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

Quantifying gender differences in the impact of internet addiction on adolescent depression: A causal inference approach

BACKGROUND

The rising prevalence of adolescent depression in China has raised concerns about internet influence. This study identified predictors of internet addiction (IA) and quantified its gender-specific impact on depression.

METHOD

In April-May 2023, 8176 adolescents from six (6) junior high schools in Henan, China, were randomly sampled. IA and depression were assessed via the 20-item internet addiction test (IAT) and 10-item Center for Epidemiologic Studies Depression (CESD-10) scale, respectively. IA's impact on depression was analyzed using four approaches: IPW (confounder weighting), DML (high-dimensional control), PSM (covariate balancing), and RA (residual adjustment).

RESULTS

Among the males, 31.8 % reported depression and 17.7 % reported IA while females, 49.4 % reported depression and 21.3 % IA. The mean ages were 14.5 ± 0.94 (males) and 14.4 ± 0.93 (females). DML revealed the overall effect of 0.22 (95 % CI: 0.17-0.23; p < 0.001), higher in males (95 % CI: 0.23, 95 % CI: 0.18-0.31) than females (0.17, 95 % CI: 0.11-0.23). IPW estimated an effect of 0.30 (95 % CI: 0.25-0.34; p < 0.001), also higher in males (0.34, 95 % CI: 0.28-0.39) than females (0.29, 95 % CI: 0.23-0.36). PSM and RA yielded similar results. Predictors of IA included low self-esteem, history of negative life events, poor sleep quality, and one-child family status.

CONCLUSION

Internet addiction (IA) exacerbates adolescent depression, disproportionately affecting males. Addressing self-esteem, negative life events, poor sleep, and one-child family challenges can mitigate IA's effects. Gender-sensitive interventions, school-based programs, and parental guidance are critical.

Explaining the Family-Centred Care of Young People With Depressive Disorders and Suicidal Ideations: A Grounded Theory Study

AIM

This study aimed to develop a theory to guide family members caring for young people with depressive disorders and suicidal ideations.

DESIGN

Strauss and Corbin's Grounded Theory.

METHODS

Theoretical sampling was used to recruit primary family caregivers (aged 22-60) of young people experiencing depressive disorders and suicidal ideations from hospitals and psychiatric clinics in Taiwan. Data were collected using interviews (n = 23) in 2023. Data were analysed using Corbin & Strauss' analytical framework, including open, axial and selective coding until theoretical saturation was reached.

RESULTS

A paradigm model was used to link the 13 categories and develop a substantive theory to help guide family members in the care of their young persons with depressive disorders and suicidal ideations. The core category that emerged was 'Struggling to contain the young person's life by adjusting, assisting, and protecting them from diving into depression'. Other key categories interconnected with this core category were-creating a nurturing environment, adjusting to changes, protecting the young person's safety and assisting with their medical treatment.

CONCLUSION

Family caregivers could use this theory as a guide to enhance the care of young persons experiencing depressive disorders and suicidal ideations and accompany them alongside the healing process.

IMPLICATIONS FOR THE PROFESSION

Nursing professionals could provide psychoeducation to family caregivers on how to hold the young person gently and acquire compassion for the young persons' lived experience, thoughts and emotions, by creating a nurturing environment, adjusting to changes, protecting their safety and assisting with their medical treatment.

IMPACT

This theory provides valuable guidance for future intervention research aimed at improving family caregivers' ability to care for young persons with depressive disorders and suicidal ideations.

REPORTING METHOD

The COREQ guidelines were utilised.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Factors Associated with Suicidal Behavior in Adolescents: An Umbrella Review Using the Socio-Ecological Model

Adolescent suicide is a critical social issue with profound and lasting individual and collective consequences. This umbrella review examines factors associated with adolescent suicidal behavior through the socioecological framework of prevention and seeks to identify gaps in the existing literature. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and included a comprehensive search of the of the Web of Science, Scopus, and Cochrane databases in both English and Spanish, covering the period from 2018 to 2024, using terms related to adolescence and suicidal behavior. Out of 6,138 articles identified, 37 met the quality criteria and were selected for analysis. The studies highlighted individual risk factors such as age, gender, belonging to ethnic or gender minorities, emotional disorders, self-destructive behavior, emotional regulation, and experience of physical or emotional pain. Interpersonal factors such as parental relationships, sexual abuse, social isolation, peer pressure, and loneliness were also found. However, the review revealed a worrying lack of studies on societal and community factors and a paucity of research focusing on protective factors. The study highlights the need to include factors related to the physical and social environments that influence health and behavior in future research, as well as to enhance the resources and strengths of adolescents.

Impact of parental marital status on self-harm in Chinese primary school students: the mediating role of depression and the moderating effect of classmate relationships

Background

Self-harm is an increasing global public health concern, with a growing prevalence in younger children. This study investigates the associations between parental marital status and self-harm behaviors among primary school students, with a focus on the mediating role of depressive symptoms and the moderating effect of classmate relationships.

Methods

A cross-sectional survey was conducted among 33,285 students (grades 3-6; mean age = 10.36 years) in the Shapingba District of Chongqing, China, from September to December 2020. Self-report measures included the Children's Depression Inventory (CDI), general demographic data, self-harm behaviors, and parental marital status. Data were analyzed using SPSS 26.0 for descriptive statistics and Mplus 8.1 for structural equation modeling (SEM), assessing the effects of parental marital status on self-harm.

Results

The reporting rates of depression and self-harm in grades 3-6 of primary school are 16.3% and 12.7%, respectively. Parental separation exhibited a more pronounced overall impact on self-harm (β = 0.120) compared to divorce (β = 0.105). Positive classmate relationships mitigated the indirect effect of separation on self-harm mediated by depression, reducing it from 0.098 to 0.072. Additionally, these relationships attenuated the direct effect of divorce on self-harm, decreasing it from 0.088 to 0.043. Depression significantly mediates the relationship between parental separation and children's self-harm, with direct and indirect effects accounting for 53% (β = 0.057) and 47% (β = 0.063) of the total effect, respectively.

Conclusion

The marital status of parents, especially in cases of separation, has a significant impact on self-harm behaviors among primary school students, with depression acting as a key mediating factor. Supportive classmate relationships can alleviate this effect, highlighting their importance in mental health interventions. These findings offer valuable insights for the development of policies aimed at reducing self-harm and enhancing psychological well-being among children.

Trajectories of depressive symptoms among young people in London, UK, and Tokyo, Japan: a longitudinal cross-cohort study

BACKGROUND

Research suggests gender inequalities in adolescent mental health are context dependent and might be preventable through social and structural change. However, variations in the size of gender inequalities in mental health across diverse cultural contexts could be due to incomparable measurement. We aimed to compare a measurement of mental health among young people in Tokyo, Japan, and London, UK, and test the hypothesis that gender inequalities in depressive symptom trajectories are larger in London than in Tokyo.

METHODS

For this longitudinal cross-cohort study, we extracted responses to the 13-item Short Mood and Feelings Questionnaire (SMFQ) by young people who participated in three consecutive waves of the Tokyo Teen Cohort (TTC) and the London-based Resilience, Ethnicity and Adolescent Mental Health (REACH) cohorts. We used multigroup and longitudinal confirmatory factor analysis to examine measurement invariance of the SMFQ by cohort, gender, and age. Latent growth curve models were used to estimate and compare mean trajectories of SMFQ from ages 11-16 years among boys and girls, overall, and in each cohort.

FINDINGS

7100 young people from TTC and REACH (3587 boys [50·5%] and 3513 girls [49·5%]) were included in the analysis. With the TTC and REACH cohorts combined, we found very strong evidence of differences in SMFQ between boys and girls, with a mean starting level of 0·71 points (95% CI 0·42-0·95) higher and mean rate of change of 0·73 points (95% CI 0·62-0·82) higher in girls versus boys. Among the 4287 participants in REACH (2097 [48·9%] boys and 2190 [51·1%] girls), a difference in SMFQ was evident between boys and girls at age 11-12 years (difference in mean intercepts: 0·75 [95% CI 0·25-1·25]). Among the 2813 participants in TCC (1490 boys [53·0%] and 1323 girls [47·0%]), differences in SMFQ between boys and girls emerged at a later age, between ages 11 years and 14 years, during which SMFQ decreased among boys and increased among girls (mean difference in slopes 0·52 [95% CI 0·40 to 0·65]). The difference in SMFQ between boys and girls widened year-on-year in both cohorts; by age 16 years, the difference in SMFQ between boys and girls in REACH (mean difference in slopes 0·98 [95% CI 0·77 to 1·20]) was around twice as large as in TTC (0·52 [0·40 to 0·65]). The annual rate of increase in SMFQ among girls in REACH (1·1 [95% CI 0·9-1·3]) was around four times greater than among girls in TTC (0·3 [0·2-0·4]). We found little evidence to suggest these differences in gender inequalities were due to incomparable measurement.

