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

Dysfunctional attitudes, social support, and adolescent depression

Adolescent depressive symptoms represent a significant public health concern, with negative life events and dysfunctional attitudes playing pivotal roles in their development. A cross-sectional study by Yu et al assessed the interplay between dysfunctional attitudes, social support, and depressive symptoms in 795 Chinese adolescents (49.9% male, mean age 15.2 ± 1.8 years, age range 11-18 years) from five middle schools in Shandong Province. Using the Dysfunctional Attitudes Scale, Adolescent Life Events Scale, Beck Depression Inventory, and Social Support Rating Scale, the study identified that dysfunctional attitudes, particularly over-autonomy and over-perfectionism, mediate the relationship between negative life events and depressive symptoms. Social support moderated this relationship, significantly reducing depressive symptoms. These findings underscore the need for preventive and therapeutic strategies targeting dysfunctional attitudes and enhancing social support to address adolescent depressive symptoms. In this article, we extend their findings to highlight the significance of culturally tailored interventions that incorporate familial and community dynamics in mitigating depressive symptoms, particularly in collectivist societies.

Protective and risk factors of anxiety in children and adolescents during COVID-19: A systematic review and three level meta-analysis

BACKGROUND

In order to gain a deepened understanding of the impact of public health emergency and to develop effective interventions and preventions, this study aimed to evaluate risk and protective factors associated with anxiety in children and adolescents and to explore potential moderators in the background of COVID-19 within the framework of socio-ecological model.

METHODS

A literature search was conducted in Web of Science, MEDLINE, PubMed, Scopus, EBSCO, ScienceDirect, Emerald, and CNKI for studies published from early 2020 to early 2023 that examined factors associated with anxiety among children and adolescents with age range of 6 to 17 years old. Random effects models and a three-level meta-analytic approach were used.

RESULTS

In total, 141 articles and 1,018,171 subjects were included, with 1002 effect sizes extracted. 32 protective factors and 48 risk factors were examined, yielding significance for 14 protective factors and 29 risk factors, including individual factors (e.g., gender, logOR = -0.37, 95 % CI [-0.47, -0.27], p < 0.001; age, logOR = -0.12, 95 % CI [-0.22, -0.02], p = 0.02; emotional functioning, logOR = -1.45, 95 % CI [-1.84, -1.05], p < 0.001; pre-existing condition logOR = 0.94, 95 % CI [0.58, 1.30], p < 0.001; electronic device or internet addiction, logOR = 1.81, 95 % CI [0.74, 2.88], p < 0.001), family factors (e.g., family socioeconomic status, logOR = -0.25, 95 % CI [-0.39, -0.10], p < 0.001; family functioning, logOR = -1.31, 95 % CI [-1.60, -1.02], p < 0.001; anxiety level of caregiver, logOR = 1.06, 95 % CI [0.75, 1.37], p < 0.001), community factors (e.g., overall social support, logOR = -0.93, 95 % CI [-1.84, -1.05], p < 0.001; school burden, logOR = 0.56, 95 % CI [0.21, 0.90], p = 0.002), and COVID-19-related factors (e.g., higher exposure risk in local community or city, logOR = 0.48, 95 % CI [0.17, 0.78], p = 0.002; distant learning, logOR = 0.73, 95 % CI [0.19, 1.28], p = 0.008; COVID-19-related distress, logOR = 1.42, 95 % CI [0.55, 2.29], p = 0.001;). The majority of studies showed no publication bias. Age group moderated the relationship between gender and level of anxiety (F (1,96) = 4.42, p = 0.038), and no other moderator showed significance.

LIMITATIONS

This study does not reveal causality but correlation in nature, and our findings should be interpretated with caution.

CONCLUSIONS

Public health emergencies could bring challenges to the mental health of children and adolescents. Prevention and intervention strategies for children and adolescents with high risks, and family-based and community-based programs should be encouraged to buffer the adverse impact on children and adolescents. This study has been prospectively registered at PROSPERO (registration number: CRD42022316746).

Unraveling depressive symptom networks: A three-year longitudinal study among Chinese junior high school adolescents

Adolescence is the peak period for the occurrence of mental health issues, particularly in the stage of junior high school. Depressive symptoms are among the most frequently experienced psychological problems. However, little is known about the symptom-level interaction features of depressive symptoms and the roles of different symptoms across the junior high school stage. To address these gaps, this study conducted a three-year longitudinal study that recruited 1301 Chinese junior high school adolescents (48.2% females; mean age = 12.46 ± 0.62, ranging from 11 to 14 in the first year). The Center for Epidemiological Studies Depression Scale was used to assess depressive symptoms. The regularized partial correlation network and the cross-lagged panel network models were used to explore the symptom-level interaction pattern. In regularized partial correlation networks, "I felt depressed" was a stable central symptom throughout the junior high school stage. Besides, "I felt lonely" and "I felt that people disliked me" were the other central symptoms in grade 7 and grade 8, and "I felt everything I did was an effort" played a central role in grade 9. Within cross-lagged panel networks, "I felt that people disliked me" and "I felt hopeless about the future" had important effects on predicting other depressive symptoms from grade 7 to 8 and from grade 8 to 9. By investigating the longitudinal interaction patterns of depressive symptoms among junior high school adolescents, the current study identifies core symptoms that could be potential prevention or intervention targets and provides a novel insight for understanding depressive symptoms during adolescence in depth.

How dispositional optimism-pessimism relates to early adolescents' emotional maladjustment during COVID-19? Moderating roles of knowledge about the disease and parent-child conflicts

Introduction

The COVID-19 pandemic and associated containment measures changed the daily lives of children and adolescents around the world. To investigate the individual differences in emotional maladjustment under the COVID-19 pandemic, this study focused on the roles of dispositional optimism-pessimism, knowledge about the COVID-19 disease, and conflicts with parents among Chinese early adolescents.

Method

edge about the COVID-19 disease, and conflicts with parents among Chinese early adolescents. The participants were 2,958 early adolescents aged 10 to 14 years old who completed online questionnaires during the pandemic.

Results

While higher pessimism and lower optimism both led to increased emotional maladjustment, pessimism made a greater contribution. Knowledge about the disease and parent-child conflicts were both risk factors for adolescents' emotional maladjustment, yet optimism and pessimism interacted with different factors. More knowledge about the disease intensified the effect of pessimism, and more parent-conflict undermined the effect of optimism.

Discussion

Our findings provide directions for future aid in adolescence during hard periods depending on one's personality.

Predictors of depression among Chinese college students: a machine learning approach

BACKGROUND

Depression is highly prevalent among college students, posing a significant public health challenge. Identifying key predictors of depression is essential for developing effective interventions. This study aimed to analyze potential depression risk factors among Chinese college students using the Random Forest Algorithm (RFA) and to explore gender differences in risk patterns.

METHODS

A cross-sectional study was conducted with 10,043 undergraduate students from Guizhou Normal University. Thirty-three variables were analyzed using RFA. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D), with a score of ≥ 16 indicating depression risk. The variables included sociodemographic characteristics, physical and psychological health indicators, behavioral and lifestyle factors, socioeconomic conditions, and family mental health history.

RESULTS

The RFA identified several factors associated with depression risk, with suicidal ideation, anxiety, and sleep quality exhibiting the strongest associations. Other significant predictors included academic stress, BMI, vital capacity, psychological resilience, physical fitness test scores, major satisfaction, and social network use. The model achieved an accuracy of 87.5% and an AUC of 0.927. Gender-stratified analysis suggested different patterns: physical fitness indicators showed stronger associations with depression risk among male students, while BMI was more strongly associated with depression risk among female students.

CONCLUSIONS

This cross-sectional study identified factors associated with depression risk among Chinese college students, with psychological factors showing the strongest associations. Gender-specific patterns were observed, suggesting the importance of considering gender differences when developing mental health interventions. However, longitudinal studies are required to establish causal relationships and validate these findings through intervention trials.

Universal depressive symptom screening in middle schools in Istanbul: An epidemiologic study

INTRODUCTION

Depression is a significant public health concern, with severe adolescent morbidity and mortality. Promoting adolescents' mental health is increasingly recognized, and schools are proposed as screening and preventive intervention sites. This cross-sectional study aimed to screen self-reported elevated depressive symptom prevalence among secondary school students in Istanbul, Turkey. The secondary objectives were determining behavioral problems, resilience, positive attitudes, and risk factors associated with depressive symptoms.

METHODS

Data collection was conducted between April-June 2022. Six thousand one hundred ten students from nine randomly selected schools from different city districts were approached. Depression was screened by the Centre for Epidemiological Studies Depression Scale for Children (CES-DC). The Strengths and Difficulties Questionnaire (SDQ) was used for screening behavioral problems and positive attitudes. Resilience was evaluated by the Child and Youth Resilience Measure (CYRM).

