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Despite this, data on these issues remain limited in low- and middle-income countries (LMICs), including Vietnam. This study aims to estimate the prevalence of SOMD and HRB and examine their associations among high school students in Vietnam.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional survey was conducted with 3,025 students from four high schools and four continuing education centers across Ho Chi Minh City. Participants completed a self-administered questionnaire capturing demographic information, HRB (using the YBRS scale), and SOMD (using the DASS-21 screening scale). SOMD assessments focused on symptoms of depression, anxiety, and stress rather than clinical diagnoses, while HRB covered substance use, risk-taking, physical fighting, suicidal ideation, unsafe sexual behaviors, unhealthy diet, physical inactivity, and sleep deprivation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 2,631 students included in the analysis, prevalence rates were 42.6% for symptoms of depression, 50.3% for symptoms of anxiety, and 31.1% for symptoms of stress. Engagement in HRB varied widely, from 4.0% for unsafe sexual behaviors to 79.9% for physical inactivity, with 91.6% reporting involvement in multiple HRB. Students experiencing SOMD were significantly more likely to engage in HRB compared to those without SOMD, with odds ratios ranging from 1.24 to 4.64.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>SOMD and HRB represent dual and interrelated challenges among Vietnamese adolescents, underscored by their high prevalence. These findings emphasize the critical need for integrated interventions addressing both mental health symptoms and health risk behaviors, especially in resource-constrained LMIC settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00127-025-03043-7","type":"journal-article","created":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T16:52:38Z","timestamp":1767977558000},"page":"2185-2195","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Unmasking the burden of mental health symptoms and risk behaviors in Vietnamese adolescents: evidence from a multicenter cross-sectional study involving 2,631 high school students"],"prefix":"10.1007","volume":"61","author":[{"given":"Truc Thanh","family":"Thai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong-Tuyet Vo","family":"Le","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trang Thi","family":"Nguyen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ngon","family":"Van Dinh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuan Le","family":"Mai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hoai-Thuong Thi","family":"Tran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ngoc-Bich Thi","family":"Nguyen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khanh-Ha Mai","family":"Huynh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thu-An Thi","family":"Nguyen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hy-Han Thi","family":"Bui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minh Cuong","family":"Duong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,9]]},"reference":[{"key":"3043_CR1","unstructured":"World Health Organization. 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