In recent years, the proportion of adolescents who report mental health problems has increased. Simultaneously, there have been declines in adolescent engagement in certain health risk behaviors. But are there specific patterns for mental and behavioral health risks that we should be aware of?
In an article and accompanying video abstract being early released this week in Pediatrics, entitled “Trends in Mental and Behavioral Health Risks in Adolescents: 1999-2021,” Rebekah Coley, PhD, Jane Leer, PhD, and Lindsay Lanteri, MA, from Boston College and San Diego State University describe profiles of mental and behavioral health risks and how they vary by demographic characteristics (10.1542/peds.2024-068774).
The authors analyzed annual cohorts of responses from high school students in 1991–2021 to the nationally representative Youth Risk Behavior Surveys. They looked at trends in the following categories of mental and behavioral health risks:
- Internalizing: depressive symptoms, suicidality
- Substance use: alcohol use, marijuana use
- Sexual risk: number of sexual partners, use of effective contraception
- Violence: carrying weapons, fighting
There were 5 profiles that were identified, in decreasing frequency:
- Low Everything (48% of adolescents)—increased over time.
- High Sex (20%)—decreased over time.
- High Everything (13%)—decreased over time.
- High Substance Use (10%)—decreased over time.
- High Internalizing (9%)—increased over time to be second-most commonly seen profile.
What do we do with this new information? In an invited commentary, Jennifer Poon, MD, Teal Benevides, PhD, and Beth Emrick, MD, from Augusta University and Marshall University note that, while knowing about these profiles is helpful, the Youth Risk Behavior Survey is not perfect (10.1542/peds.2024-070122). It does not include questions about 2 important internalizing behaviors—anxiety and eating disorders—that have increased in prevalence recently. Risk behaviors also have changed over time and include activities such as vaping and those associated with social media use. Finally and importantly, as this survey is administered to high school students, those who don’t attend school (for instance, those who are unhoused, or those with chronic school absenteeism) are excluded, and these are adolescents who are at higher risk for these mental and behavioral health risks.
Remember that adolescence is a time of discovery and risk-taking. While knowing about these profiles is important, we need to screen every adolescent for mental health issues and behaviors that can put their health at risk.
