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Psychosocial risk clustering in high school students

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Abstract

Background

This secondary analysis describes the frequency of self-reported psychosocial risk factors in a geographically defined population of adolescents and quantifies the extent of multiple risks. Cluster analysis is used to develop three empirically distinct psychosocial risk clusters.

Methods

High school students in grades 9–13 from all seven public and two catholic high schools in the study area completed a class-administered survey. The analysis is based on 3540 surveys reflecting approximately a 71% response. Cumulative risk was calculated by summing the number of times students exceeded a pre-defined threshold on a series of global rating scales. Risk clusters were created using a non-hierarchical cluster analysis technique for binary data. Clusters were partially validated by examining differences in socio-demographic and health utilization patterns. Reliability was assessed by examining two, three, and four-group solutions across gender and grade strata.

Results

Multiple symptoms of emotional distress were reported by 37% of the sample, multiple stressors by 62% of the sample, and poly-drug use by 33%. In addition, three empirically distinct clusters were derived. Normals, 21% of the sample, did not report excessive stress or distress, and did not use substances. The Stressed (45%) reported excessive stress and distress predominantly related to schoolwork, parents, and facing problems. Virtually none used drugs. Substance Users (34%) reported excessive stress, distress, and high levels of substance use: smoking, drinking, and use of illicit drugs. Clusters were significantly different with respect to most socio-demographic factors, self-reported general health, and most aspects of health service utilization suggesting that they have some validity for targeting programs.

Conclusions

This study highlights the importance of focusing on multi-morbidities and illustrates the use of cluster analysis to identify risk profiles that may be amenable to school-based health promotion and prevention programs.

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References

  1. Kataoka SH, Zhang L, Wells KB (2002) Unmet need for mental health care among U.S. children: variation by ethnicity and insurance status. Am J Psychiatry 159(9):1548–1555

    Article  PubMed  Google Scholar 

  2. Offord DR, Boyle MH, Fleming JE, Blum HM, Grant NI (1989) Ontario child health study. Summary of selected results. Can J Psychiatry 34(6):483–491

    CAS  PubMed  Google Scholar 

  3. Pollock NK, Martin CS (1999) Diagnostic orphans: adolescents with alcohol symptoms who do not qualify for DSM-IV abuse or dependence diagnoses. Am J Psychiatry 156(6):897–901

    CAS  PubMed  Google Scholar 

  4. Gotlib IH, Lewinsohn PM, Seeley JR (1995) Symptoms versus a diagnosis of depression: differences in psychosocial functioning. J Consulting Clin Psychol 63(1):90–100

    Article  CAS  Google Scholar 

  5. Rushton JL, Forcier M, Schectman RM (2002) Epidemiology of depressive symptoms in the National Longitudinal Study of Adolescent Health. J Am Acad Child Adolesc Psychiatry 41(2):199–205

    Article  PubMed  Google Scholar 

  6. Pine DS, Cohen E, Cohen P, Brook J (1999) Adolescent depressive symptoms as predictors of adult depression: moodiness or mood disorder? Am J Psychiatry 156(1):133–135

    CAS  PubMed  Google Scholar 

  7. Aalto-Setälä T, Marttunen M, Tuulio-Henriksson A, Poikolainen K, Lönnqvist J (2002) Depressive symptoms in adolescence as predictors of early adulthood depressive disorders and maladjustment. Am J Psychiatry 159(7):1235–1237

    Article  PubMed  Google Scholar 

  8. Achenbach TM, Howell CT, McConaughy SH, Stanger C (1995) Six-year predictors of problems in a national sample of children and youth: II. signs of disturbance. Am Acad Child Adolesc Psychiatry 34(4):488–498

    Article  CAS  Google Scholar 

  9. WHO (1996) The health of youth: a cross-national survey. WHO Regional Publications, European Series No 69

    Google Scholar 

  10. Szilagyi PG, Schor EL (1998) The health of children. Health Services Res 33(4):1001–1039

    CAS  Google Scholar 

  11. Weist MD, Lowie JA, Flaherty LT, Pruitt D (2001) Collaboration among the education, mental health, and public health systems to promote youth mental health. Psychiatr Services 52(10):1348–1351

    Article  CAS  Google Scholar 

  12. Pickett W, Garner MJ, Boyce WF, King MA (2002) Gradients in risk for youth injury associated with multiple-risk behaviours: a study of 11,329 Canadian adolescents. Social Sci Med 55:1055–1068

