Research suggests that household social risks are associated with worse mental health in adolescents, but prior studies have been limited. We evaluated the association between social risks and symptoms of depression and anxiety in adolescents 1 year later by conducting a retrospective cohort study at an integrated health system with 45 practices. Adolescents were screened for depression using the Patient Health Questionnaire–2 (PHQ-2) and anxiety using the Generalized Anxiety Disorder–2 (GAD-2). Of the 4748 adolescents, 1220 (25.7%) had at least 1 social risk, 226 (5.7%) reported symptoms of depression, and 410 (10.2%) reported symptoms of anxiety. Adolescents in households with at least 1 social risk were more likely to report symptoms of depression (β = 0.15, 95% confidence interval [CI] = 0.07-0.23) and anxiety (β = 0.21, 95% CI = 0.11-0.31) and had greater odds of a positive PHQ-2 (odds ratio [OR] = 1.50, 95% CI = 1.12-2.01) and positive GAD-2 (OR = 1.57; 95% CI = 1.32, 1.87).
AlderwickHGottliebLM.Meanings and misunderstandings: a social determinants of health lexicon for health care systems. Milbank Q. 2019;97(2):407-419.
2.
National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Care Services; Committee on Integrating Social Needs Care into the Delivery of Health Care to Improve the Nation’s Health. Integrating Social Care Into the Delivery of Health Care: Moving Upstream to Improve the Nation’s Health. Washington, DC: National Academies Press; 2019.
3.
Council on Community Pediatrics. Poverty and child health in the United States. Pediatrics. 2016;137(4):e20160339.
4.
SeligmanHKBerkowitzSA.Aligning programs and policies to support food security and public health goals in the United States. Annu Rev Public Health. 2019;40:319-337.
5.
RigdonJMontezKPalakshappaD, et al. Social risk factors influence pediatric emergency department utilization and hospitalizations. J Pediatr. 2022;249:35-42.e34.
6.
PalakshappaDGargAPeltzAWongCACholeraRBerkowitzSA.Food insecurity was associated with greater family health care expenditures in the US, 2016-17. Health Aff (Millwood). 2023;42(1):44-52.
7.
Council on Community Pediatrics; Committee on Nutrition. Promoting food security for all children. Pediatrics. 2015;136(5):e1431-1438.
HinesCTMarkowitzAJJohnsonAD.Food insecurity: what are its effects, why, and what can policy do about it?Policy Insights Behav Brain Sci. 2021;8(2):127-135.
10.
CainKSMeyerSCCummerE, et al. Association of food insecurity with mental health outcomes in parents and children. Acad Pediatr. 2022;22(7):1105-1114.
11.
BernardRHammarlundRBouquetM, et al. Parent and child reports of food insecurity and mental health: divergent perspectives. Ochsner J. 2018;18(4):318-325.
12.
HatemCLeeCYZhaoXReesor-OyerLLopezTHernandezDC.Food insecurity and housing instability during early childhood as predictors of adolescent mental health. J Fam Psychol. 2020;34(6):721-730.
13.
KeenRChenJTSlopenNSandelMCopelandWETiemeierH.Prospective associations of childhood housing insecurity with anxiety and depression symptoms during childhood and adulthood. JAMA Pediatr. 2023;177:818-826.
14.
KimHHKeenRTangADencklaCSlopenN.Longitudinal patterns of childhood homelessness and early adolescent trajectories of internalising and externalising behaviour. J Epidemiol Community Health. 2023;77(4):216-223.
15.
SpencerAEBaulTDSikovJ, et al. The relationship between social risks and the mental health of school-age children in primary care. Acad Pediatr. 2020;20(2):208-215.
16.
ParishWBeilHHeF, et al. Health care impacts of resource navigation for health-related social needs in the accountable health communities model. Health Aff (Millwood). 2023;42(6):822-831.
17.
RenaudJMcClellanSRDePriestK, et al. Addressing health-related social needs via community resources: lessons from accountable health communities. Health Aff (Millwood). 2023;42(6):832-840.
18.
BerkowitzRLBuiLShenZ, et al. Evaluation of a social determinants of health screening questionnaire and workflow pilot within an adult ambulatory clinic. BMC Fam Pract. 2021;22(1):256.
19.
EderMHenningerMDurbinS, et al. Screening and interventions for social risk factors: technical brief to support the US preventive services task force. JAMA. 2021;326(14):1416-1428.
20.
