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Population-level monitoring of adolescent mental health is a critical public health activity used to help define local, state, and federal priorities. The Youth Risk Behavior Surveillance System includes a single-item measure of experiences of sadness or hopelessness as an indicator of risk to mental health. In 2021, 42% of high school students reported having felt sad or hopeless for 2 weeks or more during the past 12 months. The high prevalence of US high school students with this experience has been highlighted in recent studies and media reports.
This study seeks to examine associations between this single-item measure of experiences of sadness or hopelessness with other indicators of poor mental health including frequent mental distress and depressive symptoms.
We analyzed survey data from a national sample of 737 adolescents aged 15-19 years as a part of the Teen and Parent Surveys of Health. Participants were recruited from AmeriSpeak, a probability-based panel designed to be representative of the US household population. Feeling sad or hopeless was operationalized as a “yes” response to the item, “During the past 12 months, did you ever feel so sad or hopeless almost every day for 2 weeks or more in a row that you stopped doing some usual activities?” Unadjusted and adjusted prevalence ratios (aPRs) were calculated to examine associations between the single-item measure of having felt sad or hopeless almost every day for 2 weeks with moderate to severe depressive symptoms, frequent mental distress, and functional limitation due to poor mental health. Adjusted models controlled for age, race and ethnicity, sex assigned at birth, and sexual identity.
Overall, 17.3% (unweighted: 138/735) of adolescents reported that they felt sad or hopeless for 2 weeks or more during the past 12 months, 30.2% (unweighted: 204/716) reported moderate to severe depressive symptoms, 18.4% (unweighted: 126/732) reported frequent mental distress, and 15.4% (unweighted: 107/735) reported functional limitation due to poor mental health. After adjusting for demographics, adolescents who reported that they felt sad or hopeless for 2 weeks or more were 3.3 times as likely to report moderate to severe depressive symptoms (aPR 3.28, 95% CI 2.39-4.50), 4.8 times as likely to indicate frequent mental distress (aPR 4.75, 95% CI 2.92-7.74), and 7.8 times as likely to indicate mental health usually or always interfered with their ability to do things (aPR 7.78, 95% CI 4.88-12.41).
Associations between having felt sad or hopeless for 2 weeks or more and moderate to severe depressive symptoms, frequent mental distress, and functional limitation due to poor mental health suggest the single-item indicator may represent relevant symptoms associated with poor mental health and be associated with unmet health needs. Findings suggest the single-item indicator provides a population-level snapshot of adolescent experiences of poor mental health.
Population-level monitoring of adolescent mental health is a critical public health activity [
One such measure of poor adolescent mental health that has received growing attention in recent studies and media reports is a single-item measure of experiences of sadness or hopelessness [
This descriptive study seeks to expand the understanding of this single-item measure by examining its alignment with established measures of poor mental health.
We analyzed survey data from a national sample of 737 adolescents aged 15-19 years. Data were collected by NORC at the University of Chicago, May to September 2022, as part of the Teen and Parent Surveys of Health (TAPS). Participants were recruited from AmeriSpeak, a probability-based panel designed to be representative of the US household population. Selected US households are sampled using area probability and address-based sampling from the NORC National Sample Frame to form the AmeriSpeak general adult panel. Recruitment occurs by US mail, telephone, and field interviews. In addition to the general adult panel, there are also subpanels of specific populations, including the AmeriSpeak teen panel of adolescents aged 13-17 years [
Participants received the equivalent of US $20 in AmeriPoints, redeemable for a gift card [
The analysis included four indicators of poor mental health: (1) felt sad or hopeless, based on a
The following demographic characteristics were examined: sex assigned at birth, age, race/ethnicity, and sexual identity. We present the weighted prevalence of each indicator of poor mental health overall and by demographic characteristics. Missing observations were excluded in calculations for each variable. To examine associations between feeling sad or hopeless and the other indicators of poor mental health, we used predicted margins in logistic regression to calculate prevalence ratios and adjusted prevalence ratios (aPRs), adjusting for demographics and accounting for the complex survey design.
