Increase in Internalizing Behaviors in Teens Observed Over Last 30 Years

TUESDAY, March 18, 2025 (HealthDay News) — From 1991 to 2021, there was an increase in the prevalence of high internalizing behaviors among adolescents, while the prevalence of behavioral health risks decreased, according to a study published online March 18 in Pediatrics.

Rebekah Levine Coley, Ph.D., from Boston College in Chestnut Hill, Massachusetts, and colleagues examined samples of 178,658 high school students from the 1991 to 2021 national Youth Risk Behavior Survey using latent class analysis. Adolescents self-reported mental and behavioral health risk behaviors, including internalizing, substance use, sexual risk behaviors, and violence.

The researchers identified five distinct profiles. There was an increase in the prevalence of the largest group: Low Everything (48 percent of adolescents) from 1999 to 2021. The smallest group (High Internalizing [9 percent of adolescents]) also increased. Decreases were seen in High Sex (20 percent), High Everything (13 percent), and High Substance Use (10 percent), with the trajectories strengthening during the COVID-19 pandemic. The Low Everything and High Internalizing profiles were predominated by younger adolescents, while older adolescents predominated in the High Sex and High Everything profiles. The High Internalizing and High Sex profiles were predominated by females, while males predominated in the High Everything and High Substance Use profiles. The High Substance Use profile had an overrepresentation of White adolescents, while other profiles had an overrepresentation of youth of color.

“These analyses provide important information to support the efforts of policymakers, health practitioners, and others who seek to optimize the well-being of U.S. youth,” the authors write.

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