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中国青少年抑郁症流行病学，近5年研究
在过去的五年中，中国青少年抑郁症的流行病学研究揭示了其高发病率、不断上升的趋势以及多方面的风险因素，同时强调了早期干预和治疗的重要性。以下是对中国青少年抑郁症流行病学及其相关研究的详细总结：
1. 流行病学概述及患病率
中国青少年抑郁症的患病率较高，且呈现出上升趋势。
- 全球范围的上升趋势： 一项发表于2024年3月的系统综述和荟萃分析显示，全球约五分之一的儿童和青少年患有抑郁症或有抑郁症状，并且这一比例随着时间推移而增加。具体而言，从1989年到2022年，轻度至重度抑郁症和中度至重度抑郁症的患病率呈上升趋势（P = 0.002，P = 0.034），而重度抑郁症的患病率没有显著变化（P = 0.636）。该研究的汇总患病率数据显示，轻度至重度、中度至重度以及重度抑郁症的患病率分别为21.3%、18.9%和3.7%。另一项基于2019年全球疾病负担研究的报告也指出，1990年至2019年间，全球青少年和年轻人（10-24岁）的抑郁症患病率、发病率和伤残调整生命年（DALYs）均有所增加。
- 中国儿童和青少年的患病率：
- 一项2021年发表的中国全国性精神疾病流行病学调查发现，中国6-16岁儿童和青少年任何精神疾病的加权患病率为17.5%（95% CI：17.2-18.0），这是迄今为止中国报告的最高患病率。该研究强调了制定全面干预计划的紧迫性。
- 2018年的一项荟萃分析涵盖了中国29,626名儿童和青少年，发现抑郁症状的汇总患病率为19.85%（95% CI：14.75%-24.96%），各研究报告的患病率介于4%至41%之间。该研究还指出，抑郁症状的患病率与研究所在的地区显著相关，其中中部地区最高（23.7%），其次是西部（22.7%），东部为17.8%，东北地区最低（14.5%）。
- 2023年对湖北省黄石市青少年抑郁症的描述性分析显示，在674名精神疾病患者中，抑郁症最为常见，占41.84%（282例）。这项研究观察到，自2018年以来，抑郁症呈上升趋势，尤其是在2021年。
- 中国总体疾病负担： 尽管专门针对青少年抑郁症的全国性流行病学数据相对较少，但从中国整体抑郁症和焦虑症的疾病负担来看，其呈现上升趋势。2024年发布的一项研究基于全球疾病负担研究2021年的数据，显示从1990年到2021年，中国抑郁症病例数从3440万增加到5310万，增长了54%。该研究还指出，COVID-19对抑郁症和焦虑症的疾病负担产生了显著不利影响。
2. 风险因素
多项研究揭示了中国青少年抑郁症的多种风险因素，包括生理、心理和社会环境因素。
- 性别差异：
- 全球研究显示，抑郁症的负担在女性中更为显著，无论年龄组别和世界区域。
- 在中国，全国性调查发现，男性、年龄较小的个体以及来自发达地区的儿童和青少年患任何精神疾病的患病率较高。然而，具体到抑郁症，研究结果显示男性群体的抑郁症患病率随年龄增长而下降，而女性群体则随年龄增长而上升。
- 在黄石市的青少年抑郁症患者中，男女比例为1:2.44，女性患者明显多于男性。
- 年龄因素：
- 全球范围内，抑郁症发病率和患病率最显著的年龄效应出现在20-24岁的人群中。
- 黄石市的研究发现，抑郁症发病率最高的年龄是16岁。
- 社会经济和地域因素：
- 全国性调查显示，来自发达地区的儿童和青少年患精神疾病的患病率更高，但在城乡地区之间没有发现差异。
- 黄石市的研究显示，城市地区的诊断病例多于农村地区。
- 全球研究表明，高收入地区（如北美高收入国家和澳大利亚）的抑郁症标准化患病率和发病率呈上升趋势，而低收入或中等收入地区大多有所下降。
- 学业压力和负面学校经历：
- 学业压力是中国青少年抑郁症的重要诱发因素之一。
- 2022年的一项网络分析研究发现，负面学校经历可以预测青少年的抑郁症。在该研究中，中国青少年核心抑郁症状是负面情绪，而“学校中的负面经历”中最核心的节点是学业表现不佳和同伴关系问题。研究强调，学校中的负面情绪和同伴关系困难与抑郁症显著相关。
- 家庭因素：
- 家庭相关因素是中国青少年抑郁症的重要原因，包括留守儿童以及未被家人认可/理解的青少年更容易被诊断为抑郁症。
- 2021年一项针对抑郁症青少年非自杀性自伤行为的研究显示，家庭凝聚力（family cohesion）和家庭适应性（family adaptability）得分较低的青少年更容易出现自伤行为。
- 睡眠障碍：
- 睡眠障碍与青少年抑郁症密切相关。黄石市的研究发现，大多数抑郁症患者有睡眠障碍（84.75%）。
- 2023年的一项研究发现，在中国青少年中，睡眠时间长短与抑郁症状的风险显著相关，睡眠时间越长，抑郁症状的风险越低。研究发现，睡眠时间少于7小时的青少年抑郁症状患病率为52.66%，而睡眠时间大于等于9小时的青少年患病率仅为20.49%。