RESULTS

The final study sample comprised 2780 participants (response rate 47.7 %) with a mean age of 12.4 ± 1.1 years (females:52.7 %). Elevated depressive symptoms were detected in 31.2 % of the students. Female students exhibited higher scores in CES-DC and total difficulties but lower resilience scores in CYRM than male students. In a multiple regression analysis, female gender, higher total difficulties score, lower resilience score, and lower perceived academic performance significantly predicted CES-DC [F(6,2279) = 421, p < 0.01].

DISCUSSION

Our findings showed high rates of elevated self-reported depressive symptoms in a city sample among Turkish adolescents at middle schools, in addition to coexisting behavioral difficulties and decreased resilience indicating poor psychosocial functioning. Given the prevalent depressive symptoms, screening and intervention programs involving resilience promotion may involve school systems to prevent adolescent depression.

Factors Associated With Mental Health Literacy, Depression, and Anxiety Amongst Indonesian Adolescents

AIMS

This study aims to identify factors associated with mental health literacy (mental health knowledge and attitudes towards mental health and help-seeking behaviours), depression and anxiety amongst adolescents, and test the hypothesised model by examining the interrelationships between these outcomes.

DESIGN

Cross-sectional descriptive quantitative research.

METHODS

Using convenient sampling, 615 adolescents from four public schools completed online questionnaires measuring mental health literacy, depression, and anxiety. The data were analysed using Pearson correlation, multiple linear regression, and structural equation modelling (SEM).

RESULTS

Individual factors (e.g., gender, physical health and past traumatic experiences), family factors (e.g., parental criticism and family support) and school/community factors (e.g., academic pressure and safety) were associated with mental health outcomes. SEM revealed an association between higher mental health knowledge and better attitudes towards mental health and help-seeking behaviours but did not show a significant association with depression and anxiety.

CONCLUSIONS

Findings emphasise the need for holistic and culturally safe approaches to address adolescent mental health in Indonesia.

IMPLICATIONS

Future research should focus on developing and evaluating tailored mental health interventions in Indonesia that address individual, family, school, and community factors. These interventions should target the interrelated aspects of mental health literacy, depression, and anxiety identified in this study. Key areas for intervention include enhancing self-esteem, promoting help-seeking behaviours, supporting spirituality, managing long-term conditions, improving sleep hygiene, encouraging physical activity, teaching stress management techniques, fostering diversity, managing trauma, and combating discrimination. A comprehensive approach to adolescent mental well-being should integrate parental involvement, peer support systems, community engagement initiatives, and mental health literacy education.

IMPACT

This research informs future interventions such as school-based programs, family-oriented campaigns, and community initiatives to support adolescent mental health, potentially influencing policy decisions, and resource allocation in mental health services.

REPORTING METHOD

STROBE guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No direct patient or public contribution.

Feasibility, Acceptability, and Preliminary Efficacy of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents in China: A Pilot Study

Currently, there is a lack of cost-effective and accessible intervention resources for Chinese adolescents with emotional disorders. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A), which aims to apply transdiagnostic treatment principles to target core dysfunctions across a range of emotional disorders with a single protocol, could fill this gap. We first modified the UP-A for use in the Chinese cultural context and then assessed its feasibility, acceptability, and preliminary efficacy using a single-arm design. Twenty-four Chinese adolescents (14.1 ± 1.2 years old) with emotional disorders completed a 12-week group UP-A intervention along with their parents. Multiple outcomes were evaluated at five time points: pretreatment (T1), week 4 (T2), week 8 (T3), posttreatment (T4), and 3-month follow-up (T5). The results showed a low dropout rate (16.7%), high attendance (at 10.2 ± 1.6 sessions in adolescents and 10.7 ± 2.0 sessions in parents), and sufficient participant satisfaction. Adolescents exhibited significant decreases in emotional disorder severity (g = -1.298 to -1.341) and emotional symptoms (g = -0.440 to -1.988) and significant improvements in emotion regulation (ER) strategies, resilience, functional outcomes, and executive function. The efficacy of the intervention was significant starting at T2 and was maintained at T4 and T5. Exploratory analyses revealed that predictors of treatment outcomes included the presence of multiple comorbidities, the severity of emotional disorders, adaptive ER strategies, and resilience at T1. This study demonstrated the feasibility, acceptability, and preliminary efficacy of the Chinese version of the UP-A, and future randomized controlled trials are warranted.

Ecological analysis of air particulate matter exposure and depression among adolescents in developing regions of Hubei, China

BACKGROUND

Adolescent depression is a health issue influenced by various factors, with the impact of environmental factors, particularly air pollution, being insufficiently understood. This study investigates the relationship between particulate matter (PM2.5) and adolescent mental health.

METHODS

A survey of middle school students in two rural counties of Hubei Province-Tongcheng and Lichuan-was conducted using multi-stage probability sampling. Data on demographics, mental health, and social conditions were collected via self-administered questionnaires. PM2.5 exposure levels were obtained from the NASA Giovanni database using a two-step machine learning model. Depression levels were measured with the PHQ-9 scale. Generalized linear regression and structural equation modeling were used to analyze the relationship between PM2.5 and depression.

RESULTS

The study included 2780 valid responses (mean age 13.49 years, 52.73% male). The findings indicated a correlation between PM2.5 exposure, left-behind children status, and negative coping strategies with higher PHQ-9 scores. Each unit increase in PM2.5 was associated with a 1.004 increase in the PHQ-9 score (P < 0.01). Left-behind children had scores 1.023 times higher than their peers (P = 0.039), while positive coping correlated with lower scores (RR = 0.855, P < 0.001). The influence of PM2.5 on depression was fully indirect, mediated by personal traits and family/community environments (β = -0.003, P = 0.855).

LIMITATIONS

The cross-sectional design limits causal inferences, and self-reporting may introduce bias. The focus on middle schoolers from two counties may limit broader applicability.

CONCLUSIONS

This research underscores the complex factors contributing to adolescent depression, with individual characteristics playing a crucial role. The impact of air pollution on depression is mediated by personal traits and the community environment.

Dysfunctional attitudes, social support, negative life events, and depressive symptoms in Chinese adolescents: A moderated mediation model

BACKGROUND

Depression is a prevalent psychological issue in adolescents that is significantly related to negative life events (NLEs) and dysfunctional attitudes. High levels of social support can significantly buffer NLEs' effect on depression. Currently, there is limited research on how social support moderates the relationship between NLEs, dysfunctional attitudes, and depression in adolescents in China. It is imperative to investigate this moderating effect to mitigate dysfunctional attitudes in adolescent undergoing depressive mood, ultimately enhancing their overall mental health.

AIM

To investigate the relationship and underlying mechanisms between specific dysfunctional attitudes, social support, and depression among Chinese adolescents.

METHODS

This is a cross-sectional study which selected five middle schools in Shandong Province for investigation in March 2022. Participants included 795 adolescents (49.87% male, mage = 15.15, SD = 1.84, age range = 11-18 years old). All participants completed the Dysfunctional Attitude Scale, Adolescent Life Event Scale, Beck Depression Inventory, and Social Support Rating Scale. A moderated mediation model was conducted to examine the relationship between specific dysfunctional attitudes, social support, and depression.

RESULTS

Results indicated that NLEs affected depression through the mediating role of specific dysfunctional attitudes (autonomy attitudes β = 0.21; perfectionism β = 0.25). Moreover, social support was found to moderate the mediating effect between NLEs, specific dysfunctional attitudes, and depressive symptoms (autonomy attitudes b2 = -0.08; perfectionism b2 = -0.09).

CONCLUSION

Dysfunctional attitudes mediated and social support moderated the relationship between NLEs and depression. Social support can buffer depression symptoms among adolescents with autonomy attitudes and perfectionism.

Prevalence of depressive symptoms among urban school adolescents in Vietnam: The role of youth, family, and school relationships

BACKGROUND

Adolescents frequently encounter a spectrum of psychiatric conditions, predominantly depressive and anxiety disorders, along with various behavioral disturbances.

OBJECTIVE

This investigation aims to delineate the prevalence of depressive disorders among adolescents in urban Vietnam and to elucidate the interrelationships between familial and school-related dynamics and adolescent depression.

MATERIALS AND METHODS

A cross-sectional survey was conducted in 2022, involving 507 students aged 15 to 17 from high schools in Hanoi, Vietnam. Reynolds Adolescent Depression Scale - Second Edition (RADS-2) was used to assess the presence of depressive symptoms. Social-demographic characteristics, adolescent-family and adolescent-school relationships, and academic environment characteristics of high school students were interviewed. Multivariate Tobit regression models were employed to discern contributory factors across four domains of RADS-2.

