Effects of sex and age on the association of relational aggression with mental health problems and functional impairment in adolescents

Introduction Relational aggression (RA), characterized by behaviors aimed at inflicting social harm, is prevalent during adolescence and linked to adverse mental health outcomes. Although RA has been associated with internalizing and externalizing problems, less is known about its relationship with functional impairments (i.e., a reduced ability to perform daily roles) and sex and age differences. This study aimed to examine the associations between RA and mental health outcomes and functional impairment, and to test the effects of sex and age on these associations. Methods Data were used from a representative sample of 2,838 adolescents aged 13–17 years from Arkhangelsk, Russia. Participants completed validated self-report measures assessing RA, depressive symptoms, anxiety, somatic complaints, posttraumatic stress, conduct problems, alcohol use, and functional impairment. Multivariate path analyses were used to estimate associations between RA and all outcomes simultaneously, adjusting for sex, age, and a proxy measure of socioeconomic status (SES). Results RA was significantly associated with depressive symptoms, somatic complaints, posttraumatic stress, conduct problems, alcohol use, and functional impairment, but not anxiety after accounting for the substantial intercorrelations among symptom domains. Sex moderated these associations, with boys showing greater increases in internalizing symptoms and girls exhibiting higher conduct problems and alcohol use at higher levels of RA. Age and the SES proxy measure were also significant predictors of mental health outcomes. No RA-by-age interactions were observed. Discussion By modeling multiple outcomes simultaneously, this study provides novel evidence that RA is associated with a broad and distinctive pattern of psychosocial difficulties beyond general internalizing or externalizing distress. Findings suggest that RA is a clinically relevant marker of adolescent vulnerability with sex-specific correlates that may inform targeted prevention efforts.