OF ADOLESCENTS WHO REPORT PSYCHOSOMATIC SYMPTOMS IN COMPARISON TO THOSE WHO ARE CHRONICALLY ILL J.C. Suris, MD, PhD, Richard Belanger, MD, Andre Berchtold, PhD, Anne-Emmanuelle Ambresin, MD, Pierre-Andre Michaud, MD. Research Group on Adolescent Health, Institute of Social and Preventive Medicine, University of Lausanne
Purpose: This study examines the rates of PTSD symptomatology in adolescents living with HIV. Existing research has demonstrated that HIV positive adolescents have higher rates of psychiatric symptoms than their HIV negative counterparts. Commonly reported psychological morbidities among HIV positive youth include depression, anxiety, substance abuse and childhood sexual abuse. Additionally, high rates of PTSD have been documented in persons living with HIV/AIDS. There is also an increasing awareness that the diagnosis of HIV can in itself be perceived as a traumatic event and therefore be linked to the development of PTSD symptoms. A diagnosis of PTSD can have negative health conse-
Purpose: To assess the respective impact on health status of having either psychosomatic symptoms or a chronic condition. Methods: Using the SMASH 2002 database (a cross sectional survey among a representative sample of Swiss youths aged 1620 years), we defined psychosomatic symptoms as having reported at least one symptom (headache, stomach ache, sleeping problems, or dizziness) very often in the previous 12 months and chronic condition as a disease lasting at least 6 months and requiring continuous medical care and/or a disability limiting daily activities. Based on these two variables, 3 groups were created: those
S48
Abstracts / 46 (2010) S17–S81
reporting at least a psychosomatic symptom but no chronic condition (PS, n ¼ 1010; 14%), those reporting a chronic condition but not PS (CC; n ¼ 497; 6.9%) and those not reporting any (Control group; n ¼ 5709; 79.1%) that was used as the reference category. Those reporting both PS and CC (n ¼ 213) were not included in the analyses. Analyzed health variables were: poor health, depression, having been hospitalized, missing school due to illness, and having seen (once or twice/3 times or more) their primary care physician, a specialist or a mental health specialist in the previous 12 months. We performed a multinomial logistic regression controlling for age, gender, family structure and relationship with parents. Results are given as relative risk ratios (RRR) with 95% confidence intervals. Results: Compared to the Control group, and contrary to CC, PS youths were more likely to be depressed (RRR PS: 3.30 [2.63/ 4.14]; CC: 1.35 [.96/1.89]) and to have seen their primary care physician (RRR PS: 1.68 [1.23/2.30]; CC: 1.32 [.92/1.89]) or a mental health specialist (RRR PS: 1.95 [1.18/3.22]; CC: 1.06 [.61/1.83]) three or more times in the previous 12 months. Both groups were significantly more likely than the control group to report poor health (RRR PS: 3.20 [1.94/5.28]; CC: 2.15 [1.46/3.17]), having been hospitalized (RRR PS: 1.39 [1.08/1.81]; CC: 1.86 [1.39/2.48]) and having missed school due to their illness (RRR PS: 2.79 [1.65/4.73]; CC: 2.10 [1.22/3.60]), although no differences were observed among them. Additionally, those in the CC group, but not in PS, were significantly more likely than the control group to have seen a specialist once or twice (RRR PS:.99 [.78/1.25]; CC: 3.40 [2.56/ 4.52]) or 3 times or more (RRR PS: 1.15 [.85/1.55]; CC: 6.50 [4.66/ 9.08]). Conclusions: Although similar in some aspects, adolescents reporting psychosomatic symptoms seem to do worse than those suffering from a chronic condition: they are more depressed and have seen their primary care physician or a mental health specialist more often. The fact that CC youths are more likely than PS ones to have seen a specialist can be attributed to the regular follow-up of their chronic condition. Our results seem to indicate that having psychosomatic symptoms can be as or even more handicapping than having a chronic condition. Sources of Support: The SMASH02 survey was carried out with the financial support of the Swiss Federal Office of Public Health and the participating cantons.
