A new report published online on March 18, 2025, and set to appear in the April issue of Pediatrics, reveals important trends in adolescent mental and behavioral health from 1999 to 2021. The study, titled “Trends in Mental and Behavioral Health Risks in Adolescents: 1999-2021”, highlights a steady decline in risky behaviors such as substance use, violence, and unsafe sexual activities among U.S. adolescents, along with a rise in depressive symptoms, particularly among a small but growing group of youth.
Study Overview
The research, led by Rebekah Levine Coley, a professor at Boston College’s Lynch School of Education and Human Development, in collaboration with researchers from San Diego State University, analyzed data from the Centers for Disease Control and Prevention’s biennial Youth Risk Behavior Surveys. The surveys included responses from 178,658 students in grades 9 through 12 over the course of the study.
Between 1999 and 2021, the data revealed a consistent decrease in the prevalence of risky behaviors such as substance use, violent actions, and unsafe sexual practices among adolescents. These positive changes indicate that a growing number of young people are making healthier lifestyle choices.
Key Findings
Decline in Risky Behaviors: The majority of adolescents, and an increasing number across the study’s cohorts, ceased engaging in risky behaviors. These include activities such as substance abuse, involvement in violence, and participation in unsafe sexual practices. Notably, this shift suggests a societal movement toward healthier, more responsible behaviors among youth.
Rise in Depression Symptoms: While the decrease in risky behaviors is encouraging, the study also found that a smaller, but growing group of adolescents reported elevated symptoms of depression, including feelings of hopelessness and increased suicidality. This group, while still representing less than nine percent of those surveyed, suggests that mental health concerns are becoming more prevalent among young people.
Mental Health and Risky Behaviors Intersection: The research also highlighted that a small subset of adolescents exhibited both heightened risky behaviors and significant mental health issues, such as depression and suicidality. This group necessitates additional public health measures to address both behavioral and mental health challenges simultaneously.
Implications for Public Health
The findings underscore the dual nature of adolescent well-being, where many are adopting healthier behaviors, but mental health challenges, particularly depression, are rising. Rebekah Levine Coley, who also directs the Center for Child and Family Policy at Boston College, emphasized the importance of focusing on the adolescents who are experiencing both depression and risky behaviors. She explained that identifying these youth is crucial for implementing targeted prevention and intervention strategies.
“Perhaps the most important finding from this work highlights the dominant and increasing prevalence of adolescents with low levels of internalizing behaviors who are also abstaining from multiple types of behavioral health risks,” Coley said. “Simultaneously, the relatively modest but increasing number of youth reporting elevated indications of depression points to target populations for prevention and treatment efforts, which is critical information for policymakers and health practitioners seeking to optimize the well-being of U.S. adolescents.”
Conclusion
The study reveals a complex picture of adolescent health, with clear progress in reducing risky behaviors, but an urgent need to address rising mental health concerns, especially depression. Given the increasing prevalence of depression among adolescents, healthcare providers and policymakers must develop more effective strategies to support mental health while continuing to promote healthy behaviors. By focusing on prevention and early intervention, there is an opportunity to improve the well-being of young people across the U.S. and ensure that they receive the help they need to thrive.
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