Overall, 17.3% (unweighted: 138/735) of adolescents reported feeling sad or hopeless for 2 weeks or more during the past 12 months, 30.2% (unweighted: 204/716) reported moderate to severe depressive symptoms, 18.4% (unweighted: 126/732) reported frequent mental distress, and 15.4% (unweighted: 107/735) reported functional limitation due to poor mental health (
Adolescents reporting that they had felt sad or hopeless had 3.3 times the prevalence of moderate to severe depressive symptoms (aPR 3.28, 95% CI 2.39-4.50), 4.8 times the prevalence of frequent mental distress (aPR 4.75, 95% CI 2.92-7.74), and 7.8 times the prevalence of functional limitation due to poor mental health (aPR 7.78, 95% CI 4.88-12.41) compared to those not reporting sadness or hopelessness (
Percent distribution of demographic characteristics of adolescent respondents by having felt sad or hopeless almost every day for 2 weeks (past 12 months), moderate to severe depressive symptoms (past 2 weeks), frequent mental distress (past 30 days), and functional limitation due to poor mental health usually or always (past 12 months)a.
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Overall, n | Felt sad or hopeless almost every day for 2 weeks (past 12 months)b, n (%) | Moderate to severe depressive symptoms, PHQ-8c score ≥10 (past 2 weeks)d, n (%) | Frequent mental distress (past 30 days)e, n (%) | Functional limitation due to poor mental health |
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| Total | 737 | 138 (17.3) | 204 (30.2) | 126 (18.4) | 107 (15.4) | |
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Female | 392 | 96 (20.8) | 138 (38.5) | 87 (22.8) | 75 (19.4) |
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Male | 337 | 39 (13.5) | 63 (21.4) | 39 (14.5) | 32 (11.8) |
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15-17 | 529 | 93 (15.1) | 123 (24.4) | 77 (14.0) | 64 (13.1) |
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18-19 | 208 | 45 (21.1) | 81 (39.6) | 49 (25.8) | 43 (19.2) |
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White, non-Hispanic | 372 | 64 (15.5) | 100 (29.8) | 55 (15.5) | 52 (15.9) |
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Black, non-Hispanic | 123 | 21 (18.4) | 30 (23.0) | 19 (20.4) | 15 (14.9) |
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Hispanic/Latino | 153 | 36 (23.5) | 53 (36.3) | 35 (25.4) | 25 (17.4) |
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All other races, non-Hispanic | 89 | 17 (9.7) | 21 (26.8) | 17 (13.5) | 15 (8.9) |
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Lesbian/gay | 29 | 11 (36.5) | 13 (41.2) | 7 (18.4) | 10 (31.1) |
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Straight/heterosexual | 561 | 77 (13.7) | 124 (26.6) | 79 (17.4) | 61 (13.4) |
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Bisexual | 75 | 26 (34.0) | 36 (53.2) | 20 (27.1) | 16 (22.5) |
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Another identity/unsure | 72 | 24 (21.1) | 31 (32.7) | 20 (17.4) | 20 (18.7) |
aTable shows unweighted numbers (n) and weighted percentages (%). Missing observations were excluded in the calculation of percentages for each variable.
bFelt sad or hopeless is based on a “Yes” response to the question “During the past 12 months, did you ever feel so sad or hopeless almost every day for 2 weeks or more in a row that you stopped doing some usual activities?”
cPHQ-8: 8-item Patient Health Questionnaire.
dHaving moderate to severe depressive symptoms is based on a sum score of ≥10 on the PHQ-8 and aligns with depressive symptom severity cutoff guidelines for the PHQ, measuring number and frequency of symptoms experienced in the past 14 days.
eFrequent mental distress is based on a response of “Always” or “Most of the time” to the question “During the past 30 days, how often was your mental health not good? (Mental health includes stress, anxiety, and depression).” Response options were “Always,” “Most of the time,” “Sometimes,” “Rarely,” and “Never.”
fFunctional limitation due to poor mental health is based on response of “Always” or “Usually” to the question “During the past 12 months, how often has your mental health interfered with your ability to do things other young people your age do?” Response options were “Always,” “Usually,” “Sometimes,” “Rarely,” or “Never.”
gAdolescents reported sex at birth in response to the survey question: “What sex were you assigned at birth, on your original birth certificate?”
hAll other races category included American Indian, Alaska Native, Native Hawaiian or Pacific Islander, some other race, or selected more than one race category.
iSexual identity was based on response to the question “Which of the following best represents yourself?” Adolescents selected from the following response options: “Lesbian or gay”; “Straight, that is, not lesbian or gay”; “Bisexual”; “Something else”; “I don’t know the answer.” Responses of “Something else” or “I don’t know the answer” were coded as “Another identity/Unsure.”