69. INCORRECT CONDOM USE AMONG DEPRESSED ADOLESCENTS AND YOUNG ADULTS: AN EVENTLEVEL ANALYSIS Lydia Shrier, MD, MPH, Courtney Walls, MPH, Christopher Lops, MA, Henry Feldman, PhD. Children’s Hospital Boston Purpose: (1) To describe condom use errors in depressed adolescents and young adults and (2) to identify characteristics of these young people and of their sexual intercourse events associated with incorrect condom use. Methods: Depressed, sexually active outpatients ages 15 to 22 completed an audio computer-assisted self-interview about their demographic characteristics, sexual beliefs and behaviors, and psychological traits and symptoms. Participants then used a handheld computer for two weeks to complete brief reports about their affective states in response to random prompts several times a day and to report on episodes of penile-vaginal intercourse (sex events). For each sex event in which a condom was used, incorrect condom use was defined as a response indicating incorrect use on at least one of five questions about their condom use. Event-level and individual-level correlates of incorrect condom use were examined
using logistic regression analysis adjusted for age, gender, and within-individual clustering. Variables significant at p < .10 were entered into the multivariate model. Results: Of 52 participants, 37 (71%; median age 18 years and 84% female) reported any condom use during the study and were included in these analyses (n ¼ 164 events). Nearly one-third of participants (32%) reported a history of sexually transmitted infection (STI) and 32% reported using hormonal contraception. Over one-fourth of condom use events (27%) were with a non-main partner and 15% of events were preceded by substance use within the previous two hours. For 17% of events, the reported reason for having sex was related to emotional or physical feeling (to change mood, to relax, or for physical pleasure). Incorrect condom use was reported for more than one-half of condom use events (54%); most often, only one error was indicated (81% of incorrect use events). The most common error was not holding onto the condom when pulling the penis out of the vagina (35% of all condom use events); genitals touching after the condom was off, not putting the condom on before sex started, the condom not staying on during sex, and the condom breaking were each reported less frequently (5% 15%). The odds of incorrect condom use increased when the reported reason for a sex event was to change mood, to relax, or for physical pleasure (odds ratio [OR] 2.34, 95% confidence interval [CI] 1.18 – 4.64). This association remained significant after adjusting for STI history, hormonal contraception, and strength of belief that feelings affect sexual behavior, but was attenuated once impulsiveness was included in the model (adjusted OR 2.32, 95% CI .86 – 6.22). Impulsiveness increased the odds of incorrect condom use (adjusted OR 1.32 per 1-point increase on 13-point scale, 95% CI 1.13 – 1.56), and history of STI decreased the odds of incorrect condom use (adjusted OR .34, 95% CI .13 – .85). Conclusions: Even if they use a condom when they have sex, depressed adolescents and young adults are at increased risk of STI because they frequently use the condom incorrectly. Psychological and behavioral factors may help to identify those depressed youth who are at particularly high risk of incorrect condom use. Sources of Support: NIH R21MH72533 and MCH T71MC00009.
70. DOES ADOLESCENT DEPRESSION PREDICT CONCURRENT SEXUAL RELATIONSHIPS? Eva Moore, MD, Pamela Matson, PhD, MPH, Jonathan Ellen, MD. Johns Hopkins School of Medicine Purpose: Concurrent sexual partnerships play an important role in the spread of sexually transmitted infections (STIs) in adolescents. Concurrency can be assessed by asking the index person if they perceive their partner to be concurrent, or by asking the partner if s/he is concurrent. Due to social desirability and perception, either of these can be over or underestimates. Another determinant of sexual risk and STIs is depression. Understanding the measures of adolescent concurrency and its association with depression is pertinent to better recognizing the determinants of STI risk in adolescents. Methods: Female and male adolescents, aged 14-19, were recruited from an urban STD clinic and interviewed face to face from August 2000 to June 2002. The index participant nominated their main partner, and if that person agreed that they were a main partner and also completed the interview, they were included in this analysis. Thereby, cross sectional data from 90 main partner dyads are presented. An index level analysis was performed. Participants were asked about depressive symptoms in the past week using a modified 8 item CES-D. A score of 7 or more was considered positive for depressive symptoms. Concurrency was assessed by the questions: ‘‘Did you have at least one other partner during the
S47
