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Purpose  Depression and health risk behaviors in adolescents are leading causes of preventable morbidity and mortality. Primary care visits provide prime opportunities to screen and provide preventive services addressing risk behaviors/conditions. This study evaluated the co-occurrence of depression and health risk behaviors (focusing on smoking, drug and alcohol misuse, risky sexual behavior, and obesity-risk) with the goal of informing preventive service strategies.    Methods  Consecutive primary care patients (n=217), ages 13 to 18 years, selected to over-sample for depression, completed a Health Risk Behavior Survey and the Diagnostic Interview Schedule for Children and Adolescents (DISC) depression module.    Results  Youths with DISC-defined past-year depression were significantly more likely to report risk across multiple risk-areas, Wald X 2 (1)=14.39, p<.001, and to have significantly higher rates of past-month smoking, X 2 (1)=5.86, p=.02, substance misuse, X 2 (1)=15.12, p<.001, risky sex, X 2  (1) =5.04, p=.03, but not obesity-risk, X 2  (1) =0.19, p=.66. Cross-sectional predictors of risk behaviors across risk areas were similar. Statistically significant predictors across all risk domains included: youths’ expectancies about future risk behavior; attitudes regarding the risk behavior; and risk behaviors in peers/others in their environments.    Conclusions  Depression in adolescents is associated with a cluster of health risk behaviors that likely contribute to the high morbidity and mortality associated with both depression and health risk behaviors. Consistent with the United States National Prevention Strategy (2011) and the focus on integrated behavioral and medical health care, results suggest the value of screening and preventive services using combination strategies that target depression and multiple areas of associated health risk.

Depression and Health Risk Behaviors: Towards Optimizing Primary Care Service Strategies for Addressing Risk