HenriksonNBBlasiPRDorseyCN, et al. Psychometric and pragmatic properties of social risk screening tools: a systematic review. Am J Prev Med. 2019;57(6, suppl 1):S13-S24.
21.
KroenkeKSpitzerRLWilliamsJB.The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care. 2003;41(11):1284-1292.
22.
RichardsonLPRockhillCRussoJE, et al. Evaluation of the PHQ-2 as a brief screen for detecting major depression among adolescents. Pediatrics. 2010;125(5):e1097-e1103.
23.
Byrd-BredbennerCEckKQuickV.GAD-7, GAD-2, and GAD-mini: psychometric properties and norms of university students in the United States. Gen Hosp Psychiatry. 2021;69:61-66.
24.
KroenkeKSpitzerRLWilliamsJBLöweB.The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review. Gen Hosp Psychiatry. 2010;32(4):345-359.
25.
GhandourRMShermanLJVladutiuCJ, et al. Prevalence and treatment of depression, anxiety, and conduct problems in US children. J Pediatr. 2019;206:256-267.e253.
26.
MadiganSRacineNVaillancourtT, et al. Changes in depression and anxiety among children and adolescents from before to during the COVID-19 pandemic: a systematic review and meta-analysis. JAMA Pediatr. 2023;177(6):567-581.
27.
AnandPBhurjiNWilliamsNDesaiN.Comparison of PHQ-9 and PHQ-2 as screening tools for depression and school related stress in inner city adolescents. J Prim Care Community Health. 2021;12:21501327211053750.
28.
RyuHJLeeSChungJH.Association between asthma and generalized anxiety disorder-7 (GAD-7) in Korean adolescents. J Asthma. 2023;60(1):123-129.
29.
ReinauerCTittelSRMüller-StierlinA, et al. Outpatient screening for anxiety and depression symptoms in adolescents with type 1 diabetes—a cross-sectional survey. Child Adolesc Psychiatry Ment Health. 2023;17(1):142.
30.
BarkerMMBeresfordBBlandMFraserLK.Prevalence and incidence of anxiety and depression among children, adolescents, and young adults with life-limiting conditions: a systematic review and meta-analysis. JAMA Pediatr. 2019;173(9):835-844.
31.
FramMSFrongilloEAJonesSJ, et al. Children are aware of food insecurity and take responsibility for managing food resources. J Nutr. 2011;141(6):1114-1119.
32.
YangPHernandezBSPlastinoKA.Social determinants of mental health and adolescent anxiety and depression: findings from the 2018 to 2019 National Survey of Children’s Health. Int J Soc Psychiatry. 2023;69(3):795-798.
33.
McCurdyKGormanKSMetallinos-KatsarasE.From poverty to food insecurity and child overweight: a family stress approach. Child Dev Perspect. 2010;4(2):144-151.
34.
RobinsonESutinARDalyMJonesA.A systematic review and meta-analysis of longitudinal cohort studies comparing mental health before versus during the COVID-19 pandemic in 2020. J Affect Disord. 2022;296:567-576.
35.
BerkowitzSABasuS.Unmet social needs and worse mental health after expiration of COVID-19 federal pandemic unemployment compensation. Health Aff (Millwood). 2021;40(3):426-434.
36.
DonnellyRFarinaMP.How do state policies shape experiences of household income shocks and mental health during the COVID-19 pandemic?Soc Sci Med. 2021;269:113557.
37.
ZuckerbrotRACheungAJensenPSSteinREKLaraqueD. Guidelines for adolescent depression in primary care (GLAD-PC): part I. Practice preparation, identification, assessment, and initial management. Pediatrics. 2018;141(3):e20174081.
38.
MangioneCMBarryMJNicholsonWK, et al. Screening for depression and suicide risk in children and adolescents: US preventive services task force recommendation statement. JAMA. 2022;328(15):1534-1542.
39.
JinJ.Screening for anxiety in children and adolescents. JAMA. 2022;328(14):1469-1470.
40.
JinJ.Screening for depression and suicide risk in children and adolescents. JAMA. 2022;328(15):1570.
GargABrochierATripodisYMessmerEDrainoniML.A social care system implemented in pediatric primary care: a cluster RCT. Pediatrics. 2023;152(2):e2023061513.
43.
SchickedanzAPeralesLHolguinM, et al. Clinic-based financial coaching and missed pediatric preventive care: a randomized trial. Pediatrics. 2023;151(3):e2021054970.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