RESULTS

Among the 507 adolescents, the mean scores on the RADS scale were 15.1 ± 4.2 for the dysphoric mood domain, 16.4 ± 4.0 for the anhedonia-negative domain, 13.1 ± 4.4 for the negative self-evaluation domain, and 12.4 ± 3.7 for the somatic complaints domain. The analysis indicated that adolescents with suboptimal parental relationships, absence of confidants, frequent parental conflicts, exposure to parental arguments, substantial exam-related stress, or overwhelming academic demands were more likely to exhibit elevated depressive symptoms. Conversely, adolescents who were satisfied with their friendships at school and received care, support from teachers or friends, and involved in school's extracurricular activities lower exhibited levels of depression.

CONCLUSIONS

Findings reveal the significant impact of family and peer relationships, as well as academic stress, on the development of depressive symptoms. These significant results inform the design and development of future interventions aimed at mitigating depression risks among high school students, emphasizing the crucial roles of both educational institutions and family dynamics.

Depression in nursing students during the COVID-19 pandemic: Systematic review and meta-analysis

The pandemic meant a change in academic approach. This had an impact on the mental health of students, leading to, among other problems, depressive disorders. The aim of this study was to find out the prevalence and factors that favoured the development of depression in nursing students during the COVID-19 pandemic. A systematic review with meta-analysis of prevalence was conducted in October 2023, using Pubmed, CINAHL and Scopus as the data sources used for the search. This review followed the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Search equation was: "(undergraduate nurses OR nursing students) AND depression AND (COVID-19 OR Sars-CoV-2)". The final set of articles was N = 12. Quantitative primary studies using anonymous scales and surveys to assess the prevalence of depression in nursing students in the last 3 years were included. Studies show a high prevalence of depression among young university students with figures above 50%. The total sample of students in the meta-analysis was n = 4,479 with a prevalence value of 32% (CI95% 22%-42%). Affected students are characterised by young, female students. Concerns included generalised academic uncertainty, social isolation, work overload, fear of contagion and concern about teaching delivery. Coping mechanisms were generally resilience, spiritual support, laughter therapy, seeking information about COVID-19 and eating food. In conclusion, students, especially female students, are at high risk of depression due to social isolation. In addition, coping techniques were inadequate and future strategies to prevent this situation should be considered.

Association between breakfast consumption, breakfast quality, mental health and quality of life in Turkish adolescents: A high school-based cross-sectional study

This study aimed to determine the frequency of breakfast consumption and breakfast quality among adolescents and to evaluate the relationships between breakfast consumption, breakfast quality, mental health, and health-related quality of life. This cross-sectional study included 449 students from 17 high schools between December 2022 and May 2023. A face-to-face questionnaire measuring the frequency of breakfast consumption, Mediterranean diet quality index (KIDMED), health-related quality of life (KIDSCREEN), and depression, anxiety and stress scales (DASS-21) was performed. Of the students, 54.1% skipped breakfast 2 or more times a week and 75.9% had poor breakfast quality. There were significant differences in breakfast quality classification according to the frequency of breakfast consumption (p = 0.003). Breakfast consumption ≤1 time/week or 2-5 times/week was associated with depression, anxiety and low adherence to the Mediterranean diet. No relationship was observed between breakfast quality and stress, depression or anxiety (p = 0.620, p = 0.586, p = 0.539, respectively) or between breakfast quality and the KIDSCREEN-27 subscales (p > 0.05). However, those eating poor-quality breakfasts had better results in physical wellbeing (p = 0.022), psychological wellbeing (p = 0.024), autonomy and parent relations (p = 0.017) than breakfast-skippers and also scored lower for depression, stress and anxiety (all p < 0.001). In conclusion, the frequency of breakfast consumption had a stronger association with reduced symptoms of stress, depression and anxiety, as well as improvements in all dimensions of health-related quality of life, compared to the quality of breakfast consumed. Given the association of breakfast consumption with mental health outcomes in adolescents, our findings are of great importance, especially to parents, clinicians and nutritional educators.

School belonging mediates the association between negative school climate and depressive symptoms among Chinese adolescents: a national population-based longitudinal study

Background

A negative school climate is an important factor affecting students' mental health. However, few studies have focused on the mechanisms underlying the relationship. This study aimed to explore the mediating effect of school belonging on the association between negative school climate and depressive symptoms among Chinese adolescents, using a nationwide longitudinal survey.

Methods

We conducted a longitudinal study using data from the 2013 (T1) and 2014 (T2) waves of the China Education Panel Survey (CEPS). A negative school climate was assessed by school administrators' reports. School belonging and depressive symptoms were evaluated using adolescents' self-reports. We used a cross-lagged panel model to explore the mediating effect of school belonging on the association between negative school climate and depressive symptoms, adjusting for a set of covariates.

Results

In total, 7,049 Chinese adolescents with a mean age of 12.9 years were included in this study. The results of the cross-lagged model showed that negative school climate at T1 was significantly negatively associated with school belonging at T2 (β = -0.089, 95%CI = -0.111--0.067, p < 0.001), and was positively associated with depressive symptoms at T2 (β = 0.032, 95%CI = 0.012-0.054, p = 0.002). In addition, school belonging at T1 was significantly negatively associated with depressive symptoms at T2 (β = -0.025, 95%CI = -0.050--0.001, p = 0.045). Mediation analysis showed that school belonging played a mediating role in the association between negative school climate and depressive symptoms (β = 0.002, 95%CI = 0.001-0.005, p = 0.041).

Conclusion

Among Chinese adolescents, a negative school climate is associated with a greater risk of depressive symptoms. Improving school belonging may be helpful in decreasing the impact of a negative school climate on depressive symptoms in adolescents.

Mental toughness in adolescents: bridging family relationships and depression across personality traits

BACKGROUND

Adolescence is a pivotal stage vulnerable to mental health issues like anxiety and depression. While family relationships, mental toughness, and personality traits are known to impact adolescent mental health, their interactive and moderating roles are not fully understood.

AIM

This study aims to investigate the mediating role of mental toughness in the relationship between family relationships and depression among high school students, and to examine the varying impacts of personality traits on this mediation.

METHOD

A cross-sectional study was conducted on a sample of 734 adolescents. Participants completed measures assessing family relationships, mental toughness, personality traits, and mental health outcomes (depression). Latent Profile Analysis, Multiple Regression Analysis, and Structural Equation Modeling, to investigate these relationships.

RESULTS

The study found that mental toughness significantly mediates the relationship between family relationships and depression. Notably, this mediating effect varied between personality type; it was more pronounced in the moderate-reserved type compared to the proactive-engaged type. LPA identified two distinct personality types of students based on their personality traits, with differential patterns of family relationships, mental toughness, and depression. Multiple regression analysis indicated that character and adaptability, components of mental toughness, were significant negative predictors of depression.

CONCLUSION

The study contributes to understanding the dynamics of adolescent mental health, particularly in the context of Chinese high school students. It underscores the importance of considering family dynamics, personality traits, and mental toughness in developing effective mental health interventions for adolescents.

The prevalence and its associated factors of psychological stress among middle school students in China: pooled evidence from a systematic scoping review

Psychological issues are of significant concern in present-day society, as poor mental well-being results in depression and suicidal behavior. Understanding the current situation of psychological stress among secondary school students will help policy makers to formulate targeted measures to help them cope with stress, and at the same time evaluate the effectiveness of the existing policies to address the shortcomings and enhance the diversification of interventions. The main purpose of this review was to map the existing evidence on the prevalence and levels of psychological stress among adolescents in China, and to identify the associated risk factors. This review strictly adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A comprehensive search was performed spanning Web of Science, PubMed, and Scopus databases. Studies involving only humans and full text in English were selected. Selection was limited to samples from mainland China, Hong Kong, Macau, and Taiwan. Variables were extracted, exploring the factors that affected the mental wellness of Chinese middle school students. A final 15 articles and 1 report were included. The findings revealed psychological stress is prevalent among Chinese middle school population, with the degree of prevalence from low to severe stress levels. Three dimensions of psychological stress affecting Chinese secondary school students: school, family and lifestyle. Within the school, the factors included academic stress, peer relationships etc. Family-related factors were comprised of parent-child relationship, parents' mental health status etc. Lastly, lifestyle-related factors included poor diet, sedentary and inactivity etc. Our findings suggest that policy makers should reduce the excessive emphasis on examination results and focus on the all-round development of students, and that schools should organize a variety of extra-curricular activities to reduce students' stress. Parents should create a harmonious family atmosphere to minimize conflicts and maintain close communication with teachers.

Systematic Review Registration

OSF; https://doi.org/10.17605/OSF.IO/HEFCP.

