Trends in Mental and Behavioral Health Risks in Adolescents: 1999-2021.

Objectives: To identify distinct profiles of adolescent mental and behavioral health risks and variation over cohorts and demographic strata from 1999 through 2021. We expected increased mental health risks and decreased behavioral health risks.

Methods: We analyzed repeated, cross-sectional, nationally representative samples of high school students from the 1991-2021 national Youth Risk Behavior Survey (N = 178 658) using latent class analysis. Adolescents self-reported mental and behavioral health risk behaviors, including internalizing (depressive symptoms, suicidality), substance use (alcohol, marijuana use), sexual risk behaviors (number of sexual partners, effective birth control), and violence (weapons carriage, fighting).

Results: We identified 5 distinct profiles. The largest group, Low Everything (48% of adolescents), grew notably in prevalence from 1999 to 2021. The smallest, High Internalizing (9% of adolescents), also grew. High Sex (20%), High Everything (13%), and High Substance Use (10%) all decreased, with all trajectories strengthening between 2019 and 2021 during the COVID-19 pandemic. Younger adolescents predominated in the Low Everything and High Internalizing profiles, and older adolescents predominated in the High Sex and High Everything profiles. Females were more prevalent in the High Internalizing and High Sex profiles, and males were more prevalent in the High Everything and High Substance Use profiles. White adolescents were overrepresented in the High Substance Use profile, and youth of color were overrepresented in the other profiles.

Conclusions: Results showing decreasing proportions of adolescents reporting comorbid mental and behavioral health risks or behavioral health risks only, but increases in mental health problems only, help to identify and target key populations for prevention and treatment efforts.