INTERPRETATION

Gender inequalities in emotional health among young people are context dependent and might be preventable through social and structural change.

FUNDING

Japanese Society for the Promotion of Science, UK Economic and Social Research Council, and European Research Council.

TRANSLATION

For the Japanese translation of the abstract see Supplementary Materials section.

Physical activity and mental health in Chinese high school students: a cross-sectional study

Adolescent physical activity (PA) is essential for mental health. However, the declining PA levels amongst this group pose global challenges. This study examines the relationship between PA and mental health amongst 1668 Chinese high school students, focusing on gender and grade-level differences. Only 30.9% of students met the recommended 60 min of daily moderate-to-vigorous PA (MVPA), with boys showing a significantly higher compliance rate than girls (44.2% vs. 25.2%, P < 0.001). MVPA compliance was linked to better mental health, as compliant students had a lower mental health detection rate (43.6%) compared with non-compliant peers (56.4%, P < 0.001). The grade 11 students were at the highest risk of mental health issues (OR = 2.421, 95% CI: 1.893-3.096 and P < 0.001), whilst being female (OR = 0.630, 95% CI: 0.502-0.791 and P < 0.001). Meanwhile, MVPA non-compliance (OR = 0.792, 95% CI: 0.736-0.851 and P = 0.008) were additional risk factors. Poorer mental health correlated with reduced time in vigorous PA and increased time in low-intensity activities (P = 0.001). These findings highlight the low PA levels and significant mental health risks amongst adolescents, particularly girls and grade 11 students. Targeted interventions promoting PA, time management and mental health support are critical.

Sex and age differences in depression and anxiety networks among adolescents with idiopathic scoliosis: A network analysis

BACKGROUND

Depression and anxiety are prevalent psychological challenges among patients with adolescent idiopathic scoliosis (AIS), affecting individuals across both sex and age groups.

AIM

To explore the network structure of depression and anxiety symptoms, with a focus on identifying differences at the symptom level between sex and age subgroups.

METHODS

A total of 1955 participants diagnosed with AIS aged 10-18 years were assessed using the Patient Health Questionnaire Depression Scale (PHO-9) and the Generalized Anxiety Disorder Scale (GAD-7), and 765 patients exhibiting PHQ-9 or GAD-7 scores ≥ 5 were enrolled in our study. Network analysis and network comparison tests were utilized to construct and compare the depression-anxiety symptoms networks among sex and age subgroups.

RESULTS

The results revealed GAD3 "Excessive worry" and PHQ2 "Sad mood" were the most significant central symptoms in all subgroups, while "Sad mood" had higher strength than "Excessive worry" in the lower age group. In the network comparisons, the female network exhibited tighter connectivity, especially on GAD6 "Irritability" and GAD2 "Uncontrollable worry", while only PHQ3 "Sleep" and PHQ9 "Suicidal ideation" had differences at the local level in the lower age group.

CONCLUSION

Several interventions targeting excessive worry and sad mood could reduce the risk of depression and anxiety symptoms in the AIS population. Furthermore, specific anxiety symptoms in females, along with sleep disturbances and suicidal ideation in the lower age group, should be addressed at an early stage to prevent significant disruptions in mental health trajectories.

Impact of the Life is Precious™ Program on Academic Performance and School Functioning Among Latina Adolescents at Risk of Suicide

This exploratory study examines the impact of Life is Precious™ (LIP), a treatment-adjacent afterschool program, on academic performance and school functioning among Latina adolescents at risk of suicide. Utilizing a quasi-experimental design, the study compared the outcomes of LIP participants with individuals receiving usual care (UC) over a 12-month period. Results included a statistically significant group-by-time interaction on academic performance, indicating that the LIP group's grades improved over time while the UC group's grades declined. Though LIP was not significantly associated with school functioning, the direction of the estimated impact of LIP was positive, with a medium effect size. Combined with prior research, these results highlight the potential benefits of culturally responsive, community-based interventions like LIP in addressing both educational and mental health needs among Latina adolescents at high risk of suicide. Further research with larger samples is needed to substantiate these findings and explore long-term outcomes.

Multidimensional stress and self-harm in Chinese preadolescents: A cross-sectional study

BACKGROUND

Limited research has been conducted on self-harm among preadolescents in China. This study investigated the influence of multidimensional stress on high levels of self-harm behavior in preadolescents.

METHOD

This large-scale cross-sectional study of 7-14-year-old primary school students in grades 3-6 was conducted in Southwest China between September and December 2020. Data on sociodemographic characteristics and multidimensional stressors were collected and analyzed.

RESULTS

The self-harm prevalence among the 48,117 preadolescents was 13.6 % (n = 6561), with respective prevalence rates of 13.2 % in males and 14.1 % in females. Chi-square and binary logistic regression analyses were employed. The most important factors for self-harm were ranked as follows: high academic pressure (OR = 2.00, 95 % CI 1.90-2.09), poor relationship with parents (OR = 1.89, 95 % CI 1.78-2.00), frequently being bullied (OR = 1.53, 95 % CI 1.47-1.60), early-onset menstruation (OR = 1.33, 95 % CI 1.22-1.46), frequent smartphone use (OR = 1.31, 95 % CI 1.26-1.37), poor classmate relationships (OR = 1.31, 95 % CI 1.24-1.38), poor relationship between parents (OR = 1.11, 95 % CI 1.08-1.14), poor family financial situation (OR = 1.11, 95 % CI 1.05-1.17), and being bullied within the past 1 month (OR = 1.05, 95 % CI 1.02-1.07).

LIMITATIONS

The limitations of this study include its cross-sectional design, the use of a non-structured questionnaire, the subjectivity of some items, the reliance on a single question about self-harm, and the possibility that participants may have concealed the true nature of their behaviors.

CONCLUSION

Preadolescents in China exhibited high rates of self-harm behaviors. It is recommended that schools and families pay more attention to the mental health of preadolescent students, especially with regard to self-harm, and develop targeted interventions to address this issue.

Exploring the experience of stigma among children and adolescents with epilepsy in China: A qualitative study

OBJECTIVE

Epilepsy-related stigma negatively affects the lives of children and adolescents. This study aims to explore the experience of stigma among children and adolescents with epilepsy in China.

METHODS

This study used purposive sampling to select children and adolescents aged 10-18 diagnosed with epilepsy. A total of sixteen participants with epilepsy engaged in semi-structured interviews. The interviews were audio-recorded, transcribed and translated. The data were then analyzed using a thematic analysis approach to identify themes and subthemes.

RESULTS

The study identified four themes in the stigma experiences of children and adolescents with epilepsy: (1) The triggers of stigma, which include epilepsy stereotypes, seizure manifestations, and their unpredictability; (2) Concerns and uncertainties encompassing ASMs, academic pressure, future concerns, and transition uncertainties; (3) The impact of stigma on daily life including sleep and physical activity; and (4) Strategies and resources for addressing stigma, highlighting the importance of education and peer support.

CONCLUSION

Our findings provide a better understanding of the experience of epilepsy-related stigma among children and adolescents in China. The experiences of stigma described reveal the complex causes and the profound negative impact on their lives. However, it's important to note that children and adolescents can also have positive experiences when confronted with stigma. Psychosocial outcomes can be improved through comprehensive education and peer support. Our findings can inform further research into evidence-based strategies for stigma reduction interventions that promote well-being.

AI as the Therapist: Student Insights on the Challenges of Using Generative AI for School Mental Health Frameworks

The integration of generative AI (GenAI) in school-based mental health services presents new opportunities and challenges. This study focuses on the challenges of using GenAI chatbots as therapeutic tools by exploring secondary school students' perceptions of such applications. The data were collected from students who had both theoretical and practical experience with GenAI. Based on Grodniewicz and Hohol's framework highlighting the "Problem of a Confused Therapist", "Problem of a Non-human Therapist", and "Problem of a Narrowly Intelligent Therapist", qualitative data from student reflections were examined using thematic analysis. The findings revealed that while students acknowledged AI's benefits, such as accessibility and non-judgemental feedback, they expressed significant concerns about a lack of empathy, trust, and adaptability. The implications underscore the need for AI chatbot use to be complemented by in-person counselling, emphasising the importance of human oversight in AI-augmented mental health care. This study contributes to a deeper understanding of how advanced AI can be ethically and effectively incorporated into school mental health frameworks, balancing technological potential with essential human interaction.

Cognitive Aspects of Generalised Anxiety Disorder in Adolescents: Exploring Intolerance of Uncertainty, Cognitive Avoidance, and Positive Beliefs About Worry

Intolerance of uncertainty, cognitive avoidance, and positive beliefs about worry have been well researched in adults with Generalised Anxiety Disorder (GAD), but few studies have explored these aspects in adolescent clinical samples. To address this gap, we compared the three cognitive variables amongst 12-18 year-olds with diagnoses of GAD (n = 46), those with other anxiety disorders (n = 18), and a group with low self-reported anxiety (n = 38). Adolescents with GAD reported significantly higher intolerance of uncertainty and positive beliefs about worry relative to their peers with other anxiety diagnoses, whilst levels of cognitive avoidance did not differ significantly. Intolerance of uncertainty and cognitive avoidance, but not positive beliefs about worry, were significantly higher amongst young people with GAD compared to the non-anxious community group. This novel study provides preliminary evidence for the relevance and specificity of intolerance of uncertainty to the maintenance of GAD in adolescence.

