Associations Between Mental Health Status and Sleep and Physical Activity Among Adolescents in Hawai'i

This study examined associations between mental health status, physical activity, and sleep among Hawai'i adolescents using data from the 2017-2021 Hawai'i State High School Youth Risk Behavior Survey (YRBS). Mental health outcomes included feelings of sadness/hopelessness and suicidality. Logistic regression models assessed associations between physical activity, sleep, and mental health outcomes, adjusting for covariates including race, bullying, and the COVID-19 pandemic. Sleep duration, sleep location, and physical activity were significantly associated with mental health outcomes. Adolescents who slept longer were less likely to report sadness/hopelessness (6-7 vs. 0-5 hours: adjusted odds ratio [aOR]=0.59, 95% confidence interval [CI]=0.52-0.67; 8+ vs. 0-5 hours: aOR=0.36, 95% CI=0.32-0.41) and suicidality (6-7 vs. 0-5 hours: aOR=0.64, 95% CI=0.54-0.76; 8+ vs. 0-5 hours: aOR=0.38, 95% CI=0.31-0.46). Adolescents without a stable place to sleep had higher odds of suicidality (aOR=1.69, 95% CI=1.29-2.21). Physical activity was also protective; adolescents active for 6-7 days per week had lower odds of sadness/hopelessness (aOR=0.75, 95% CI=0.65-0.87) and suicidality (aOR=0.71, 95% CI=0.61-0.83) compared with those active 0-2 days. Boys had lower odds of both outcomes than girls. Compared with Whites, Filipinos, other Asians, and Pacific Islanders had lower odds of suicidality. Adolescents surveyed during the COVID-19 pandemic had increased odds of sadness/hopelessness. These findings underscore the importance of adequate sleep and physical activity for adolescent mental health, highlight the unique experiences of Hawai'i adolescents, and underscore the need to identify disparities among major adolescent groups to inform mental health prevention and intervention strategies.