Teen Sex and Drug Use May Be Cause of Depression, Not the Effect

Teen Sex and Depression

A new study is challenging the belief that young people begin sex and drug behaviors 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 behavior, but binge drinking and frequent use of marijuana contribute substantial risk."

Hallfors' advice to health professionals is to routinely screen for drug use and sexual behavior 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' 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 behaviors. 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 four and a half times more likely to be depressed compared to abstainers. Boys who used marijuana were more than three times more likely to be depressed compared abstainers.

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

Because the research is based on data collected over a two-year period, the study was able to show that the drug and alcohol use and sexual experimentation preceded depressive symptoms, which challenges the popular notions about self-medicating.

Lucas says low mood can come after risky behavior in adolescence, but adds, "I think it's partially true for a portion of kids. It's not the whole story."

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

"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. "Depression usually precedes those behaviors and will likely persist after substance abuse."