Latent class analysis of health behaviors, anxiety, and suicidal behaviors among Korean adolescents

This study examined how health behavior patterns are associated with anxiety and suicidal behaviors among Korean adolescents. Data were collected from a national cross-sectional sample of adolescents (n = 54,948, 51.5 % boys) in the 2020 Korea Youth Risk Behavior Web-based Survey. Latent class analysis was conducted based on 12 health behaviors (e.g., eating habits, physical activity, and substance use) using the R-based Jamovi 2.3.21 program. Four classes of health behaviors were identified: Class 1 (boys: 45.4 %, girls: 34.4 %) engaged in healthy behaviors; Class 2 (boys: 31.7 %; girls: 22.3 %) had unhealthy eating habits; Class 3 (boys: 18.0 %; girls: 39.9 %) had the lowest physical activity; and Class 4 (boys: 5.0 %, girls: 3.4 %) engaged in substance use, including smoking, drinking, and problematic smartphone use. Overall, girls had a higher odds ratio (OR) for anxiety and suicidal behaviors than boys did. Among girls, Class 4 had a higher OR for anxiety (OR = 2.78, 95 % confidence interval CI = 2.40–3.21), suicidal ideation (OR = 3.99, 95 % CI = 3.46–4.62), suicide plan (OR = 3.32, 95 % CI = 2.66–4.16), and suicide attempts (OR = 5.62, 95 % CI = 4.43–7.12) than Class 1. This study has a few limitations including the participants' response bias, the use of a self-report survey, and the lack of diagnosis by clinicians. Adolescents engaging in substance abuse (Class 4) were more prone to anxiety symptoms and suicidal behaviors (ideation, plan, and attempts) than those engaged in healthy behaviors (Class 1). We suggest that more attention is needed to develop suicide prevention strategies that consider adolescent substance use patterns such as current smoking, drinking, and problematic smartphone use.