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Lai W, Wu H, Yang L, Chen R, Xin Z, Zhang X, Wang W, Guo L, Huang G, Lu C. Prevalence of unhealthy behaviors and their associations with non-suicidal self-injury, suicidal ideation and suicide attempt among Chinese adolescents. Child Adolesc Psychiatry Ment Health 2024; 18:61. [PMID: 38812024 PMCID: PMC11137955 DOI: 10.1186/s13034-024-00742-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/23/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Unhealthy lifestyle behaviors among adolescents have emerged as a significant public health concern worldwide, however, there is little investigation on the impact of unhealthy behaviors on non-suicidal self-injury (NSSI), suicidal ideation (SI) and suicide attempt (SA). This study aimed to investigate the prevalence of seven unhealthy behaviors as well as their associations with NSSI, SI and SA, and to explore whether the aforementioned associations differ across sex. METHODS A total of 74,152 adolescents were included in this study via a multi-stage, stratified cluster, random sampling method in 2021. Information about unhealthy behaviors (insufficient physical activity, current smoking, current drinking, excessive screen time, long homework time, insufficient sleep and unhealthy BMI), NSSI, SI, SA and other demographics was collected. Sampling weights were used to estimate the prevalence, and the weighted logistic regression models were performed. Stratified analyses by sex and sensitive analyses were conducted. RESULTS Overview, the weighted prevalence of adolescents had more than five unhealthy behaviors were 5.2%, with boys showing a higher prevalence than girls (6.5% vs.3.8%). Current smoking, current drinking, excessive screen use, long homework time, insufficient sleep, and unhealthy BMI were significantly associated with NSSI, SI and SA. Moreover, adolescents with high lifestyle risk scores were associated with an increased risk of NSSI (5-7 vs. 0: OR 6.38, 95% CI 5.24-7.77), SI (5-7 vs. 0: OR 7.67, 95% CI 6.35-9.25), and SA (5-7 vs. 0: OR 9.57, 95% CI 6.95-13.17). Significant sex differences were found in the associations of unhealthy behaviors with NSSI, SI and SA. CONCLUSION Unhealthy behaviors are quite common among Chinese adolescents. Adolescents with multiple unhealthy behaviors are associated with increased risks of NSSI, SI, and SA. The implementation of school and family-based interventions to promote healthy lifestyles is recommended as a preventive measure against self-injurious behavior and suicidality in adolescents.
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Affiliation(s)
- Wenjian Lai
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen university, 74 Zhongshan Rd 2, Guangzhou, 510080, China
| | - Herui Wu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen university, 74 Zhongshan Rd 2, Guangzhou, 510080, China
| | - Liwen Yang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen university, 74 Zhongshan Rd 2, Guangzhou, 510080, China
| | - Ruiying Chen
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen university, 74 Zhongshan Rd 2, Guangzhou, 510080, China
| | - Zhiyao Xin
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen university, 74 Zhongshan Rd 2, Guangzhou, 510080, China
| | - Xiaojuan Zhang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen university, 74 Zhongshan Rd 2, Guangzhou, 510080, China
| | - Wanxin Wang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen university, 74 Zhongshan Rd 2, Guangzhou, 510080, China
| | - Lan Guo
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen university, 74 Zhongshan Rd 2, Guangzhou, 510080, China
| | - Guoliang Huang
- Center for Adverse Drug Reaction Monitoring of Guangdong, 753 Dongfeng East Road, Guangzhou, 510080, China.
| | - Ciyong Lu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen university, 74 Zhongshan Rd 2, Guangzhou, 510080, China.
