SEX AND DRUGS FIRST, THEN DEPRESSION

CHARLOTTESVILLE, Va. - A new study is challenging the belief that young
people begin sex and drug behaviours to "self-medicate" depression.

"Findings from the study show depression came after substance and
sexual activity, not the other way around," says health policy
researcher Denise Dion Hallfors.

The study, published in the October edition of the American Journal of
Preventive Medicine, uncovered gender-specific pathways to depression.

"For females, even modest involvement in substance use and sexual
experimentation elevates depression risk," the study found. "In
contrast, boys show little added risk with experimental behaviour, but
binge drinking and frequent use of marijuana contribute substantial
risk."

Hallfors's advice to health professionals is to routinely screen for
drug use and sexual behaviour in teens.

Psychiatrist Chris Lucas, a clinical coordinator with the New York
University Child Study Center, also advocates more vigilant screening.
He says pediatricians who give yearly before-school checkups are in a
unique position to ask a few simple questions that could uncover clues
about depression.

Only about one in five adolescents who have depression will be
recognized and diagnosed, Lucas says.

Hallfors's study culled data from a national survey of adolescents to
create a population-based sample of 13,491 girls and boys in Grades 7
to 11. Each child was placed in one of 16 groups based on his or her
reported experience with a range of risk behaviours. One of the groups
was "abstainers" -- those who had never tried alcohol, tobacco or
other drugs, and who had never had sex.

Depression rates for each of the other 15 groups were compared to the
abstainer group one year later. The study found that girls who had
experimented with drugs and sex were two to three times more likely to
be depressed than abstaining girls.

Male binge drinkers were 4.5 times more likely to be depressed
compared to abstainers. Boys who used marijuana were more than three
times more likely to be depressed compared to abstainers.

Lucas says Hallfors's study reiterates the fact that experimentation
with substance use and sex -- along with reduced academic functioning
and social isolation -- can be markers for depression.

"It can be quite hard to detect depression," he says. "The general
thinking is that depression precedes risky behaviours like substance
abuse."

Understanding the timing is crucial when pediatricians and child
psychologists begin to craft prevention and treatment strategies,
Hallfors says.

Health professionals often try antidepressants or talk therapy first,
she says, when they believe that depression precedes adolescent
experimentation with adult behaviours.

"If you have a boy or girl coming in with depression and a substance
use problem, would treating the substance abuse be enough to also curb
the depression?" Hallfors asks.

"I would think that that is optimistic," Lucas says.