- 越来越多的证据表明失眠在抑郁症的发展中起着重要作用，针对失眠的干预有望预防青少年抑郁症。
- 童年期虐待：
- 童年期虐待（CM）与抑郁症青少年中的网络成瘾（IA）密切相关。2024年的一项网络分析研究发现，“情绪虐待”和“性虐待”是连接CM和IA的关键桥梁症状，它们在理解和干预青少年IA中扮演重要角色。情绪虐待也是抑郁症青少年非自杀性自伤的独立风险因素。
- 人际关系问题：
- 人际关系问题是青少年抑郁症的诱发因素之一。在抑郁症青少年中，人际关系问题得分较高是出现非自杀性自伤的独立风险因素。
- 基因因素：
- 遗传因素也被认为是导致青少年抑郁症的重要因素之一。
- 维生素D水平：
- 2023年的一项研究发现，基线血清25(OH)D水平较高与早期青少年（平均12.49岁）两年内累积抑郁症发病风险较低以及抑郁症状随时间增加的轨迹风险降低相关。基线维生素D缺乏（VDD）与抑郁症状增加的轨迹风险增加相关，且在男性中这种关联更为显著。这表明维生素D补充剂可能对降低早期青少年抑郁症风险具有潜在益处。
3. 伴随症状和行为
抑郁症青少年常常伴随其他心理健康问题和异常行为。
- 非自杀性自伤行为 (NSSI)： 抑郁症青少年的NSSI发生率较高。黄石市的研究发现，51.77%的抑郁症青少年有自伤行为。
- 自杀意念和自杀尝试： 抑郁症青少年自杀意念和自杀尝试的比例显著高于非NSSI组。黄石市的研究显示，80.85%的抑郁症青少年曾有自杀或自杀未遂行为。
- 学业、工作和生活功能障碍： 大部分抑郁症个体感到冷漠、孤独和迟钝，无法正常学习、工作和生活（75.18%）。
4. 医学生群体中的抑郁症
医学生群体是一个特殊的青少年及青年人群，其精神健康问题值得关注。
- 2019年的一项针对中国医学生的荟萃分析显示，抑郁症、焦虑症、自杀意念和饮食障碍的患病率分别为29%、21%、11%和2%。该研究指出，中国医学生抑郁症、焦虑症和自杀意念的患病率相对较高，应引起重视，并建议及时筛查和适当干预。
5. 预防和治疗
针对青少年抑郁症的预防和治疗研究也在进行中。
- 干预失眠预防抑郁症： 2025年的一项随机临床试验显示，基于应用程序的认知行为疗法（CBT-I）在预防有失眠和亚临床抑郁症的青少年（15-25岁）未来发生重度抑郁症方面有效。CBT-I组在12个月随访期间新发重度抑郁症的风险显著低于对照组，其预防MDD的需要治疗人数（NNT）为10.9。
- 抗抑郁药物的比较疗效： 2025年的一项网络荟萃分析评估了不同抗抑郁药物在治疗青少年抑郁症方面的成功率。研究发现，在改善儿童抑郁评定量表修订版（CDRS-R）分数方面，阿戈美拉汀、氟西汀和舍曲林显著优于安慰剂。在临床总体印象-严重度（CGI-S）方面，舍曲林更有效。对于功能改善，艾司西酞普兰在儿童总体评估量表（CGAS）上表现最佳。阿戈美拉汀（CDRS-R：SUCRA 86.4%）和帕罗西汀（MADRS：SUCRA 99.9%）在症状严重程度量表上表现出最大疗效。舍曲林（CGI-S：SUCRA 100%）在临床医生评估的严重程度方面表现优异，而艾司西酞普兰（CGAS：SUCRA 96.1%）在功能恢复方面排名最高。临床决策应优先考虑艾司西酞普兰用于功能恢复，舍曲林用于需要快速缓解症状的重症病例。
- 针对核心症状和桥梁症状的干预： 针对学校中的负面情绪和同伴关系困难，以及童年期虐待（尤其是情绪虐待）和网络成瘾相关的症状，应采取相应的同伴支持和干预措施。
- 社会和政府层面的关注： 中国抑郁症和焦虑症的疾病负担在过去三十年持续上升，且存在性别、年龄组和省份间的显著差异，这对于政府和政策制定者制定干预策略至关重要。政府和卫生部门应考虑公共卫生突发事件对抑郁症和焦虑症负担的潜在影响。
总结
近五年的研究表明，中国青少年抑郁症问题日益突出，患病率高且呈上升趋势，尤其受到性别、年龄、地域、学业压力、家庭环境、睡眠质量、童年期经历和人际关系等多种因素的影响。这些研究强调了早期识别、干预和治疗的重要性，例如通过改善睡眠、补充维生素D以及应用心理治疗和药物治疗等多种手段来应对这一挑战。政府、学校、家庭和社会各界应共同努力，加强对青少年心理健康的关注，提供必要的支持和资源，以减少抑郁症对青少年及其家庭和社会的长远负面影响。
References
1Global burden of depression or depressive symptoms in children and adolescents: A systematic review and meta-analysis.PubMed
Bingqing Lu, Lixia Lin, Xiaojuan Su
J Affect Disord. 2024 Jun 1;354:553-562. doi: 10.1016/j.jad.2024.03.074. Epub 2024 Mar 14.