Mediation and interaction of problematic internet use in the relationship between sexual minority status and depressive symptoms: Gender-based analysis

BACKGROUND

Previous studies have demonstrated that sexual minorities are at a higher risk of experiencing depressive symptoms. However, few prior investigations have examined the potential mechanisms involved. This study aimed to employ the four-way decomposition approach that integrates the analysis of mediation and interaction to investigate the potential role of problematic internet use between sexual orientation and depressive symptoms.

METHODS

The participants were recruited through a multi-stage, stratified cluster, and random sampling method in China. Students who identified as "gay or lesbian" and "bisexual" were defined as "sexual minorities". The Young's Internet Addiction Test (IAT) was used to evaluate problematic internet use. The Center for Epidemiologic Studies Depression Scale (CESD-20) was used to evaluate depressive symptoms.

RESULTS

A total of 59,859 adolescents were included in this study, with 30,180 (53.25 %) boys and 29,679 (46.75 %) girls. Of these, 7263 (12.13 %) were identified as sexual minorities. Gender differences were observed in the association between sexual orientation, problematic internet use, and depressive symptoms. The mediating effect of problematic internet use was 28.80 % for boys and 36.84 % for girls, respectively. The interaction effect between problematic internet use and sexual minority status on depressive symptoms was 21.19 % and 9.65 % for boys and girls, respectively.

LIMITATIONS

The current study was limited by the cross-sectional design.

CONCLUSION

These findings suggest that prevention and intervention programs aimed at improving mental health outcomes among sexual minority adolescents should prioritize considering the impact of problematic internet use and potential gender differences.

Analyzing the psychometric properties of the PHQ-9 using item response theory in a Chinese adolescent population

BACKGROUND

People are more likely to fall victim to depression during adolescence since it is a period of rapid biopsychosocial transformation. Despite this, most depression research has concentrated on clinical issues, and evaluating depressive symptoms in teenagers is not as widespread. This study used item response theory (IRT) to examine the psychometric properties of the Patient Health Report scale (PHQ-9) in Chinese adolescents. Meanwhile, item function difference tests were used to check whether there were differences in depression symptoms in this group based on education and gender.

METHODS

In this research, the PHQ-9 was employed as a measurement tool, and 5958 valid data points were obtained from 12 secondary schools in China (Mage = 13.484; SDage = 1.627; range 11-19 years; 52.17% boys).

RESULTS

IRT shows that all items of the PHQ-9 satisfy monotonicity, unidimensionality and local independence and that they have good psychometric properties. Furthermore, DIF analysis revealed gender and educational disparities in adolescent depressive symptoms.

CONCLUSION

The study indicates that the PHQ-9 possesses favourable psychometric properties for use in Chinese adolescents. As a result, it serves as a valuable tool for effectively screening depressive symptoms in adolescents. It provides a foundation for prioritizing the development of secondary school students' physical and mental health.

Central symptoms and network associations of depressive symptoms among school-aged students: A network analysis

BACKGROUND

Depression is one of the most prevalent mental health problems occurred among school-aged students. Conceptualizing depressive symptoms as a network of interacting symptoms, this study used network analysis to identify central symptoms and network associations of depressive symptoms. The study also investigated how networks of depressive symptoms differ across school aged periods.

METHODS

A total of 2514 Chinese school-aged students in Grades 4 to 11 were recruited and asked to complete the Child Depression Inventory in this study.

RESULTS

The results showed that self-hatred consistently emerged as a central symptom of depressive symptoms across all school stages. Beyond this, each school stage had its unique central symptoms: loneliness was prominent in both elementary school and junior high school, while fatigue was more specific symptom to senior high school. When comparing the network structures across different school stages, there was a significant difference in network structure between elementary school students and junior high school students. The comparison in global strength showed that the network connectivity of depression network is stronger among elementary school students, with showing closer symptom associations.

CONCLUSIONS

By identifying central symptoms and their distinct associations, particularly the pronounced symptom interconnections among elementary school students, this study emphasize the critical importance of early interventions. Recognizing these stage-specific characteristics is essential for the development of effective prevention and intervention programs for depressive symptoms in school-aged students.

Global, Regional, and National Epidemiology of Depression in Working‐Age Individuals, 1990–2019

Background. Depression is a disorder that can have a serious impact on functioning and quality of life. Understanding the global, regional, and national epidemiology of depression in working‐age populations (15–49 years) is important for informing mental health policies and services. However, up‐to‐date data have been lacking, especially in developing regions. Methods. This study delved into the prevalence of depression among individuals in the working‐age group, specifically those between 15 and 49 years, by analyzing data from the 2019 Global Burden of Disease, Injuries, and Risk Factors Study (GBD). The comprehensive analysis aimed to determine the age‐standardized prevalence, incidence, and disability‐adjusted life years (DALYs) associated with depression across diverse groups. It considered factors such as geographical regions, age brackets, genders, and sociodemographic indices, spanning a time frame from 1990 to 2019. Results. Globally, the estimated prevalent cases, incident cases, and DALYs for depression increased from 1990 to 2019. Regionally, certain regions like Central Latin America saw rapid increases in age‐standardized prevalence and incidence rates over time. By sociodemographic regions, all tiers witnessed rises in incident cases, with high sociodemographic index (SDI) areas having the greatest burden in 2019. Nationally, countries such as India, China, and the United States had the highest total prevalence and incidence in 2019, while nations like Yemen and Angola reported exceptionally high age‐standardized rates (ASRs). Peak prevalence risk occurred in the mid‐to‐late 40s age range. Period effects showed declining risks over time. Earlier birth cohorts, especially before the mid‐1960s, faced higher risks than more recent generations. Population growth rather than epidemiological changes appeared to drive increases in disease burden. Conclusion. From 1990 to 2019, the overall trend of depression burden in working‐age individuals presents regional and national variations and differs by age, sex, period, and cohort.

Frequency of depression and correlates among Chinese children and adolescents living in poor areas under the background of targeted poverty alleviation: results of a survey in Weining county

BACKGROUND

There is a lack of epidemiological data on depressive morbidity in children and adolescents in rural China. This study determines the frequency and correlates of depression among children and adolescents to offer useful insights for family education and government policy-making in rural China.

METHODS

A cross-sectional online survey was conducted between April 20 to May 10, 2022. Depression was assessed using the Center for Epidemiologic Studies Depression Scale (CES-D), and the correlative factors of depression were analyzed.

RESULTS

In this study, 23,180 children and adolescents were enrolled (median (range) age: 12 (9-18) years); of them, 8,261 (35.6%) suffered from depression with a CES-D score of > 15. The onset of depression was significantly related to age, grade, gender, parental absence, attending key schools or classes, presence of moderate or severe internet addiction (IA), school record, social relationships, parental occupation, and education status. Furthermore, female gender (OR = 1.175; 95% CI: 1.108-1.247; p < 0.001), junior middle school (OR = 1.487; 95% CI: 1.380-1.601; p < 0.001), parental absence (OR = 1.272; 95% CI: 1.183-1.367; p < 0.001), attending key schools (OR = 1.221; 95% CI: 1.120-1.332; p < 0.001), attending key classes (OR = 1.099; 95% CI: 1.001-1.207; p = 0.048), and presence of moderate or above IA (OR = 13.593; 95% CI: 12.028-15.361; p < 0.001) were the most prominent independent factors for depression.

CONCLUSION

Depression is very common among Chinese children and adolescents living in poor areas of Weining County. Older age, higher school grade, female gender, parental absence, attending key schools or classes, and the presence of moderate to severe IA are some important factors that may dictate the occurrence of depression in these children and adolescents.

Risk and Protective Factors of Depression in Family and School Domains for Chinese Early Adolescents: An Association Rule Mining Approach

Depression is one of the most common psychological problems in adolescence. Familial and school-related factors are closely related to adolescents' depression, but their combined effects need further examination. The purpose of this study was to explore the combined effects of risk/protective factors of depression in family and school domains using a sample of Chinese adolescents differing in gender, age group and left-behind status. A total of 2455 Chinese students in primary and secondary school participated in the cross-sectional survey and reported multiple risk/protective factors in family and school environments and depressive symptoms. Association rule mining, a machine learning method, was used in the data analyses to identify the correlation between risk/protective factor combinations and depression. We found that (1) Family cohesion, family conflict, peer support, and teacher support emerged as the strongest factors associated with adolescent depression; (2) The combination of these aforementioned factors further strengthened their association with depression; (3) Female gender, middle school students, and family socioeconomic disadvantages attenuated the protective effects of positive relational factors while exacerbating the deleterious effects of negative relational factors; (4) For individuals at risk, lack of mental health education resources at school intensified the negative impact; (5) The risk and protective factors of depression varied according to gender, age stage and left-behind status. In conclusion, the findings shed light on the identification of high-risk adolescents for depression and underscore the importance of tailored programs targeting specific subgroups based on gender, age, or left-behind status.