Changes in internalizing and externalizing problems in Dutch children and adolescents receiving outpatient youth care before and during the COVID-19 pandemic

The COVID-19 pandemic significantly impacted the mental health of children and adolescents, but its effects on treatment outcomes in youth care remain unclear. This study examines whether the pandemic influenced treatment outcomes for internalizing and externalizing problems in children receiving outpatient youth care. We analyzed data from three groups of children who received outpatient youth care (N = 1090, Mage = 12.85): those treated entirely before the pandemic, those who transitioned into pandemic-related measures during treatment, and those treated entirely during the pandemic. The Child Behavior Checklist was used to assess internalizing and externalizing problems at the start and end of treatment. Repeated measures ANCOVAs and χ2 tests of independence were conducted to evaluate changes in problem severity and clinical status, and ANCOVAs were used to compare between-group differences. The results suggest that while overall treatment outcomes were not directly affected by the pandemic, fewer children treated during the pandemic recovered from externalizing problems compared to those treated before the pandemic. Additionally, children treated entirely during the pandemic exhibited higher levels of internalizing and externalizing problems at both the start and end of treatment, and those transitioning into the pandemic also had elevated externalizing problems at both time points. Although the pandemic did not affect the change in problems during treatment, the increased severity of issues at both the start and end of treatment indicates a deterioration in child mental health since the pandemic. Appropriate support, preventive interventions, and regular monitoring of mental health problems may mitigate future impacts.

Exploring the interconnections of loneliness, anxiety, and depression among nursing students: a network analysis approach

Objective

Nursing students experience higher rates of anxiety and depression than students in other disciplines due to the demanding academic requirements and clinical training challenges. Loneliness and symptoms of anxiety and depression occur simultaneously; however, the specific interrelationships between these states remain inadequately investigated. This study aimed to utilize network analysis to examine the item-level reciprocal action between loneliness, anxiety, and depression among nursing students.

Methods

A total of 888 nursing students were assessed using the short-form UCLA Loneliness Scale (ULS-6), the Generalized Anxiety Disorder 7-item Questionnaire (GAD-7), and the Patient Health Questionnaire-9 (PHQ-9) on loneliness, anxiety, and depression, respectively. Descriptive analyses were conducted using SPSS 26.0, whereas other statistical analytical procedures were performed using R software. The Gaussian graphical model was used to estimate network, and the Network Comparison Test was applied to compare differences in networks across gender and grades.

Results

The results indicated that 58.6% of nursing students exhibited varying degrees of loneliness. Network analysis revealed that loneliness formed a separate cluster with limited connections to anxiety and depression communities. The edges between PHQ3-PHQ4 (insomnia or hypersomnia and fatigue), GAD1-GAD2 (feeling anxious and excessive worrying), ULS1-ULS2 (lonely and no one) showed the strongest positive edges within their communities, respectively. And the strongest inter-community edges were observed between GAD5-PHQ8 (fidgety-retardation), ULS6-PHQ4 (isolation-fatigue), and ULS1-GAD1 (lonely-feeling anxious). The centrality analysis identified GAD2 (excessive worrying), ULS6 (isolation), PHQ4 (fatigue), and PHQ2 (feeling down) as the most central node, indicating their significant influence on the overall network structure. Additionally, PHQ8 (retardation), PHQ2 (feeling down), GAD5 (fidgety), and GAD1(feeling anxious) played a crucial role as bridging symptoms that linked the three communities. In addition, there is no statistically significant difference in the network structure except strength of GAD3 (generalized anxiety) and GAD6 (irritable) between sexes.

Conclusions

This study highlights the high prevalence of loneliness among nursing students and its distinct yet limited connection to anxiety and depression, emphasizing its unique role as a standalone psychological construct. The central symptoms in the network and important bridge symptoms across different psychological communities highlight the complexity of mental health symptom networks. This underscores the importance of targeting central symptoms for domain-specific interventions and addressing bridge symptoms to mitigate comorbidities across psychological conditions among nursing students.

The Impact of Life and Adverse Childhood Events on Help-Seeking Behaviours-A Cross-Sectional Survey of School-Age Adolescents in Jordan

Traumatic life and childhood events are associated with adverse health outcomes, particularly for adolescents, who are vulnerable to such events and exhibit distinct health behaviours and needs. Nevertheless, the influence of exposure to these events on their help-seeking behaviour remains largely unexplored, especially in the Eastern Mediterranean region. This study aims to estimate the prevalence of adverse events among adolescents in Jordan and examine how adverse events shape the help-seeking behaviours.

METHODS

A national cross-sectional survey of 4407 school-age (12-18 years) adolescents living in Jordan was conducted between December 2022 and April 2023 using multi-state stratified cluster sampling. The study utilised self-report questionnaires as well as validated tools. These were adapted to ensure cultural relevance and sensitivity and translated to Arabic.

RESULTS

The prevalence of at least one adverse event is around 16%, while that of four or more ACEs stands at around 41% in our population. The most commonly reported event was being infected or having a family member infected with COVID-19 at 60.3%. Specific individual characteristics and traumatic events appeared to shape their help-seeking behaviour, particularly family affluence and smoking status as well as exposure to COVID-19.

CONCLUSIONS

The study underscores the need to understand help-seeking patterns among school-age adolescents in light of exposure to traumatic events. Based on this study's findings, special attention should be paid to the impact certain events have on adolescents' mental health and their help-seeking behaviours. Positive help-seeking behaviours that resonate with adolescents' beliefs, emphasising contextual factors in mental health coping, should be promoted.

Suicidality in Adolescence: Insights from Self-Reports on Depression and Suicidal Tendencies

Background and Objectives. Suicide represents a primary global health concern, particularly among young individuals aged 15 to 29. Clinicians are actively engaged in efforts to prevent suicide and implement timely interventions. This study aimed to evaluate the effectiveness of self-reported measures in differentiating between adolescents exhibiting suicidal ideation (SI) only and those at risk or with a previous history of suicide attempts (SA). Methods. Seventy-eight adolescent patients (mean age: 15.53 ± 1.49) were classified into two groups using the Columbia Suicide Severity Rating Scale (C-SSRS). Forty-five patients presented with SI but lacked a prior history of SA, while 33 adolescents had a documented history of either concrete or interrupted SA. Notably, all participants in the SA group also reported SI. Participants completed the Multi-Attitude Suicide Tendency Scale (MAST) and the Beck Depression Inventory-Short Form (BDI-SF) to assess protective and risk factors associated with suicidality, as well as perceived depression. Results. Attraction toward life (AL) exhibited a negative correlation with perceived depression in both groups, whereas attraction toward death (AD) was positively correlated with depression in the SA group. In the SI group, scores for repulsion by life (RL) demonstrated a positive correlation with depression. Furthermore, RL scores were significantly higher in the SA group. ROC analysis revealed good accuracy for both assessment tools in differentiating the two groups. Conclusions. The BDI-SF and MAST are effective instruments for identifying adolescents at risk for suicide and implementing tailored preventive and therapeutic interventions. The user-friendly nature and adaptability make those self-report measures useful in various settings, allowing administration without clinician involvement.

The Association between Academic Stress and Problematic Internet Use among Adolescents: A Three-Level Meta-Analysis

Despite previous studies examining the relationship between problematic Internet use and academic stress in adolescents, significant limitations remain, especially in terms of the nature of the stress and moderators. This study systematically examines the association between academic stress and problematic Internet use in adolescents, using a three-level meta-analysis. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, it conducted a comprehensive database search including 49 studies, with 166 effect sizes and 189,483 adolescents. The results indicate a positive correlation between academic stress and problematic Internet use in adolescents. Additionally, moderation analysis revealed that both sources of academic stress and academic stress measurement tools significantly moderated the association. The association between mixed academic stress (intrapsychic and external stressors) and problematic Internet use was significantly stronger than that between external academic stress and problematic Internet use. The association was weaker when using the Academic Expectations Stress Inventory than other scales. These findings highlight that problematic Internet use is often an maladaptive coping strategy for adolescents under academic stress, and this behavior does not vary with the specific use of the Internet. However, it also suggests that under certain cultural contexts, external academic stress can be transformed into motivation for learning. This study deepens our understanding of how academic stress influences adolescent Internet use and underscores the need for improved measurement tools to capture the complexity of academic stress.

Adolescent girls' explanations of high rates of low mood and anxiety in their population: a co-produced qualitative study

BACKGROUND

From early adolescence, girls face greater risk of experiencing low mood and anxiety relative to boys, with recent evidence that this may be worsening. There is a paucity of mental health research that meaningfully progresses understanding of these gender disparities, including that engages adolescent girls' own perspectives, limiting our ability to direct further research and enhance intervention approaches.

