Mental health trends among female youth and the relationship with violence

Abstract

Objective: Investigate if the prevalence of depression/suicidality changed from 2001 to 2015 among adolescent females exposed to sexual assault or physical fighting, and if various violent exposures or the accumulation of events induced differential levels of risk.

Methods: Eight national Youth Risk Behavior Surveillance (YRBS) cross-sectional databases (2001-2015) were analyzed using complex survey techniques. For the trends analyses, logistic regression was used to evaluate linear, quadratic or cubic trends, with contrast statement methods to identify inflection points. Multiple logistic regression models were built to understand associations with other risk factors. The 2015 database was used for the differential analyses and hypotheses were tested using logistic regression models.

Results: There was a statistically significant decline in depression/suicidality from 2001 to 2009 followed by an incline through 2015 for sexual assault victims (P=0.0001) and physical fighters (P<0.0001). Bullying and electronic bullying contributed to increases in latter years. For sexual assault victims, methamphetamine use declined (2001-2015) and team sports participation increased (2009). For physical fighters, sexual assault and carrying a weapon had a similar quadratic trend. Among fighters the prevalence of other violent exposures (1+) was approximately 2 times greater than non-fighters (2001-2015) and exceeded 65% when accounting for bullying and electronic bullying (2011-2015). Differentiation of risk between various violent events was only observed for electronic bullying (OR=2.51; 95% CI=[2.02, 3.13]) vs. bullying (OR=1.43; 95% CI=[1.13, 1.79]) and victimization (OR 3.79; 95% CI=[3.33, 4.30]) vs. violence related behaviors (OR=2.31; 95% CI=[1.81, 2.96]). There was a positive dose-response relationship with the cumulative number of violent events, one event produced a risk of 1.40 (95% CI=[1.33, 1.48]) which increased with each additional exposure.

Conclusions: The direction of depression/suicidality prevalence changes among sexual assault victims and physical fighters may be attributable to unique modifiable risk factors. The emergence of electronic bullying contributed to increases in depression/suicidality, poly victimization, and induced greater risk than bullying. The accumulation of violent exposures is seemingly a stronger predictor of depression/suicidality. Overall, efforts to reduce exposure across multiple or more prevalent forms of violence has the potential to reduce the risk of depression/suicidality among female adolescent victims and aggressors of violence.