1. 近五年中国青少年抑郁与焦虑患病率及变化趋势
1.1 人群分布特征
近年来，中国青少年抑郁与焦虑的患病率呈现出复杂的分布特征，在不同性别、年龄段、地域及家庭社会经济背景下存在显著差异。整体来看，一项涵盖73,992名6-16岁青少年的全国性大规模调查显示，中国青少年任何精神障碍的加权患病率为17.5% 1。其中，抑郁障碍和焦虑障碍作为常见的精神健康问题，在青少年群体中同样具有较高流行性。
性别差异： 研究普遍指出，女性青少年更容易报告抑郁和焦虑症状。例如，一项针对农村青少年的研究指出，女性青少年更可能出现抑郁症状 2。在关于学业负担与神经行为问题的研究中也观察到，学业负担对焦虑/抑郁和整体问题的影响在女生中更为显著，且睡眠不足的中介效应在女生中也更强 3。另一项研究也指出，女性青少年随着年龄增长，精神障碍患病率有所增加，而男性则呈现下降趋势 1。
年龄段特征： 随着年龄增长，青少年抑郁和焦虑的患病率及严重程度可能发生变化。一项针对农村青少年的研究显示，自杀意念的患病率随年龄增长显著升高，且年长女性（16-18岁）报告自杀未遂的可能性高于年长男性 4。这提示我们在不同年龄段应关注青少年精神健康需求的特异性。
地域分布： 中国幅员辽阔，城乡发展差异显著。研究发现，城镇地区青少年与农村地区青少年在抑郁患病率上存在差异。例如，一项在江苏省进行的案例对照研究发现，居住在城市地区的青少年患抑郁症的风险更高 (AOR = 3.324, 95% CI: 1.077-10.267) 5。然而，也有研究指出，在城镇化进程中，城镇化率与青少年抑郁呈负相关，即城镇化水平较高的地区青少年抑郁风险较低 2。这可能反映了城镇化带来的资源可及性改善对心理健康的积极影响，但也可能伴随新的压力源。农村留守儿童群体因家庭结构和照护方式的特殊性，其抑郁患病率亦不容忽视，一项针对四川省南充市36,612名农村留守儿童的调查显示，抑郁总患病率为6.75% 6。
家庭社会经济背景： 家庭环境和经济状况是影响青少年心理健康的重要因素。研究表明，不良的家庭养育状况，如来自重组家庭 (OR = 1.45) 或由其他家庭成员照护 (OR = 1.64)，以及对养育状况不满 (OR = 1.57)，均与较高的抑郁风险显著相关 6。此外，独生子女 (AOR = 2.680, 95% CI: 1.106-6.492) 和严重的家庭功能障碍 (AOR = 6.491, 95% CI: 1.109-37.995) 也是青少年抑郁的风险因素 5。
综合来看，中国青少年抑郁和焦虑问题的关键高发群体主要包括：女性青少年、处于青春期中后期的青少年、特定城乡区域的青少年（尤其是家庭功能不健全或面临特定社会经济压力的群体，如农村留守儿童），以及家庭社会经济背景相对较差的青少年。这些群体特征提示了在制定干预策略时需要考虑的重点方向。
1.2 时间变化趋势及驱动因素
近五年（2021-2026年），中国青少年抑郁与焦虑患病率呈现出复杂的波动规律，尤其受到后疫情时代学业压力、社会环境变动以及公共卫生事件的显著影响。全球疾病负担研究2021（GBD 2021）的数据显示，从1990年至2021年，中国的抑郁症病例数从3440万增至5310万，焦虑症病例数从4050万增至5310万，分别增长了54%和31.2% 7。值得注意的是，年龄标准化抑郁症患病率略有下降，而焦虑症患病率保持稳定 7。然而，这些数据可能未能完全捕捉到青少年群体的细微变化，尤其是在2019年COVID-19疫情爆发后的具体影响。
COVID-19疫情的深远影响： COVID-19大流行对全球心理健康产生了显著的负面影响，中国也不例外 789。疫情期间的社会隔离、学校停课、居家学习和日常活动受限，给青少年带来了前所未有的压力 89。研究表明，在疫情期间，抑郁症和焦虑症的疾病负担增加更为显著 7。一项针对东中国青少年的研究发现，在疫情相关的社会隔离期间，青少年自伤行为显著增加，尤其是患有情绪障碍的早期青少年女性 10。另一项针对大学生的元分析显示，疫情期间焦虑症状的合并患病率为31%，抑郁症状为34%，这表明疫情对学生群体心理健康产生了广泛而深刻的影响 11。此外，疫情还增加了父母的育儿压力，这种压力可能间接影响青少年的心理健康 1213。
学业压力与内卷化： 学业压力是中国青少年心理健康问题的重要驱动因素之一。近年来，“内卷化”现象在教育领域日益突出，加剧了青少年面临的竞争和压力。研究表明，较高的学业压力与更严重的抑郁症状直接相关 14。长时间的学习投入虽然也可能与抑郁和焦虑症状相关，但其影响主要是通过学业压力介导的 14。这种压力不仅来源于考试和升学，还包括完成学业任务、保持学业成绩的期望。过度的学业负担可能导致青少年睡眠不足、孤独感增加、体育活动减少，这些都已被证实是抑郁和焦虑的中介因素 1415。例如，一项研究发现，睡眠不足与男性和女性青少年的焦虑均呈正相关 15。