AIMS

We examined low mood and anxiety from the perspective of adolescent girls, asking: What do adolescent girls perceive to be causing their population's high rates of low mood and anxiety?

METHODS

We adopted a co-produced qualitative design, guided by ecological systems theory, conducting focus groups in 2022 with 32 adolescent girls aged 16 to 18 years in England. Data were analysed using reflexive thematic analysis.

ANALYSIS

Participants framed low mood and anxiety among adolescent girls as "normal", and discussed potential explanations including persistent reiteration and expectation of gendered norms, intense educational pressures in ways that can be gendered, difficulties within peer relationships, and comparison and insecurity in social media contexts. Throughout, participants highlighted how complex these issues are, including nuances around individual differences, sociodemographic contexts, and societal contexts.

CONCLUSIONS

The study offers a critically important contribution to evidence on gendered inequalities in low mood and anxiety, drawing attention to the interwoven and complex nature of girls' lives and illuminating various aspects that would benefit from greater research. The insights gained through exploration with girls themselves hold policy and practical relevance to enhance systems to meet girls' needs.

Contributing Factors to the Rise in Adolescent Anxiety and Associated Mental Health Disorders: A Narrative Review of Current Literature

BACKGROUND

The prevalence of anxiety among adolescents has seen a notable increase in recent years, becoming a significant public health concern. In fact, anxiety is substantially more prevalent in Generation Z (individuals born between 1997 and 2012) than in any of the past three generations. We aimed to examine what factors contribute to the increased prevalence in teen anxiety and identify points of intervention.

METHODS

This study employed a narrative review method. We performed a literature search of the PubMed, ScienceDirect, and Medline databases and identified original research and review articles discussing increased anxiety and other mental health disorders in Generation Z.

RESULTS

We provide a comprehensive overview of the factors contributing to the increased rates of adolescent anxiety, including academic pressures, social media influence, family dynamics, and broader societal stressors.

CONCLUSIONS

In this narrative review, we examine the multifaceted nature of adolescent anxiety, identifying contributing factors. Additionally, we discuss potential clinical, educational, and community-based interventions to prevent and treat adolescent anxiety. By understanding and addressing the underlying causes of anxiety, it is possible to mitigate its impact and promote healthier developmental trajectories for young individuals.

Depression symptom severity and behavioral impairment in school-going adolescents in Uganda

BACKGROUND

During adolescence, a critical developmental phase, cognitive, psychological, and social states interact with the environment to influence behaviors like decision-making and social interactions. Depressive symptoms are more prevalent in adolescents than in other age groups which may affect socio-emotional and behavioral development including academic achievement. Here, we determined the association between depression symptom severity and behavioral impairment among adolescents enrolled in secondary schools of Eastern and Central Uganda.

METHODS

This cross-sectional study was conducted among 1,669 adolescents enrolled in secondary schools in Eastern and Central Uganda. Our outcome variable was behavioral impairment defined as self-reported behavior that interferes with an individuals' ability to do schoolwork (school performance) or get along with others (peer interaction) (yes/no). The key independent variable was depression symptom severity assessed using the Child and Adolescent Symptom Inventory-5 (CASI-5), a behavior rating scale for symptoms of DSM-5 emotional and behavioral disorders. Modified Poisson regression models tested the independent association between depressive symptom severity and behavioral impairment. Prevalence Rate Ratios (PRR) and 95% confidence intervals (95%CI) were reported.

RESULTS

Participants' mean age was 15.3 years (SD = 1.8), 58.5% were female, 86.8% witnessed domestic violence, 47.4% had behavioral impairment, and 2.8% had mild depression symptoms. School-going adolescents with mild depression symptoms had two times higher risk of behavioral impairment when compared to those with no or slight depression symptoms, after controlling for potential confounders. Other factors independently associated with higher risk for behavioral impairment were female sex (Adj. PRR 1.27, 95%CI 1.12, 1.43) compared to males, taking alcohol (Adj. PRR 1.42, 95%CI 1.25, 1.61) compared to not taking alcohol, boarding school enrollees (Adj. PRR 1.62, 95%CI 1.33, 1.98), and day school enrollees (Adj. PRR 1.46, 95%CI 1.21, 1.76) compared to mixed (day and boarding) school enrollees respectively, advanced level enrolment (Adj. PRR 1.25, 95%CI 1.05, 1.48) compared to ordinary level enrolment, and attending urban schools (Adj. PRR 1.27, 95%CI 1.11, 1.45) compared to rural secondary school attendance.

CONCLUSIONS

Behavioral impairments are widespread among Ugandan secondary students. Mild depression symptoms adversely affect adolescents' academic and social lives, potentially leading to long-term consequences. Where feasible, early detection of depressive symptoms and treatment may mitigate their negative effects on student school performance ability and peer/social interaction. Future research should examine school-level factors influencing academic performance by depression status. Policymakers in education and gender sectors should prioritize mental health programs in secondary schools.

Burden of depressive and anxiety disorders in China and its provinces, 1990-2021: findings from the Global Burden of Disease Study 2021

BACKGROUND

Depressive and anxiety disorders constitute a major component of the disease burden of mental disorders in China.

AIMS

To comprehensively evaluate the disease burden of depressive and anxiety disorders in China.

METHOD

The raw data is sourced from the Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2021. This study presented the disease burden by prevalence and disability-adjusted life years (DALYs) of depressive and anxiety disorders at both the national and provincial levels in China from 1990 to 2021, and by gender (referred to as 'sex' in the GBD 2021) and age.

RESULTS

From 1990 to 2021, the number of depressive disorder cases (from 34.4 to 53.1 million) and anxiety disorders (from 40.5 to 53.1 million) increased by 54% (95% uncertainty intervals: 43.9, 65.3) and 31.2% (19.9, 43.8), respectively. The age-standardised prevalence rate of depressive disorders decreased by 6.4% (2.9, 10.4), from 3071.8 to 2875.7 per 100 000 persons, while the prevalence of anxiety disorders remained stable. COVID-19 had a significant adverse impact on both conditions. There was considerable variability in the disease burden across genders, age groups, provinces and temporal trends. DALYs showed similar patterns.

CONCLUSION

The burden of depressive and anxiety disorders in China has been rising over the past three decades, with a larger increase during COVID-19. There is notable variability in disease burden across genders, age groups and provinces, which are important factors for the government and policymakers when developing intervention strategies. Additionally, the government and health authorities should consider the potential impact of public health emergencies on the burden of depressive and anxiety disorders in future efforts.

"What Are Some of the Things You Are Worried About?": An Analysis of Youth's Open-Ended Responses of Current Worries

INTRODUCTION

There is widespread concern that contemporary global issues (e.g., climate change, technology use) are exacerbating a "youth wellbeing crisis." However, we have heard little about this issue from youth themselves. To ascertain whether youth themselves are worried about global issues, their mental health, or other aspects of their life, we asked youth an open-ended question about their current worries. Further, we assessed whether mental health was related to self-generated worries.

METHODS

Participants, 516 youth 13-19 years old (Mage = 15.60, SD = 1.65, 48.2% female) from Canada, responded to the question: "What are some of the things you are worried about?" Youth also self-reported on demographics, social anxiety, depressive symptoms, and general worry.

RESULTS

Youth generated a range of worries, with the most common worries being school and their future. Few adolescents directly mentioned the state of the world, covid, or their own mental health. Worries were differentially associated with mental health problems and youth who reported worrying about "everything" or reported many worries had worse mental health compared to peers.

CONCLUSIONS

Contemporary issues, that often are cited as a concern, were not a focal point of youth's responses. Asking open-ended questions to youth about their worries may be a way to identify which youth may be experiencing poor mental health.

Gender difference in anxiety and related factors among adolescents

Background

Anxiety is widespread among adolescents, and research has shown that this condition can profoundly affect their mental, emotional, and physical well-being. The purpose of this study was to analyze gender differences in anxiety levels among adolescents and to explore the influencing factors and pathways.

Methods

A total of 3601 adolescents were included in this study (age: 15.14±1.97 years; male: 48.76%). Gender, age, school category, grade, duration of sleep, duration on Internet, anxiety and several social factors were investigated by online questionnaire. Teachers were responsible for organizing students to fill out the questionnaire. The Generalized Anxiety Disorder (GAD-7) was applied to measure participants' anxiety levels over the past 2 weeks. An Ordinal Logistic Regression measured risk factors of anxiety, while a path analysis was used to estimate the structural relationship between risk factors and anxiety.

Results

The severity of anxiety in female was higher. Approaching graduation, lack of sleep, poor peer relationships, poor ability to complete tasks, and unwillingness to seek help when in a bad mood were risk factors for anxiety in both male and female adolescents. Among female, prolonged Internet access is a risk factor for anxiety. The fit indices for the modified models were appropriate (male: GFI=0.999, IFI=0.996, TLI=0.976, CFI=0.995, AGFI=0.990, RMSEA=0.021, SRMR=0.016; female: GFI=0.997, IFI=0.990, TLI=0.971, CFI=0.990, AGFI=0.990, RMSEA=0.020, SRMR=0.018).