Associations between adolescent report of having felt sad or hopeless almost every day for 2 weeks (past 12 months) and moderate to severe depressive symptoms (past 2 weeks), frequent mental distress (past 30 days), and functional limitation due to poor mental health usually or always (past 12 months).
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Moderate to severe depressive symptoms (PHQ-8a score ≥10; past 2 weeks)b | Frequent mental distress (past 30 days)c | Functional limitation due to poor mental health usually or always (past 12 months)d | ||||||||||
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Weighted percentage (%)e | PRf (95% CI) | aPRg (95% CI)h | Weighted percentage (%) | PR (95% CI) | aPR (95% CI) | Weighted percentage (%) | PR (95% CI) | aPR (95% CI) | ||||
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Yes | No |
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Yes | No |
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Yes | No |
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Yes | 74.5 | 25.5 | 3.59 (2.65-4.86) | 3.28 (2.39-4.50) | 55.0 | 45.0 | 5.05 (3.11-8.18) | 4.75 (2.92-7.74) | 56.0 | 44.0 | 8.02 (4.93-13.04) | 7.78 (4.88-12.41) |
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No | 20.7 | 79.3 | Reference | Reference | 10.9 | 89.1 | Reference | Reference | 7.0 | 93.0 | Reference | Reference |
aPHQ-8: 8-item Patient Health Quetionnaire.
bHaving moderate to severe depressive symptoms is based on a sum score of ≥10 on the PHQ-8 and aligns with depressive symptom severity cutoff guidelines for the PHQ, measuring number and frequency of symptoms experienced in the past 14 days.
cFrequent mental distress is based on a response of “Always” or “Most of the time” to the question “During the past 30 days, how often was your mental health not good? (Mental health includes stress, anxiety, and depression).” Response options were “Always,” “Most of the time,” “Sometimes,” “Rarely,” and “Never.”
dFunctional limitation due to poor mental health is based on response of “Always” or “Usually” to the question “During the past 12 months, how often has your mental health interfered with your ability to do things other young people your age do?” Response options were “Always,” “Usually,” “Sometimes,” “Rarely,” or “Never.”
eTable shows weighted row percentages (%). Missing observations were excluded in calculations for each variable.
fPR: prevalence ratio.
gaPR: adjusted prevalence ratio.
hAdjusted for age, race and ethnicity, sex assigned at birth, and sexual identity.
iFelt sad or hopeless is based on a “Yes” response to the question “During the past 12 months, did you ever feel so sad or hopeless almost every day for 2 weeks or more in a row that you stopped doing some usual activities?”
Our study identified strong associations between having felt sad or hopeless and having moderate to severe depressive symptoms, frequent mental distress, and functional limitation due to poor mental health. Results suggest the single-item YRBSS measure offers a depiction of poor mental health among adolescents and support its use in population studies.
Mental health is a broad concept that includes a range of functioning across various contexts and environments [
Several limitations of our study must be acknowledged. First, we used data from a small sample of adolescents recruited from a panel, and we found prevalence of having felt sad or hopeless among this sample to be far lower than the national prevalence found in the 2021 YRBSS cycle [
Population-level monitoring of adolescent health behaviors is a critical public health activity that helps ensure awareness of changing needs of adolescents and helps support priority-setting for public health programming [
adjusted prevalence ratio
Centers For Disease Control and Prevention
8-item Patient Health Questionnaire
Teen and Parent Surveys of Health
Youth Risk Behavior Surveillance System
This study was funded, in part, by the Centers for Disease Control and Prevention (CDC) contract task order number 75D30119F06605 to NORC at the University of Chicago. This project was also supported by an appointment to the Research Participation Program at the CDC, administered by the Oak Ridge Institute for Science and Education through an inter-agency agreement between the U.S. Department of Energy and the CDC. The authors acknowledge that the copyright of this study is held under the provisions of the U.S. Government’s contract rights.
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention (CDC).
None declared.