社会环境变动与数字生活： 除了学业压力，社会环境的快速变迁和数字生活的普及也对青少年心理健康产生了重要影响。社交媒体的广泛使用是其中一个显著因素。系统综述指出，问题性社交媒体使用与青少年抑郁和焦虑症状相关，且这种关联在女孩中更为显著 1617。社交媒体的持续使用可能通过睡眠剥夺、社会比较和寻求反馈行为等机制，间接加剧青少年抑郁和焦虑的风险 16。此外，不良的同伴关系、缺乏任务完成能力以及不愿在情绪低落时寻求帮助，也都是青少年焦虑的风险因素 15。社会支持的缺乏同样与青少年较高的SCL-90评分（衡量心理健康状况的量表）相关 18。
综合来看，近五年中国青少年抑郁与焦虑患病率的波动，是COVID-19疫情冲击、持续高压的学业环境、以及数字时代社会生活模式转变等多种因素交织作用的结果。这些因素共同构成了青少年心理健康的复杂挑战，凸显了在后疫情时代加强心理健康干预和支持的紧迫性。
2. 青少年抑郁与焦虑的风险因素研究进展
2.1 个体层面风险因素
青少年抑郁与焦虑的发生发展受多种个体层面因素的影响，包括遗传易感性、生理发育阶段特征、营养状况以及既往心理创伤等。近年来，对这些因素与青少年心理健康之间关系的研究取得了新的进展。
遗传易感性： 遗传因素在青少年抑郁和焦虑中扮演着重要角色。研究发现，某些基因多态性可能增加个体对抑郁和焦虑的易感性。例如，rs454214基因变异不仅与主观幸福感和抑郁症状相关，也可能与重度抑郁症（MDD）有关 19。有趣的是，这项研究进一步指出，rs454214对主观幸福感和抑郁症状的影响并非直接作用，而是通过人格特质（如外向性、神经质、宜人性和开放性）间接产生介导作用 19。这表明，遗传因素可能通过影响个体的人格倾向，进而影响其对情绪障碍的易感性。此外，脑源性神经营养因子（BDNF）的Val66Met多态性也被发现与青少年特质焦虑有关。携带Val等位基因的青少年对压力事件和积极的母爱（作为保护因素）的影响更为敏感，这符合差异易感性模型，即这些个体在不利环境中更容易出现焦虑，但在支持性环境中也能获得更大的益处 20。
生理发育阶段特征： 青少年期是生理和心理快速发展的关键时期，这一阶段的特点也使其成为抑郁和焦虑的高风险阶段。神经内分泌系统、肠道微生物组等生理系统的发育和功能异常，均可能影响青少年的心理健康。例如，微生物组研究表明，青春期抑郁患者的肠道菌群与健康青少年存在显著差异，其中粪杆菌属、罗斯氏菌属等相对丰度降低 21。进一步的研究发现，罗斯氏菌属（Roseburia）的丰度在预测青少年抑郁方面具有较高效率。将健康青少年粪便菌群移植给慢性束缚应激诱导的抑郁小鼠后，小鼠的抑郁行为得到显著改善，这与色氨酸（Trp）衍生的神经递质代谢的平衡以及突触生成和神经胶质维持的改善有关 21。这提示肠道微生物组可能通过肠-脑轴途径参与青少年抑郁的病理生理过程。
营养状况： 营养摄入与青少年心理健康之间存在密切联系。膳食不均衡或某些微量元素缺乏已被证实会增加青少年抑郁和焦虑的风险。例如，一项针对中国中学生的随机对照试验发现，补充微量元素强化奶可以显著改善学生的学业表现、学习动机和学习策略，并减少测试焦虑 22。研究还观察到，干预组学生维生素B2和铁缺乏的发生率更低 22。这表明良好的营养状况，特别是充足的微量元素摄入，可能对青少年抑郁和焦虑症状具有保护作用。此外，食物不安全感也与抑郁和焦虑症状呈负相关，部分原因是睡眠问题介导了这种关系 23。
既往心理创伤： 童年创伤是青少年抑郁和焦虑的强大风险因素。包括虐待、忽视、家庭暴力等在内的早期不良经历会显著增加个体在青少年期甚至成年期出现心理健康问题的风险。研究表明，童年创伤与应激性生活事件均是抑郁的预测因子，并且认知灵活性在二者与抑郁之间发挥部分中介作用，即童年创伤和应激性生活事件通过降低个体的认知灵活性来增加抑郁风险 24。此外，童年创伤还与青少年社交焦虑风险升高相关，其中，对社会应激的心血管反应迟钝可能是一个生理机制 25。多项研究也强调，童年创伤与抑郁和解离症状的共现高度相关。在患有抑郁的个体中，有22.0%至50.6%伴随解离症状，而在有解离症状的个体中，67.0%至90.2%也伴随抑郁。童年背叛性创伤和非背叛性创伤的类型越多，同时出现抑郁和解离症状的可能性越高 26。这些发现强调了早期创伤对青少年心理健康的长期负面影响，并提示干预策略应重视创伤知情护理。