Conclusion

The female adolescents might have higher levels of anxiety, that academic stress, sleep, peer relationships, competence, and level of social support might be influence factors on anxiety in adolescents, and that "daily duration on Internet" might not be the risk factor in male adolescent.

The effect of social media use on adolescents' subjective well-being: Longitudinal evidence from Switzerland

BACKGROUND AND RELEVANCE

Problematic social media use and low subjective well-being in adolescents coincide. However, the causal evidence on the effect of (problematic) social media use on subjective well-being is inconclusive. The analysis by Orben et al. (2022: Nature Communications 13: 1649) demonstrates that the effect is moderated by age and gender, giving rise to 'developmental windows of sensitivity to social media'. In this study, we provide an update of the development of adolescents' subjective well-being and problematic social media use in Switzerland. Furthermore, we investigate, whether 'developmental windows of sensitivity to social media' apply to Switzerland.

DATA AND METHODS

For the description of trends, we use data from the survey Health Behaviour in School-aged Children (HBSC; N = 59'662, 2002-2022, age: 11-15). We identify the effect of problematic social media use on subjective well-being using HBSC trend data from 2018 to 2022 applying multiple OLS regression. To identify the causal effect of social media use on subjective well-being we exploit panel/cohort data of adolescents from the study Transitions from Education to Employment (TREE; N = 19'809, 2016-2022, age: 15-22) applying panel regression models.

RESULTS

We demonstrate that decreases in subjective well-being coincide with increases in problematic social media use. Causal inference shows that the effect of social media use on subjective well-being only applies to females with low or middle parental educational background until the age of 18 years.

DISCUSSION AND CONCLUSION

Our study enhances the findings of Orben et al. (2022). It reaffirms the importance of health interventions targeted at vulnerable groups.

The effect of depression on non-suicidal self-injury and psychological status in adolescents with unipolar and bipolar disorders

OBJECTIVE

To investigate the effects of depression on non-suicidal self-injury (NSSI) and related psychological conditions in adolescents with unipolar disorder (UD) and bipolar disorder (BD), and to provide a basis for accurate prevention and intervention of NSSI behaviors in adolescents.

METHODS

This cross-sectional study collected data from adolescents aged 12-18 years with depressive episodes who exhibited NSSI behaviors and attended the psychiatric outpatient clinic of Huangshi City Psychiatric Specialized Hospital from 2018 to 2023. Depressive episodes were clinically diagnosed by two psychiatrists according to the ICD-10.

RESULTS

In terms of NSSI behavioral patterns and severity, adolescents with UD displayed more frequent behaviour of intentionally burning themselves with cigarettes and had more instances of self-inflicted suicidal thoughts that were not carried out compared to those with BD, and the differences between the two groups were statistically significant (P < 0.05). For psychological status, Nurses' Global Assessment of Suicide Risk (NGASR) scores were significantly higher in adolescents with BD than in those with UD (P < 0.05). There was a significant negative correlation between anxiety scores and the frequency of NSSI in adolescents with BD (P < 0.05); that is, the more anxious the adolescents with BD, the lower the frequency of NSSI. The NGASR scores of adolescents with UD and BD were significantly and positively correlated with the frequency of NSSI occurrences (P < 0.05); higher NGASR scores of adolescents with UD and BD corresponded with higher frequencies of NSSI.

CONCLUSION

The differences in NSSI behaviors between adolescents with UD and those with BD were statistically significant in terms of self-injury method and severity. Adolescents with UD experienced more severe consequences related to NSSI behaviors. Regarding psychological conditions, adolescents with BD are at a higher risk of suicide. An inverse relationship was observed between anxiety severity and the frequency of NSSI in adolescents with BD; severe anxiety was associated with lower NSSI frequency. Additionally, higher suicide risk was associated with a higher frequency of NSSI in adolescent patients with either UD or BD. Therefore, different prevention and intervention measures are needed to address NSSI behaviors in adolescents with UD and BD.

Gender differences in the prevalence, correlated factors and comorbidity of depression in adolescents: a cross-sectional study in Shanghai, China

Background

Prior studies have reported gender differences in the prevalence, comorbidity rates and related factors of depression during adolescence. But the gender differences in depression vary across studies. Besides, the evidence from Chinese adolescent samples is limited. This study aimed to explore gender differences in the depression-related factors, the potential interactions of the associated factors and clinical features of comorbid depression and anxiety among Chinese adolescents.

Methods

A cross-sectional study involving 3,510 participants aged 11 to 16 years from schools (private and public) in Shanghai was conducted with an anonymous paper-and-pencil questionnaire. Children's Depression Inventory (CDI), Child Anxiety Related Emotional Disorders (SCARED), Strengths and Difficulties Questionnaire (SDQ) were used to evaluate depression, anxiety and behavioral and emotional difficulties, respectively. Logistic regression model was used to explore the possible correlated factors of adolescent depression and analyze the interactions of the risk factors.

Results

Our results showed that there was no gender difference in the prevalence rates of depression (χ 2 = 0.047, p = 0.83), but the prevalence of depression in females began to exceed that of males at the ages of 15 and 16. The factors associated with depression varied by gender. Private school was a risk factor for depression only in boys (adjusted OR = 1.842 [95% CI, 1.286-2.636]), whereas girls from nuclear families (adjusted OR = 1.631 [95% CI, 1.156-2.300]) and other family structures (adjusted OR = 2.682 [95% CI, 1.502-4.788]) were more likely to experience depression compared to their peers in extended family structures. Interaction analyses showed there was a negative interaction between abnormal peer problems and 7th grade among boys (adjusted OR = 0.288 [95% CI, 0.086-0.951]). Furthermore, comorbidity rates of depression and anxiety were higher in girls than that in boys (χ 2 = 14.457, p < 0.001). And girls with comorbidity showed increased SDQ peer problems scores (Z = -3.151, p = 0.002).

Conclusion

The findings indicate it is important to develop gender-specific interventions for adolescent depression. And for boys, evaluating peer relationships may be particularly crucial in lower grades. Moreover, recognizing the gender-specific clinical features of comorbid depression and anxiety is important for appropriate clinical diagnosis and targeted treatment.

Stress, physical activity, and mindfulness practices among youth amidst COVID-19

Introduction

The COVID-19 pandemic has exacerbated stress and anxiety among young people, particularly university students, impacting their mental well-being and daily life. Given the rise in social isolation and economic uncertainty, the adoption of mindfulness practices such as sophrology, meditation, and yoga becomes essential for improving their mental health. This study aims to evaluate the impact of these practices on stress levels and their effect on engagement in physical activities among youths.

Method

This study employed a mixed methods design to assess the impact of different wellness and mindfulness practices on stress levels and physical activity (PA) engagement among university students. Quantitative data were gathered electronically from 218 students at the University of Rouen and the university of Paris-Cité through validated questionnaires, including custom tools on sports and mindfulness practices and the Perceived Stress Scale (PSS). The sample consisted mainly of young adults aged 18 to 35, with a majority of 170 female and 48 male participants. Qualitative insights were gathered through semi-structured interviews with three directors of the university's sports and physical activities department (SUAPS), as well as four wellness program instructors. Data analysis involved statistical techniques using Statistical Analysis System (SAS) software for quantitative data, while qualitative data were analyzed thematically using Sphinx software, a tool for textual analysis. Ethical approval for the study was obtained, and confidentiality of all participants was maintained throughout the research.

Results and conclusion

The COVID-19 pandemic had significant effects on French university students' PA, mental health, and stress levels. Lockdowns led to a decline in sports practices for many, while others adapted by increasing their engagement in fitness and wellness practices. The majority of participants (64.68%) reported moderate levels of stress. A significant correlation was found between motivations for mental health support and stress management, and higher levels of stress (p = 0.0000 and p = 0.0024, respectively). Regular participation in wellness activities was associated with lower stress (p = 0.0193). The findings reinforce the idea that incorporating wellness practices into educational environments can strengthen students' mental resilience and overall well-being, equipping them with essential tools to effectively cope with future stressors.

Editorial: Adolescent mental health in a rapidly changing world

There is substantial evidence that adolescent mental health has deteriorated considerably since the early 2010s across many countries, and much more strongly among girls than boys. This is probably due to a combination of societal changes that strongly influenced the lives of adolescents. The societal changes include the rise of social media and of academic pressure, the COVID-19 pandemic and increasing worries about the future. Moreover, the decreasing trend in adolescent mental health might have resulted into more mental health awareness and a tendency to overinterpret negative psychological experiences as signs of mental health problems. Several suggestions for future research are provided to increase our understanding of the origins of the recent trends in adolescent mental health.