identified (sometimes known as somatoform disorders or complex medico-psycho-social presentations). The Clinic offers multi-disciplinary treatment, taking a rehabilitative approach that aims to improve the adolescent’s day-to-day functioning. As part of this process, the team attempts to help families to gradually draw a link between somatic and psychological aspects of their condition. The purpose of this study was to (a) examine how family health beliefs change over the course of treatment, and (b) explore whether changes in health beliefs impact on improvements in adolescent functioning. Its strengths include a prospective design with a 12-month follow-up, which is rarely achieved in research with this population. Methods: 50 adolescents and their parents were recruited to the study, 40 of whom were female. They were aged between 12 and 17 years (M ¼ 14.4, SD ¼ 1.32). 36% met criteria for Chronic Fatigue Syndrome, and the remaining 64% received a DSM-IV diagnosis of one of the Somatoform Disorders. Participants and their parents completed questionnaires measuring physical and psychosocial functioning and illness perceptions at recruitment, 4 months into treatment, and 12 months later. Multivariate analyses of variance (MANOVAs) were conducted to examine how adolescent functioning and family health beliefs changed over the 12-month period. Further, multiple-regression analyses were conducted to determine whether changes in health beliefs influenced functional improvements. Results: There were significant improvements in adolescent physical and psychosocial functioning over the course of treatment (F [4,28] ¼ 10.00, p < .001, Wilk’s Lambda ¼ .412, partial eta squared ¼ .588). Parent health beliefs also changed significantly over this time period (for mothers, F [10, 21] ¼ 3.34, p ¼ .01, Wilk’s Lambda ¼ .4, partial eta squared ¼ .614; for fathers, F [10,12] ¼ 2.76, p ¼ .050, Wilk’s Lambda ¼ .3, partial eta squared ¼ .697). However, adolescent health beliefs were less amenable to change (F(10, 20) ¼ 1.43, p ¼ .237, Wilk’s Lambda ¼ .6, partial eta squared ¼ .417). A significant model emerged when changes in adolescent functioning were predicted by changes in mother’s health beliefs (F [5, 27] ¼ 3.108, p ¼ .024). This model accounted for 24.8% of the variance in adolescent psychosocial functioning. Conclusions: This study provides support for a family-based approach to adolescents with complex-medico-psycho-social conditions. It illustrates that parental health beliefs may be a more important therapeutic target than those of the adolescent. Sources of Support: This study was supported in part by a grant from the Medical Foundation of the University of Sydney.
quences for people living with HIV as people with PTSD are more likely to engage in substance abuse and less likely to adhere to antiretroviral therapy compared to people without PTSD. Surprisingly, however, relatively little attention has been paid to this area in the adolescent population. A better understanding of PTSD and PTSD-HIV in HIV positive adolescents can help the development of interventions that will target mental health, adherence and overall quality of life of adolescents living with HIV. Methods: Ninety three HIV positive adolescents were screened for mental health issues as part of routine care in an HIV Adolescent Medicine clinic in a large metropolitan city. Participants were between the ages of 14 and 24 (mean 19.3) and were 47 % (n ¼ 44) male and 53% (n ¼ 49) female. The brief mental health screening instrument utilized in the clinic, adapted from the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire, screens for anxiety, PTSD, HIV-PTSD, panic, depression, substance abuse, psychosis and cognition. Adolescents are routinely screened at least once per year and appropriate referrals are initiated for comprehensive assessment and treatment as clinically indicated. Results: Nine-three HIV positive adolescents were screened for mental health issues. Seventy-three percent of the adolescents were positive for some mental health concern, with 44% scoring positive in two or more areas. The most commonly identified issues were depression and anxiety. Specifically, 43% of the adolescents were positive for generalized anxiety, 30% for depression and 25% for some type of PTSD, including 11% HIV-PTSD. Additionally, 25% were positive for substance abuse, 16% for cognition and 6% for psychosis. Among adolescents who were positive for some type of PTSD, 9 were positive for PTSD only, 6 for PTSDHIV only and 4 were positive for both PTSD and PTSD-HIV. Adolescents with PTSD were more likely to also endorse symptoms of generalized anxiety, (63% vs 42%), depression (42% vs. 27%) panic (21% vs. 9%) and cognition (26% vs. 14%) when compared to adolescents without PTSD. Conclusions: HIV positive adolescents in our clinic report experiencing high levels of depression, generalized anxiety and PTSD, including PTSD related to their HIV diagnosis. Adolescents with PTSD were more likely to also endorse symptoms of generalized anxiety, depression, panic and cognition difficulties when compared to adolescents without PTSD. Our results indicate the need for additional research in this area that can inform the development of specific interventions tailored for HIV positive adolescents with PTSD symptoms. Sources of Support: None.
67.
68.