BACKGROUND: Depression is the leading cause of health-related disability. A proportion of depression cases begin in childhood and increase dramatically during adolescence. This systematic review and meta-analysis aimed to estimate the global prevalence of depression or depressive symptoms in children and adolescents and explore the temporal and regional distribution of depression or depressive symptoms. METHODS: This systematic review and meta-analysis identified peer-reviewed literature published through April 8, 2023, using the MEDLINE, Embase and APA PsycINFO databases, supplemented by reverse reference searches. Observational studies published in English and based on validated instruments with prevalence data on depression or depressive symptoms in children and adolescents aged ≤18 years were eligible. Random-effects meta-analysis and meta-regression analysis were performed using R software. RESULTS: This systematic review and meta-analysis included a total of 96 studies (29 countries, 528,293 participants) published between 1989 and 2022. The pooled prevalence of mild-to-severe, moderate-to-severe, and major depression were 21.3 % (95%CI, 16.7 %-26.7 %), 18.9 % (95%CI, 14.6 %-24.2 %), and 3.7 % (95%CI, 2.7 %-5.1 %) respectively. Meta-regression analysis showed that from 1989 to 2022, the prevalence of mild-to-severe and moderate-to-severe depression increased over time (P = 0.002, P = 0.034, respectively), but the prevalence of major depression did not change significantly (P = 0.636). LIMITATIONS: Only English articles were included. There was significant heterogeneity across the included studies. The studies included were mostly based on self-report scales to assess depressive symptoms. CONCLUSION: In this systematic review, about one in five children and adolescents globally suffered from depression or had depressive symptoms, and this proportion was increasing over time.
2Burden of depressive and anxiety disorders in China and its provinces, 1990-2021: findings from the Global Burden of Disease Study 2021.PubMed
Wei Tian, Guangcan Yan, Shangzhi Xiong, et al.
Br J Psychiatry. 2026 Jan;228(1):18-28. doi: 10.1192/bjp.2024.267.
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.
3Prevalence of mental disorders in school children and adolescents in China: diagnostic data from detailed clinical assessments of 17,524 individuals.PubMed
Fenghua Li, Yonghua Cui, Ying Li, et al.
J Child Psychol Psychiatry. 2022 Jan;63(1):34-46. doi: 10.1111/jcpp.13445. Epub 2021 May 21.
BACKGROUND: To date, no national-scale psychiatric epidemiological survey for children and adolescents has been conducted in China. In order to inform government officials and policymakers and to develop a comprehensive plan for service providers, there was a clear need to conduct an up-to-date systematic nationwide psychiatric epidemiological survey. METHODS: We conducted a two-stage large-scale psychiatric point prevalence survey. Multistage cluster stratified random sampling was used as the sampling strategy. Five provinces were selected by comprehensively considering geographical partition, economic development, and rural/urban factors. In Stage 1, the Child Behavior Checklist was used as the screening tool. In Stage 2, Mini-International Neuropsychiatric Interview for Children and Adolescents and a diagnostic process based on the Diagnostic and Statistical Manual were used to make the diagnoses. Sampling weights and poststratification weights were employed to match the population distributions. Exploratory analyses were also performed using socio-demographic factors. Prevalence in socio-demographic factor subgroups and overall were estimated. Rao-Scott adjusted chi-square tests were utilized to determine if between-group differences were present. Factor interactions were checked by logistic regression analyses. RESULTS: A total of 73,992 participants aged 6-16 years of age were selected in Stage 1. In Stage 2, 17,524 individuals were screened and diagnosed. The weighted prevalence of any disorder was 17.5% (95% CI: 17.2-18.0). Statistically significant differences in prevalence of any psychiatric disorder were observed between sexes [χ (1, N = 71,929) = 223.0, p < .001], age groups [χ (1, N = 71,929) = 18.6, p < .001] and developed vs. developing areas [χ (1, N = 71,929) = 2,129.6, p < .001], while no difference was found between rural and urban areas [χ (1, N = 71,929) = 1.4, p = .239]. Male, younger individuals, children, and adolescents from developed areas had higher prevalence of any psychiatric disorder. The prevalence of any psychiatric disorder was found to decrease with the age in the male group, while the female group increased with the age. Individuals diagnosed with attention-deficit hyperactivity disorder, oppositional defiant disorder, a tic disorder, conduct disorder, and major depression disorder had the highest rates of comorbidity. CONCLUSIONS: The prevalence of any psychiatric disorder we found is the highest ever reported in China. These results urgently need to be addressed by public mental health service providers and policymakers in order to provide access to the necessary treatments and to reduce the long-term negative impact of these conditions on families and the society as a whole.