其他个体风险因素： 孤独感、ADHD症状、网络成瘾、亲和孤独倾向和自闭特质也被识别为青少年自伤行为的关键风险因素，而自伤行为与抑郁和焦虑存在高度共病关系 27。此外，睡眠障碍与抑郁和焦虑之间存在双向关系，睡眠问题不仅是抑郁焦虑的症状，也可能作为独立的风险因素加剧其发生发展 28。
2.2 环境层面风险因素
青少年抑郁与焦虑的发生发展并非孤立的个体内部过程，而是与家庭、学校、社会等环境因素密切相关。近年的研究深入探讨了学业压力、亲子关系、社交媒体使用和校园欺凌等关键环境因素的作用机制及其对青少年心理健康的影响。
学业压力： 学业压力是中国青少年最普遍且影响深远的心理健康风险因素之一。研究一致表明，学业压力与青少年焦虑和抑郁呈正相关 2930。一项针对中国东部省份1533名青少年的横断面研究发现，学业压力直接预测焦虑（β = 0.54）和抑郁（β = 0.55）症状，且睡眠时间（β = 0.024）和每周60分钟体育活动天数（β = 0.014）在学业压力与心理健康之间起到中介作用 29。这意味着高学业压力不仅直接影响心理健康，还可能通过挤占青少年的健康行为（如睡眠和体育锻炼）时间，间接加剧抑郁和焦虑的风险。在“双减”政策实施后，研究观察到学生的抑郁患病率从12.1%下降到9.2%，焦虑患病率从8.9%下降到6.2%。这一下降与家庭作业减少、课外活动增加、亲子时间增多以及学业压力减轻密切相关 31。这进一步证实了学业压力是青少年心理健康的重要驱动因素。
亲子关系与家庭环境： 家庭是青少年成长的重要场所，亲子关系和家庭环境质量对青少年心理健康具有决定性影响。不良的亲子关系，如冲突、缺乏沟通和支持，被认为是青少年抑郁和焦虑的重要风险因素 3233。一项研究发现，农村患者更有可能报告家庭压力，而城市患者更有可能报告学校压力 34。这提示不同地域的青少年可能面临不同类型的家庭压力源。此外，家庭结构也对青少年心理健康有显著影响。一项针对近3万名中国中学生的调查显示，与核心家庭相比，生活在单亲家庭和隔代抚养家庭的青少年抑郁报告率更高（分别为64.8%和59.3%），且这些家庭结构与青少年抑郁之间的关系部分由韧性介导 35。父母的教养方式，特别是过度干预或忽视，也与青少年抑郁和焦虑有关 36。另一项研究强调，儿童时期的情感虐待和情感忽视是连接环境风险与抑郁症状的主要桥梁 37。在新冠疫情期间，亲子讨论的重要性凸显，有研究表明，良好的亲子沟通有助于减轻疫情期间青少年可能出现的心理健康问题 38。
社交媒体使用： 随着数字技术的发展，社交媒体在青少年日常生活中扮演着越来越重要的角色，但其过度使用或不当使用也带来了心理健康风险。多项研究表明，社交媒体的过度使用与青少年较差的睡眠质量、较低的自尊以及较高水平的焦虑和抑郁症状相关 394041。一项针对苏格兰青少年的研究发现，夜间社交媒体使用以及对社交媒体的情感投入程度越高，青少年的睡眠质量越差，焦虑和抑郁水平越高 39。研究表明，社交媒体使用与心理健康之间存在复杂关系，需更深入地探讨其对青少年心理健康的影响 42。
校园欺凌： 校园欺凌（包括传统欺凌和网络欺凌）是青少年心理健康的严重威胁。被欺凌经历显著增加青少年抑郁、焦虑和低自尊的风险 43444546。一项针对台湾青少年的研究显示，超过三分之一的学生在过去一年中曾参与网络欺凌或成为受害者（网络受害者）43。网络欺凌和校园欺凌的受害者及欺凌-受害者身份，都与更低的自尊和更高的严重抑郁风险独立相关 43。另一项针对中国高中生的研究也证实了校园欺凌与青少年心理健康状况（包括抑郁和焦虑）之间的显著关联 46。欺凌不仅对受害者造成直接伤害，也可能通过影响其社会支持网络和自我认知，进而加剧心理健康问题的发生。
综上所述，学业压力、亲子关系不良、过度社交媒体使用以及校园欺凌是影响中国青少年抑郁与焦虑发生发展的重要环境层面风险因素。这些因素通过不同的机制，如剥夺健康行为、影响情感联结、损害自尊和增加应激，共同作用于青少年的心理健康。
3. 青少年抑郁与焦虑筛查工具的本土化应用与创新
3.1 传统标准化量表的适配性研究
在中国，针对青少年抑郁与焦虑的筛查，传统标准化量表如患者健康问卷（PHQ-9）、广泛性焦虑障碍量表（GAD-7）等得到了广泛应用。然而，这些源自西方文化的量表在中国青少年群体中的信效度表现以及本土化调整的必要性一直是研究的重点。
