Psychosocial risk factors associated with depressive symptoms among adolescents in secondary schools in mainland china: A systematic review and meta-analysis

Depression Among Adolescents in a Rural Area of Haryana, India: A Community-Based Study Using Patient Health Questionnaire-9

Introduction: The estimates of prevalence of depression among adolescents in the Indian community are limited; most studies are institution-based. Early identification and management of depression can provide significant health dividends to the affected adolescents, and better health consequences in their adulthood.

Objectives: To determine the prevalence of depression among 10- to 19-year-old residents in a rural area of Haryana, India, and to assess factors associated with adolescent depression.

Methods: A sample of 630 adolescents (between 10 to 19 years of age) residing in the selected area of Ballabgarh (Haryana) were selected using simple random sampling technique. Home visits were made, in which participants were administered the Patient Health Questionnaire (PHQ)-9 to screen for depression. The prevalence and 95%CI were estimated. In addition, a semi-structured interview schedule was administered to identify sociodemographic variables and other factors associated with adolescent depression. Unadjusted and adjusted OR were reported with p-value, using multivariable logistic regression analysis.

Results: The age-adjusted prevalence of depression among adolescents was 20.6% (95% CI: 16.9-24.2). The prevalence in late and early adolescence was 11.7% and 8.9%, respectively. It was higher in girls (22.3%) as compared with boys (19.2%). Mild depression was the most common type identified. On multivariable logistic regression, depression was associated with birth order of four or more (Adjusted OR (AOR)=3.0 (95%CI: 1.4-6.3), p<0.01), presence of long-standing illness in the past three months (AOR=3.0 (95%CI: 1.4-6.1), p<0.01), impaired self-perceived body image (AOR=2.9 (95%CI: 1.8-4.6), p<0.01), and perceived stressful event(s) in the past six months (AOR=4.9 (95%CI: 2.8-8.6), p<0.01).

Conclusion: One in five adolescents was screened positive for depression, necessitating focus on screening and early identification of depressive symptoms, especially at the primary care level.

Depressive Symptom and Associated Factors Among School Adolescents of Urban, Semi-Urban and Rural Areas in Bangladesh: A Scenario Prior to COVID-19

Background: The purpose of this study was to investigate the prevalence of depressive symptom and the factors associated with this condition among urban, semi-urban and rural adolescents in the Dhaka district of Bangladesh. Methods: A cross sectional study using two stage cluster sampling procedure was performed. A self-administered questionnaire was conveyed to 2,355 adolescents from nine secondary schools of Dhaka district of Bangladesh. Of the respondents, 2,313 completed the nine item Patient Health Questionnaire (PHQ-9). Besides, sociodemographic information, self-reported body image as well as modification of Leisure Time Exercise Questionnaire (LTEQ) and WHO Global PA Questionnaire (GPAQ) were used to determine the sociodemographic and lifestyle factors associated with depressive symptom among adolescents. Results: A total of 30.1% adolescents were found to be suffering from moderate to severely severe depressive symptom. Females (60.8%) were found suffering significantly more than males (39.2%). Sociodemographic factors, for example, residential setting and family size were found significantly associated with depressive symptom among adolescents. Adjusted estimate of logistic regression shows that physical inactivity (AOR: 1.44; 95% CI: 1.14-1.84), >2 h/day screen time (AOR: 1.68; 95% CI: 1.39-2.03), sleep dissatisfaction (AOR: 3.23; 95% CI: 2.64-3.96), and underweight body image perception (AOR: 2.30; 95% CI: 1.70-3.13) were significantly associated with depressive symptom among adolescents. Conclusions: Among urban, semi-urban and rural school adolescents in Dhaka, Bangladesh, depressive symptom is quite prevalent. To lessen the spread of depressive symptom among Bangladeshi adolescents, urgent steps should therefore be taken.

A systematic review of the association between biological markers and environmental stress risk factors for adolescent depression

INTRODUCTION

Although the aetiology and pathophysiology of depression are multifactorial, to date most studies have examined either biological or environmental mechanisms without looking at the integration of both; with most studies conducted in high-income countries (HICs). Therefore, we conducted a systematic review of worldwide studies investigating the relationship between biological and environmental stress risk factors for major depressive disorder (MDD) in adolescence.

METHODS

We searched MEDLINE (via Ovid), PsycINFO, Cochrane Database of Systematic Reviews, Web of Science (Core Collection), Lilacs, African Journals Online and Global Health for prospective and cross-sectional studies that examined the association between biological markers and environmental stress risk factors in MDD during adolescence.

FINDINGS

Of 11,089 articles identified, 21 were included, with only two from middle-income countries. Increased inflammation, telomere length and brain abnormalities, including blunted reward-related activity, white matter disruptions, and altered volume of limbic brain regions, were associated with increased risk for MDD mainly in the context of early life adversity. There is little evidence suggesting that the neurobiological changes investigated were associated with MDD in the context of recent life stress.