4Prevalence of depressive symptoms in children and adolescents in China: A meta-analysis of observational studies.PubMed
Wen-Wang Rao, Dan-Dan Xu, Xiao-Lan Cao, et al.
Psychiatry Res. 2019 Feb;272:790-796. doi: 10.1016/j.psychres.2018.12.133. Epub 2018 Dec 25.
Depressive symptoms are common in children and adolescents. The prevalence of depressive symptoms in children and adolescents in China vary significantly across studies. A meta-analysis of the prevalence of depressive symptoms in children and adolescents in China was conducted. Literature search was performed in both English (PubMed, PsycINFO and EMBASE) and Chinese (China National Knowledge Internet, WANFANG Data and SinoMed) databases. Random-effects model was used to synthesize the prevalence of depressive symptoms. Eighteen studies covering 29,626 participants were identified and analyzed. All these studies used the same measurement to identify depressive symptoms. The reported point prevalence of depressive symptoms ranged between 4% and 41% in the studies; the pooled prevalence of depressive symptoms was 19.85% (95% confidence interval: 14.75%-24.96%). In the subgroup analyses the prevalence of depressive symptoms was significantly associated with the region where the study was conducted: 17.8% in eastern, 23.7% in central, 22.7% in western, and 14.5% in northeast regions of China (P < 0.001). Considering the adverse impact of depressive symptoms on health outcomes, regular screening and effective interventions should be implemented in this population.
5Analysis of risk factors of non-suicidal self-harm behavior in adolescents with depression.PubMed
Can Shao, Xiaomeng Wang, Qingyan Ma, et al.
Ann Palliat Med. 2021 Sep;10(9):9607-9613. doi: 10.21037/apm-21-1951.
BACKGROUND: Adolescents are a high-risk group for non-suicidal self-injury (NSSI), which seriously affects their physical and mental health. This study aimed to explore the risk factors for depressive adolescents with NSSI. METHODS: A total of 153 adolescents with depression were divided into the NSSI group (n=65) and non-NSSI group (n=88) according to the criteria stipulated by Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). The Beck scale for suicidal ideation (BSS), adolescent self-rating life events checklist (ASLEC), family adaptability and cohesion evaluation scale II-Chinese version (FACES II-CV), childhood trauma questionnaire short form (CTQ SF), and multidimensional scale of perceived social support (MSPSS) were applied to evaluate suicidal ideation, frequency and intensity of stressful life events, family functions, childhood trauma, and perceived support, respectively. We applied two-dimensional logistic regression to identify risk factors for NSSI. RESULTS: Female gender ratio, suicidal ideation, and attempted suicide were significantly higher in the NSSI group than in the non-NSSI group (all P<0.05). Scores of interpersonal relationships in ASLEC, emotional abuse, and emotional neglect in the CTQ-SF were significantly higher in the NSSI group than those in the non-NSSI group (all P<0.001). The scores of family cohesion (P=0.001) and family adaptability (P=0.01) were significantly lower in the NSSI group than in the non-NSSI group. The MSPSS was used to assess support from the family, and the index was significantly lower in the NSSI group (P<0.001). After adjusting for age and gender, BSS score, interpersonal relationship score, emotional abuse score, and emotional neglect score were identified as independent risk factors for NSSI. CONCLUSIONS: The rate of NSSI in adolescents with depression is high. Higher scores of BSS, interpersonal relationship, emotional abuse, and neglect were independently associated with NSSI.
6Prevalence of mental health problems among medical students in China: A meta-analysis.PubMed
Wen Zeng, Ruiqi Chen, Xingyue Wang, et al.
Medicine (Baltimore). 2019 May;98(18):e15337. doi: 10.1097/MD.0000000000015337.