The association between academic pressure and adolescent mental health problems: A systematic review

BACKGROUND

Academic pressure is a potential contributor to adolescent mental health problems, but international evidence on this association has never been synthesised.

METHODS

We conducted the first systematic review of the association between academic pressure and adolescent depression, anxiety, self-harm, suicidality, suicide attempts and suicide. We searched MEDLINE, PsycINFO, ERIC and Web of Science (core collection) up to November 24, 2022, for studies of school-going children or adolescents, which measured academic pressure or timing within the school year as the exposure and depression, anxiety, self-harm, or suicidal ideation, attempts or suicide as outcomes. Risk of bias was assessed using the Mixed Methods Appraisal Tool. We used narrative synthesis to summarise the evidence. The review was prospectively registered with PROSPERO (CRD42021232702).

RESULTS

We included 52 studies. Most studies assessed mixed anxiety and depressive symptoms (n = 20) or depressive symptoms (n = 19). Forty-eight studies found evidence of a positive association between academic pressure or timing within the school year and at least one mental health outcome.

LIMITATIONS

Most studies were cross-sectional (n = 39), adjusted for a narrow range of confounders or had other limitations which limited the strength of causal inferences.

CONCLUSIONS

We found evidence that academic pressure is a potential candidate for public health interventions which could prevent adolescent mental health problems. Large population-based cohort studies are needed to investigate whether academic pressure is a causal risk factor that should be targeted in school- and policy-based interventions.

FUNDING

UCL Health of the Public; Wellcome Institutional Strategic Support Fund.

Effects of physical activity in child and adolescent depression and anxiety: role of inflammatory cytokines and stress-related peptide hormones

Depression and anxiety are the most common mental illnesses affecting children and adolescents, significantly harming their well-being. Research has shown that regular physical activity can promote cognitive, emotional, fundamental movement skills, and motor coordination, as a preventative measure for depression while reducing the suicide rate. However, little is known about the potential role of physical activity in adolescent depression and anxiety. The studies reviewed in this paper suggest that exercise can be an effective adjunctive treatment to improve depressive and anxiety symptoms in adolescents, although research on its neurobiological effects remains limited.

Factors associated with severe depressive symptoms among Chinese secondary school students in Hong Kong: a large cross-sectional survey

Background

Many adolescents were reported to have severe depressive symptoms, and a careful assessment of its correlates is essential for prevention and intervention programs. This study aimed to gain insight into the prevalence of severe depressive symptoms and its association with factors at four levels (individual, relationship, school and society) in a large sample of Hong Kong Chinese secondary school students.

Methods

Secondary school students from Secondary 1 through 7 were selected as participants using a cluster random sampling method. A questionnaire including inventories measuring 24 factors at the four levels (six individual factors, 11 relationship factors, three school factors, and four society factors) was completed by 8,963 participants (56.3% female) with a mean age of 15.1 (SD = 1.8) years. Students with a score of ≥15 on the Patient Health Questionnaire were defined as having severe depressive symptoms. The association between severe depressive symptoms and correlates were examined by t-test and χ2 test. Logistic regression models using a hierarchical approach then examined the individual contribution of these 24 factors to severe depressive symptoms with the control of other factors in the model.

Results

7.4% of the students have severe depressive symptoms. Twenty-two of the 24 factors were significantly associated with severe depressive symptoms in bivariate analyses. In the logistic regression, 11 factors (three individual factors: age, self-esteem and self-mastery; six relationship factors: tobacco use, alcohol drinking, drug use, paternal psychological control, dinner with parents, and perceived social support from friends; one school factor: felt pressure from homework; and one society factor: number of sibling) were statistically significant. Felt pressure from homework, alcohol drinking, and perceived social support from friends were the strongest correlates of severe depressive symptoms.

Conclusion

The prevalence of self-reported severe depressive symptoms in Hong Kong Chinese secondary school students was high, and the identification of multiple associated factors at the four levels simultaneously provides a knowledge basis for the development of a comprehensive, multivariate model of factors influencing severe depressive symptoms in Chinese secondary school students. The factors identified in the present study may be helpful when designing and implementing preventive intervention programs.

Relationship between depression and quality of life among students: a systematic review and meta-analysis

The objectives of this systematic review were to estimate the prevalence of depression and to identify the relationship between depression and quality of life (QOL) among high school and university students. Literature search was performed in the Scopus, Embase, PubMed, Scielo, CINAHL and Web of Science databases, following the PRISMA methodology. The results were presented through descriptive approaches and meta-analysis. Thirty-six studies met the eligibility criteria, and twenty-six were included in the meta-analysis. The prevalence of depressive symptoms was 27% (95% CI 0.21-0.33) among students, being high school and university students was 25% (95% CI 0.14-0.37) and 27% (95% CI 0.20-0.34), respectively, and most studies have shown that depression was associated with low QOL. Among the limitations of the study is the difficulty of generalizing the results found, considering the large sample of health students. New studies should be conducted considering the severity, duration, and patterns of depressive symptoms in high school and university students, to better understand the relationship between depression and QOL.

Class climate, adolescent financial and academic strain, and depressive symptoms

Understanding the risk and protective factors that influence the trajectory of depressive symptoms may help schools better support students in adolescence. The present study used a multilevel framework to examine the effects of adolescent perceptions of financial strain, academic strain, and class climate on their depressive symptoms in the context of Confucian collectivism and an exam-centered culture. The study also investigated the multi-level moderating effects of students' perceptions of class climate and gender on the association between perceptions of strains and depressive symptoms. Drawing on a sample of 13,087 adolescents aged 12-18 years (mean age = 14.53, SD = 1.228) from 28 counties/districts in China, multilevel analysis was conducted, with demographic factors controlled for. The results revealed that the perceptions of financial strain and academic strain were significantly and positively associated with adolescent depressive symptoms, while class climate was significantly and negatively associated with depressive symptoms. Notably, the association between financial strain and depressive symptoms was moderated by class climate at the class level, the association was weaker in classes with a more positive class climate. Furthermore, the results revealed that academic strain was more positively associated with depressive symptoms among female adolescents than male adolescents. These findings highlight the importance of cultivating adolescents in a class climate with the aim of alleviating the financial strain and academic strain; they also indicate the importance of applying gender-specific efforts in programs with an academic strain and depression focus.

The long-term association between paternal involvement in infant care and children's psychological well-being at age 16 years: An analysis of the Japanese Longitudinal Survey of Newborns in the 21st Century 2001 cohort

BACKGROUND

Some studies conducted in the United Kingdom have shown long-term associations between paternal involvement in childcare and adolescents' mental health issues. However, findings were inconsistent, and similar epidemiologic studies have not been conducted in other countries in Europe or Asia. Thus, we aimed to examine this association using Japanese population-based cohort study data.

METHODS

The Japanese Longitudinal Survey of Newborns in the 21st Century commenced in 2001. Data from 18,568 16-year-olds enrolled in the survey were analyzed. Poor psychological well-being was assessed using the WHO-5 Well-being Index. Paternal involvement in childcare-in tasks such as changing diapers-was assessed at the children's 6 months of age. We created four groups from least involvement to most active involvement based on the frequency of fathers' performing the tasks.

RESULTS

The risk of poor psychological well-being was lower among more active involvement groups compared with the least involvement group, after adjusting for potential confounders (risk ratios = 0.90 [95 % confidence intervals: 0.85, 0.95] for the most active group).

LIMITATIONS

Due to 16 years of follow-up, loss to follow-up may have caused a selection bias.

CONCLUSIONS

Our study is the first in Asian countries to show that fathers' active involvement in childcare is associated with poor psychological well-being in adolescence. Encouraging fathers' involvement in childcare may ameliorate prevalent issues of school refusals and withdrawals in the long term in Japan.

The McMaster Family Assessment Device (FAD) dimensions involved in the prediction of adolescent depressive symptoms and their mediating role in regard to socioeconomic status

Family functioning plays an important role in explaining the high prevalence of depressive symptoms in adolescents and it is necessary to identify the family functioning characteristics responsible for this relationship. In turn, while socioeconomic status (SES) is associated with adolescent depressive symptoms, the mechanisms that explain this relationship are largely unknown. In this study, we used the McMaster Family Assessment Device (FAD) to obtain a picture of the family functioning dimensions that genuinely contribute to explaining the relationship between family functioning and adolescent depressive symptoms and analyzed the mediating effect of family functioning on the impact of SES on depressive symptoms. Regression-based conditional process analysis was used with a sample of 636 adolescents aged 12-17 years. Pratt's measures in regression analyses showed that 95% of the variance in depressive symptoms was accounted for by three of the six FAD dimensions: the ability to experience and express emotions appropriately-Affective Responsiveness-the ability to maintain adequate involvement among family members-Affective Involvement-and the ability to set and abide by rules and standards of behavior-Behavioral Control. Results also showed that the impact of SES on depressive symptoms was mediated by the existence of clear expectations about standards of behavior and behavioral patterns for handling family tasks-Behavioral Control and Roles-and, for the boys, by experiencing and expressing emotions appropriately. The results emphasize the importance of affect and clear-cut family rules to prevent adolescent depressive symptoms and suggest that the existence of family rules and roles buffer the impact of SES on adolescent wellbeing.