INTERPRETATION

The developmental trajectory of depression appears to start with early life adversities and occurs in the context of immune and brain abnormalities. Understanding these biopsychosocial processes will help to improve our ability to detect individuals at risk of developing depression in adolescence. However, generalizability is limited by few studies examining both biological and environmental stress risk factors and a lack of studies on adolescents and young adults in low-and-middle-income countries (LMICs).

Parent-Adolescent Communication and Early Adolescent Depressive Symptoms: The Roles of Gender and Adolescents' Age

Positive parent-adolescent communication has been found to be negatively related to adolescent depressive symptoms; however, few studies have investigated the moderating effects of adolescent gender and age on this relationship, especially during early adolescence in China. The present study investigated the joint moderating effects of adolescent gender and age on the linkage of father-adolescent and mother-adolescent communication with adolescents' depressive symptoms. A total of 11,455 Chinese junior high school students (M age = 14.15 years, SD = 1.22 years; 49.86% boys; N grade7 = 5712, N grade9 = 5743) completed ad hoc questionnaires of parent-adolescent communication and depressive symptoms. Multiple linear regression analyses were conducted. Results indicated that gender and age jointly moderated the association between parental communication and adolescent depressive symptoms. Specifically, for girls, the negative effects of both father-adolescent and mother-adolescent communication on depressive symptoms were stronger in 9th grade students than in 7th grade students, while for boys, the negative effects were not different between 7th grade students and 9th grade students. These findings suggest that in China, the protective effects of positive parent-adolescent communication on adolescents' depressive symptoms may be most salient among senior-grade girls in junior high school.

Influencing Factors of Depression among Adolescent Asians in North America: A Systematic Review

Background: Asian American adolescents experience rates of depression comparable to or greater than those of other ethnic minorities. The purpose of this systematic review is to summarize psychosocial factors related to depressive symptoms of Asian American adolescents between the ages of 10 to 19. Methods: Various electronic databases were systematically searched to identify research articles published from 2000 to 2021, and the psychosocial factors influencing depression among Asian adolescents in North America were examined. Results: A total of 81 studies were included in this systematic review. Consistent findings on relationships between depressive symptoms and influencing factors included (a) acculturative stress, (b) religious or spiritual significance for females, (c) parent–child cohesion, (d) harsh parenting style, (e) responsive parenting style, (f) racial or ethnic discrimination, (g) being bullied, (h) positive mentor presence, and (i) exposure to community violence. Collectively, the majority of included studies suggest that depressive symptoms were more likely found among Asian American adolescents who (a) are older, (b) are female, (c) have immigrant status, (d) exhibit coping behaviours, (e) face academic challenges, (f) face a poor socioeconomic situation, (g) perceive parent–child conflict, (h) perceive maternal disconnectedness, and (i) perceive negative peer relations. A number of conflictive findings also existed. Discussion/Conclusions: This systematic review provides a summary of the various psychosocial factors on individual, familial, and social levels, which influenced the depressive symptoms of Asian American adolescents. Such findings offer a starting point to examine what factors should be necessarily included in related depression-preventive intervention design and evaluation. Culturally sensitive care, strengthened family–school–community collaboration, and targeted research efforts are needed to meet the needs of Asian adolescents experiencing a range of depressive symptoms.

Depression, anxiety and associated factors among Chinese adolescents during the COVID-19 outbreak: a comparison of two cross-sectional studies

The 2019 coronavirus disease (COVID-19) is a public health emergency of international concern. In China, all schools were shut down and students were home quarantined to prevent disease spread; these steps could have potential negative effects on mental health of adolescents. This study aimed to examine changes in depression and anxiety among Chinese adolescents during the COVID-19 epidemic, and explore factors associated with depression and anxiety. Two survey administrations were conducted among Chinese adolescents between February 20 and February 27 and between April 11 and April 19, 2020, respectively. The Center for Epidemiological Studies-Depression Scale (CES-D) and the 7-item Generalized Anxiety Disorder (GAD-7) scale were used to assess depressive symptoms and anxiety symptoms, respectively. A total of 9554 and 3886 adolescents participated in the first and second surveys. During the initial survey, the prevalence of depression was 36.6% (95% CI: 35.6-37.6%) while the prevalence of anxiety was 19% (95% CI: 18.2-19.8%). Rates of depression and anxiety increased to 57.0% (95% CI: 55.4-58.6%) and 36.7% (95% CI: 35.2-38.2%), respectively, in the second survey. Multivariable logistic regression analyses revealed that group membership in the second survey, female gender, senior secondary school enrollment, and concerns about entering a higher grade were positively associated with both depression and anxiety. Conversely, a sleep duration of ≥6 h/day, an exercise duration ≥30 min/day, having the same as typical or higher study efficiency during the COVID-19 outbreak, and living in provinces with 1000-9999 confirmed COVID-19 cases were negatively associated with depression and anxiety. In conclusion, compared to figures reported during the COVID-19 outbreak, the prevalence of depression and anxiety in Chinese adolescents significantly increased after the initial outbreak. Regular screening and appropriate interventions are urgently needed to reduce the risk for emotional disturbances among adolescents during and after the initial COVID-19 outbreaks.