    Article  Google Scholar 

  13. Galambos NL, Tilton-Weaver LC (1998) Multiple-risk behaviour in adolescents and young adults. Health Rep 10(2):9–20

    CAS  PubMed  Google Scholar 

  14. Bruns C, Geist CS (1984) Stressful life events and drug use among adolescents. J Human Stress Fall:135–139

    Google Scholar 

  15. Glied S, Pine DS (2002) Consequences and correlates of adolescent depression. Arch Pediatr Adolesc Med 156:1009–1014

    PubMed  Google Scholar 

  16. Tomori M, Zalar B, Plesničar BK, Ziherl S, Stergar E (2001) Smoking in relation to psychosocial risk factors in adolescents. Eur Child Adolesc Psychiatry 10:143–150

    Article  CAS  PubMed  Google Scholar 

  17. Maney DW, Higham-Gardill DA, Mahoney BS (2002) The alcohol-related psychosocial and behavioural risks of a nationally representative sample of adolescents. J School Health 72(4):157–163

    PubMed  Google Scholar 

  18. Adams DM, Overholser JC, Spirito A (1994) Stressful life events associated with adolescent suicide attempts. Can J Psychiatry 39:43–48

    CAS  PubMed  Google Scholar 

  19. Williams PG, Colder CR, Richards MH, Scalzo CA (2002) The role of self-assessed health in the relationship between gender and depressive symptoms among adolescents. J Pediatr Psychol 27(6):509–517

    Article  PubMed  Google Scholar 

  20. De Man AF, Leduc CP (1995) Suicidal ideation in high school students: depression and other correlates. J Clin Psychol 51(2):173–181

    PubMed  Google Scholar 

  21. Tremblay S, Dahinten S, Kohen D (2003) Factors related to adolescents’ self-perceived health. Suppl Health Rep 14:7–16

    Google Scholar 

  22. Tomori M, Azlar B, Plesničar BK, Ziherl S, Stergar E (2001) Smoking in relation to psychosocial risk factors in adolescents. Eur Child Adolesc Psychiatry 10:143–150

    Article  CAS  PubMed  Google Scholar 

  23. WHO (1996) The health of youth: a cross-national survey. WHO Regional Publications, European Series No 69

    Google Scholar 

  24. Park J (2003) Adolescent self-concept and health into adulthood. Suppl Health Rep 14:41–52

    CAS  Google Scholar 

  25. Flannery WP, Sneed CD, Marsh P (2003) Toward an empirical taxonomy of suicide ideation: a cluster analysis of the youth risk behavior survey. Suicide Life Threatening Behav 33(4):365–372

    Article  Google Scholar 

  26. Hughes SO, Power TG, Francis DJ (1992) Defining patterns of drinking in adolescence: a cluster analytic approach. J Studies Alcohol 53(1):40–47

    CAS  Google Scholar 

  27. Adlaf EM, Zdanowicz YM (1999) A cluster-analytic study of substance problems and mental health among street youths. Am J Drug Alcohol Abuse 25(4):639–660

    Article  CAS  PubMed  Google Scholar 

  28. Tubman JG, Wagner EF, Langer LM (2003) Patterns of depressive symptoms, drinking motives, and sexual behaviour among substance abusing adolescents: implications for health risk. J Child Adolescent Subs Abuse 13(1):35–57

    Google Scholar 

  29. Galambos NL, Tilton-Weaver LC (1998) Multiple-risk behaviour in adolescents and young adults. Health Rep 10(2): 9–20

    CAS  PubMed  Google Scholar 

  30. Vander Stoep A, Weiss NS, Saldanha E, Cheney D, Cohen P (2003) What proportion of failure to complete secondary school in the US population is attributable to adolescent psychiatric disorder. J Behav Health Services Res 30(1):119–124

    Article  Google Scholar 

  31. Weissman MM, Wolk S, Goldstein RB, Moreau D, Adams O, Greenwald S, Klier CM, Ryan ND, Dahl RE, Wickramaratne P (1999) Depressed adolescents grown up. JAMA 281(18):1707–1713

    Article  CAS  PubMed  Google Scholar 

  32. Pine DS, Cohen P, Gurley D, Brook J, Ma Y (1998) The risk for early-adulthood anxiety and depressive disorders in adolescents with anxiety and depressive disorders. Arch Gen Psychiatry 55:56–64

    Article  CAS  PubMed  Google Scholar 

  33. Nutbeam D (1997) Indicators of adolescent health: expanding the framework for assessing health status among young people. Promotion Education IV:10–15