BACKGROUND: The prevalence of mental health problems in medical students has continuously increased and is higher than the prevalence of mental health problems in students with other majors, which could lead to undesirable consequences for the students and their future patients. In China, the current states of medical education and healthcare workplaces differ in certain areas from those in Western or other Asian countries. However, the mental health status of Chinese medical students has not been systematically analyzed. OBJECTIVES: The purpose of this meta-analysis was to summarize the prevalence of mental health problems in Chinese medical students. METHODS: All cross-sectional studies that investigated the prevalence of any mental health problem among Chinese medical students were retrieved from the following databases: EMBASE, PubMed, PsycINFO, OVID, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials. We accepted each individual trial's inclusion and exclusion criteria for participants. The National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was adopted to appraise the methodological quality of each study. RevMan (version 5.3) was used to analyze the data. RESULTS: Ten cross-sectional studies involving a total of 30,817 Chinese medical students were included. The prevalence of depression, anxiety, suicidal ideation, and eating disorders were 29%, 21%, 11%, and 2%, respectively. Subgroup analysis revealed no significant differences in the prevalence of depression and suicidal ideation between genders and no significant difference in the prevalence of depression between individuals of different ages (20 years and older or younger than 20 years). CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: Chinese medical students have relatively high prevalence of depression, anxiety, and suicidal ideation but a low prevalence of eating disorders. Mental health problems in Chinese medical students should be taken seriously, and timely screening of and proper intervention in these mental health problems are highly recommended.
7Descriptive analysis of depression among adolescents in Huangshi, China.PubMed
Xiaozhi Zhang, Yueming Yan, Zhuofan Ye, et al.
BMC Psychiatry. 2023 Mar 16;23(1):176. doi: 10.1186/s12888-023-04682-3.
BACKGROUND: More adolescents suffered from depressive disorder, and what was worse, the morbidity increased annually. The situation was getting worse during COVID-19 pandemic. The prevalence of depression among adolescents in China has increased a lot due to social and economic development, family-associated reasons, academic stress, interpersonal relationships, and so on. OBJECTIVE: This study aimed to determine the prevalence, gender differences, risk factors, and abnormal illness behaviors of depression among adolescents in Huangshi, China. METHODS: A descriptive analysis was conducted based on the data from clinical interviews and self-reports by the patients. Depression was assessed and diagnosed using the DSM-5 Diagnostic and Statistical Manual of Mental Disorders. RESULTS: Depression was most frequently seen in 674 patients with mental illnesses (282, 41.84%). The male-to-female ratio was 1:2.44, and their age ranged from 9 to 18. The majority of patients are in high school (261/282, 92.55%), and the highest morbidity occurred at 16 years. More cases were diagnosed in urban than in rural areas. Genetic factors, school violence, academic stress, sleep disorders, and family-related factors were essential factors leading to depression among adolescents. Most patients had sleep disorders (84.75%). In family-related factors, left-behind children and unrecognized/misunderstood by their families were prominently diagnosed with depression. A large portion of individuals with depression felt apathetic, solitary, and sluggish and were unable to study, work, and live normally (212/282, 75.18%); they even committed suicide or attempted suicide (228/282, 80.85%) and inflicted self-harm (146/282, 51.77%). CONCLUSIONS: An increasing trend of depression has been observed since 2018, especially in 2021. This depression has led to suicide or suicidal attempts and self-harm, reflecting the severity of mental health among adolescents in Huangshi. Therefore, this study aimed to draw the attention of society, families, and schools to the importance of mental health among adolescents, providing guidance and references for the prevention, diagnosis, and treatment of young depressive disorders in China.
8Global, regional and national burdens of depression in adolescents and young adults aged 10-24 years, from 1990 to 2019: findings from the 2019 Global Burden of Disease study.PubMed
Cheng-Hao Yang, Jia-Jie Lv, Xiang-Meng Kong, et al.
Br J Psychiatry. 2024 Aug;225(2):311-320. doi: 10.1192/bjp.2024.69.
BACKGROUND: Depression is a significant mental health concern affecting the overall well-being of adolescents and young adults. Recently, the prevalence of depression has increased among young people. Nonetheless, there is little research delving into the longitudinal epidemiology of adolescent depression over time. AIMS: To investigate the longitudinal epidemiology of depression among adolescents and young adults aged 10-24 years. METHOD: Our research focused on young people (aged 10-24 years) with depression, using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019. We explored the age-standardised prevalence, incidence and disability-adjusted life-years (DALYs) of depression in different groups, including various regions, ages, genders and sociodemographic indices, from 1990 to 2019. RESULTS: The prevalence, incidence and DALYs of depression in young people increased globally between 1990 and 2019. Regionally, higher-income regions like High-Income North America and Australasia recorded rising age-standardised prevalence and incidence rates, whereas low- or middle-income regions mostly saw reductions. Nationally, countries such as Greenland, the USA and Palestine reported the highest age-standardised prevalence and incidence rates in 2019, whereas Qatar witnessed the largest growth over time. The burden disproportionately affected females across age groups and world regions. The most prominent age effect on incidence and prevalence rates was in those aged 20-24 years. The depression burden showed an unfavourable trend in younger cohorts born after 1980, with females reporting a higher cohort risk than males. CONCLUSIONS: Between 1990 and 2019, the general pattern of depression among adolescents varied according to age, gender, time period and generational cohort, across regions and nations.