Rural Chinese youth during the transition into adulthood: Family dynamics and psychological adjustment

Rural youth in China experience numerous challenges during their transition into adulthood. Yet, research on this transition and its relevant influential factors is rare. Through the lens of family systems theory, this study examined the impacts of family dynamics (i.e., interparental and parent-adolescent interactions) in adolescence on the psychological adjustment of youth as they transition into adulthood. Participants were 1330 youth and their mothers in rural Gansu. In 2004, mothers completed questionnaires of interparental and parent-adolescent interactions when youth were adolescents (M_age  = 15.03, SD = 1.15). In 2009, youth completed questionnaires of depression and self-esteem when they were emerging adults (M_age  = 20.03, SD = 1.15). Results of structural equation modelling suggested that while interparental interactions in adolescence were not associated with the psychological adjustment of youth in emerging adulthood, positive parent-adolescent interactions in adolescence predicted better psychological adjustment of youth in emerging adulthood. Furthermore, mediation analysis showed that although interparental interactions did not directly affect the psychological adjustment of youth, they were positively associated with parent-adolescent interactions, which in turn contributed to the psychological adjustment of youth. The results reveal an enduring influence of family dynamics on psychological adjustment among rural Chinese youth during the transition into adulthood.

Depression among adolescents in a rural community of north India: A cross-sectional study

Background:

There is a paucity of literature on depression among adolescents in the north Indian community.

Objectives:

The aim of this study was to estimate the prevalence of depression among adolescents residing in a rural community of north India, and to determine associated factors, psychiatric comorbidities, and functional impairment.

Methods:

A simple random sample of 630 adolescents aged 10-19 years was drawn. Participants were enrolled in house-to-house visits, and screened for depression using the nine-item version of Patient Health Questionnaire (PHQ-9). Diagnostic confirmation and assessment of psychiatric comorbidities was done using Mini International Neuropsychiatric Interview for Children and Adolescents (MINI Kid) for 10-17-year-old adolescents, and MINI for 18 year olds. Prevalence was reported with 95% confidence interval. Multivariable logistic regression analysis was done to determine the association of depression with socio-demographic and other factors. Children's Global Assessment Scale (CGAS) was used to assess functional impairment.

Results:

The prevalence of depression was 3.7% (95% CI: 2.3–5.2) (n = 583), comparable in both sexes. Over half the participants with depression had psychiatric comorbidities; the most common were conduct disorder, oppositional defiant disorder, and attention deficit hyperactivity disorder; nearly two-fifth had suicidal ideas/attempt. About two-third of participants with depression had functional impairment. Depression was associated with perceived frequent conflicts at home [adjusted odds ratio (aOR) = 4.0 (95% CI: 1.0-16.0), P = 0.049], and perceived stressful event (s) in past six months [aOR = 7.0 (95% CI: 2.4-20.3), P < 0.01], which were predominantly related to academics.

Conclusion:

Study results indicate the need to strengthen diagnostic and therapeutic/rehabilitative mental health services in adolescent age group. Low-stress lifestyle could be a promising approach to sidestep depressive symptoms.

Mental health and its correlates among children and adolescents during COVID-19 school closure: The importance of parent-child discussion

BACKGROUND

School closures due to the COVID-19 outbreak have affected 87% of the world's students physically, socially, and psychologically, yet rigorous investigation into their mental health during this period is still lacking.

METHODS

A cross-sectional online survey of 4-342 primary and secondary school students from Shanghai, China was conducted during March 13-23, 2020. Besides demographic information, psychological distress (including depression, anxiety, and stress), life satisfaction, perceived impact of home quarantine, and parent-child discussions on COVID-19 were assessed.

RESULTS

The three most prevalent symptoms were: anxiety (24.9%), depression (19.7%), and stress (15.2%). Participants were generally satisfied with life and 21.4% became more satisfied with life during school closures. Senior grades were positively correlated with psychopathological symptoms and negatively associated with life satisfaction, whereas the perceived benefit from home quarantine and parent-child discussions on COVID-19 were negatively correlated with psychopathological symptoms and positively correlated with life satisfaction. Among participants who perceived no benefit from home quarantine, those who had discussions with their parents about COVID-19 experienced less depression, anxiety, and stress.

LIMITATIONS

Limitations included the inability to infer the casual relationship, no parental report for mental health of children aged 6 to 9, and the inadequate measurement of parent-child discussion.

CONCLUSIONS

Mental health problems and resilience co-existed in children and adolescents during the COVID-19 outbreak. Given the important role of parent-child discussions, open communication between parents and children about the pandemic should be encouraged to help children and adolescents cope with mental health problems in public health crisis.