Stress, Psychosocial Factors, and the Outcomes of Anxiety, Depression, and Substance Abuse in Rural Adolescents

Mental disorders cost the United States approximately 170 billion dollars in just one year (HHS, 2002). The onset of a diagnosable mental disorder such as anxiety, depression, and substance abuse can begin in adolescence. Rural adolescents are at risk for negative outcomes due to psychosocial/socioeconomic stressors and a lack of access to health care. This secondary data analysis used a cross-sectional sample of 466 adolescents from four rural high schools in western Pennsylvania to examine the relationships among demographic variables (age, gender, birth order, parents present in household, subject having a job), stress (life events), psychosocial factors (optimism, perceived social support, coping), and the outcomes of anxiety, depression, and substance abuse (alcohol, drugs, smoking). Lazarus' Theory of Stress and Coping and Lerner's Developmental Contextualism was used to form the theoretical framework. Descriptive statistics, correlational and regression analysis were the primary methods of analysis.Over 33% of the subjects reported depressive symptoms; 20% reported higher levels of anxiety symptoms. Approximately 74% report that they have used alcohol at least once; 53% report having tried at least one other drug such as cocaine or marijuana. Over 38% smoke cigarettes at least occasionally.Gender differences were found in the sample. Females reported greater anxiety and depressive symptoms than males. Gender had both a direct and indirect effect on the outcomes of anxiety and depression with negative life events and psychosocial factors (optimism, social support, and coping) acting as mediators. Stress, optimism, perceived social support of family, and avoidance coping were found to have a mediating effect on the relationship between demographics and substance abuse. The results of this study support the proposed model and the hypotheses that stress and psychosocial factors are mediators between the relationships among the demographic and outcome variables. Empirical data gathered and reported in this and other studies will assist health care professionals (e.g., physicians, nurse practitioners, and school nurses) to develop and implement interventions that target mediating variables such as coping. These interventions have the potential to improve rural adolescents' ability to socialize, adapt, and cope; assisting them in making better decisions and growing into productive, healthier adults