9Temporal and spatial trend analysis of all-cause depression burden based on Global Burden of Disease (GBD) 2019 study.PubMed
Junjiao Liu, Yueyang Liu, Wenjun Ma, et al.
Sci Rep. 2024 May 29;14(1):12346. doi: 10.1038/s41598-024-62381-9.
Depression has been reported as one of the most prevalent psychiatric illnesses globally. This study aimed to obtain information on the global burden of depression and its associated spatiotemporal variation, by exploring the correlation between the global burden of depression and the social development index (SDI) and associated risk factors. Using data from the Global Burden of Disease study from 1990 to 2019, we described the prevalence and burden of disease in 204 countries across 21 regions, including sex and age differences and the relationship between the global disease burden and SDI. The age-standardized rate and estimated annual percentage change were used to assess the global burden of depression. Individuals with documented depression globally ranged from 182,183,358 in 1990 to 290,185,742 in 2019, representing an increase of 0.59%. More patients experienced major depressive disorder than dysthymia. The incidence and disability-adjusted life years of depression were the highest in the 60-64 age group and much higher in females than in males, with this trend occurring across all ages. The age-standardized incidence and adjusted life-years-disability rates varied with different SDI levels. Relevant risk factors for depression were identified. National governments must support research to improve prevention and treatment interventions.
10Effectiveness of app-based cognitive behavioral therapy for insomnia on preventing major depressive disorder in youth with insomnia and subclinical depression: A randomized clinical trial.PubMed
Si-Jing Chen, Jian-Yu Que, Ngan Yin Chan, et al.
PLoS Med. 2025 Jan 21;22(1):e1004510. doi: 10.1371/journal.pmed.1004510. eCollection 2025 Jan.
BACKGROUND: Increasing evidence suggests that insomnia plays an important role in the development of depression, supporting insomnia intervention as a promising approach to prevent depression in youth. This randomized controlled trial evaluated the effectiveness of app-based cognitive behavioral therapy for insomnia (CBT-I) in preventing future onset of major depressive disorder (MDD) in youth. METHODS AND FINDINGS: This was a randomized, assessor-blind, parallel group-controlled trial in Chinese youth (aged 15-25 years) with insomnia disorder and subclinical depressive symptoms. Participants were randomly assigned (1:1) to 6-week app-based CBT-I or 6-week app-based health education (HE) delivered through smartphones. Online assessments and telephone clinical interviews were conducted at baseline, post-intervention, 6- and 12-month follow-ups. The primary outcome was time to onset of MDD. The secondary outcomes included depressive symptoms and insomnia at both symptom and disorder levels. Between September 9, 2019, and November 25, 2022, 708 participants (407 females [57%]; mean age, 22.1 years [SD = 1.9]) were randomly allocated to app-based CBT-I group (n = 354) or app-based HE group (n = 354). Thirty-seven participants (10%) in the intervention group and 62 participants (18%) in the control group developed new-onset MDD throughout the 12-month follow-up, with a hazard ratio of 0.58 (95% confidence interval 0.38-0.87; p = 0.008). The number needed to treat to prevent MDD at 1 year was 10.9 (6.8-26.6). The app-based CBT-I group has higher remission rates of insomnia disorder than the controls at post-intervention (52% versus 28%; relative risk 1.83 [1.49-2.24]; p < 0.001) and throughout 12-month follow-up. In addition, the CBT-I group reported a greater decrease in depressive (adjusted difference -1.0 [-1.6 to -0.5]; Cohen's d = 0.53; p < 0.001) and insomnia symptoms (-2.0 [-2.7 to -1.3], d = 0.78; p < 0.001) than the controls at post-intervention and throughout 6-month follow-up. Insomnia was a mediator of intervention effects on depression. No adverse events related to the interventions were reported. CONCLUSIONS: App-based CBT-I is effective in preventing future onset of major depression and improving insomnia outcomes among youth with insomnia and subclinical depression. These findings highlight the importance of targeting insomnia to prevent the onset of MDD and emphasize the need for wider dissemination of digital CBT-I to promote sleep and mental health in the youth population. TRIAL REGISTRATION: ClinicalTrials.Gov (NCT04069247).
11Vitamin D and depressive symptoms in an early adolescent cohort.PubMed
Gengfu Wang, Mengyuan Yuan, Junjie Chang, et al.
Psychol Med. 2023 Sep;53(12):5852-5860. doi: 10.1017/S0033291722003117. Epub 2022 Oct 18.
