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Abstract
Clinical depression among adolescents is relatively common, with an annual prevalence of 2% to 4%, and cumulative prevalence during adolescence of 25%.1 Diagnosed cases likely represent a “tip of the iceberg” phenomenon, with a much larger incidence of less pervasive symptoms that may warrant clinical attention.2 Depressive symptoms may be under-recognized in the context of other major causes of adolescent morbidity and mortality: attention deficit disorder; alcohol, tobacco, and other drug use; early pregnancy; and suicide, among others.3 The importance of depression in adolescent health clearly supports detailed understanding of its epidemiology. Among the risk factors associated with depression, socioeconomic status is consistently identified. Despite differences in definitions and measurement, persons in the lowest socioeconomic groups may have roughly twice the likelihood of depression as those in the highest socioeconomic groups.4 Similar disparities have been demonstrated for adolescents and are linked to alcohol, tobacco and other drug use.5,6 In this issue, Goodman et al. confirm the linkage between household income and depression.7 In addition, school-level income was significantly associated with depression: students from schools with higher average household income reported fewer depressive symptoms than those from schools with lower average household income. Most importantly, Goodman et al show that school-level income modifies the strength of the relationship between household income and adolescent depressive symptoms. This means for example, that average depression scores of teens from families with an annual household income of $20,000 (in 1994 dollars) attending schools in the lowest quartile of average income have about 11% more depressive symptoms than those attending schools in the highest quartile of average income. The effects are adjusted for covariates such as parental education, household size, sex, race, and age. Although these differences are modest given the developmental complexity of depression and its role in adolescent health, these findings are an important contribution to the understanding of disparities in adolescent health.
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