Using population attributable risk to help target preventive interventions for adolescent depression

Prevention of adolescent depression has become a public health priority in the United States (US) and in other developed economies. Population attributable risk (PAR) can provide an estimate of the incidence reduction that would occur if a particular factor were removed.

To determine PAR of vulnerability factors for new-onset depressive episodes in United States (US) adolescents.

National Longitudinal Study of Adolescent Health. The sample was comprised of nationally representative adolescents in grades 7-12, with mean age of 15.7 years.

We determined PAR for identified vulnerability factors for US adolescents measured at baseline predicting a depressive episode at one-year follow-up. The baseline factors included socio-demographics and physical health factors; interpersonal relations; community and school factors and cognition/affect regulation.

Factors with significant PAR were identified from each major domain of adolescent life. With the exception of age, sexual activity had the highest PAR. Interpersonal relations, particularly those involving family members rather than peers, represented the most important group of contributing factors. Similarly, low levels of constructive community involvement (e.g. religious activity) and higher levels of delinquent activity had significant PAR. Current depressed mood had relatively high PAR whereas negative self-cognitions had relatively low PAR.

Poor affect regulation, existent depressed mood, and accompanying negative cognitions are important potential intervention targets. Our findings also suggest expanding the focus of preventive interventions to encompass all interpersonal and community domains of the adolescent experience.