The Impact of School Education on Depressive Symptoms in Chinese Adolescents: a Prospective Longitudinal Study

There is a growing but limited literature on psychological distress among Chinese students, especially the impact of the COVID-19 pandemic, using a longitudinal comparison between in school and at home. This study aimed to assess the psychological status of adolescents in school and related risk and protective factors. We surveyed 13,637 adolescents before the COVID-19 outbreak (T1) and 10,216 after two months of home confinement (T2). The 9-item Patient Health Questionnaire (PHQ-9) was used to assess depressive symptoms or the severity of depression among the adolescents. In addition, the Childhood Trauma Questionnaire and the Connor-Davidson Resilience Scales were also used to screen for experiences of abuse and neglect and to measure resilience in adolescents. At baseline, 22.34% reported depressive symptoms. At T2, this rate decreased to 14.86%. When adolescents were in school, age (P < .0001), gender (P < .0001), and experience of abuse (P < .0001) were risk factors, while parent-child relationship (P < .0001), and resilience (P < .0001) were protective factors for depressive symptoms. After leaving school, age and physical abuse were no longer risk factors for depression. The negative impact of school education on the mental health of adolescents in China exceeds even the impact of the pandemic and home isolation. The focus should be on those adolescents with abuse experience and poor parent-child relationships to prevent the onset of psychological and psychiatric disorders.

Somatic, Emotional and Behavioral Symptomatology in Children during COVID-19 Pandemic: The Role of Children's and Parents' Alexithymia

The COVID-19 pandemic has deeply affected the psychophysical wellbeing of children worldwide. Alexithymia, a personality trait involving difficulties in identifying and expressing feelings represents a vulnerability factor for stress-related disorders. Under pandemic stress exposure, we aimed to investigate the role of parents' and children's alexithymia in the psychophysical symptomatology shown by children and to evaluate possible differences according to age, gender and history of COVID-19 infections. The perception of parents and children about the impact of the pandemic on children's emotional, social and physiological wellbeing was also explored. Sixty-five familial triads were surveyed in the period from March to May 2022: children (n = 33 males; mean age = 9.53, sd = 1.55), mothers (mean age = 44.12; sd = 6.10) and fathers (mean age = 47.10; sd = 7.8). Both parental and children's alexithymia scores were significantly associated with somatic and externalizing symptomatology in children. Self-reported anger and externally oriented thinking scores were higher in younger children (age 8-9.9 years) than in older ones (10-12 years). Girls scored higher than boys in somatic complaints, as reported by parents. No difference emerged between children affected/not affected by COVID-19. Notably, children reported a greater negative impact of the pandemic on their emotional and psychosocial well-being than their parents. The findings emphasize the role of alexithymia in the occurrence of psychophysical symptoms in children during the COVID-19 pandemic. The reduced parental awareness of the emotional burden imposed by the pandemic on children indicates the need to better consider how epidemics affect children's mental health and to develop adequate preventive strategies to support them in these exceptional times.

The role of parental conflict in predicting adolescent depression symptoms during the COVID-19 pandemic: A longitudinal study

The present study was designed to investigate the association and the underlying mechanism between parental conflict and adolescent depression during the COVID-19 pandemic. In a longitudinal study, a total of 655 Chinese adolescents ranging from 13 to 16 years old completed a three-wave survey (W1, W2, W3) via a survey website. The data was collected three times: March 15-20, 2020 (W1, the outbreak period of the COVID-19 pandemic in Mainland China), June 20-25, 2020 (W2, the trough stage), and December 15-20, 2020 (W3, six months after the trough stage). The SPSS 16.0 software was used to investigate the relationships among study variables. The findings showed that a double-hump effect was found for depression detection among adolescents during the pandemic, with depression rates in W1 (26.9%) and W3 (29%) were higher than that in W2 (21.9%). The parental conflict subscales of content and resolution had a greater impact on adolescent adjustment than other subscales. The parental conflict had direct and indirect impacts (through reducing family support and increasing burdensomeness) on adolescent depression symptoms in W3. It was concluded that when the COVID-19 pandemic was in a trough curve for more than six months, adolescent adjustment was significantly impacted by the pandemic, and parental conflict was an important risk factor in predicting individual adjustment. Therefore, family intervention is recommended when improving adolescent adjustment during the COVID-19 pandemic.

Barriers to a classroom-based universal prevention program for depressive symptoms in Chinese adolescents: A qualitative study

Universal prevention is a practical approach to preventing depressive symptoms in adolescents, but barriers might reduce its effectiveness. This study explored possible barriers to universal prevention of depressive symptoms in Chinese adolescents. We interviewed thirteen adolescents who participated in the program. Thematic analysis was used to analyse the data. The results revealed three categories of barriers. The first category was participants' maladaptive coping strategies and beliefs about negative emotions. They tended to use avoidance coping, did not believe that negative emotions can be regulated, and had an unrealistic wish for a quick fix. The second category originated from the prevention contents. The complexity of the psychological techniques and the lack of proficiency among the participants were important barriers. The third category was the setting of the psychological course. Participants were reluctant to invest cognitive effort in the psychological course. The large-size class also made it challenging to have an in-depth exploration into emotions and thoughts. Our study added to the existing literature by providing more knowledge of barriers to universal prevention. Future research and practice need to adequately address these barriers so that universal prevention can be conducted more effectively.

The relationship between childhood abuse and depression among adolescents: The mediating role of school connectedness and psychological resilience

BACKGROUND

Adolescent depression is a major public health concern worldwide, and depressive symptoms among adolescents in Chinese secondary school increase with grade. Although numerous studies noted that childhood abuse was associated with the development of depression in adolescents, the underlying mediators involved in this pathway remain unclear. Therefore, our study aims to explore whether psychological resilience and school connectedness mediate the association between childhood abuse and depression among Chinese adolescents.

METHODS

A cross-sectional survey was carried out among 1607 adolescents at four high schools located in Henan Province, Central China. Structural equation modeling was performed to determine whether psychological resilience and school connectedness mediate the influence of childhood abuse on depression.

RESULTS

Findings revealed that childhood abuse was directly (β = 0.410, p < 0.001) and indirectly (β = 0.141, p < 0.001) related to depression. Specifically, psychological resilience (β = 0.018, p = 0.009), school connectedness (β = 0.087, p < 0.001), and school connectedness together with psychological resilience (β = 0.036, p < 0.001) partially mediated the relationship between childhood abuse and depression.

CONCLUSIONS

The detrimental impact of childhood abuse on adolescents' depression may be reduced by fostering psychological resilience and school connectedness.

Life events and parent style for mental health in children: a cross-sectional study

BACKGROUND

Life events and parenting styles might play an important role in children's mental health.

AIMS

This study aims to explore how life events and parenting styles influence children's mental health based on a Chinese sample.

METHODS

A total of 3535 participants had at least one mental disorder (positive group), while a total of 3561 participants had no mental disorders (negative group). The Child Behavior Checklist (CBCL), Adolescent Self-Rating Life Events Check List (ASLEC) and Egna Minnen Beträffande Uppfostran (EMBU) were used for screening these two groups.

RESULTS

CBCL total scores differed significantly by sex in the Positive group according to the Mann-Whitney tests (Z = -5.40, p < 0.001). Multiple regression analyses showed that the dimensions of punishment (p = 0.014) and other (p = 0.048) in the ASLEC scale can significantly predict CBCL total scores in the Positive group. Sex, age and overprotection from the father were risk factors (p < 0.001) according to binary logistic regression.

CONCLUSIONS

Life events and parenting styles may have impacts on mental health. Fathers play a very important role in children's growth. Punitive education and fathers' overprotection might be risk factors for children's mental health.

IMPACT

It is a large sample (3535) study of Chinese children and adolescents It provides evidence that life events and parenting styles have impacts on mental health and that fathers play a very important role in children's growth. It is conducive to the development of interventions for the mental health of children and adolescents.

COVID-19 Experiences and Health-Related Implications: Results From a Mixed-Method Longitudinal Study of Urban Poor Adolescents in Shanghai

PURPOSE

This analysis aimed to investigate gender differences in adolescents' concerns and the health implications of COVID-19.