Understanding Trajectories of Generalized Anxiety Disorder Among Adolescents During the COVID-19 Pandemic: Evidence From China and the Democratic Republic of the Congo

PURPOSE

This study aims to assess anxiety trends over the COVID-19 pandemic and evaluate how pandemic-related adversities modify trajectories among underprivileged adolescents from two distinct settings.

METHODS

Data came from the Shanghai, China and Kinshasa, Democratic Republic of the Congo sites of the Global Early Adolescent Study. Data were collected three times over approximately two years: prior to the pandemic (T1) and during the pandemic (T2, T3). Analyses included adolescents (aged 10-16) with complete information on generalized anxiety disorder (GAD) across all time points (Shanghai N = 548; Kinshasa N = 334). Weighted Generalized Estimating Equations assessed anxiety at T2 and T3 relative to T1. Effect modification analyses were used to investigate if COVID-19-related adversities modified anxiety trajectories.

RESULTS

Six months into the pandemic, 15.3% (Shanghai) and 4.1% (Kinshasa) of adolescents reported having moderate-to-severe GAD. Adjusted Generalized Estimating Equation models did not suggest increases in GAD during the pandemic across both sites. However, female adolescents from Shanghai experienced increased anxiety (adjusted odds ratio [aOR]: 2.27, 95% confidence interval: 1.30-3.99) half a year into the pandemic. The trend was not sustained. COVID-related adversities did not modify anxiety trajectories in Kinshasa. In Shanghai, one year into the pandemic, we observed decreased odds of GAD among all (aOR: 0.31, 0.17-0.58) and female adolescents (aOR: 0.25, 0.08-0.75) without pandemic-associated negative household experiences.

DISCUSSION

The COVID-19 pandemic differentially affected adolescent anxiety by time, place, and gender. Future research should examine the roles of social context and resilience to better understand adolescents' mental distress and to guide health-promoting programs and policies for young people.

The relationship between Freshman students' mental health and academic achievement: chain mediating effect of learning adaptation and academic self-efficacy

The relationship between the mental health and academic achievement of college students is not only related to their individual growth and development but also has a profound impact on the quality of higher education and the cultivation of social talent. Understanding the interaction and influencing mechanisms between mental health and academic achievement can help individuals adjust learning and psychological states and achieve a virtuous cycle between mental health and academic achievement. A survey was conducted on 3871 freshmen using the Symptom Check-List-90 (SCL-90), Academic Self-efficacy Scale (ASES), China College Student Adjustment Scale (CCSAS), and basic quality assessment scores. The results showed that (1) Mental health is significantly correlated with learning adaptation, academic self-efficacy, and academic achievement, and mental health can significantly negatively predict academic achievement; (2) Learning adaptation partially mediates the relationship between mental health and academic self-efficacy; Academic self-efficacy plays a complete mediating role between mental health and academic achievement; (3) Learning adaptation and academic self-efficacy play a chain mediated role between mental health and academic achievement. Therefore, schools can enhance the cultivation of students' psychological qualities, cultivate their adaptability to changes in learning environments and learning methods, and systematically enhance the cultivation of students' academic self-efficacy to improve their academic achievements.

Association between changes in adherence to the 24-hour movement guidelines with depression and anxiety symptoms among Chinese adolescents: a prospective population-based study

BACKGROUND

The 24-hour movement guidelines (24-HMG) include screen time (ST), sleep duration, and physical activity. Previous studies have explored the associations of adherence to the 24-HMG with depression and anxiety symptoms among adolescents, ignoring changes in behaviors. This study aimed to examine whether changes in adherence to the 24-HMG were associated with depression and anxiety symptoms among adolescents.

METHODS

We recruited adolescents from Shenzhen, China in 2021 and followed them up 1 year later. Changes in adherence to the individual 24-HMG were categorized into four groups: persistent non-adherence, adherence to non-adherence, non-adherence to adherence, and persistent adherence. Changes in the numbers of adherence to the overall 24-HMG were obtained by subtracting the number of guidelines adhered to in wave 2 from that in wave 1.

RESULTS

We included 12,570 participants aged 9-18 years with 52.2% boys. Compared with persistent non-adherence for the ST/sleep duration guideline, non-adherence to adherence and persistent adherence were associated with lower depression and anxiety symptoms, but adherence to non-adherence was not. Changes in adherence to the physical activity guideline were not related to outcomes. The β coefficients (95% CIs) for each point increase in changes in the numbers of adherence to guidelines were - 0.58 (- 0.69, - 0.47) and - 0.43 (- 0.53, - 0.33) for depression and anxiety symptoms, respectively. The association of persistently adhering to sleep guideline with anxiety symptoms and the associations of changes in the numbers of adherence to the 24-HMG had sex differences.

CONCLUSIONS

Maintaining and strengthening healthy movement behaviors to meet more guidelines of the 24-HMG, especially sleep and ST, may be beneficial for preventing depression and anxiety symptoms in adolescents.

Pain and depressive symptoms among adolescents: prevalence and associations with achievement pressure and coping in the Norwegian Ungdata study

BACKGROUND

This study investigated the prevalence of pain, depressive symptoms, and their co-occurrence in Norwegian adolescents. Additionally, we investigated if perceived achievement pressure and coping with pressure were associated with pain, depressive symptoms and co-occurrent pain and depressive symptoms.

METHODS

Cross-sectional data from the Norwegian Ungdata Survey (2017-2019) were analysed. Adolescents from across Norway completed an electronic questionnaire including questions on perceived achievement pressure, coping with pressure, pain, and depressive symptoms. Descriptive statistics presented prevalence rates, and multinominal regression reported in relative risk ratios (RR) was employed to estimate associations, adjusted for gender (boys/girls), school level, and socioeconomic status.

RESULTS

The analyses included 209,826 adolescents. The prevalence of pain was 33%, 3% for depressive symptoms, and 14% reported co-occurring pain and depressive symptoms. The prevalence of co-occurring symptoms was higher in girls (22%) than boys (6%). Significant associations were found between perceived achievement pressure and pain (RR 1.11, 95% CI 1.10-1.11), depressive symptoms (RR 1.27, 95% CI 1.27-1.28), and co-occurring symptoms (RR 1.34, 95% CI 1.33-1.34). Struggling to cope with pressure was associated with pain (RR 2.67 95% CI 2.53-2.81), depressive symptoms (RR 16.68, 95% CI 15.60-17.83), and co-occurring symptoms (RR 27.95, 95% CI 26.64-29.33).

CONCLUSION

The prevalence of co-occurring pain and depressive symptoms is high among Norwegian adolescents. Perceived achievement pressure and struggling to cope with pressure were associated with isolated and, more strongly, co-occurring pain and depressive symptoms. Enhancing adolescents' ability to cope with pressure could be a crucial target in treating pain and depressive symptoms.

Sufficient sleep and physical activity can relieve the effects of long-term exposure to particulate matter on depressive symptoms among 0.31 million children and adolescents from 103 counties in China

BACKGROUND

Although long-term exposures to air pollutants have been linked to mental disorders, existing studies remain limited and inconsistent. We investigated the relationship between exposure to particulate matter (PM) and depressive symptoms, as well as the potential role of sleep duration and physical activity.

METHOD

Using the surveillance data (2019 to 2022) of common diseases and risk factors among 312,390 students aged 10-25 years, logistic regression, generalized liner model (GLM) and restricted cubic spline (RCS) were employed to investigate the relationship between long-term exposure to PM and depressive symptoms.

RESULT

Significant associations were found between PM1 (OR = 1.21, 95 % CI: 1.12-1.32), PM2.5 (OR = 1.24, 95 % CI: 1.19-1.38), and PM10 (OR = 1.87, 95 % CI: 1.69-2.07) and increased risks of depressive symptoms. Sleep duration and physical activity relieved these associations. The odds ratios (ORs) of PM1, PM2.5, and PM10 on depressive symptoms were lower in group with sufficient sleep (1.02 vs. 1.49, 1.20 vs. 1.80, 2.15 vs. 2.23), lower in group with high level MVPA (1.13 vs. 1.48, 1.14 vs. 1.58, 1.85 vs. 2.38), and lower in group with high level outdoor activity (1.19 vs. 1.55, 1.23 vs. 1.63, 1.83 vs. 2.72).

LIMITATIONS

Conclusions about causality remain speculative because of the cross-sectional design.

CONCLUSION

Sufficient sleep duration and outdoor activity may mitigate the decline in mental health among adults in developing countries caused by long-term exposure to PM. This contribution enhanced our understanding of the mechanisms linking air pollution to mental health.

How Does Perceived Social Support Impact Mental Health and Creative Tendencies Among Chinese Senior High School Students?