PREVALENCE OF PTSD SYMPTOMS IN ADOLESCENTS LIVING WITH HIV Lourdes Illa, MD1, Gustavo Benejam, PsyD.1, Onelia Lage, MD2, Lawrence Friedman, MD2, Hanna Major-Wilson, MSN1, Donna Maturo, MSN1, Debra Latson-McEwen1. 1University of Miami; 2University of Miami Miller School of Medicine
HEALTH STATUS OF ADOLESCENTS WHO REPORT PSYCHOSOMATIC SYMPTOMS IN COMPARISON TO THOSE WHO ARE CHRONICALLY ILL J.C. Suris, MD, PhD, Richard Belanger, MD, Andre Berchtold, PhD, Anne-Emmanuelle Ambresin, MD, Pierre-Andre Michaud, MD. Research Group on Adolescent Health, Institute of Social and Preventive Medicine, University of Lausanne
Purpose: This study examines the rates of PTSD symptomatology in adolescents living with HIV. Existing research has demonstrated that HIV positive adolescents have higher rates of psychiatric symptoms than their HIV negative counterparts. Commonly reported psychological morbidities among HIV positive youth include depression, anxiety, substance abuse and childhood sexual abuse. Additionally, high rates of PTSD have been documented in persons living with HIV/AIDS. There is also an increasing awareness that the diagnosis of HIV can in itself be perceived as a traumatic event and therefore be linked to the development of PTSD symptoms. A diagnosis of PTSD can have negative health conse-
Purpose: To assess the respective impact on health status of having either psychosomatic symptoms or a chronic condition. Methods: Using the SMASH 2002 database (a cross sectional survey among a representative sample of Swiss youths aged 1620 years), we defined psychosomatic symptoms as having reported at least one symptom (headache, stomach ache, sleeping problems, or dizziness) very often in the previous 12 months and chronic condition as a disease lasting at least 6 months and requiring continuous medical care and/or a disability limiting daily activities. Based on these two variables, 3 groups were created: those
S48
Abstracts / 46 (2010) S17–S81
reporting at least a psychosomatic symptom but no chronic condition (PS, n ¼ 1010; 14%), those reporting a chronic condition but not PS (CC; n ¼ 497; 6.9%) and those not reporting any (Control group; n ¼ 5709; 79.1%) that was used as the reference category. Those reporting both PS and CC (n ¼ 213) were not included in the analyses. Analyzed health variables were: poor health, depression, having been hospitalized, missing school due to illness, and having seen (once or twice/3 times or more) their primary care physician, a specialist or a mental health specialist in the previous 12 months. We performed a multinomial logistic regression controlling for age, gender, family structure and relationship with parents. Results are given as relative risk ratios (RRR) with 95% confidence intervals. Results: Compared to the Control group, and contrary to CC, PS youths were more likely to be depressed (RRR PS: 3.30 [2.63/ 4.14]; CC: 1.35 [.96/1.89]) and to have seen their primary care physician (RRR PS: 1.68 [1.23/2.30]; CC: 1.32 [.92/1.89]) or a mental health specialist (RRR PS: 1.95 [1.18/3.22]; CC: 1.06 [.61/1.83]) three or more times in the previous 12 months. Both groups were significantly more likely than the control group to report poor health (RRR PS: 3.20 [1.94/5.28]; CC: 2.15 [1.46/3.17]), having been hospitalized (RRR PS: 1.39 [1.08/1.81]; CC: 1.86 [1.39/2.48]) and having missed school due to their illness (RRR PS: 2.79 [1.65/4.73]; CC: 2.10 [1.22/3.60]), although no differences were observed among them. Additionally, those in the CC group, but not in PS, were significantly more likely than the control group to have seen a specialist once or twice (RRR PS:.99 [.78/1.25]; CC: 3.40 [2.56/ 4.52]) or 3 times or more (RRR PS: 1.15 [.85/1.55]; CC: 6.50 [4.66/ 9.08]). Conclusions: Although similar in some aspects, adolescents reporting psychosomatic symptoms seem to do worse than those suffering from a chronic condition: they are more depressed and have seen their primary care physician or a mental health specialist more often. The fact that CC youths are more likely than PS ones to have seen a specialist can be attributed to the regular follow-up of their chronic condition. Our results seem to indicate that having psychosomatic symptoms can be as or even more handicapping than having a chronic condition. Sources of Support: The SMASH02 survey was carried out with the financial support of the Swiss Federal Office of Public Health and the participating cantons.