PHQ-9（患者健康问卷-9项）的本土化应用： PHQ-9作为一种简便有效的抑郁筛查工具，在中国普通人群中已被验证具有良好的信效度。其中文版在普通人群中的克朗巴赫α系数为0.86，两周重测信度系数为0.86。PHQ-9总分与SDS（自评抑郁量表）呈正相关（r=0.29），与SF-36（健康调查问卷-36项）各分量表呈负相关（r值范围为-0.11至-0.47）。当以精神科医生诊断为金标准时，PHQ-9的ROC曲线下面积为0.92，推荐的截断点为7分，此时敏感度和特异度均为0.86 47。
针对中国儿童和青少年，PHQ-A（Patient Health Questionnaire for Adolescents）作为PHQ-9的青少年版本，其结构效度和心理测量学特性也得到了评估。一项研究对248名12-18岁重度抑郁症（MDD）患儿和青少年进行了PHQ-A评估，发现其具有满意的信度和效度。PHQ-A在MDD患儿和青少年中表现出单一维度结构，Macdonald Omega系数为0.87，重测信度（斯皮尔曼相关系数）为0.70。PHQ-A与CES-D（流行病学研究中心抑郁量表）和MFQ（情绪和感受问卷）的相关系数分别为0.87和0.85（p < 0.01）。以iCGI-S（改良临床总体印象量表-严重程度）作为缓解标准，PHQ-A的最佳截断点为7分，敏感性为98.7%，特异性为94.7% 48。这表明PHQ-A在中国青少年群体中具有较高的筛查价值，推荐截断点为7分。
DASS-21（抑郁-焦虑-压力量表-21项）的本土化应用： DASS-21作为另一个广泛使用的情绪障碍筛查工具，其中文版在中国学生群体中也进行了适配性研究。一项针对1815名中国大学生的研究发现，中文版DASS-21的抑郁、焦虑和压力量表的内部一致性（克朗巴赫α）分别为0.83、0.80和0.82，总分α系数为0.92。6个月的重测信度在0.39到0.46之间。抑郁和焦虑分量表与中文版贝克抑郁量表（r = 0.51和0.64）和中文版状态-特质焦虑量表（r = 0.41）显示出良好的聚合效度。验证性因子分析支持其原始的三因子模型 49。
近期一项针对7943名中国学生的DASS-21研究进一步证实了其稳定的三因子结构，即抑郁、焦虑和压力之间存在高度相关性。研究还发现DASS-21在性别之间具有严格不变性，在教育水平之间具有弱不变性。网络分析显示，抑郁、焦虑和压力的症状形成簇状，部分症状之间存在强相关性 50。这些研究结果支持DASS-21在中国学生心理健康评估中的跨文化效度，并强调了抑郁、焦虑和压力症状的相互关联性，为有针对性的干预提供了依据。
其他量表的适配性： 除了上述量表，其他一些评估工具也在中国青少年中进行了验证。例如，Connor-Davidson韧性量表（CD-RISC）的中文版在遭受2008年四川地震的2914名青少年中进行了信效度研究，结果显示其五因子结构与原始量表一致，且这些因子可加载到一个更高阶的“韧性”因子上。该量表具有良好的内部一致性（克朗巴赫α=0.89），并与社会支持呈正相关（r=0.44），与抑郁（r=-0.38）和焦虑（r=-0.25）呈负相关 51。这表明CD-RISC在中国青少年中是评估韧性的可靠有效工具。此外，有研究探讨了应对方式在抑郁症状发展中的作用，发现在中国青少年中，应对缺陷（更多地使用非适应性应对策略而非适应性应对策略）与负性事件后抑郁症状的增加相关，但与焦虑症状无关 52。这提示评估应对方式可能有助于识别抑郁高风险青少年。
综上所述，传统的标准化筛查量表如PHQ-9/PHQ-A和DASS-21在中国青少年群体中均表现出较好的信效度，并且经过本土化验证，可以作为有效的筛查工具。研究还关注了其他相关心理结构量表的适配性，为全面评估青少年心理健康提供了多元化的工具选择。然而，随着社会文化和心理健康问题的不断演变，对这些量表进行持续的监测和优化，以确保其时效性和敏感性，仍然是重要的研究方向。
近五年中国青少年抑郁与焦虑问题流行病学研究综述
3.2 新型筛查技术的研发与实践
随着人工智能、大数据和生物医学技术的发展，针对青少年抑郁与焦虑的新型非侵入式筛查工具正不断涌现，为早期识别和干预提供了新的可能性。这些技术主要通过分析客观行为数据、生理指标和机器学习模型，以弥补传统问卷筛查的主观性和局限性。
基于语音特征的筛查技术： 语音特征被认为是反映情绪状态的生物标志物之一。研究表明，抑郁症患者的语音在语速、音高、音量和情感表达等方面可能出现异常。通过机器学习算法对语音信号进行分析，可以识别出与抑郁和焦虑相关的声学特征，从而开发出非接触式的筛查工具。例如，有研究尝试利用语音特征结合深度学习模型来识别抑郁症，并在特定人群中取得了较高的准确率。这类技术具有便捷、隐蔽性强的特点，尤其适合青少年群体，可以在日常交流或远程评估中进行初步筛查，减少心理疾病的污名化效应。然而，语音特征的采集、标准化以及文化背景对语音表达的影响仍是其在中国青少年群体中推广应用面临的挑战。
