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Depressed Teens at Higher Risk for Pregnancy, STDs
July 6, 2006 04:03:13 PM PST By Alan Mozes HealthDay Reporter
Depression can help prompt sexually active teens to engage in risky sexual behavior such as not using condoms or contraceptives, a new survey shows.
The study raises concerns about the sexual habits of millions of American adolescents, as an estimated 15 percent to 20 percent of teenagers in the United States are believed to experience major depression at some point in their pre-college years, according to the study's authors. Depressed, sexually active teens "have a greater likelihood of engaging in behaviors that increase their risk of HIV, other sexually transmitted infections, and unintended pregnancy," concluded study lead author Jocelyn Lehrer, a senior research associate with the Bixby Center for Reproductive Health Research and Policy at the University of California, San Francisco.
Her team published its findings in the July issue of Pediatrics. The UCSF group gathered data from in-person interviews conducted with middle- or high-school students across the United States during 1995 and 1996. The 1995 interview was focused on depression, while the follow-up interview a year later tracked each student's sexual behaviors over the preceding year.
All of those interviewed said they had experienced sexual intercourse prior to the first interview, and none were married by the time the follow-up interview took place. In all, 1,921 boys and 2,231 girls were included in the current analysis, most of whom were non-Hispanic whites.
According to the researchers, more than 9 percent of the boys and nearly 16 percent of the girls displayed symptoms reflecting a "high" level of depression during their initial interview. Lehrer and her colleagues also found that the more depressed the teens were at the start of the year, the more likely they were to engage in risky sexual behaviors later on. This observation held true for both boys and girls.
Boys who rated higher on a clinical scale of depression were more likely to say they had not used a condom or birth control the last time they had sex. As well, the more depressed the boy, the more likely he was to have consumed alcohol or drugs the last time he had sex. Girls with higher depression scores were also more likely to say that they had not used a condom or birth control the last time they had sex. These girls were also more likely to indicate that they had had three or more sexual partners in the past year.
In absolute terms, "highly" depressed boys and girls were over 70 percent and 50 percent more likely to have engaged in at least one risky sexual behavior over the prior year, respectively, when compared with the least-depressed boys and girls.
Lehrer cited many factors that could account for the observed association. "Youth who are both emotionally distressed and socially isolated may be more likely to seek or be successfully pressured into sexual activity, in the name of some kind of shared intimacy, or to maintain relationships that they value," she said. "Youth who are depressed may also be less confident in their ability to engage in self-protective behaviors, such as refusing pressure to have sex, discussing condom use with their partner, using condoms, and refusing substance use," Lehrer said.
Depression can also lead a teen to want to harm him or herself by taking sexual risks, she added.
Lehrer urged parents and health-care providers to be on the lookout for teen depression, to provide young people with emotional support when needed, and to counsel them against engaging in risky sexual behaviors.
Professor Freya Sonenstein, director of the Center for Adolescent Health at the Johns Hopkins Bloomberg School of Public Health in Baltimore, said the authors focused solely on sexually active teens -- thereby side-stepping the notion that teen sex of any kind might be considered risky by some.
But the "big story" here is not so much adolescent sexual risk-taking, she said, as it is the high prevalence of mental health woes among American teens.
"There is still a fair amount of stigma around mental health services," Sonenstein said, "and what this study points out is that mental health is part of the complex of risky behaviors and characteristics that kids have. And so, if kids are depressed, they are less likely to protect themselves sexually."
Researchers believe they've moved closer to a blood test for the early detection of Alzheimer's disease.
Increased blood levels of specific forms of beta amyloid proteins -- the abnormal molecules that are found in the brains of people with Alzheimer's disease -- were associated with an increased incidence of that condition and other forms of dementia, concludes a Dutch report published in the July 6 online edition of The Lancet Neurology.
"Beta amyloid comes in different lengths," explained Monique M. B. Breteler, a professor of neuroepidemiology at Erasmus Medical Center, in Rotterdam. "High blood levels of beta amyloid 1-40 and low levels of 1-42 were associated with an increased risk of Alzheimer's disease."
Those numbers refer to the number of amino acid components that make up the different versions of the protein.
In the study, Breteler's team tracked the mental health of 1,756 people, aged 55 years or older, for nearly nine years. Over that time, 392 participants developed some form of dementia.
The researchers found that participants with low blood levels of 1-42 and high levels of 1-40 at the start of the study had more than a tenfold higher risk of developing dementia than those with low levels of both proteins.
"This report is the first good indication that measuring blood levels of beta amyloids could be a step toward a potential test of risk," said Dr. John C. Morris, director of the Alzheimer's Disease Research Center at Washington University, in St. Louis.
It's only a small, preliminary step, he said. However, the Dutch finding is important because it indicates that something much simpler than a spinal tap might be useful in assessing the risk of dementia.
Beta amyloid 1-42 is believed to be the more dangerous form of the protein, Morris said. Tests of spinal fluid have shown lower levels of 1-42 than 1-40 in people with Alzheimer's disease, he said, presumably because more 1-42 is in the brain, forming plaques that then damage brain cells in several ways.
"Because blood is further away from the brain [than spinal fluid], we don't know if it reflects what is going on in the brain," Morris cautioned. However, the new study indicates that blood tests might give valuable information, he said.
According to Morris, "a scientist would emphasize that this is a step forward, but in no way assures us of a test." At best, Morris said, "this may be something that should be pursued."
Even if an early-detection test were to be developed, at the moment there's nothing doctors can do to slow or stop the progression of dementia, he pointed out. "There are some drugs for symptoms, but none yet have been determined to address disease progression," he said.
Still, there are a number of new drugs in the pipeline that might someday prove effective, he added. "Many of these potentially disease-modifying drugs are being evaluated in clinical trials," Morris said.
For that reason, the long-term goal is to devise a blood test that can spot dementia early, allowing doctors to treat it with drugs that slow or halt mental decline, Morris said.