The senior high school period is a critical phase for the proliferation of mental health problems, as well as a key period for cognitive development among adolescents. Due to the importance of support from the external environment for students, this study aims to explore and verify the protective role of social support in the mental health and creative tendencies of senior high school students, as well as its mechanisms and boundary conditions. Based on a survey of 1463 Chinese senior high school students, a moderated mediation model was constructed. The results showed that (1) perceived social support significantly negatively predicts mental health problems and significantly positively predicts creative tendencies; (2) self-esteem mediates the impact of perceived social support on both mental health problems and creative tendencies; (3) perceived stress not only moderates the impact of self-esteem on mental health problems and creative tendencies, but also moderates the mediating effect of self-esteem. The findings of this study shed light on the positive impact of social support and the self-esteem it nurtures during the senior high school years. These insights offer valuable recommendations for practitioners aiming to prevent mental health issues and foster creative tendencies among senior high school students.

Association between sleep duration, suicidal ideation, suicidal attempt and suicidal behavior among Chinese adolescents

BACKGROUND

A relatively small number of studies have researched the relationship between sleep duration and suicidal ideation, attempts, and behavior. This research aims to investigate the link between sleep duration and suicide in Chinese adolescents, and to examine the role of depression as a mediating factor.

METHOD

Data were collected from 3315 students using a multi-stage random cluster sampling method and self-administered questionnaires. The study applied logistic regression to investigate the relationship between sleep duration and various forms of suicidal behavior, and mediation analysis to understand how depression might influence this relationship.

RESULTS

The average sleep duration among the adolescents was 7.25 h (±0.20), with 59.67 % reporting insufficient sleep. The logistic regression analysis showed that longer sleep duration is linked with lower risks of suicidal ideation (OR: 0.753, 95%CI: 0.696 to 0.814), suicidal attempts (OR: 0.830, 95%CI: 0.748 to 0.922), and suicidal behavior (OR: 0.841, 95%CI: 0.713 to 0.992). Analysis using restricted cubic spline plots indicated the connection between sleep duration and these suicidal factors was not linear. The study found that depression plays a partial mediating role between sleep duration and suicidal ideation, with an effect of 52.29 %.

LIMITATIONS

The cross-sectional study design could not prove causation.

CONCLUSIONS

There is a clear non-linear association between sleep duration and suicidal tendencies in adolescents, with depression acting as a mediator. This suggests that future research could focus on sleep and mood management as ways to address suicide risk in this age group.

Parental emotional support, self-efficacy, and mental health problems among adolescents in Hong Kong: a moderated mediation approach

Introduction

Early signs of mental health issues may develop into severe mental illnesses over time. The influence of parental emotional support on adolescent mental health problems is well acknowledged. However, prior research has predominantly focused on psychological symptoms, often neglecting the somatic symptoms associated with mental health. Additionally, there has been insufficient exploration of the mediating role of self-efficacy and the relationship between socioeconomic status (SES) and adolescent mental health, particularly within the context of Hong Kong.

Methods

Using data from 3,613 adolescents aged 15 years from 109 schools in Hong Kong who participated in the Programme for International Student Assessment 2018, this study explored the relationship between parental emotional support and two dimensions of adolescent mental health symptoms (psychological and somatic symptoms), and the mediating effect of self-efficacy and the moderating role of SES.

Results

We found that parental emotional support significantly reduced psychological and somatic symptoms, primarily by enhancing self-efficacy. MoreovSES moderated these relationships, with the impact of parental emotional support on psychological symptoms being more pronounced among adolescents from lower SES backgrounds.

Discussion

This study deepens the understanding of the mechanisms underlying adolescent mental health in Hong Kong. By highlighting the importance of parental emotional support and self-efficacy, as well as the moderating effect of SES, the findings offer valuable insights for effective interventions aimed at improving adolescent mental health.

The association between physical activity and positive affect in adolescents: the chain mediating role of psychological resilience and regulatory emotional self-efficacy

Previous studies have indicated the positive impact of physical activity on positive affect in adolescents. However, the psychological mechanism is still under-explored. The current study aims to investigate the mediating role of psychological resilience and regulatory emotional self-efficacy on the relationship between physical activity and positive affect. This cross-sectional study recruited 580 adolescents (280 females, 12 to 16 years old). All participants completed the measures of the Physical Activity Questionnaire for Adolescents (PAQ-A), the Positive and Negative Affect Scale (PANAS), the Connor-Davidson Resilience Scale, and the Regulatory Emotional Self-Efficacy Questionnaire. Results showed that the association between physical activity and positive affect was significant in adolescents. Psychological resilience played a mediating role between physical activity and positive affect. The chain mediation effect of psychological resilience and regulatory emotional self-efficacy on the relationship between physical activity and positive affect was significant. These results indicated that physical activity could positively impact adolescents' positive affect through psychological resilience and regulatory emotional self-efficacy. Our findings highlighted the importance of physical activity on positive affect on adolescents, which would benefit the mental health of this population.

Gender differences in the mental symptom network of high school students in Shanghai, China: a network analysis

BACKGROUND

Adolescence is a critical period for the onset of mental health issues. In China, high school students face significant academic and social pressures, leading to high rates of mental health challenges. Gender differences in the manifestation of these symptoms have been observed, with boys and girls exhibiting distinct psychological profiles.

OBJECTIVE

This study aims to explore the structure of psychological symptoms among Chinese high school students using network analysis, focusing on identifying core symptoms and gender differences in symptom networks. The key objectives are to: 1) identify the central psychological symptoms for boys and girls, and 2) uncover the interactions between symptoms to inform targeted interventions.

METHODS

A cluster sampling method was used to recruit 3,769 high school students (2,206 males and 1,563 females) in Shanghai. The Middle School Students Mental Health Scale (MSSMHS) was administered, and network analysis was conducted using the R packages bootnet and qgraph to assess symptom network edges, centrality, and network strength. Comparisons between male and female networks were made.

RESULTS

Network analysis showed tightly connected symptom networks for both genders, with 43 non-zero edges for boys (sparsity 0.04) and 39 for girls (sparsity 0.13). Depression was the core symptom for boys (centrality 1.20), while anxiety was central for girls (centrality 1.46). Boys showed a stronger link between interpersonal sensitivity and depression (edge value 0.20), while girls exhibited a stronger connection between anxiety and obsessive-compulsive symptoms (edge value 0.16). Network comparison tests revealed no significant differences in overall network strength between boys (4.625) and girls (4.660), with P-values greater than 0.05 across all comparisons.

CONCLUSION

This study highlights significant gender differences in the psychological symptom networks of Chinese high school students. Depression and anxiety emerged as core symptoms for boys and girls, respectively. These findings provide a foundation for developing gender-sensitive mental health interventions, emphasizing the need for tailored approaches based on gender-specific symptom profiles.

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.

Effect of physical exercise on negative emotions in Chinese university students: The mediating effect of self-efficacy

Objective

This study investigates the impact of physical activity on negative emotions among university students and examines the mediating influence of self-efficacy, aiming to furnish empirical insights and a theoretical framework to enhance and optimize the mental health of this population comprehensively.

Methods

Using the cluster random sampling method, 5341 university students were selected from three universities. The questionnaire included demographic information about university students, physical exercise behaviors, expressions of negative emotions such as depression and anxiety, and self-efficacy in physical exercise. The types of questionnaires included the Physical Activity Rating Scale (PARS-3), the General Self-Efficacy Scale (GSES), and the Depression Anxiety Stress Scales (DASS).

Results

76.877 % of university students had low exercise. The detection rates of depression, anxiety and stress in negative mood were 77.041 %, 64.276 % and 47.931 %, respectively. There were significant differences in physical exercise and negative mood scores among university students of different genders and grades. University student. Negative emotions were significantly correlated with physical exercise and self-efficacy (P < 0.001). According to the regression model, physical exercise can significantly predict negative emotions and self-efficacy. The mediating effect of self-efficacy is evident.

Conclusion

Physical exercise among university students typically comprises light workouts, associated with a high prevalence of anxiety symptoms. Self-efficacy acts as a mediator in the effects of physical exercise on negative emotions within this group.

Inconsistency in psychological resilience and social support with mental health in early adolescents: A multilevel response surface analysis approach

BACKGROUND

Given the high prevalence of adolescent mental health problems, promoting understanding and implementation of protective factors is crucial for prevention and intervention efforts addressing adolescent mental health problems. This study aims to investigate whether consistency and inconsistency in protective factors are associated with adolescent mental health problems and to inform adolescent mental health interventions that target the unique needs of adolescents and promote adolescent mental health.

METHODS

We used multistage cluster sampling to conduct psychological resilience, social support, and mental health questionnaires from April to June 2023 among 10,653 Chinese adolescents (52.3 % were boys). Data were analyzed using polynomial regressions with response surface analysis.

RESULTS

The higher levels of psychological resilience and social support in adolescents were associated with fewer mental health problems (anxiety: a1 = -1.83, P < 0.001; depression: a1 = -2.44, P < 0.001; and perceived stress: a1 = -1.20, P < 0.001). When the level of psychological resilience was greater than social support, the greater the discrepancy the higher the perceived stress among adolescents (a3 = 1.19, P < 0.001). Moreover, the consistency of psychological resilience and social support had a greater impact on girls' mental health (anxiety: a1 = -1.97, P < 0.001; depression: a1 = -2.71, P < 0.001; perceived stress: a1 = -1.23, P < 0.001).