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Jin Z, Xiao W, Zhang Y, Rong F, Yu W, Sun Y, Tao F, Wan Y. Interaction effect of screen time and sugar-sweetened beverages with depressive symptoms in adolescents: evidence from a large sample-based survey in China. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02414-w. [PMID: 38512474 DOI: 10.1007/s00787-024-02414-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 03/10/2024] [Indexed: 03/23/2024]
Abstract
Excessive screen time and the consumption of sugar-sweetened beverages are found to be independent predictors of depressive symptoms. However, the potential interaction effect of screen time and sugar-sweetened beverages, that is, whether one exposure factor strengthens the association of another with depressive symptoms, remains unclear. A large-scale adolescent health surveillance survey was conducted in 27 schools in eight regions across China. A total of 22,868 students were recruited to complete an eligible questionnaire to provide details of their screen time and sugar-sweetened beverage consumption. Depressive symptoms were assessed using the Patient Health Questionnaire (PHQ-9). Multiplicative and additive interaction models were performed to estimate the interaction effects of screen time and sugar-sweetened beverages on depressive symptoms, and whether the relationship varied by age group was also examined. The multivariate logistic regression model showed that even if the confounding factors were controlled, screen time and sugar-sweetened beverages were still risk factors for depressive symptoms in adolescents. Interaction models indicated that screen time and sugar-sweetened beverages in combination were related to greater odds of depressive symptoms. Compared with late adolescents, early adolescents had a higher probability of depressive symptoms when exposed to the joint effects. Our study may hopefully deepen the understanding of the association between screen time and sugar-sweetened beverages and depressive symptoms. Future research should further explore how and why screen time and sugar-sweetened beverages affect individuals more profoundly in early adolescence than in late adolescence and how to mitigate this.
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Affiliation(s)
- Zhengge Jin
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, Anhui, China
| | - Wan Xiao
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, Anhui, China
| | - Yi Zhang
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, Anhui, China
| | - Fan Rong
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, Anhui, China
| | - Weiqiang Yu
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, Anhui, China
| | - Ying Sun
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, Anhui, China
| | - Fangbiao Tao
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China.
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, Anhui, China.
| | - Yuhui Wan
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China.
- Anhui Provincial Key Laboratory of Population Health & Aristogenics, Hefei, Anhui, China.
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Gao H, Wang Y, Wang X, Gao M. Mediation of the association between screen time and suicidality by overweight/obesity and perceived overweight: results from the youth risk behavior surveillance system of the United States. Front Psychiatry 2024; 15:1287021. [PMID: 38501093 PMCID: PMC10944958 DOI: 10.3389/fpsyt.2024.1287021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/01/2024] [Indexed: 03/20/2024] Open
Abstract
Aim Adolescent suicide is a major public health concern, and modifiable risk factors associated with adolescent suicide remain poorly understood. This study aimed to assess the association between screen time and overweight/obesity and self-perceived overweigh and suicidality in adolescents. Methods Adolescents from the United States Youth Risk Behavior Surveillance System (YRBSS) between 2013 and 2019 were included in this cross-sectional study. The outcome was suicidality, including considered suicide, made a suicide plan, attempted suicide, and injurious suicide attempt. Multivariable logistic regression model was used to investigate the associations between screen time, overweight/obesity, self-perceived overweight, and suicidality, and expressed as odds ratio (OR) and 95% confidence interval (CI). Mediation analysis was used to explore the role of overweight/obesity and self-perceived overweight on the association between screen time and suicidality. Results A total of 30,731 adolescents were included, of which 6,350 (20.65%) had suicidality, including 5,361 (17.45%) with considered suicide, 4,432 (14.42%) with made a suicide plan, 2,300 (7.45%) with attempted suicide, and 677 (2.21%) with injurious suicide attempt. Adolescents with screen time ≥3h were related to higher odds of suicidality (OR=1.35, 95%CI: 1.23-1.46), overweight/obesity (OR=1.27, 95%CI: 1.19-1.38), and self-perceived overweight (OR=1.38, 95%CI: 1.30-1.48) after adjusting confounders. Adolescents with overweight/obesity (OR=1.30, 95%CI: 1.19-1.43) and self-perceived overweight (OR=1.54, 95%CI: 1.39-1.70) were associated with higher odds of suicidality. The association between screen time and suicidality was 4.67% mediated by overweight/obesity and 9.66% mediated by self-perceived overweight. Moreover, the mediating role of overweight/obesity was observed only in females, whereas there were no sex differences in the mediating effect of self-perceived overweight. Conclusion Both overweight/obesity and self-perceived overweight mediated the association between screen time and suicidality.