METHODS

We used two rounds of the Global Early Adolescent Study (GEAS) collected in Shanghai in 2018 and 2020. We analyzed data from 621 adolescents, comparing boys' and girls' concerns about COVID-19 and examining trends in general health and mental health by sex between the pre-COVID-19 and COVID-19 periods. Changes in health indicators over time were assessed using generalized estimating equation (GEE) models.

RESULTS

Adolescent girls reported more health concerns (52.0% vs. 42.7%) and educational concerns (61.0% vs. 46.3%) than boys, whereas boys expressed more worries about the economic consequences of COVID-19 (32.9% vs. 25.4%). Changes in health-related outcomes during the pandemic compared to the prepandemic era differed by sex and varied by COVID-related experiences. Boys reported improved overall health (OR: 1.54, 95% CI: 1.00, 2.35) in the COVID-19 period relative to the pre-COVID-19 period. Such improvements were only observed among boys who reported no family economic hardships (OR: 2.10, 95% CI: 1.24, 3.58). We found no significant change for girls (OR: 1.14, 95% CI: 0.83, 1.55), regardless of COVID-19 economic impacts. In contrast, girls reported increased anxiety (OR: 1.63, 95% CI: 1.09, 2.45), especially among those who were concerned about their academic performance (OR: 1.85, 95% CI: 1.16, 2.97). Boys experienced no such increase (OR: 0.92, 95% CI: 0.55, 1.54), regardless of their education concerns.

DISCUSSION

Adolescents' COVID-19 experiences are highly gendered and result in increased health inequalities, with greater mental health implications for girls.

Identifying Transformative Sequences in the Psychotherapeutic Interaction With Chinese Adolescents With Depression: A Conversation Analysis Approach

Previous studies seldom touch on aspects of psychotherapeutic encounters between therapists and clients with particular disorders (such as depression). Little attention has been paid to the sequence organization of psychotherapeutic interaction between therapists and clients with depression in Chinese medical settings. By adopting conversation analysis, we investigated the specifics of psychotherapeutic encounters, specifically, the transformative sequences of psychotherapeutic interaction between therapists and Chinese adolescents with depression. We identified the fourth aspect of clients’ experience transformed in the Chinese psychotherapeutic interaction with adolescents with depression: cognition, and described how the sequential organization of therapists’ actions facilitates the momentary transformation of clients’ experience (i.e., the transformation of cognition, referent, emotion, and relation) in the psychotherapeutic processes. This study not only adds to the conversation analytic study on the transformative sequences in psychotherapeutic interaction but also sheds some light on the study of how therapists transform clients’ experience in Chinese psychotherapeutic interaction.

Risk Factors Associated With School Bullying Behaviors: A Chinese Adolescents Case-Control Study, 2019

This research aimed to identify risk factors including individual characteristics and environment circumstances related to different types of school bullying (physical, relational, verbal, sexual, and possession bullying) among middle school students in China. Cases were the respondents reporting perpetrating bullying behaviors three or more times in the past year. One control was selected for each case from those participants who were not involved in school bullying in the past 12 months. Data were collected between April 2019 and May 2019 in China. After considering potential confounding variables including gender, grade level, and school, multivariable conditional logistic regression analysis was performed based on the univariate logistic analysis including 1,594 adolescents. According to conditional logistic regression analysis, alcohol use and lack of emotional management and control were the significant individual characteristics positively associated with involvement in school bullying. Alcohol use was related to all five types of school bullying perpetration. Poor relationships between family members, father's alcohol use, and parental neglect were strong risk factors for relational bullying. Lack of a sense of safety and absence of trusted people were associated with physical, relational, and verbal bullying perpetration. Results of this study provide evidence about risk factors for school bullying and have implications for potential policies to reduce bullying. Effective policies and programs need to take individual characteristics (social-emotional skills, anger control), family (parent training in conflict resolution, appropriate disciplining), peer and school factors (promoting prosocial networks, zero tolerance for bullying, appropriate disciplining policies against students who bully others, teacher training on building positive teacher-student relationships and positive discipling techniques) into consideration in order to develop effective prevention programs.

The Link between Subjective Religiosity, Social Support, and Mental Health among Young Students in Eastern Europe during the COVID-19 Pandemic: A Cross-Sectional Study of Poland and Ukraine

Religiousness has a positive effect on the mental health of an individual and social groups in many difficult situations. In the conducted research, we wanted to check, inter alia, whether religiosity and social support are positively related to the mental health of students during the COVID-19 pandemic in Poland and Ukraine. The research was conducted at a time (August 2021) when the very contagious Delta variant was spreading over Europe, and numerous pandemic-related personal restrictions and obligations (such as using facemasks in selected places, social distancing, and obligatory self-isolation of the ill or those who had contact with the pathogen) were in force in both countries. For this purpose, a representative survey was carried out using the CAPI technique on a sample of 1000 students in Poland (50% boys and 50% girls in the age range 10–19) and 1022 in Ukraine (51% boys and 49% girls in the age range 10–18). The results of the research shows that depression measured by the PHQ-9 scale was experienced by 20% of students in Poland, and 13% in Ukrainian. Anxiety, measured with the GAD-7 scale, was experienced by 9% of the Polish and 6% of the Ukrainian students. The performed regression analysis showed that religiosity had no effect on the mental health of students. The main risk factor for mental disorders was the lack of social support.

Minding the Gap: Adolescent and Parent/Caregiver Reporter Discrepancies on Symptom Presence, Impact of Covariates, and Clinical Implications

INTRODUCTION

Primary care practitioners (PCPs) provide care to adolescents in the context of their families. Supporting parent/caregiver knowledge of symptoms can create opportunities for better recognition of symptoms that can then lead to early identification, intervention, and prevention of poor outcomes.

METHOD

Cross-sectional comparative study of parent/caregiver reported versus adolescent reported symptom presence of anhedonia and depressed mood in the participants of ABCD Study.

RESULTS

Large discrepancies exist between adolescent and parent-reported presence of symptoms.

DISCUSSION

Improving understanding of the etiology, covariates, and patterns of discrepancies may improve primary care assessment, adolescent access to care, and intervention for adolescents and their families. Furthermore, providing education to families about symptom features, working to improve adolescent-caregiver communication, promoting adolescent advocacy, and connecting families to community resources are important attributes of primary care and areas of adolescent and family functioning that primary care providers can strengthen.

Disease-Related Risk Factors for Caregiver Burden among Family Caregivers of Persons with Schizophrenia: A Systematic Review and Meta-Analysis

This study aimed to conduct a quantitative synthesis of the clinical correlates of caregiver burden in schizophrenia studies published in the last two decades. Derived from eight electronic databases, this meta-analytic review revisits 34 English articles published from 2000 to 2020 relevant to family caregiver burden in the schizophrenia field. The Newcastle–Ottawa Scale (NOS) was used to assess study quality. The pooled effect sizes of the selected studies ranged from −0.390 to 0.751. The results indicated a significant association between a heavier burden and disease-related risk factors, including more severe symptoms, greater general psychopathology, greater severity of functional impairment, and longer duration of illness. The results show moderating effects of study characteristics (i.e., study quality, participants, and location) on the correlations between these disease-related risk factors and caregiver burden. This review highlights the roles of study characteristics in affecting the inconsistent results for the effects of disease-related risk factors on caregiver burden in families of patients with schizophrenia. Psychosocial interventions are essential for family caregivers of persons with schizophrenia. Future studies incorporating random samples from both high-income and low-to-middle-income countries will be crucial to understand the effects of cultural contexts on caregiver burden in families of persons with schizophrenia.

Relationships of excessive internet use with depression, anxiety, and sleep quality among high school students in northern Vietnam

PURPOSE

To examine the associations of excessive internet use with depression, anxiety, and sleep quality among high school students in northern Vietnam, a country experiencing rapid economic growth.

DESIGN AND METHODS

A cross-sectional study was conducted in a high school in northern Vietnam from July to September 2019. Symptoms of depression and anxiety were respectively assessed using the Center for Epidemiological Studies Depression Scale and the Vietnamese Anxiety Scale. Sleep quality was measured using the Pittsburgh Sleep Quality Index. Internet use and demographic characteristics were obtained using structured questionnaires. A multiple logistic regression was performed.

RESULTS

In total, 678 participants with an average age of 16.1 (standard deviation 0.9) years were included. Nearly one-third of the adolescents (30.7%) exhibited excessive internet use (> 4 h/day), 19.6% experienced depressive symptoms, 14.5% presented anxiety symptoms, and 58.8% reported poor sleep quality. Compared to non-excessive internet users, excessive internet users (> 4 h/day) experienced significantly higher levels of depressive symptoms (p = .001), anxiety (p = .008), and poorer sleep quality (p < .001). Students who were female and with fair/poor self-rated health experienced higher depression, anxiety, and poor sleep quality (p < .05). After adjusting for demographic and health-related factors, students with excessive internet use were 58% more likely to experience poor sleep quality (odds ratio, 1.58, 95% confidence interval [1.06, 2.35]).

