title: Depressive symptoms and clustering of risk behaviours among adolescents and young adults attending vocational education: a cross-sectional study.
abstract: BACKGROUND
  Depressive symptoms and risk behaviours often do not occur in isolation among adolescents and young adults. In order to improve intervention programmes, more research is needed to elucidate the clustering of risk behaviours, the association with depressive symptoms, and demographic variables. Therefore, this study examined the clustering of risk behaviours, the association with depressive symptoms, and demographic variables among adolescents and young adults in vocational education. Furthermore, the prevalence of depressive symptoms and risk behaviours was examined.
  
  
  METHODS
  This study included 584 students (mean age 18.3 years) attending vocational education in the Netherlands. Depressive symptoms and risk behaviours (binge drinking, cannabis use, smoking, delinquency and incurring debts) were assessed with self-report questionnaires. Truancy was monitored via the school registration system. Principal Components Analysis (PCA) was conducted to assess the factor structure of the risk behaviours (i.e. clustering). Linear regression analyses with a bootstrapping method were performed to assess the associations.
  
  
  RESULTS
  Binge drinking was reported by 50.5% and cannabis use by 14.2% of the students (both in the past 4 weeks), whereas 37.7% reported currently being a smoker. More than 10% reported having been questioned at a police station in the past year. Furthermore, 82.2% had been truanting in the first two months of education, 21.0% reported having debts and 29.2% reported clinically-relevant depressive symptoms. The PCA indicated two clusters. The 'substance use' cluster consisted of the risk behaviours: binge drinking, cannabis use and smoking. The 'problem behaviours' cluster consisted of the risk behaviours: delinquency, truancy and incurring debts. Both clusters were associated with depressive symptoms. Various demographic variables were associated with both clusters.
  
  
  CONCLUSIONS
  Risk behaviours formed two clusters, both of which were associated with depressive symptoms. These findings underscore the importance of screening adolescents and young adults at lower educational levels for multiple risk behaviours and depressive symptoms and of focusing on multiple risk behaviours in interventions simultaneously.
authors.affiliation: Department of Public Health, Erasmus University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, the Netherlands. r.bannink@erasmusmc.nl.
authors.forename: Rienke
authors.initials: R
authors.lastname: Bannink
authors.affiliation: Department of Public Health, Erasmus University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, the Netherlands. s.broeren@erasmusmc.nl.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Broeren
authors.affiliation: Municipality of Rotterdam, Librijesteeg 4, 3000, KS, Rotterdam, the Netherlands. jfp.heydelberg@rotterdam.nl.
authors.forename: Jurriën
authors.initials: J
authors.lastname: Heydelberg
authors.affiliation: Public Health Care for Youth, Westblaak 171, 3012, KJ, Rotterdam, the Netherlands. e.vant.klooster@cjgrijnmond.nl.
authors.forename: Els
authors.initials: E
authors.lastname: van't Klooster
authors.affiliation: Department of Public Health, Erasmus University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, the Netherlands. h.raat@erasmusmc.nl.
authors.forename: Hein
authors.initials: H
authors.lastname: Raat
mesh_terms: D000293:Adolescent; D000328:Adult; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D003863:Depression / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008385:Marijuana Smoking / Q000453:epidemiology; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D012309:Risk-Taking; D012574:Schools; D012907:Smoking / Q000453:epidemiology; D013334:Students / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014829:Vocational Education; D055815:Young Adult