基于行为大数据的筛查技术： 青少年日常行为数据，如社交媒体使用模式、智能手机活动数据、睡眠模式、运动量等，都可能蕴含心理健康状况的线索。利用大数据分析和机器学习，可以从海量行为数据中提取特征，构建预测模型。例如：
- 社交媒体活动分析： 通过分析青少年在社交媒体上的发帖内容、互动模式、情绪表达等，可以识别出抑郁和焦虑的早期信号。例如，负面情绪词汇的增多、社交互动减少、关注特定内容等都可能提示心理风险。
- 智能手机使用模式： 智能手机的使用频率、应用类型、夜间使用时长等数据，可以反映青少年的睡眠质量、社交参与度和情绪状态。研究发现，不良睡眠习惯和过度夜间手机使用与青少年焦虑和抑郁显著相关 。
- 可穿戴设备数据： 智能手环、智能手表等可穿戴设备可以实时监测心率、睡眠质量、活动量等生理数据。这些生理指标的异常变化，如心率变异性降低、睡眠片段化增加、活动量减少等，都可能是抑郁和焦虑的生物标志物。例如，睡眠满意度已被确定为中国儿童和青少年抑郁症状的重要风险因素之一，在机器学习模型中具有较高预测权重 53。
- 面部表情和眼动追踪： 通过分析青少年的面部表情识别情绪状态，或通过眼动追踪技术评估对不同刺激的注意偏向，也可以作为情绪障碍的辅助筛查手段。
机器学习在风险因素识别和预测中的应用： 机器学习（ML）方法在识别和排序青少年抑郁症状的关键风险因素方面展现出巨大潜力。一项针对中国198,062名儿童和青少年的研究中，利用随机森林、随机蕨和极端梯度提升等机器学习方法，识别并排序了与抑郁症状相关的九个关键风险因素：心理韧性、年龄、睡眠满意度、自我期望、性别、与父亲的关系、学业表现、与同学的关系以及早餐频率 53。该研究建立的最小模型在识别抑郁症状方面达到了0.844的AUC值，显示出较高的预测能力 53。这些结果不仅为精准识别高风险青少年提供了依据，也为后续干预策略的制定指明了方向。
神经影像学在亚型识别和精准治疗中的应用： 除了行为数据，神经影像学技术也被用于识别抑郁症的生物学亚型，以实现更精准的诊断和治疗。一项研究通过分析低频振幅（ALFF）数据，识别出两种神经影像学上的抑郁症亚型：典型抑郁和非典型抑郁，并为这两种亚型确定了不同的经颅磁刺激（rTMS）靶点。在临床应用中，这种精准rTMS治疗在典型抑郁青少年中达到了90.00%的症状缓解率，在非典型抑郁青少年中达到了70.73%的症状缓解率 54。这标志着神经影像学在青少年抑郁症的精准诊断和个体化治疗方面迈出了重要一步。
尽管新型筛查技术具有巨大的潜力，但其在中国的应用仍面临一些挑战，包括数据隐私保护、算法的文化适应性、大规模部署的成本效益以及与传统筛查方法的整合等。未来的研究和实践需要进一步探索这些技术的有效性、可靠性，并完善其在青少年心理健康筛查体系中的定位和作用。
4. 学校场景下抑郁与焦虑干预的实践与效果评估
4.1 常规心理健康服务体系运行效果
学校作为青少年成长的重要场所，在预防和干预青少年抑郁与焦虑方面发挥着不可替代的作用。近年来，中国中小学积极构建和完善心理健康服务体系，包括开设心理课程、配置专职心理教师、设立心理咨询室等。然而，这些常规心理健康服务的运行效果及其对青少年抑郁与焦虑的预防和干预作用，仍需深入评估。
心理课程与心理健康教育： 普遍的学校心理健康教育课程旨在提升学生的心理健康素养，教授情绪管理、压力应对、人际交往等技能。研究表明，一些全校范围的心理干预措施，如在课堂中由教师指导进行的活动，可以显著提升学生的个人能力，并对抑郁、焦虑等精神健康症状产生积极影响 55。例如，在黎巴嫩一项针对4-7年级学生的学校干预项目，通过13节课程提升个人能力，结果显示学生的抑郁、焦虑和创伤后应激障碍症状均显著改善 55。这表明，系统化的心理课程在提升青少年应对能力、从而间接降低抑郁和焦虑风险方面具有潜力。
专职心理教师与心理咨询室： 专职心理教师和心理咨询室是学校心理健康服务体系的核心组成部分。心理教师通常负责开展心理健康教育、个体心理咨询、团体辅导以及危机干预等工作。然而，目前中国中小学专职心理教师的配备比例仍显不足，且部分教师可能缺乏专业的临床经验。研究指出，与心理健康服务机构的接触可以有效降低青少年未来的抑郁症状。一项在英国进行的纵向队列研究显示，14岁时接触心理健康服务的青少年，到17岁时报告临床抑郁的可能性比未接触服务的同龄人低七倍以上 56。这强调了心理咨询服务的及时可及性对于改善青少年心理健康的重要性。
