Increased prevalence of behavioral risks among adolescent and young adult women with psychological distress in the emergency department.

Background: Mental health problems in adolescents have been recognized as a significant medical concern. They have been associated with risk-taking behaviors during adolescence.

Objective: To determine the prevalence of elevated scores for psychological distress among adolescent girls aged 15 to 21 years who present to a pediatric emergency department (PED) for general medical care and to correlate psychological distress scores with sexual and substance use behaviors.

Methods: The study was performed in the PED of an urban general hospital. We enrolled female patients aged 15 to 21 years cared for in the PED. Subjects completed the Center for Epidemiological Studies-Depression Scale 8 (CES-D8); elevated scores were defined as 7 or greater. The survey collected data on demographics, sexual practices, alcohol and drug use, and health care access and utilization.

Results: Two hundred ninety-nine subjects participated. One hundred forty-one participants (47.7%) had CES-D8 scores of 7 or greater. In multivariate logistic regression, factors associated with increased emotional distress were being white, Hispanic, or of other race; having a recent new sex partner; and recent sex without birth control. Alcohol use in the past 3 months was associated with elevated distress as was having a distant relationship with one's parents/guardians. Those who had never had sex or who had sex in the past but not within the past 3 months were also more likely to have elevated CES-D8 scores compared with those who had sex more recently with the use of birth control.

Conclusions: Screening for mental health issues in the emergency department may identify a significant number of adolescent patients in need of further evaluation, especially as half of surveyed patients reported the PED as a usual source of health care.