BACKGROUND: To explore the cross-sectional and longitudinal association between vitamin D and depressive symptoms across early adolescence. METHODS: This longitudinal study included 1607 early adolescents [mean (s.d.) age, 12.49 years; 972 (60.5%) males] from the Chinese Early Adolescents Cohort, recruited from a middle school in Anhui Province and followed up annually (2019-2021). Serum 25(OH)D levels were measured in both 2019 and 2021. Self-reports on depression were assessed at each of three time points from 2019 to 2021. RESULTS: In the whole sample, higher baseline serum 25(OH)D levels were linked with a lower risk of cumulative incident depression within two-year follow-ups (adjusted RR = 0.97, 95% CI 0.94-0.99) and the increasing trajectory of depression symptoms across the three waves (adjusted RR = 0.97, 95% CI 0.95-0.99). Baseline vitamin D deficiency (VDD) (adjusted RR = 1.50, 95% CI 1.10-2.05) were associated with an increased risk for the increasing trajectory of depression symptoms across the three waves. Remitted VDD was positively related to one dichotomous depression symptoms across three waves (adjusted OR 2.15, 95% CI 1.15-4.01). The above-mentioned significant association was also found in males. Additionally, baseline VDD (adjusted OR 1.59, 95% CI 1.04-2.44) and persistent VDD (adjusted OR 1.58, 95% CI 1.02-2.60) were linked to an increased risk of having two dichotomous depression symptoms only in males. CONCLUSIONS: Our results highlight a prospective association between baseline vitamin D and depression risk in early adolescents. Additionally, a male-specific association between vitamin D and depression risk was observed. Our findings support a potential beneficial effect of vitamin D supplementation in reducing depression risk in early adolescents.
12Comparative efficacy of antidepressant medication for adolescent depression: a network meta-analysis and systematic review.PubMed
Tianwei Wu, Fan Song, Weili Cao, et al.
BMC Psychiatry. 2025 May 10;25(1):471. doi: 10.1186/s12888-025-06941-x.
PURPOSE: To evaluate the success rate of different antidepressants in addressing depression among teenagers, while also offering substantiation for the efficacy and tolerability of these treatments in this demographic. METHODS: Participants were adolescents aged 6-18 years diagnosed with major depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) , Chinese Classification of Mental Disorders (CCMD-3) or equivalent diagnostic criteria (e.g., Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition(DSM-4) , International Classification of Diseases, Tenth/Eleventh Revision(ICD10/11) ) . We conducted a systematic search of major databases (PubMed, Cochrane Library, and Web of Science) for randomized controlled trials (RCTs) published up to October 2024. The search strategy included the following keywords: "Depression," "Depressive Disorders," "Emotional Disorders," "adolescent," "young adult, " "minors," "fluoxetine," "sertraline," "paroxetine," "agomelatine," "vilazodone," "escitalopram," and "venlafaxine." RESULTS: Our network meta-analysis(NMA) included 15 RCTs involving 12,258 participants. The included studies were assessed using the Cochrane risk of bias tool. The majority of studies had low risk of bias in terms of randomization and allocation concealment, while some studies had unclear implementation of blinding or outcome assessment. The NMA results showed that in several major indicators Children's Depression Rating Scale-Revised (CDRS-R) , Clinical Global Impression-Severity (CGI-S) and Children's Global Assessment Scale (CGAS) , agomelatine (MD = -0.34, 95 % CI = -0.59, -0.09), fluoxetine (MD = -0.31, 95 % CI = -0.42, -0.21), sertraline (MD = -0.27, 95 % CI = -0.47, -0.06) were significantly better than placebo in improving CDRS-R. In terms of CGI-S, sertraline (MD = -4.39, 95 % CI = -4.77, -4.01) was more effective. In contrast to the placebo, escitalopram (MD = 2.08,95 % CI = 1.33,2.84) was more effective in CGAS; Surface Under the Cumulative Ranking Curve (SUCRA) values showed that escitalopram (96.1 % and 86.4 %) could achieve better therapeutic effects in CGAS and Clinical Global Impressions-Improvement (CGI-I) , and agomelatine (86.4 %) was more effective in improving CDRS-R scores than other drugs. Sertraline (100 %) appears to be the most likely strategy to decelerate the increase in CGI-I scores. The effectiveness of paroxetine (99.9%) in the management of Montgomery-Asberg Depression Rating Scale (MADRS) was significantly better than that of several other drugs. CONCLUSION: For symptom severity scales, agomelatine (CDRS-R: SUCRA 86.4%) and paroxetine (MADRS: SUCRA 99.9%) demonstrated the greatest efficacy. For functional improvement, escitalopram ranked highest on CGAS (SUCRA 96.1%). Sertraline showed superiority in clinician-rated severity (CGI-S: SUCRA 100%) and improvement (CGI-I: SUCRA 80.2%). Clinical decisions should prioritize escitalopram for functional recovery and sertraline for severe cases requiring rapid symptom reduction. TRIAL REGISTRATION: PROSPERO registration number: CRD42024609880.