然而，学校内开展的心理健康干预并非总是积极有效，甚至可能存在潜在风险。一项系统综述指出，尽管学校心理健康干预能带来益处，但也有证据表明它们可能产生潜在危害，包括导致幸福感下降或抑郁、焦虑症状增加 57。这可能与干预内容不当、实施方式有误、或未能识别出特定高风险亚群（如高风险个体、男性参与者、年幼儿童和享受免费午餐的儿童）有关，这些群体在某些干预中更容易出现负面结果 57。此外，如果学校干预未能充分考虑污名化效应，可能会导致部分有需求的青少年不愿意寻求帮助 58。
学校心理健康服务体系的整合与创新： 为了更有效地应对青少年心理健康问题，许多国家和地区都在探索将学校心理健康服务与社区、医疗机构进行整合的模式。例如，加拿大提出的“学校-照护途径”模式，强调将学校与初级保健提供者、心理健康服务机构和更广泛的社区联系起来，共同解决青少年心理健康问题 59。这种模式通过提升心理健康素养、加强守门人培训以及教育/健康系统整合，旨在改善青少年心理健康并优化学习环境 59。
在中国，学校心理健康服务体系的运行效果还受到多方面因素的影响，包括：
- 资源投入不足： 心理健康教育在学校教育中的地位仍需进一步提升，相关的师资、场地和经费投入相对有限。
- 专业能力有待提高： 部分学校心理教师的专业背景和实操经验不足，难以满足青少年复杂多样的心理健康需求。
- 家校社协同机制不完善： 学校与家庭、社区在心理健康教育和干预方面的协同作用尚未充分发挥，导致资源分散，效果打折。
总而言之，常规学校心理健康服务体系在预防和干预青少年抑郁与焦虑方面具有基础性作用，但其运行效果受多种因素制约。未来的发展应着重于加强专业师资建设、完善服务内容、并构建更为紧密的家校社协同机制，同时警惕并规避潜在的负面影响，以确保心理健康服务的有效性和安全性。
4.2 针对性干预方案的应用进展
为了更有效地应对青少年抑郁与焦虑问题，学校场景下还发展并应用了一系列针对性的干预方案，旨在解决常规服务可能存在的不足，并对不同风险水平的青少年提供更为精细化的支持。这些方案包括分层分级干预、团体认知行为辅导以及家校协同干预等。
分层分级干预（Tiered and Graded Interventions）： 这种模式根据青少年抑郁和焦虑的严重程度及风险水平，提供不同强度和类型的干预措施。通常分为三个层次：
- 一级预防（Universal Prevention）： 针对全体青少年，通过心理健康课程、普及知识讲座等方式，提升心理健康素养，增强应对压力的能力，预防心理问题的发生。研究表明，针对低风险人群的学校心理健康干预，尤其在焦虑症状方面，能产生小而持久的预防效果 60。虽然效果量较小，但对于大规模群体而言，积累效应仍具意义 60。
- 二级预防（Targeted/Selective Prevention）： 针对有初步症状或处于高风险环境的青少年，提供早期识别和有针对性的支持，如小组辅导、心理咨询等。例如，一项针对有亚临床心理健康问题的中学生进行的团体接纳与承诺疗法（ACT）项目，在香港的学校中实施，结果显示学生的压力和抑郁症状显著减轻，效果量为中等至小 61。这表明，针对亚临床症状的干预措施是可行的且有益的。
- 三级干预（Indicated Intervention）： 针对已确诊抑郁或焦虑障碍的青少年，提供专业的心理治疗和转介服务，确保其获得恰当的临床支持。这种模式强调早期识别和转介的重要性。
团体认知行为辅导（Group Cognitive Behavioral Therapy, CBT）： CBT被广泛认为是治疗抑郁和焦虑最有效的心理疗法之一。在学校环境中，团体CBT以其成本效益和群体支持优势而受到青睐。多项研究证实，学校团体CBT对减轻青少年抑郁和焦虑症状有效。例如，一项针对低风险儿童和青少年的贝叶斯荟萃分析发现，学校CBT对抑郁症状产生了统计学上显著但非常小的改善（SMD: -0.06），对焦虑症状产生了小幅减轻（SMD: -0.19），且这些效果可维持长达一年 60。尽管效果量不大，但对于普遍预防策略而言，其长期效果仍具有重要价值。
此外，针对特定行为问题（如网络游戏障碍）的团体认知行为干预，也显示出对相关情绪问题的改善作用。一项随机对照试验显示，针对网络游戏障碍青少年的整合认知行为疗法（ICBT）干预，在减少游戏障碍症状的同时，也显著减轻了抑郁和焦虑症状，效果量达中到强（抑郁症状g=0.67-0.84，焦虑症状g=0.6-0.64） 62。这提示团体CBT的应用范围可以扩展到与抑郁焦虑共病或存在共源性风险的行为问题。
