Association of adolescent stress with health risk behaviors, and mental health and physical health outcomes among middle school and high school students

Objective: Describe a clinically relevant model for understanding and measuring perceived stress in adolescents; and investigate its association with demographics, health risk behaviors, physical and mental health. Background: Adolescents identify stress as their most pressing personal health concern, but little has been done to investigate stress among adolescents. The Brief Evaluation of Perceived Stress Instrument (BEPSI) was validated in primary care among adults. This study details application and revision of the BEPSI among adolescents. Methods: Representative cross sectional survey of middle (n=3024) and high school students (n=4097) in an urban Midwestern county using a two-stage cluster sample design. Youth Risk Behavior Survey with additional items to address topics of interest. Six-item measure of perceived stress addressing demands, expectations, unmet needs uncertainty, control, and perspective. Descriptive statistics, reliability testing, chi-square, and logistic regression. Results: BEPSI demonstrated a Cronbach's alpha of .88 with all items contributing to reliability. Discriminant validity was high utilizing depressive sadness and suicidality. Higher levels of perceived stress are noted among females, racial and sexual minorities, low socioeconomic status, and single parent homes. Controlling for demographics, stress was higher in teens with cigarette smoking, alcohol, marijuana, and other drug use. Perceived stress is related to increased antisocial behavior, early initiation of risk behavior; sexual activity; and parental permissiveness. Teens with obesity, poorer health, more absenteeism, and poorer sleep have higher perceived stress. Conclusion: Perceived stress is a key construct in understanding the adolescent health experience, and is effectively measure by a brief instrument with clinical and counseling relevance.