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Affiliation(s)
- Hong Gao
- Department of Mental Health, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yifei Wang
- Taiyuan University of Technology, Shanxi, China
| | - Xugang Wang
- Shanxi Xinyue Psychological Counseling Research Center, Taiyuan, Shanxi, China
| | - Ming Gao
- Department of Physical Education, Shanxi Medical University, Taiyuan, Shanxi, China
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Oh J, Kim M, Rhee SY, Rahmati M, Koyanagi A, Smith L, Kim MS, Fond G, Boyer L, Kim S, Shin JI, Yon DK. National Trends in the Prevalence of Screen Time and Its Association With Biopsychosocial Risk Factors Among Korean Adolescents, 2008-2021. J Adolesc Health 2024; 74:504-513. [PMID: 38085201 DOI: 10.1016/j.jadohealth.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 08/11/2023] [Accepted: 10/12/2023] [Indexed: 02/05/2024]
Abstract
PURPOSE Prior studies suggested an increase in screen time among adolescents during the COVID-19 pandemic; however, due to limited sample size and a short-term observation period, these associations are inconclusive and inconsistent. Thus, we aimed to compare screen time during the pandemic and the long-term trend through a Korean large-scale and long-term study of one million adolescents. METHODS Data from 2008 to 2021 on 913,191 Korean adolescents aged 12-18 years were obtained via a nationwide, large-scale, and serial study. We investigated the change of screen time use over time and the change in trend before and during the pandemic (2008-2019 vs. 2020-2021) by using weighted linear regression model with estimates of β-coefficients and 95% confidence intervals (CIs). Moreover, we analyzed the differences in vulnerability of biopsychosocial factor before and during the pandemic. RESULTS A total of 913,191 adolescents were included in this analysis. During the pandemic, the overall screen time of Korean adolescents significantly increased compared to the expected based on the prepandemic period during the pre-COVID-19 period (weighted screen time before the pandemic [133.24 min/day; 95% CI, 132.08-134.40] vs. during the pandemic [303.66 min/day; 95% CI, 300.59-306.73]; βdiff 0.331; 95% CI, 0.311-0.351). Comparing before and during the pandemic, potential risk factors associated with screen exposure included female sex, sadness, suicidal thoughts, alcohol consumption, low educational level of parents, low level of vigorous physical activity, middle school students, and low household income. DISCUSSION Through large-scale nationwide study, this study described the 14-year trend of screen time among Korean adolescents. In the era of COVID-19, the prevalence of screen exposure has been increasing more rapidly than before at the population level. Also, the pandemic amplified the differences in screen time across grade, sex, sadness, suicidal thoughts, smoking, alcohol consumption, education level of parents, physical activity, and household income groups.
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Affiliation(s)
- Jiyeon Oh
- Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Minji Kim
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea; Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Sang Youl Rhee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea; Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, South Korea
| | - Masoud Rahmati
- Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khoramabad, Iran; Department of Physical Education and Sport Sciences, Faculty of Literature and Humanities, Vali-E-Asr University of Rafsanjan, Rafsanjan, Iran
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Deu, Barcelona, Spain
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, United Kingdom
| | - Min Seo Kim
- Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Guillaume Fond
- Research Centre on Health Services and Quality of Life, Assistance Publique-Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - Laurent Boyer
- Research Centre on Health Services and Quality of Life, Assistance Publique-Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - Sunyoung Kim
- Department of Family Medicine, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea.
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea.
| | - Dong Keon Yon
- Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea; Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea; Department of Regulatory Science, Kyung Hee University, Seoul, South Korea; Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea.
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Chau K, Chau N. Substance Use Among Middle School Adolescents: Association with Family Members' and Peers' Substance Use and the Mediating Role of School and Mental Difficulties. Psychiatry 2024; 87:111-133. [PMID: 38376486 DOI: 10.1080/00332747.2024.2303897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
OBJECTIVE We assessed the associations of substance (alcohol, tobacco, cannabis, and other illicit drugs) use of adolescents with that of their family members (father, mother, step-parent, brothers/sisters, and grandparents) and peers, and the mediating role of school and mental difficulties (SMDs) which remained insufficiently addressed. METHODS This cross-sectional population-based study included 1,559 middle-school adolescents in France (mean age = 13.5 ± 1.3, 778 boys, 781 girls). They completed a questionnaire including socioeconomic features (nationality, family structure and parents' education, occupation, and income), substance use, cumulative number of substance use of family members (father, mother, step-parent, brothers/sisters, and grandparents) and peers (noted familySUcn and peerSUcn), SMDs (grade repetition, suffered physical/verbal violence, sexual abuse, lack of family/peer support, depressive symptoms, suicide attempt, and age at onset). Data were analyzed using logistic regression models and Kaplan-Meier estimates. RESULTS Most adolescents had familySUcn 1-2, 3-5, and ≥ 6 (39.1%, 23.0%, and 4.5%, respectively) and peerSUcn 1-2 and ≥ 3 (36.1% and 13.0%, respectively). Strong dose-effect associations were found between all substance use and familySUcn and peerSUcn (odds ratio adjusted for sex, age, and socioeconomic features reaching 13.44 and 9.90, respectively, most with p < .001). SMDs explained more the associations of all substance use with familySUcn than with peerSUcn (contributions reaching 69% and 34%, respectively). The proportion of subjects without each substance use decreased with age more quickly among the adolescents with higher familySUcn or peerSUcn. CONCLUSIONS Early prevention reducing familySUcn, peerSUcn and SMDs among adolescents and their families may reduce efficiently initiation and regular use of substances during adolescents' life course.