    Article  Google Scholar 

  34. Roeger L, Allison S, Martin G, Dadds V, Keeves J (2001) Adolescent depressive symptomatology: improve schools or help students? Australian J Psychol 53(3):129–134

    Google Scholar 

  35. Smith AB, Gaffney M, Nairn K (2004) Health rights in secondary schools: student and staff perspectives. Health Education Res 19(1):85–97

    Article  Google Scholar 

  36. Batstra L, Bos EH, Neeleman J (2002) Quantifying psychiatric comorbidity: lessons from chronic disease epidemiology. Soc Psychiatry Psychiatr Epidemiol 37:105–111

    Article  CAS  PubMed  Google Scholar 

  37. Greenberg MT, Weissberg RP, O’Brien MU, Zins JE, Fredericks L, Resnik H, Elias MJ (2003) Enhancing school-based prevention and youth development through coordinated social, emotional, and academic learning. Am Psychologist 58(6/7):466–474

    Article  Google Scholar 

  38. Konu A, Rimpela M (2002) Well-being in schools: a conceptual model. Health Promotion Int 17(1):79–87

    Article  Google Scholar 

  39. Burnett PC, Fanshawe JP (1997) Measuring school-related stressors in adolescents. J Youth Adolesc 26(4):415–428

    Article  Google Scholar 

  40. Craig Wm, Pepler DJ (2003) Identifying and targeting risk for involvement in bullying and victimization. Can J Psychiatry 48(9):577–582

    PubMed  Google Scholar 

  41. Borgen FH, Barnett DC (1987) Applying cluster analysis in counseling psychology research. J Counseling Psychol 34(4):456–468

    Article  Google Scholar 

  42. Stata Release 9 (2005) College Station. Stata Press, Texas

  43. Weissberg RP, Kumpfer KL, Seligman MEP (2003) Prevention that works for children and youth. Am Psychologist 58(6/7): 425–432

    Article  Google Scholar 

  44. Griesbach D, Amos A, Currie C (2003) Adolescent smoking and family structure in Europe. Social Sci Med 56:41–52

    Article  Google Scholar 

  45. Gore S, Aseltine RH, Colton ME (1992) Social structure, life stress and depressive symptoms in a high school-aged population. J Health Soc Behav 33:97–113

    Article  CAS  PubMed  Google Scholar 

  46. McLellan L, Rissel C, Donnelly N, Bauman A (1999) Health behaviour and the school environment in New South Wales, Australia. Social Sci Med 49:611–619

    Article  CAS  Google Scholar 

  47. McNeely CA, Nonnemaker JM, Blum RW (2002) Promoting school connectedness: evidence from the National Longitudinal Study of Adolescent Health. J School Health 72(4):138–146

    Article  PubMed  Google Scholar 

  48. Cuijpers P, Jonkers R, de Weerdt I, de Jong A (2002) The effects of drug abuse prevention at school: the ‘Healthy School and Drugs’ project. Addiction 97:67–73

    Article  PubMed  Google Scholar 

  49. Duffy A (2001) Adolescents with psychiatric disorders: When to treat? And with what? Can J Psychiatry 46:795–796

    CAS  PubMed  Google Scholar 

  50. Garnefski N, Legerstee J, Kraaij van den Kommer T, Teerds J (2002) Cognitive coping strategies and symptoms of depression and anxiety: a comparison between adolescents and adults. J Adolesc 25:603–611

    Article  PubMed  Google Scholar 

  51. Smith AB, Gaffney M, Nairn K (2004) Health rights in secondary schools: student and staff perspectives. Health Educ Res 19(1):85–97

    Article  PubMed  Google Scholar 

  52. Wassef A, Ingham D, Collins ML, Mason G (1995) In search of effective programs to address students’ emotional distress and behavioural problems. Part I: defining the problem. Adolescence 30(119):523–538

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This project was funded by the Bedwell Trust and initiated by the Leeds Grenville Youth Mental Health Improvement Board. The author wishes to thank these individuals for making the data accessible for this analysis. In addition, the author wishes to acknowledge the support of Michelle Koller, Research Associate; Matt Druillard and Steve Cove, Research Assistants.

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  1. Dept. of Community Health and Epidemiology, Queen’s University, Kingston, ON, Canada, K7L 3N6

    Heather Stuart PhD

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  1. Heather Stuart PhD
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Correspondence to Heather Stuart PhD.

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Stuart, H. Psychosocial risk clustering in high school students. Soc Psychiat Epidemiol 41, 498–507 (2006). https://doi.org/10.1007/s00127-006-0055-1

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