69. INCORRECT CONDOM USE AMONG DEPRESSED ADOLESCENTS AND YOUNG ADULTS: AN EVENTLEVEL ANALYSIS Lydia Shrier, MD, MPH, Courtney Walls, MPH, Christopher Lops, MA, Henry Feldman, PhD. Children’s Hospital Boston Purpose: (1) To describe condom use errors in depressed adolescents and young adults and (2) to identify characteristics of these young people and of their sexual intercourse events associated with incorrect condom use. Methods: Depressed, sexually active outpatients ages 15 to 22 completed an audio computer-assisted self-interview about their demographic characteristics, sexual beliefs and behaviors, and psychological traits and symptoms. Participants then used a handheld computer for two weeks to complete brief reports about their affective states in response to random prompts several times a day and to report on episodes of penile-vaginal intercourse (sex events). For each sex event in which a condom was used, incorrect condom use was defined as a response indicating incorrect use on at least one of five questions about their condom use. Event-level and individual-level correlates of incorrect condom use were examined
using logistic regression analysis adjusted for age, gender, and within-individual clustering. Variables significant at p < .10 were entered into the multivariate model. Results: Of 52 participants, 37 (71%; median age 18 years and 84% female) reported any condom use during the study and were included in these analyses (n ¼ 164 events). Nearly one-third of participants (32%) reported a history of sexually transmitted infection (STI) and 32% reported using hormonal contraception. Over one-fourth of condom use events (27%) were with a non-main partner and 15% of events were preceded by substance use within the previous two hours. For 17% of events, the reported reason for having sex was related to emotional or physical feeling (to change mood, to relax, or for physical pleasure). Incorrect condom use was reported for more than one-half of condom use events (54%); most often, only one error was indicated (81% of incorrect use events). The most common error was not holding onto the condom when pulling the penis out of the vagina (35% of all condom use events); genitals touching after the condom was off, not putting the condom on before sex started, the condom not staying on during sex, and the condom breaking were each reported less frequently (5% 15%). The odds of incorrect condom use increased when the reported reason for a sex event was to change mood, to relax, or for physical pleasure (odds ratio [OR] 2.34, 95% confidence interval [CI] 1.18 – 4.64). This association remained significant after adjusting for STI history, hormonal contraception, and strength of belief that feelings affect sexual behavior, but was attenuated once impulsiveness was included in the model (adjusted OR 2.32, 95% CI .86 – 6.22). Impulsiveness increased the odds of incorrect condom use (adjusted OR 1.32 per 1-point increase on 13-point scale, 95% CI 1.13 – 1.56), and history of STI decreased the odds of incorrect condom use (adjusted OR .34, 95% CI .13 – .85). Conclusions: Even if they use a condom when they have sex, depressed adolescents and young adults are at increased risk of STI because they frequently use the condom incorrectly. Psychological and behavioral factors may help to identify those depressed youth who are at particularly high risk of incorrect condom use. Sources of Support: NIH R21MH72533 and MCH T71MC00009.
70. DOES ADOLESCENT DEPRESSION PREDICT CONCURRENT SEXUAL RELATIONSHIPS? Eva Moore, MD, Pamela Matson, PhD, MPH, Jonathan Ellen, MD. Johns Hopkins School of Medicine Purpose: Concurrent sexual partnerships play an important role in the spread of sexually transmitted infections (STIs) in adolescents. Concurrency can be assessed by asking the index person if they perceive their partner to be concurrent, or by asking the partner if s/he is concurrent. Due to social desirability and perception, either of these can be over or underestimates. Another determinant of sexual risk and STIs is depression. Understanding the measures of adolescent concurrency and its association with depression is pertinent to better recognizing the determinants of STI risk in adolescents. Methods: Female and male adolescents, aged 14-19, were recruited from an urban STD clinic and interviewed face to face from August 2000 to June 2002. The index participant nominated their main partner, and if that person agreed that they were a main partner and also completed the interview, they were included in this analysis. Thereby, cross sectional data from 90 main partner dyads are presented. An index level analysis was performed. Participants were asked about depressive symptoms in the past week using a modified 8 item CES-D. A score of 7 or more was considered positive for depressive symptoms. Concurrency was assessed by the questions: ‘‘Did you have at least one other partner during the