ArticleEpidemiology (Cambridge, Mass.)2026
Longitudinal Transitions Between Internalizing and Externalizing Symptoms and Associations with Substance Use among US Young Adults, 2016-2023.
Article in Epidemiology (Cambridge, Mass.), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors.
Funding
Abstract
backgroundInternalizing and externalizing symptoms are key mental health indicators that frequently co-occur in young populations. This study examined transition probabilities between none/low-symptom, exclusive internalizing (e.g., depression, anxiety), exclusive externalizing (e.g., aggression, impulsivity), and co-occurring states in young adulthood and assessed associations with substance use.
methodsUsing four waves (Waves 4-7) of the Population Assessment of Tobacco and Health Study (2016-2023), this prospective cohort study applied Markov multistate transition modeling to estimate transition probabilities across four mental health states based on self-reported past 12-month symptoms. We then examined how current (daily, nondaily) nicotine use, past 30-day binge drinking, cannabis use, prescription drug misuse, and sociodemographic characteristics were associated with transitions between mental health states among baseline young adults (18-24 years).
resultsIn the sample (N = 5,575), the baseline prevalences of none/low-symptom, exclusive internalizing, exclusive externalizing, and co-occurring states were 62.5%, 12.1%, 10.4%, and 13.9%, respectively. Sizable transition probabilities from internalizing or externalizing symptoms to co-occurring symptoms were observed in both short-term (21.6% and 19.7% at Wave 2) and long-term (14.7% and 14.4% at Wave 4) analyses. Co-occurring states demonstrated greater stability (43.9% short-term; 16.4% long-term) than internalizing or externalizing symptom states. Nicotine use was associated with transitions from none/low to internalizing symptoms; binge drinking and prescription drug misuse with transitions to externalizing symptoms; and cannabis use with transitions to both internalizing and externalizing symptoms.
conclusionTransitions to co-occurring symptoms are frequent in young adulthood and may be associated with patterns of substance use.
Indexed as
Identifiers
What Socratic holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.