Browse > Article
http://dx.doi.org/10.5765/jkacap.210017

The Association of Anxiety Severity With Health Risk Behaviors in a Large Representative Sample of Korean Adolescents  

Woo, Kyung Soo (Department of Psychiatry, Daegu Catholic University School of Medicine)
Ji, Yoonmi (Department of Psychiatry, Daegu Catholic University School of Medicine)
Lee, Hye Jeong (Department of Psychiatry, Daegu Catholic University School of Medicine)
Choi, Tae Young (Department of Psychiatry, Daegu Catholic University School of Medicine)
Publication Information
Journal of the Korean Academy of Child and Adolescent Psychiatry / v.32, no.4, 2021 , pp. 144-153 More about this Journal
Abstract
Objectives: Anxiety disorders are the most common psychiatric disorders in adolescents and seem to occur the earliest among all forms of psychopathology. The aim of this study was to investigate the association of anxiety severity with health risk behaviors and mental health in adolescents. Methods: Data from the 2020 Korean Youth Risk Behavior Web-Based Survey were analyzed. A total of 54948 adolescents responded to the 7-item Generalized Anxiety Disorder Scale (GAD-7) for the assessment of their anxiety severity as well as to the mental health and health risk behavior survey. Logistic regression analysis, t tests, and variance analysis of a complex sample general linear model were used to examine the association of anxiety severity with health behaviors and mental health. Results: After statistical adjustment for sociodemographic characteristics, the subjects in the severe anxiety group were significantly more likely to be current smokers (odds ratio [OR]: 2.08, 95% confidence interval [CI]: 1.72-2.50), current drinkers (OR: 1.91, 95% CI: 1.67-2.19), experience habitual substance use (OR: 10.89, 95% CI: 8.22-14.42), have sexual intercourse (OR: 2.10, 95% CI: 1.76-2.51), and have unprotected intercourse (OR: 2.21, 95% CI: 1.67-2.92) than those in the normal group. Anxiety severity negatively correlated with sleep satisfaction and happiness, but positively correlated with stress perception, loneliness, depressive symptoms, and suicidality. Conclusion: Adolescent anxiety is associated with health risk behaviors and poor mental health. Thus, early screening and intervention for anxiety in adolescents could contribute to the management and coping of youth health risk behaviors in the community.
Keywords
Adolescents; Anxiety; Health risk behaviors; Generalized Anxiety Disorder Scale; Mental health;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Smith JP, Book SW. Anxiety and substance use disorders: a review. Psychiatr Times 2008;25:19-23.
2 Baskin-Sommers A, Sommers I. The co-occurrence of substance use and high-risk behaviors. J Adolesc Health 2006;38:609-611.   DOI
3 Kroenke K, Spitzer RL, Williams JB, Monahan PO, Lowe B. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med 2007;146:317-325.   DOI
4 Shear MK, Bjelland I, Beesdo K, Gloster AT, Wittchen HU. Supplementary dimensional assessment in anxiety disorders. Int J Methods Psychiatr Res 2007;16 Suppl 1:S52- S64.   DOI
5 Merikangas KR, He JP, Burstein M, Swanson SA, Avenevoli S, Cui L, et al. Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication-- Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry 2010;49:980-989.   DOI
6 Wittchen HU, Lieb R, Pfister H, Schuster P. The waxing and waning of mental disorders: evaluating the stability of syndromes of mental disorders in the population. Compr Psychiatry 2000;41:122-132.   DOI
7 Tiirikainen K, Haravuori H, Ranta K, Kaltiala-Heino R, Marttunen M. Psychometric properties of the 7-item Generalized Anxiety Disorder Scale (GAD-7) in a large representative sample of Finnish adolescents. Psychiatry Res 2019;272:30-35.   DOI
8 Wittchen HU, Nelson CB, Lachner G. Prevalence of mental disorders and psychosocial impairments in adolescents and young adults. Psychol Med 1998;28:109-126.   DOI
9 Lim MH, Rodebaugh TL, Zyphur MJ, Gleeson JF. Loneliness over time: the crucial role of social anxiety. J Abnorm Psychol 2016;125:620-630.   DOI
10 Acquah EO, Topalli PZ, Wilson ML, Junttila N, Niemi PM. Adolescent loneliness and social anxiety as predictors of bullying victimisation. Int J Adolesc Youth 2016;21:320-331.   DOI
11 Gallagher M, Prinstein MJ, Simon V, Spirito A. Social anxiety symptoms and suicidal ideation in a clinical sample of early adolescents: examining loneliness and social support as longitudinal mediators. J Abnorm Child Psychol 2014;42:871-883.   DOI
12 Dieleman GC, Huizink AC, Tulen JH, Utens EM, Creemers HE, van der Ende J, et al. Alterations in HPA-axis and autonomic nervous system functioning in childhood anxiety disorders point to a chronic stress hypothesis. Psychoneuroendocrinology 2015;51:135-150.   DOI
13 Tsoory M, Cohen H, Richter-Levin G. Juvenile stress induces a predisposition to either anxiety or depressive-like symptoms following stress in adulthood. Eur Neuropsychopharmacol 2007;17:245-256.   DOI
14 Bentley KH, Franklin JC, Ribeiro JD, Kleiman EM, Fox KR, Nock MK. Anxiety and its disorders as risk factors for suicidal thoughts and behaviors: a meta-analytic review. Clin Psychol Rev 2016;43:30-46.   DOI
15 Garber J, Weersing VR. Comorbidity of anxiety and depression in youth: implications for treatment and prevention. Clin Psychol (New York) 2010;17:293-306.   DOI
16 Chase RM, Pincus DB. Sleep-related problems in children and adolescents with anxiety disorders. Behav Sleep Med 2011;9:224-236.   DOI
17 Spinhoven P, Elzinga BM, Giltay E, Penninx BW. Anxious or depressed and still happy? PLoS One 2015;10:e0139912.   DOI
18 American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. 5th ed. Arlington, VA: American Psychiatric Association;2013.
