Fang Shihan, Chen Fazhan, Zhu Xiaoying, Bian Jing, Zhang Jinshen, Wang Yating, Wang Yanbo
Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Psychosomatic Medicine Department, Hangzhou, 310013, People's Republic of China.
School of Medicine, Tongji University, Shanghai, 200092, People's Republic of China.
J Multidiscip Healthc. 2025 Aug 20;18:5039-5060. doi: 10.2147/JMDH.S533788. eCollection 2025.
This longitudinal qualitative study aimed to explore the dynamic symptom management journeys of adolescents with depression, integrate Symptom Management Theory (SMT) with journey mapping, and identify stage-specific characteristics, emotional experiences, and unmet needs across the illness trajectory to inform targeted interventions.
A longitudinal qualitative design with reflexive thematic analysis (RTA) was adopted. Twelve adolescents with depression (aged 12-18 years) were recruited from a tertiary psychiatric hospital in Zhejiang Province, China. Data were collected through semi-structured interviews at three time points: baseline, 1-month, and 3-month follow-ups, supplemented by observation notes and self-management diaries. Journey mapping was used to visualize dynamic interactions across four phases (symptom recognition, help-seeking, treatment engagement, and daily management), with longitudinal integration of data to track temporal changes.
The symptom management journey was non-linear, characterized by distinct emotional and behavioral patterns across phases: numbness and self-loathing during symptom recognition (eg, self-harm as emotional outlet, somatization like headaches); fear and shame in help-seeking (eg, passive medical-seeking due to family coercion, reliance on online support); oscillating hope and skepticism during treatment (eg, selective adherence to preferred therapies like hypnotherapy over Modified Electroconvulsive Therapy) and fluctuating recovery confidence in daily management (eg, re-engaging with interests such as painting or running, forming peer support networks). Key barriers included familial misunderstanding, academic stigma, and inadequate relapse prevention tools, while facilitators involved personalized coping strategies and incremental family adaptation.
This study captures the dynamic, contextually embedded nature of symptom management in adolescent depression through longitudinal journey mapping, revealing critical tensions between individual agency and multi-level contextual influences (family, school, healthcare). The findings contribute in-depth qualitative insights into stage-specific needs, supporting the development of patient-centered, phase-adapted interventions.
本纵向定性研究旨在探索抑郁症青少年的动态症状管理历程，将症状管理理论（SMT）与历程映射相结合，识别疾病轨迹中特定阶段的特征、情感体验和未满足的需求，以为针对性干预提供依据。
采用带有反思性主题分析（RTA）的纵向定性设计。从中国浙江省的一家三级精神病医院招募了12名抑郁症青少年（年龄在12至18岁之间）。在三个时间点通过半结构化访谈收集数据：基线、1个月和3个月随访，并辅以观察记录和自我管理日记。历程映射用于可视化四个阶段（症状识别、寻求帮助、治疗参与和日常管理）的动态交互，并纵向整合数据以跟踪时间变化。
症状管理历程是非线性的，各阶段具有不同的情感和行为模式：症状识别期间表现为麻木和自我厌恶（例如，自我伤害作为情绪发泄途径，出现如头痛等躯体化症状）；寻求帮助时表现为恐惧和羞耻（例如，因家庭强迫而被动求医，依赖在线支持）；治疗期间希望与怀疑摇摆不定（例如，选择性坚持偏好的疗法，如催眠疗法而非改良电休克疗法），日常管理中康复信心波动（例如，重新参与绘画或跑步等兴趣活动，形成同伴支持网络）。主要障碍包括家庭误解、学业污名以及复发预防工具不足，而促进因素包括个性化应对策略和家庭的逐步适应。
本研究通过纵向历程映射捕捉了青少年抑郁症症状管理的动态、情境嵌入性质，揭示了个体能动性与多层次情境影响（家庭、学校、医疗保健）之间的关键紧张关系。研究结果为特定阶段需求提供了深入的定性见解，支持以患者为中心且适应阶段的干预措施的开发。
