Co-occurrence of emotional and behavioral problems in Washington State youth: Prevalence and links to socioeconomic stress

Background: Adolescent depression and suicidality are common and virulent, but often undetected. The co-occurrence of such emotional difficulties with behavioral problems predicts especially poor global functioning through the transition to adulthood. Methods: We estimated the prevalence of co-occurring emotional problems (EP) and behavioral problems (BP) in Washington State adolescents, using 10th grade respondents to the 2010 Healthy Youth Survey. We used logistic regression to examine associations between emotional (depression, suicide ideation and attempt) and behavioral (heavy drinking, physical fighting, gang membership, weapon-carrying) problem indicators and socioeconomic stress as measured by past-year food insecurity. Results: Among 26117 respondents, 18% had BP alone, 17% had EP alone and 17% had both. Forty-seven percent of youth indicating BP also reported EP, compared to 26% of those denying BP. Endorsement of depression was associated with heavy drinking (odds ratio [OR]=2.4, p<0.001), physical fighting (OR=2.3, p<0.001), gang membership (OR=1.9, p<0.001) and weapon-carrying (OR=2.3, p<0.001). Associations between past-year suicide attempt and problem behaviors were even stronger. Youth endorsing either EP or BP were twice as likely to report food insecurity; those with problems in both domains had a 4.6-fold increased odds of food insecurity. Conclusions: Almost half of 10th graders with BP also suffer emotionally, indicating that interventions for youth with behavioral issues should address EP, and that screening for depression and suicidality should target those with BP. Adolescent mental health surveillance is an important tool for monitoring the prevalence and trends in these impairing conditions, identifying high risk groups, and optimizing prevention efforts.