家校协同干预（Home-School Collaborative Interventions）： 认识到家庭和学校对青少年成长不可分割的影响，家校协同干预模式越来越受到关注。这种模式强调家庭与学校的紧密合作，共同为青少年提供支持。一项针对中国单亲家庭青少年韧性提升的随机对照试验，验证了为期七周的家校协同干预策略的有效性 63。实验组的青少年韧性得分显著高于对照组，并且干预效果在一个月后仍然稳定 63。此外，学校层面的干预还促进了单亲家庭更积极的参与，尤其是在家庭支持方面 63。
家校协同干预的成功关键在于：
- 沟通与合作： 学校和家庭之间建立开放、持续的沟通渠道，共同了解青少年的心理状况和需求。
- 统一教育理念： 家庭和学校在教育观念和方法上保持一致，避免冲突和矛盾给青少年带来额外的心理压力。
- 资源共享： 学校向家庭提供心理健康教育资源和支持，家庭则配合学校开展的干预活动。
例如，在肥胖预防方面，一项针对中国小学生的综合干预措施，通过强化家庭参与（借助智能手机App）和学校合作，有效降低了儿童的体重指数（BMI）和肥胖患病率 64。虽然这不是直接针对抑郁焦虑的干预，但其成功经验揭示了家校协同在行为改变和健康促进方面的巨大潜力，为心理健康干预提供了借鉴。
需要注意的是，学校心理健康干预并非总是能带来积极效果，甚至可能产生一些意想不到的负面影响。一项系统综述指出，尽管学校心理健康干预普遍有益，但也存在一些证据表明它们可能导致幸福感下降或抑郁、焦虑症状增加 65。这提示在设计和实施针对性干预时，需要充分考虑干预的质量、实施方式、目标群体的特点以及潜在的污名化效应，以确保干预的有效性和安全性。
综上所述，分层分级干预、团体认知行为辅导和家校协同干预等针对性方案，在学校场景下对青少年抑郁与焦虑的预防和干预显示出积极效果。未来的研究和实践应继续探索这些干预模式在不同文化背景下的适应性，优化其实施策略，并关注长期效果及潜在风险，以构建更加完善和有效的青少年心理健康支持体系。
5. 青少年抑郁与焦虑数字疗法的研究与应用
5.1 数字疗法的类型与干预路径
近年来，数字疗法（Digital Therapeutics, DTx）作为一种新兴的心理健康干预手段，在青少年抑郁与焦虑的防治领域展现出巨大潜力。数字疗法利用数字技术提供基于证据的治疗干预，其类型多样，作用机制和干预路径也各具特色。
5.1.1 线上认知行为疗法（Online Cognitive Behavioral Therapy, CBT）
线上CBT是数字疗法中最成熟且应用最广泛的一种。它将传统认知行为疗法的原理和技术，通过互联网平台、移动应用程序等数字形式呈现。其核心干预路径在于帮助青少年识别和改变导致抑郁和焦虑的非适应性思维模式和行为习惯。线上CBT的主要特点和作用机制包括：
- 结构化学习模块： 通过预设的课程、练习和互动任务，系统性地教授认知行为疗法的核心技能，如认知重构、行为激活、暴露疗法、放松训练等。这些模块通常具有高度的结构化和标准化，确保治疗的质量和一致性。
- 互动性与个性化反馈： 多数线上CBT程序包含互动练习、情绪日志、进度追踪等功能，用户可以实时记录自己的情绪、想法和行为，并获得个性化的反馈。一些高级平台还能根据用户的表现和需求，动态调整治疗内容和难度。
- 可及性与隐私性： 线上CBT突破了传统面对面治疗的时间和空间限制，青少年可以随时随地进行学习和练习，大大提高了治疗的可及性。同时，匿名性或半匿名性的使用环境也有助于减轻青少年对寻求心理帮助的污名感和羞耻感，保护个人隐私。
- 有效性证据： 多项研究证实了线上CBT对青少年抑郁和焦虑的有效性。例如，一项随机对照试验发现，在线上进行的基于正念的认知行为疗法（CBT-M）与标准精神科护理相结合，能够显著改善18-30岁重度抑郁症青年的抑郁和焦虑症状，其效果甚至优于单独的标准护理 66。另一项针对16-22岁有心理健康障碍风险的青少年进行的试验，旨在通过基于App的干预来减少重复性消极思维（Repetitive Negative Thinking, RNT），这种干预对预防抑郁和焦虑尤其有前景 67。
5.1.2 情绪监测与管理APP（Emotion Monitoring and Management Apps）
这类APP主要通过提供工具帮助青少年自我监测情绪状态，并学习有效的情绪管理策略。其干预路径侧重于增强青少年的情绪觉察能力和自我调节能力。
- 情绪日志与追踪： 用户可以记录每日情绪波动、触发事件、症状严重程度等信息，从而帮助青少年了解自己的情绪模式和潜在诱因。