13Depressive Symptoms and Negative Experiences in School: A Network Analysis.PubMed
Yi Huang, Petr Macek, Jinjin Lu
Asia Pac J Public Health. 2022 Jul;34(5):510-515. doi: 10.1177/10105395221092848. Epub 2022 Apr 29.
Negative experiences in school predict adolescents' depression. However, the dynamic interactions of depressive symptoms with adolescents' negative experiences in school remain unclear. This study aimed to applied network analysis to detect the complex relationships between early adolescents' depressive symptoms and negative experiences in school. We adopted the data from a Chinese national survey conducted in 2018. Eight hundred ninety-seven adolescents from 10 to 15 years old were included. The measurements included an 8-item depression screener scale and a 14-item scale assessing negative experiences in school. The centrality analysis suggested that Chinese early adolescents' core depressive symptoms were negative affections. Regarding "negative experiences in the school," the most central nodes were poor academic performance and peer relationships. The bridge-centrality results showed negative emotions in school and difficulties in peer relationships were significantly linked to depression. Educators should pay attention to adolescents' negative affection and difficulties in peer relationships in school settings because they are potential signs of depression. Relevant peer support intervention aiming for adolescents' social development should be underscored.
14Network analysis of childhood maltreatment and internet addiction in adolescents with major depressive disorder.PubMed
Song Wang, Feng Geng, Mengyue Gu, et al.
BMC Psychiatry. 2024 Nov 5;24(1):768. doi: 10.1186/s12888-024-06224-x.
BACKGROUND: Childhood maltreatment (CM) is closely linked to internet addiction (IA), especially in adolescents with Major Depressive Disorder (MDD). Previous studies have shown that adolescents who experience CM are more likely to develop IA and other psychological problems. This study aims to explore the complex relationship between CM and IA through network analysis, particularly identifying the core symptoms and bridge symptoms to better understand the development of IA in these adolescents. METHODS: A cross-sectional study was conducted in seven hospitals in Anhui Province, China, involving 332 adolescents diagnosed with MDD using DSM-5 criteria. The Childhood Trauma Questionnaire - Short Form (CTQ-SF) and the Internet Addiction Test (IAT) were used to assess CM and IA symptoms, respectively. Gender-based network analysis was also performed. RESULTS: Network analysis constructed a CM-IA network and identified core and bridge symptoms. "Depress/moody/nervous being offline", "Request an extension for longer time", "Sleep loss due to late-night logins", and "emotional abuse" emerged as central symptoms within the CM-IA network. Additionally, "emotional abuse", "sexual abuse", and "complaints about online time" were identified as key bridge symptoms linking CM and IA. These symptoms demonstrated significant connectivity, underscoring their critical role in linking CM and IA. CONCLUSION: The findings highlight the complex relationship between CM and IA in adolescents with MDD. Specific symptoms, such as emotional abuse and online-related symptoms, play important roles in understanding and intervening in adolescent IA. Future interventions should target these core and bridge symptoms for more effective prevention and treatment.
15Sleep duration is associated with depressive symptoms in Chinese adolescents.PubMed
Shujuan Lin, Qinghai Gong, Jingru Chen, et al.
J Affect Disord. 2023 Nov 1;340:64-70. doi: 10.1016/j.jad.2023.07.114. Epub 2023 Aug 1.
BACKGROUND: Depressive symptoms have become one of the most common mental health problems in adolescents. Identifying potential factors associated with adolescent depressive symptoms could be practical and essential for early intervention programs. The association between sleep duration and depressive symptoms in adolescents is inconsistent and needs further exploration. METHODS: A total of 7330 participants aged 10-19 years were included in this study. Sleep duration was categorized into <7 h, 7-8 h, 8-9 h, and ≥ 9 h per day. The Chinese version of the Center for Epidemiology Scale for Depression was used to assess depressive symptoms. Binary logistic regression analysis was performed to evaluate the association between sleep duration and the risk of depressive symptoms. Restrictive cubic spline analyses were conducted to evaluate the dose-response relationship between sleep duration and depressive symptoms. RESULTS: Thirty-four percent of the participants suffered from depressive symptoms. The prevalence of depressive symptoms in adolescents with sleep durations of <7 h, 7-8 h, 8-9 h, and ≥9 h per day was 52.66 %, 37.80 %, 27.55 %, and 20.49 %, respectively. After adjusting for potential covariates, long sleep duration was significantly associated with a decreased risk of depressive symptoms in adolescents. A nonlinear relationship between sleep duration and depressive symptoms was identified. CONCLUSIONS: Long sleep duration is independently associated with a decreased risk of depressive symptoms in Chinese adolescents.