Modifiable Factors Associated with Adolescent Mental Health: Evidence from the Spartanburg County Youth Risk Behavior Survey

Background: This study examined demographic, school, behavioral, social, and academic factors associated with adolescent mental health and assessed in an exploratory analysis whether the association between academic performance and persistent sadness differed by sex. Methods: We analyzed data from 1112 adolescents participating in the 2022 Spartanburg County Youth Risk Behavior Survey. Survey-weighted logistic regression models examined persistent sadness and suicide planning, and survey-weighted ordinal logistic regression examined poor mental health. Models adjusted for demographic characteristics, bullying, school connectedness, feeling unsafe at school, physical activity, sleep, screen time, caring-adult support, and academic performance. Results: Female and bullying exposure were associated with higher odds across all three mental health outcomes, whereas longer sleep duration and greater caring-adult support were associated with lower odds across all three outcomes. Greater school connectedness was associated with lower odds of suicide planning and poor mental health, but not significantly with persistent sadness. Feeling unsafe at school was associated with persistent sadness and suicide planning, while greater screen time was associated with persistent sadness and poorer mental health. Academic performance was not independently associated with the outcomes overall. However, its association with persistent sadness differed by sex (p = 0.014). Higher academic performance was associated with lower odds of persistent sadness among female students, but not among male students. A sensitivity analysis combining sparse academic-grade categories showed a similar directional pattern, although the interaction did not reach statistical significance (p = 0.060). Conclusions: These findings identify potentially modifiable factors across school, behavioral, and relational contexts and illustrate how locally administered Youth Risk Behavior Survey (YRBS) data can inform school- and community-based adolescent mental health prevention planning and future research, while recognizing the observational nature of the findings.