CONCLUSIONS

Excessive internet use in Vietnamese high school students was significantly associated with poor sleep quality, but not with depression or anxiety.

Mechanisms of Cognitive Impairment in Depression. May Probiotics Help?

Depression is the major cause of disability globally. Apart from lowered mood and accompanying symptoms, it leads to cognitive impairment that altogether predicts disadvantaged social functioning. Reduced cognitive function in depression appears a bit neglected in the field of clinical and molecular psychiatry, while it is estimated to occur in two-thirds of depressed patients and persist in at least one third of remitted patients. This problem, therefore, requires elucidation at the biomolecular and system levels and calls for improvement in therapeutic approach. In this review study, we address the above-mentioned issues by discussing putative mechanisms of cognitive decline in depression: (1) increased oxidative stress and (2) inflammation, (3) disturbed hypothalamus-pituitary-adrenals axis, and (4) reduced monoamines functionality. Moreover, we acknowledge additional underpinnings of cognitive impairment in depressed elderly: (5) vascular-originated brain ischemia and (6) amyloid-beta plaque accumulation. Additionally, by reviewing molecular, pre-clinical and clinical evidence, we propose gut microbiota-targeted strategies as potential adjuvant therapeutics. The study provides a consolidated source of knowledge regarding mechanisms of cognitive impairment in depression and may path the way toward improved treatment options.

The Association Between Family Function and Adolescents' Depressive Symptoms in China: A Longitudinal Cross-Lagged Analysis

The complex interrelationships between family function and adolescents' depressive symptoms are not yet fully clarified, especially in China. Based on the family systems theory, this study explored the relationships between family function and Chinese adolescents' depressive symptoms by a 3-year longitudinal study design. Three waves of data were collected from 1,301 Chinese middle school students in Grade 7 to Grade 9. All participants completed the Chinese Family Assessment Instrument (CFAI) and the Center for Epidemiologic Studies Depression Scale (CES-D) once a year during the junior middle school period. Our results showed that both family function and adolescent depressive symptoms were stable in Grade 7 and Grade 8, but in Grade 9, family function increased and depressive symptoms declined. Furthermore, we found that the family function in Grade 7 negatively influenced depressive symptoms of adolescents in Grade 8, while adolescent depressive symptoms in Grade 8 negatively impacted subsequent family function in Grade 9, namely there was a circular effect between family function and adolescent depressive symptoms. These findings suggest that the associations between family function and adolescents' depressive symptoms are dynamic and time-dependent. Our study contributes to the intervention aimed at the reduction of adolescent depressive symptoms from the family perspective.

Association Between Online Self-Directed Learning Ability and Negative Emotions Among College Students During the COVID-19 Pandemic: A Cross-Sectional Study in Anhui Province, East China

Background: This study investigated the correlation between depression, anxiety, and stress among college students engaged in online learning during the coronavirus disease 2019 (COVID-19) pandemic and self-directed learning (SDL) ability, which could provide a scientific basis for mental health education of the college students. Methods: A cross-sectional study was conducted among 5,558 students from two universities in Anhui province, East China. The Depression, Anxiety, and Stress Scale-21 (DASS-21) and the Self-directed Learning Ability Scale were used to conduct an online questionnaire survey. Results: A total of 35.15, 36.32, and 17.24% of college students reported symptoms of depression, anxiety, and stress, respectively. Males and nonmedical students were at higher risks to suffer from depression, anxiety, and stress. In adjusted model, compared with Q1 of self-management ability, the odds ratio (OR) of the Q2, Q3, and Q4 were as follows: 0.635 (0.531-0.759), 0.504 (0.415-0.611), and 0.312 (0.248-0.392) for depression; 0.639 (0.535-0.764), 0.653 (0.540-0.789), and 0.421 (0.338-0.525) for anxiety; and 0.649 (0.523-0.805), 0.579 (0.457-0.733), and 0.482 (0.364-0.637) for stress. For information capability, decrease in risk was even more pronounced: Q2 (0.654, 0.540-0.794), Q3 (0.560, 0.454-0.690), and Q4 (0.233, 0.181-0.301) for depression; Q2 (0.781, 0.646-0.945), Q3 (0.616, 0.501-0.757), and Q4 (0.276, 0.216-0.353) for anxiety; and Q2 (0.444, 0.357-0.553), Q3 (0.454, 0.357-0.578), and Q4 (0.272, 0.202-0.368) for stress. Compared with the Q2 group of cooperation learning ability, cooperation learning ability quartiles were positively associated with depression (Q1: 1.382, 95% CI: 1.138-1.678), anxiety (Q4: 1.260, 95% CI: 1.008-1.576), and stress (Q1: 2.002, 95% CI: 1.583-2.532; Q3: 1.600, 95% CI: 1.252-2.044; Q4: 1.674, 95% CI: 1.243-2.255). Conclusion: The prevalence of depression, anxiety, and stress among college students was high for those studying online at home during the COVID-19 pandemic, especially among nonmedical students and males. SDL ability was negatively associated with negative emotions of the college students during this period of online learning.

Prevalence of depression and its associated factors among adolescents in China during the early stage of the COVID-19 outbreak

Background

The outbreak of the 2019 coronavirus disease outbreak (COVID-19) had a detrimental impact on adolescents’ daily life and studying, which could increase the risk of depression. This study examined the prevalence of depressive symptoms (depression hereafter) among Chinese adolescents and its associated factors.

Methods

An online survey was conducted during the COVID-19 outbreak in China. Adolescents aged 11–20 years who currently lived in China were invited to participate in the study. Data were collected with the “SurveyStar” platform using the Snowball Sampling method. Depression was assessed using the Center for Epidemiologic Studies Depression Scale (CES-D).

Results

A total of 9,554 adolescents participated in the study. The prevalence of depression was 36.6% (95% CI [35.6%–37.6%]); the prevalence of mild and moderate-severe depression was 9.2% (95% CI [8.9%–9.5%]) and 27.4% (95% CI [26.9%–27.9%]), respectively. Female gender (OR = 1.235, P < 0.001), senior secondary school grade (OR = 1.513, P < 0.001), sleep duration of <6 h/day (OR = 2.455, P < 0.001), and living in Hubei province (total number of infected cases > 10,000) (OR = 1.245, P = 0.038) were significantly associated with higher risk of depression. Concern about COVID-19 (OR = 0.632, P < 0.001), participating in distance learning (OR = 0.728, P = 0.001), sleep duration of >8 h/day (OR = 0.726, P < 0.001), exercise of >30 min/day, and study duration of ≥4 h/day (OR = 0.835, P < 0.001) were associated with lower risk of depression.

Conclusion

Depression was common among adolescents in China during the COVID-19 outbreak. Considering the negative impact of depression on daily life and health outcomes, timely screening and appropriate interventions are urgently needed for depressed adolescents during the COVID-19 outbreak.

Parent-Child Discrepancies in Perceived Parent-Child Communication and Depressive Symptoms in Early Adolescents in China

Although recent studies demonstrated that parent-child discrepancies in the perceived family processes were associated with children's developmental outcomes, few studies have addressed this issue in different types of families in mainland China. The present study investigated that how discrepancies in parents' and adolescents' perceptions of parent-adolescent communication were associated with early adolescent depressive symptoms in a nationally representative sample (N = 15,377) with 7010 father-adolescent dyads (adolescents: Mage = 14.24 years, SD = 1.25 years; 5960 adolescents from two-parent families, 443 adolescents from single-father families) and 8367 mother-adolescent dyads (adolescents: Mage = 14.02 years, SD = 1.18 years; 6670 adolescents from two-parent families, 1362 adolescents from single-mother families) in China. Adolescent respondents completed a measure of depressive symptoms and all informants reported on the perceived levels of parent-adolescent communication. Results indicated that adolescents reported parent-child communication more negatively than did their parents. Father-adolescent discrepancies were also greater in intact families than non-intact families. Polynomial regression analyses indicated that while there was a significant interactive effect of father-reported and adolescent-reported father-adolescent communication in Chinese two-parent families, no significant interaction was found for mother-adolescent dyad. Besides, adolescent-reported mother-child communication interacted with mother-reported communication in Chinese single-mother families only. The findings clarify parent-adolescent discrepancies in parent-child communication in different types of families in China and they have theoretical and practical implications on the role of discrepancies in parents and adolescent children on perceived parent-adolescent communication in early adolescent depressive symptoms.