19 Horiuchi S, Tsuda A, Toyoshima N, Aoki S, Sakano Y. Association of increased levels of happiness with reduced levels of tension and anxiety after mental stress testing in Japanese college students. Psychology (Irvine) 2013;4:682-687.   DOI
20 Moylan S, Jacka FN, Pasco JA, Berk M. How cigarette smoking may increase the risk of anxiety symptoms and anxiety disorders: a critical review of biological pathways. Brain Behav 2013;3:302-326.   DOI
21 Woodward LJ, Fergusson DM. Life course outcomes of young people with anxiety disorders in adolescence. J Am Acad Child Adolesc Psychiatry 2001;40:1086-1093.   DOI
22 Kessler RC, Crum RM, Warner LA, Nelson CB, Schulenberg J, Anthony JC. Lifetime co-occurrence of DSM-III-R alcohol abuse and dependence with other psychiatric disorders in the National Comorbidity Survey. Arch Gen Psychiatry 1997;54:313-321.   DOI
23 Gullone E. Developmental psychopathology and normal fear. Behav Change 1996;13:143-155.   DOI
24 Merikangas KR, He JP, Burstein M, Swendsen J, Avenevoli S, Case B, et al. Service utilization for lifetime mental disorders in U.S. adolescents: results of the National Comorbidity Survey-Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry 2011;50:32-45.   DOI
25 Pailing AN, Reniers RLEP. Depressive and socially anxious symptoms, psychosocial maturity, and risk perception: associations with risk-taking behaviour. PloS one 2018;13:e0202423.   DOI
26 Igra V, Irwin CE. Theories of adolescent risk-taking behavior. In: DiClemente RJ, Hansen WB, Ponton LE, editors. Handbook of adolescent health risk behavior. Boston: Springer;1996. p.35-51.
27 Brener ND, Collins JL. Co-occurrence of health-risk behaviors among adolescents in the United States. J Adolesc Health 1998;22:209-213.   DOI
28 Flory K, Lynam D, Milich R, Leukefeld C, Clayton R. Early adolescent through young adult alcohol and marijuana use trajectories: early predictors, young adult outcomes, and predictive utility. Dev Psychopathol 2004;16:193-213.   DOI
29 Andersen A, Krolner R, Currie C, Dallago L, Due P, Richter M, et al. High agreement on family affluence between children's and parents' reports: international study of 11-year-old children. J Epidemiol Community Health 2008;62:1092-1094.   DOI
30 Spitzer RL, Kroenke K, Williams JB, Lowe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 2006;166:1092-1097.   DOI
31 Glantz MD, Anthony JC, Berglund PA, Degenhardt L, Dierker L, Kalaydjian A, et al. Mental disorders as risk factors for later substance dependence: estimates of optimal prevention and treatment benefits. Psychol Med 2009;39:1365-1377.   DOI
32 Seo JG, Park SP. Validation of the Generalized Anxiety Disorder-7 (GAD-7) and GAD-2 in patients with migraine. J Headache Pain 2015;16:97.   DOI
33 Korea Disease Control and Prevention Agency. The 16th reports on the Korea youth risk behavior web-based survey (2020). Cheongju: Korea Disease Control and Prevention Agency;2021 [cited 2021 Jun 1]. Available from: http://www.kdca.go.kr/yhs/yhshmpg/ result/yhsresult/statsBookList.do.
34 Dyer ML, Easey KE, Heron J, Hickman M, Munafo MR. Associations of child and adolescent anxiety with later alcohol use and disorders: a systematic review and meta-analysis of prospective cohort studies. Addiction 2019;114:968-982.   DOI