Association of behavioral characteristics and mental health indices in a large nationwide representative sample of schoolchildren aged 11-15 years in Albania

Aim To assess the independent associations of behavioral factors with many mental health indices among children in Albania. Methods This cross-sectional study carried out in Albania in 2022 included a nationwide representative sample of 5454 schoolchildren aged 11, 13, and 15 years (52% girls; response rate: 96%). Data on ten mental health indices were collected, in addition to behavioral characteristics and sociodemographic factors. A general linear model was used to assess the independent associations of behavioral factors with mental health indices. Results Irrespective of sociodemographic characteristics, the scores of all mental health indices were significantly worse among schoolchildren who reported lifetime smoking and alcohol consumption, those who engaged less frequently in physical activity, those who skipped breakfast at least on one weekday, and those who consumed fresh fruit less than daily compared with their counterparts who were, respectively, never smokers, had never drunk alcohol, were more physically active, consumed breakfast regularly, and consumed fresh fruit daily. Conclusions Irrespective of sociodemographic boundaries, this study showed significant associations between behavioral characteristics and the mental health of Albanian schoolchildren. This highlights the importance of promoting healthy behaviors among children to mitigate the risk of mental health challenges. Interventions aimed at encouraging regular physical activity, consistent breakfast consumption, and daily intake of fresh fruit may enhance the mental resilience of school-aged children.