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Signs of depression and anxiety in middle school students were linked to greater cardiometabolic risks in the years following, according to a prospective study of U.S. Latinx youth.

Internalizing mental health symptoms around the age of 13 were tied with later sleep problems (ß = 0.36, 95% CI 0.24-0.48), having overweight or obesity (adjusted OR 2.57, 95% CI 1.29-5.15), and engaging in sedentary behavior (ß = 0.19, 95% CI 0.09-0.30), found Kathleen Roche, PhD, MSW, of the Milken Institute School of Public Health at George Washington University, and colleagues.

Experiencing internalizing symptoms in middle school was also linked with these symptoms 4 years later (ß = 0.48, 95% CI 0.39-0.56), the researchers wrote in the .

On the other hand, the symptoms were inversely linked with having a healthy diet (ß = -0.21, 95% CI -0.32 to -0.09) and engaging in physical activity (ß = -0.16, 95% CI -0.27 to -0.05) by age 17.

These findings likely reflect an "underestimate" of the effects of early adolescent mental health on later adolescent physical health because the assessments began in 2018 -- 2 years prior to the pandemic -- which was linked to significant increases in depression and anxiety, Roche told 番茄社区app.

Given that both mental and physical health concerns are more pronounced in this population, Roche's group sought to examine what Latinx youth's mental health challenges might mean for their physical health outcomes.

She noted this is one of the first studies that linked depression and anxiety during middle school years with greater sleep and metabolic risk factors a few years later.

"Mental health symptoms are strong correlates of these poor physical health outcomes," she pointed out. These "early signs" of poor physical health are particularly concerning as they have the potential to significantly increase young people's risk of cardiometabolic outcomes into adulthood.

As for the study's implications, Roche said that so many of the current interventions to target cardiometabolic risk for those at risk center around increasing physical activity, eating healthy, and other lifestyle changes.

"In focusing only that way, we're missing this really important component of mental health because kids who feel sad and anxious and depressed are going to have a much harder time being motivated to engage in the kinds of behaviors that are important to physical health," she said. "These mental health symptoms really set in motion, a pattern of behaviors that then become habitual."

"If we could do more to help kids experience more positive mental health, we will help set the stage for them to adopt the kinds of behaviors that promote physical health," Roche added.

The researchers leveraged data from the Pathways to Health/Caminos al Bienestar study of Latinx adolescents and their mothers. Hispanic participants were randomly selected from the 2017-2018 enrollment lists of middle school students in one suburban Atlanta school district. The sample included 547 students (55.4% female, 89.5% U.S. born). A total of 38.2% teens self-identified only as Latinx or Hispanic, while 24.7% said they were also white, 4.8% Black, 2.4% Asian, 3.7% American Indian or Indigenous, and 3.7% "other."

At follow-up in 2022, the average internalizing t-score was 57.52 compared with 53.95 a few years prior. Internalizing symptoms included "an array of mental health symptoms," Roche's group said, extending to feelings of depression, sadness, loneliness, crying, worrying, and somatization like headaches and stomachaches with no known cause.

Male participants reported fewer internalizing symptoms both at baseline and follow-up, as well as fewer sleep challenges and more vigorous physical activity. Maternal education was inversely linked to overweight and obesity and positively associated with teens' sedentary behavior.

By 2022, almost 40% had overweight or obesity and 14.5% had diabetes/prediabetes or hypertension/prehypertension risk. Participants spent on average 5.88 hours a day engaged in sedentary behavior and 2.8 days engaged in vigorous physical activity. Mean scores for sleep problems were 5.25 based on the (higher scores indicate more difficulty sleeping) and mean scores for a healthy diet were 6.67 using the 16-item Food Habits Scale (higher scores reflect a healthier diet).

Health behaviors weren't recorded at baseline, which prevented the researchers from examining how these might also predict later mental health problems. Other limitations were the self-reported measures by the students and lack of "objective assessments" from healthcare providers.

In future studies, Roche plans to explore "pathways to success" by identifying which kids "bounce back" in the face of negative impacts on their trajectories and identify "sources of strength and resilience" to inform later interventions.

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