Problem Behaviors and Psychological Distress Among Teens Seen in a National Sample of Emergency Departments

Background: Problem behaviors, such as substance use and peer aggression, frequently coexist and are common among youth seen in emergency departments (EDs). EDs are increasingly urged to screen for both psychological distress and problem behaviors.

Objective: To inform screening and intervention efforts, we aimed to identify classes of problematic substance use and peer aggression in a sample of adolescents from 16 pediatric EDs, and to examine the relative prevalence of psychological distress in identified classes.

Methods: We completed a cross-sectional survey of youth (n = 5001) presenting for any reason to 16 pediatric EDs across the United States, with the use of validated measures of demographics, alcohol and substance use, and peer aggression. We used standard latent class analysis techniques to create behavioral risk classes of adolescents based on violence and substance use variables; then we conducted logistic regression to examine the relationship between psychological distress and the latent classes.

Results: Three classes of problem behaviors were identified: low-risk (few problem behaviors, 91.2% of sample), medium risk (high cigarette smoking; moderate violence, alcohol/substance use; 5.2%), and high risk (high levels of all problem behaviors, 3.5%). A significant directional association (P < .001) between worse psychological distress and higher-risk behavior classes was noted, even after adjusting for demographics.

Conclusions: Youth seen in the ED for any reason who report higher levels of past-year substance use and peer aggression are significantly more likely to report negative mood symptoms. Targeted screening and interventions for this population may be indicated.