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Chau K, Perrin P, Chau N. Associations between excessive screen time and school and out-of-school injuries among adolescents: A population-based study. Psychiatry Res 2024; 331:115679. [PMID: 38142602 DOI: 10.1016/j.psychres.2023.115679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 12/10/2023] [Accepted: 12/14/2023] [Indexed: 12/26/2023]
Abstract
Most adolescents spend excessive screen time (with television viewing, computer/console gaming, discussion forums/chatting online, internet surfing, doing homework, and electronic mails) which may impact the occurring of various types of school and out-of-school injuries. We assessed their associations and potential confounding factors among 1559 middle-school students from north-eastern France (mean age=13.5 ± 1.3). Participants completed a questionnaire including socioeconomic features, daily screen time for various screen-based activities (coded 1=<2, 2 = 2-4, 3=≥5 h; daily-total-screen time level (TDST) was defined as their sum, categorized into <7/7-11/≥12), various injury types during the school-year, behavior and health difficulties (BHDs; alcohol/tobacco/cannabis/other illicit drugs use, suffered physical/verbal violence, sexual abuse, poor family-peer support, sleep difficulty, depressive symptoms, suicide attempt, and time at onset). Most subjects had TDST≥7 (82.3 %). There were dose-effect associations of TDST with school-physical/sports training, school-free-time, out-of-school-sports, and single/repeated injuries (sex-age-adjusted odds ratio reaching 4.45). BHDs explained up to 39 % of these associations. The frequency of subjects without various BHDs decreased with age since age 10 more quickly among the participants with both TDST≥7 and injury than among the others. Our findings may inform health care providers, parents, schools, and public policy that reducing elevated screen time is efficient to prevent injuries and BHDs among adolescents.
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Affiliation(s)
- Kénora Chau
- University of Lorraine, Faculty of Medicine, Department of General Medicine, Vandoeuvre-lès-Nancy F-54500, France; INSERM, Centre d'Investigations Cliniques Plurithématique 1433, UMR 1116, Université de Lorraine and CHU de Nancy, Vandoeuvre-lès-Nancy, France
| | - Philippe Perrin
- University of Lorraine, RU 3450 DevAH - Development, Adaptation and Handicap, Faculty of Medicine, University Hospital of Nancy, Department of Paediatric Oto-Rhino-Laryngology, Vandoeuvre-lès-Nancy F-54500, France
| | - Nearkasen Chau
- INSERM, U1018, CESP, Paris Sud University, Paris Descartes University, Paris UMR-S1178, France.
