P3A354: Depression Symptoms over Time in Adolescent Athletes

Background: One in five adolescents has symptoms of depression. While sports are generally considered protective for mental health, athletes still have morbidity. Screenings for depression are often conducted annually, however, depression symptoms may change in adolescents at shorter time intervals. Within person and between person changes each give valuable information to help clinicians appreciate relevant changes in depression. The purpose of this study was to examine short-term changes in depression symptoms in adolescent athletes.

Methods: High school students from a freshman health class were recruited. Participants were excluded if they did not play an organized sport or provide data across five time-points. Participants filled out the Patient Health Questionnaire-9 (PHQ-9) biweekly to assess depression symptoms over a sixteen-week period. The PHQ-9 results were coded as “minimal depression” (score 0-4), “mild depression” (score 5-9), “moderate depression” (score 10-14), “moderately severe depression” (score 15-19), and “severe depression” (score 20-27). Between-person and within-person variation were calculated. An alluvial diagram was created to visualize how individuals fluctuated between depression categories over time.

Results: A total of 29 participants, (7 males), reported depression symptoms on five time-points. 25 participants were excluded, 18 for limited data and 7 for not playing an organized sport. The overall average PHQ-9 score, across all time-points, was 5.76 ± 4.35 (range 0-22). The between-person standard deviation ranged from 3.98 to 4.99. The within-person standard deviation ranged from 0.55 to 5.79. Across all time-points, the percentage of those with minimal depression ranged from 41.4-55.2%, those with mild depression ranged from 24.1-41.4%, those with moderate depression ranged from 10.3-24.1%, those with moderately severe depression ranged from 0-6.9% and those with severe depression ranged from 0-3.4%. 78.6% of responses always remained in the minimal range. Only one participant (0.7%) reported severe depression. 62.1% of participants fluctuated between depression levels at least once over the course of five time-points. 57% of males fluctuated between depression levels over the course of five time-points. 63.6% of females fluctuated between depression levels over the course of five time-points. Nearly 2/3 met MCID at least once and over half (51.7%) met the MCID at least twice.

Conclusion: The vast majority of participants experienced clinically significant changes in depression symptoms over 16 weeks. Substantial fluctuations demonstrate a need for depression evaluations more frequently. We found clinically relevant changes in between-person and within-person variability of depression scores. Due to large sex differences in depression during adolescents, more research is needed to determine the relationship between depression at shorter intervals and sex.