Geographic, Sociodemographic Challenges Linked to Poor Mental Health Symptoms in Youth


Race/ethnicity, parental education, household income, housing tenure, household food sufficiency, and health insurance coverage are all factors linked to the likelihood of mental health challenges in children and adolescents.

Children and adolescents are susceptible to poor mental health symptoms based on varying understated geographic and sociodemographic factors, according to a new study led by Junxiu Liu, PhD, of the department of population health science and policy at Icahn School of Medicine.1

Previous research has informed the well-understood commonality of mental health issues among high school-aged students. A Centers for Disease Control and Prevention (CDC) report found more than one-third of high school students faced mental health challenges during the pandemic.2 Also, a Pew Research Center survey discovered 40% of US parents believed mental health was a top concern for their children.3

Liu and colleagues drew their data from Household Pulse Survey (HPS), conducted by the US Census Bureau and other federal agencies to collect data on social and economic effects of the COVID-19 pandemic on US household households, between June 1 – November 12, 2022.1

The sample included 103,296 households, with 190,017 youths aged <18 years old. Data was based on parent’s responses and included the following categories:

  • Race/ethnicity
  • Parent’s educational level
  • Income level
  • Housing status (if they rent or not)
  • Food insufficiency
  • Health insurance coverage.

The report found 34.5% (95% CI, 33.7 - 35.3) of the youths had mental health symptoms, with rates differing across states. For example, in Florida, 27.9% of youth had mental health symptoms (95% CI, 23.8 – 32.0), while in New Hampshire, 46.4% of youth had mental health symptoms (95% CI, 41.9 – 50.9).

The team also conducted subgroup analyses for race/ethnicity, finding significant variations in the prevalence of mental health symptoms in the sociodemographic subgroups.

The prevalence of symptoms among children and adolescents of difference race/ethnicities were as followed:

- 22.6% among non-Hispanic Asian (95% CI,19.9 - 27.3)

- 28.5% among non-Hispanic Black (95% CI, 26.2 - 30.7)

- 32.2% among Hispanic (95% CI, 29.6 - 34.8)

- 37.7% among non-Hispanic White (95% CI, 36.8 - 38.5)

- 41.0% among “other” race/ethnicity groups (95% CI, 37.6 - 44.4)

Youths who had parents who attended higher education had more mental health problems; the prevalence of mental health symptoms among children of parents who had graduate degrees was 37.4% (95% CI, 36.3 - 38.5), opposed to just 30.3% of children who had parents with less than a high school education (95% CI, 23.8 - 36.8).

Then, youths in families with higher annual income (>$200,000) had lower rates of mental health symptoms, while youths with lower income (<$25,000) had more mental health symptoms (30.7% [95% CI, 29.1 - 32.3] vs 37.3% [95% CI, 34.8 - 39.8%]).

Youth had a lower prevalence (29.5% [95% CI, 27.3 - 31.7]) when their household “owned their housing free and clear” but a higher prevalence (49.0% [95% CI, 40.8 - 57.3]) when “household units occupied without rent payments.”

Meanwhile for youths who had food insufficiency, the prevalence of mental health symptoms was 58.0% (95% CI, 51.7 - 64.2). But for youths who did not have food insufficiency, the prevalence of mental health symptom was more than halved (26.3% [95% CI, 25.4 -27.1]).

Finally, youths with public household health insurance had a higher prevalence of 37.7% (95% CI, 36.1 - 39.2) while youths with private insurance had a lower prevalence of 34.4% (95% CI, 32.6 - 34.3).

The investigators noted some limitations of the study.

“The assessment of mental health symptoms relied on parental report of symptoms of anxiety and depression over the past 4 weeks, which is not a diagnostic method and may not capture long-term symptoms or other mental health conditions,” the team wrote. “In addition, because of the lack of individual-level data for youths, we estimated the prevalence of mental health symptoms among youths using personal weights adjustment according to the analytical guideline provided by the US Census Bureau.”

Yet, despite the limitations, the findings still stress the importance of addressing mental health challenges facing children and adolescents in the US.

“Our results highlight the necessity of developing and implementing tailored and targeted interventional programs that take into account geographic and sociodemographic variations in mental health symptoms,” investigators concluded. “Policymakers and health care providers should pay special attention to the subgroups of youths who are disproportionately affected by mental health symptoms, such as those living in households that do not pay rent and those experiencing food insufficiency.”


  1. Liu J, Zhou Z, Cheng X, Vangeepuram N. Geographic and Sociodemographic Variations in Prevalence of Mental Health Symptoms Among US Youths, 2022. Am J Public Health. 2023;113(10):1116-1119. doi:10.2105/AJPH.2023.307355
  2. Centers for Disease Control and Prevention. Mental health, suicidality, and connectedness among high school students during the COVID-19 pandemic—Adolescent Behaviors and Experiences Survey, United States, January–June 2021. MMWR Suppl. 2022;71(3):16–21. mmwr.su7103a3
  3. Pew Research Center. Parenting in America today. January 24, 2023. Available at: Accessed October 4, 2023.

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