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Maria R. Khan, PhD; Jay S. Kaufman, PhD; Brian Wells Pence, PhD; Bradley N. Gaynes, MD; Adaora A. Adimora, MD; Sharon S. Weir, PhD; William C. Miller, MD, PhD

Arch Pediatr Adolesc Med. 2009;163(7):644-652.

Objective  To measure associations among depression, sexual risk behaviors, and sexually transmitted infection (STI) among white and black youth in the United States.

Design  Analysis of prospective cohort study data. Wave I of the National Longitudinal Study of Adolescent Health occurred in 1995 when participants were in grades 7 through 12. Six years later, all Wave I participants who could be located were invited to participate in Wave III and to provide a urine specimen for STI testing.

Setting  In-home interviews in the continental United States, Alaska, and Hawaii.

Participants  Population-based sample. A total of 10 783 Wave I (adolescence) and Wave III (adulthood) white and black respondents with sample weight variables.

Main Exposures  Chronic depression (detected at Waves I and III) and recent depression (detected at Wave III only) vs no adult depression (not detected at Wave III).

Outcome Measures  Multiple sexual partners and inconsistent condom use in the past year and a current positive test result for Chlamydia trachomatis, Neisseria gonorrhoeae, or Trichomonas vaginalis (adulthood).

Results  Recent or chronic depression in adulthood was more common for blacks (women, 19.3%; men, 11.9%) than for whites (women, 13.0%; men, 8.1%). Among all groups (white men and women, and black men and women), adult depression was associated with multiple partners but not with condom use. Among black men, depression was strongly associated with STI (recent: adjusted prevalence ratio, 2.36; 95% confidence interval, 1.26-4.43; chronic: adjusted prevalence ratio, 3.05; 95% confidence interval, 1.48-6.28); having multiple partners did not mediate associations between depression and STI.

Conclusions  Integration of mental health and STI programs for youth is warranted. Further research is needed to elucidate how depression may influence the prevalence of STI among black men.

Author Affiliations: Department of Epidemiology, School of Public Health (Drs Khan, Kaufman, Adimora, Weir, and Miller), Department of Psychiatry (Dr Gaynes), and Division of Infectious Diseases, Department of Medicine, School of Medicine (Drs Adimora and Miller), The University of North Carolina at Chapel Hill; National Development and Research Institutes and Public Health Solutions, New York, New York (Dr Khan); and Department of Community and Family Medicine and Duke Global Health Institute and Center for Health Policy, Duke University, Durham, North Carolina (Dr Pence).

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