LIMITATIONS

The cross-sectional study design limited the inference of causal relationships between variables.

CONCLUSIONS

These results emphasize that adolescents need a balanced development of protective factors and targeted intervention programs for different mental health problems.

How Distressed Are Adolescent Students? A Mix-Method Study on High School Students in Northern Italy, Two Years after the Beginning of the COVID-19 Pandemic

Adolescence is a central phase for the development of a person's identity, involving complex multidimensional changes and increasing vulnerability to distress. This study aimed to investigate the psychological well-being of adolescent students in Brescia (Northern Italy), two years after the beginning of the COVID-19 pandemic. An online survey investigated the extent and the reasons reported by high school students (13-21 years) for their emotional distress (ED), also considering other factors such as physical activity, nutrition, sleep and smartphone overuse. The main reasons for ED were classified through a qualitative analysis of the free-text answers. A total of 1686 students agreed to participate, and 50% showed a presence of ED. According to a multiple logistic analysis, adolescents were more at risk of ED if they were female (AdjOR 2.3), older (AdjOR 1.6), slept less than 8 h (AdjOR 1.5), perceived increased anxiety (AdjOR 3.4), and adopted certain eating behaviors, e.g., comfort food consumption (AdjOR 2.0). According to free-text answers, the main reasons for ED were "school pressure", "relationships with family and peers", "negative emotional states" and "the pandemic". The results show a high level of ED among adolescents, and the reported reasons may help to better address their psychological needs after the pandemic.

Reliability of ChatGPT in automated essay scoring for dental undergraduate examinations

BACKGROUND

This study aimed to answer the research question: How reliable is ChatGPT in automated essay scoring (AES) for oral and maxillofacial surgery (OMS) examinations for dental undergraduate students compared to human assessors?

METHODS

Sixty-nine undergraduate dental students participated in a closed-book examination comprising two essays at the National University of Singapore. Using pre-created assessment rubrics, three assessors independently performed manual essay scoring, while one separate assessor performed AES using ChatGPT (GPT-4). Data analyses were performed using the intraclass correlation coefficient and Cronbach's α to evaluate the reliability and inter-rater agreement of the test scores among all assessors. The mean scores of manual versus automated scoring were evaluated for similarity and correlations.

RESULTS

A strong correlation was observed for Question 1 (r = 0.752-0.848, p < 0.001) and a moderate correlation was observed between AES and all manual scorers for Question 2 (r = 0.527-0.571, p < 0.001). Intraclass correlation coefficients of 0.794-0.858 indicated excellent inter-rater agreement, and Cronbach's α of 0.881-0.932 indicated high reliability. For Question 1, the mean AES scores were similar to those for manual scoring (p > 0.05), and there was a strong correlation between AES and manual scores (r = 0.829, p < 0.001). For Question 2, AES scores were significantly lower than manual scores (p < 0.001), and there was a moderate correlation between AES and manual scores (r = 0.599, p < 0.001).

CONCLUSION

This study shows the potential of ChatGPT for essay marking. However, an appropriate rubric design is essential for optimal reliability. With further validation, the ChatGPT has the potential to aid students in self-assessment or large-scale marking automated processes.

A qualitative, multi-perspective study on causal beliefs about adolescent depression

OBJECTIVES

The current study aimed to examine: (1.1) causal beliefs about adolescent depression in a sample of adolescents with a clinical depression and their mothers and fathers; (1.2) within-family overlap of causal beliefs; (2.1) mothers' and fathers' reflected causal beliefs about their child's perspective; (2.2) the accuracy of mothers' and fathers' reflected causal beliefs as related to their child's causal beliefs.

DESIGN

Qualitative study using a within-family approach.

METHODS

Adolescents with a current clinical depression (MDD/dysthymia; N = 34) and their parents (N = 34 mothers, N = 26 fathers) were independently interviewed about their causal beliefs about the adolescents' depression. Parents were additionally interviewed about their perception of their child's causal beliefs (i.e., reflected causal beliefs).

RESULTS

The causal beliefs most frequently mentioned by adolescents, mothers and fathers are: characteristics of the child, social factors, school and various stressful experiences. Parent-child overlap was relatively low, specifically for the themes of bewilderment, cumulative effect and stressful life events, whereas overlap was relatively high for themes of social factors, school and stressful experiences outside of the family. Parents were relatively accurate in their reflected causal beliefs, but tended to underestimate their child's insights into possible causes of their depression. Accuracy of parents' reflected causal beliefs was particularly low for the theme cumulative effect and high for social factors.

CONCLUSIONS

The various causal beliefs of adolescents and their parents could be used in therapeutic setting. Future research could examine whether (guided) conversations may promote alignment within families and treatment efficacy.

Relationship Between Father-Child Attachment and Adolescents' Anxiety: The Bidirectional Chain Mediating Roles of Neuroticism and Peer Attachment

Background

Adolescent anxiety is closely associated with the quality of parent-child attachment. However, previous studies have predominantly focused on the impact of mother-child attachment. Little is known about the direct and indirect associations of father-child attachment on adolescent anxiety.

Purpose

This study aims to investigate the association and underlying mechanisms that link father-child attachment and adolescent anxiety. A bidirectional chain mediating model was constructed to test whether neuroticism and peer attachment play bidirectional mediating roles in father-child attachment and adolescent anxiety.

Methods

The proposed model was examined among 763 adolescents aged 11-16 years (male 53.1%) from four middle schools in Central China. Students completed questionnaires on father-child attachment, anxiety, neuroticism and peer attachment. The correlation and bidirectional chain mediating effect analyses were conducted using SPSS Process.

Results

(1) Father-child attachment negatively correlated with adolescent anxiety and neuroticism, and positively correlated with peer attachment; (2) Father-child attachment had an indirect association on adolescent anxiety through three pathways: a partial mediating effect on neuroticism, a partial mediating effect on peer attachment, and a bidirectional chain mediating effect involving both neuroticism and peer attachment.

Conclusion

This study revealed father-child attachment has an indirect association with adolescent anxiety through the bidirectional chain mediation of neuroticism and peer attachment. These empirical findings shed light on the intricate dynamic between father-child attachment and anxiety among Chinese adolescents, highlighting the crucial role of fathers in the prevention and reduction of adolescent anxiety from the perspectives of father-child dynamics, personal traits, and interpersonal relationships.

School socioeconomic status and psychological complaints among adolescents in 44 countries: The mediating role of schoolwork pressure and classmate support and the moderating role of family SES and country-level income inequality

Previous research has reported both positive and negative associations between school socioeconomic status (SES) and internalizing problems among adolescents. Little is known about cross-national differences in this association, as well as potential mediators and moderators. Therefore, this study investigated this association using representative cross-national samples of adolescents whilst exploring the mediating role of schoolwork pressure and classmate support, and the moderating role of family SES and country-level income inequality. Using data from adolescents aged 11-15 from 44 countries, participating in the 2017/2018 Health Behaviour in School-aged Children (HBSC) study (N = 202,202), we employed multilevel regression models with cross-level interactions. School SES was operationalized as the average family affluence of adolescents within a school and psychological complaints (e.g., feeling low/depressed) were used as an indication of internalizing problems. On average across countries, adolescents in higher SES schools reported more psychological complaints, with a large effect size. However, differences in this association were observed across countries, with a positive association in 19 out of 44 countries, a negative association in one country, and nonsignificant associations in the remaining countries. Schoolwork pressure partially mediated the average association between school SES and psychological complaints, as school SES was positively associated with schoolwork pressure which was associated with more psychological complaints. Our results did not support the mediating role of classmate support. Also, we found a moderating effect of family SES, indicating a stronger positive association between school SES and psychological complaints for those with a below average family SES compared to those with an average and above average family SES. No moderating effect was observed for country-level income inequality. These findings suggest that adolescents with low family SES attending higher SES schools are especially at risk for psychological complaints, and may therefore require tailored support. A promising strategy to reduce psychological complaints entails addressing schoolwork pressure.

Post-migration stress, quality of life, and mental health among accompanied and unaccompanied young refugees in Germany: How do adolescents feel after fleeing?

This study examines the impact of post-migration living difficulties (PMLDs) and quality of life (QoL) on the mental health of 55 young refugees who arrived in Germany either accompanied or unaccompanied. The results reveal that nearly 62% of the participants exhibited clinically significant symptoms of depression or post-traumatic stress disorder. Regression analyses indicate that psychopathology was associated with being unaccompanied and experiencing lower QoL, while QoL was associated with higher economic status and lower PMLDs. Mediation analysis further demonstrates that higher economic status and reduced PMLDs were associated with higher QoL, which, in turn, correlated with lower levels of psychopathology. These findings emphasise the importance of considering PMLDs and QoL, as well as economic status and being accompanied/unaccompanied, in the assessment and treatment of young refugees in the host country.