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Chau N, Perrin P, Gauchard G, Bhattacherjee A, Senapati A, Belbraouet S, Guillemin F, Falissard B, Chau K. Associations between School-Behavior-Health Difficulties and Subsequent Injuries among Younger Adolescents: A Population-based Study. Psychiatry 2023; 86:344-363. [PMID: 37522706 DOI: 10.1080/00332747.2023.2238571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Objective: School-behavior-health difficulties (SBHDs) may alter physical/mental capabilities and consequently increase injury risk during daily activities. This study assessed the associations of potential SBHDs and their cumulative number (SBHDcn) with various injury types among younger adolescents. Methods: The study population included 1,559 middle-school adolescents in France (10-18 years, 98% under 16,778 boys and 781 girls). They completed a questionnaire at school-year end collecting socioeconomic features (nationality, family structure, parents' education/occupation/income), school/out-of-school injuries during the school-year (dependent variables), and SBHDs starting before the school-year (low academic performance, alcohol/tobacco/cannabis/other-illicit-drugs use, physical/verbal violence, sexual abuse, perpetrated violence, poor social support, poor general health status, sleep difficulty, depressive symptoms, and suicide attempt). Data were analyzed using logistic regression models and Kaplan-Meier estimates. Results: Injuries were frequent during school-physical/sports-training (10.9%), other-school-training (4.7%), school-free-time (7.4%), out-of-school-sports-activity (16.5%), and traffic (2.2%). Single injury (one injury all injury types combined) and ≥2 injury types affected 23.3 and 7.9% of subjects, respectively. The proportion of adolescents without SBHDs decreased with age more quickly among those with each injury type than among those without injury. Various SBHDs were associated with most injury types, single injury, and ≥2 injury types (sex-age-adjusted odds/relative-risk ratios reaching 11, p < .001). A dose-effect association was found between SBHDcn 1-2/3-5/≥6 and both single injury and ≥2 injury types (sex-age adjusted relative risk ratios reaching 12.66, p < .001, vs. SBHDcn = 0). Socioeconomic features had a moderate confounding role in these associations. Conclusions: SBHDs strongly predict injuries among adolescents. Our findings may inform healthcare providers about their prominent role in detecting/reducing SBHDs and injuries.
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Chau K, Chau N. Association between untreated low back pain and injury proneness and confounding role of behavioral-health difficulties among younger adolescents: a population-based study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023:10.1007/s00586-023-07679-4. [PMID: 37103577 DOI: 10.1007/s00586-023-07679-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/29/2023] [Accepted: 03/22/2023] [Indexed: 04/28/2023]
Abstract
PURPOSE Low back pain (LPB) is mostly left untreated (LBPuntreated) and may increase the injury risk due to associated behavioral-health difficulties (BHDs) among adolescents. This study assessed the association between LBPuntreated (vs. treated LBP (LBPtreated)) and injuries and the mediating role of BHDs among younger adolescents (10-16 years). METHODS This population-based study compared 328 adolescents with LBPuntreated (mean age = 13.7 ± 1.3) with 291 with LBPtreated (mean age = 13.3 ± 1.2) from north-eastern France. They completed a questionnaire collecting, at school-year end, socioeconomic features, LBPtreated/LBPuntreated, BHDs (alcohol/tobacco use, excessive screen-time, poor social support, poor physical health, depressive symptoms, and pain limiting activities), and injuries during the current school-year. Data were analyzed using multinomial logistic regression models and Kaplan-Meier estimates. RESULTS The proportion of subjects without alcohol/tobacco use or depressive symptoms decreased with time more quickly since age 10 among the adolescents with LBPuntreated than among those with LBPtreated. Hence, most LBP early started and the subjects with LBPuntreated had a higher risk of single injury (sex-age-class-level-socioeconomic-features-adjusted relative risk ratio RR = 1.63, p < 0.05, vs. LBPtreated) and a much higher risk of ≥ 2 injuries (RR = 2.60, p < 0.001). BHDs played a strong mediating role in the association between LBPuntreated and ≥ 2 injuries (contribution = 48%) but a modest mediating role in that between LBPuntreated and single injury (contribution = 10%) (pseudo R2 = 7.6%). CONCLUSION LBPuntreated is common and associated with injuries partly due to BHDs (which may alter physical/mental capabilities, risk perception/awareness, and vigilance) among younger adolescents. Our results may inform healthcare providers that they can detect/treat LBP and BHDs to prevent their aggravation and injuries.
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Affiliation(s)
- Kénora Chau
- Department of General Medicine, INSERM, Centre d'Investigations Cliniques Plurithématique 1433, UMR 1116, University of Lorraine, 20199, 9, avenue de la Forêt de Haye, 54500, Vandoeuvre-lès-Nancy, Meurthe-et-Moselle, France
| | - Nearkasen Chau
- Institut National de la Santé et de la recherche médicale (INSERM), unit 1178, CESP, Paris Sud University, Paris Descartes University, Maison de Solenn, 97, Boulevard de Port Royal, 75679, Paris Cedex 14, France.
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