Higher Depressive Symptoms Are Associated with Decreased Condom Use over 36 Months Among African American Female Adolescents

Background: African American female adolescents experience elevated prevalence of both depressive disorders and sexually transmitted diseases (STDs).  While cross-sectional studies point to an association between higher depressive symptoms and increased sexual risk engagement, there is a paucity of research longitudinally investigating this association.  Thus, the current study investigated the relationship between depressive symptomatology and condom use over 36-months among African American female adolescents participating in an STD prevention intervention.

Methods: African American female adolescents (N=701; M age = 17.6) enrolled in an STD prevention intervention completed audio computer-assisted self-interview (ACASI) assessments conducted at baseline, and at 6-, 12-, 18-, 24-, 30-, and 36-months post-baseline. Depression symptom levels were measured as the total score on the CES-D-R. Linear and logistic generalized estimating equations (GEE) were used to examine the association between depressive symptom levels and: (a) condom use at last sex; (b) proportion condom use in the past 90 days; and (c) consistent condom use in the past 90 days in both unadjusted and adjusted models. 

Results: In adjusted GEE models accounting for intervention condition and baseline factors correlated with depressive symptoms (e.g., past abuse history, social support), higher depressive symptoms were associated with: decreased condom use at last sex (AOR = .90; 95% CI: .86, .94) and decreased consistent condom use in the past 90 days (AOR = .89, 95% CI: .85, .93).  Additionally, for every one percent increase in depressive symptoms, there was a 7.2 percentage point decrease in the proportion condom use in the past 90 days (p < .0001).

Conclusions: Elevated depressive symptoms were common among African American female adolescents participating in an STD prevention intervention. Higher depressive symptoms were associated with decreased condom use, posing increased risk for STDs and unintended pregnancy.  STD prevention interventions may benefit by incorporating content to address adolescents’ depressive symptoms.