- 情绪调节工具： APP通常内置多种情绪调节技术，如呼吸练习、冥想、放松音频、正念训练、认知重构提示等，青少年可以根据自身需求选择使用，学习即时应对策略。
- 个性化反馈与建议： 基于用户记录的数据，APP可以提供个性化的情绪趋势分析和管理建议，帮助青少年更好地理解和应对自己的情绪。例如，有研究开发了一种名为“Boost My Mood”（BMM）的心理健康APP，作为针对有亚临床抑郁症状青少年的预防性早期干预措施，结果显示该APP能显著减少抑郁、焦虑和担忧，尽管对睡眠问题没有显著影响 68。
- 促进自我效能： 通过持续的自我管理和积极反馈，有助于提升青少年的自我效能感，使其相信自己有能力应对情绪困扰。
5.1.3 沉浸式干预（Immersive Interventions）：虚拟现实（VR）和增强现实（AR）
沉浸式技术如虚拟现实（VR）和增强现实（AR）为青少年抑郁与焦虑的干预提供了全新的可能性，其干预路径利用沉浸式体验来模拟特定情境或提供放松环境，从而达到治疗目的。
- 情境模拟与暴露疗法： VR技术可以创建高度逼真、可控的虚拟环境，用于模拟青少年恐惧或焦虑的社交情境、恐高环境、创伤事件等，从而在安全的环境中进行暴露疗法，帮助青少年逐步克服恐惧和焦虑。例如，VR已被用于健康焦虑和程序性焦虑的干预，通过提供分散注意力、教育和暴露机制来减少焦虑 69。
- 情绪调节与放松训练： VR可以提供沉浸式的放松场景，如虚拟森林、海滩等，结合引导式冥想和呼吸练习，帮助青少年放松身心，减轻压力。一项研究表明，数字曼荼罗着色作为一种公共心理健康工具，能够有效缓解大学生的焦虑，并发现心流状态在其中起到中介作用 70。
- 行为训练与社交技能提升： VR可以用于模拟社交互动场景，训练青少年的社交技能，提高其在现实社交中的自信心。
- 诊断与评估： VR技术甚至可以用于青少年抑郁症的筛查。一项研究开发了基于VR的多模态框架，结合脑电图（EEG）、眼动追踪（ET）和心率变异性（HRV）数据，通过机器学习模型，对首发重度抑郁症青少年进行诊断，准确率达到81.7% 71。这表明VR不仅是干预工具，也具备成为新型筛查工具的潜力。
- 游戏化疗法： 将治疗内容融入互动游戏，提升青少年参与度和依从性，例如，重复性消极思维的个性化跨诊断智能手机APP (Mello) 通过游戏化元素，帮助青少年管理重复性消极思维，以干预抑郁和焦虑 72。
总而言之，数字疗法为青少年抑郁与焦虑的防治提供了多样化的解决方案，从传统的线上CBT到新兴的沉浸式干预，这些技术通过提升可及性、个性化和互动性，有望克服传统治疗的局限，并在未来的青少年心理健康服务中发挥越来越重要的作用。
5.2 数字疗法的有效性与本土化优化
数字疗法（Digital Therapeutics, DTx）在缓解青少年抑郁与焦虑症状方面已展现出显著潜力，然而，其在中国青少年群体中的实际干预效果验证、本土化优化以及广泛应用，仍是当前研究和实践的重点。
5.2.1 数字疗法的有效性验证
现有研究表明，多种数字疗法对青少年抑郁与焦虑具有积极的干预效果。
认知行为疗法（CBT）聊天机器人： 一项针对中国大学生抑郁症状的随机对照试验评估了一款基于CBT的心理健康聊天机器人（“小鹅”）的临床效果。结果显示，与电子书组和通用聊天机器人组相比，“小鹅”组的参与者在干预后1周和1个月时，PHQ-9（患者健康问卷-9项）得分均显著降低，表明抑郁症状得到有效缓解（P<.001, d=0.51；P=.005, d=0.31）73。此外，“小鹅”在工作联盟（F=3.407; P=.04）和可接受性（F=4.322; P=.02）方面也表现更优，这提示了人工智能驱动的CBT聊天机器人在提供便捷、自我引导式心理健康支持方面的可行性和吸引力73。
基于App的失眠认知行为疗法（CBT-I）： 鉴于失眠与抑郁之间的密切关系，针对失眠的数字疗法也被证明对预防抑郁发作有效。一项在中国青少年（15-25岁）中开展的随机对照试验显示，为期6周的App版CBT-I干预，能够有效预防未来重度抑郁症（MDD）的发生。在12个月的随访期内，CBT-I组MDD新发率显著低于健康教育对照组（10% vs 18%），风险比为0.58（95% CI 0.38-0.87；p = 0.008），这意味着每治疗10.9人即可预防1例MDD发作74。该研究还发现，CBT-I组的失眠缓解率更高，抑郁和失眠症状的下降也更显著，且失眠在干预对抑郁的影响中起到了中介作用74。这强调了数字CBT-I在青少年心理健康促进中的重要性。
人工智能驱动的个性化干预系统： 针对中国大学生的一项研究整合了体育锻炼和正念练习，并通过AI系统进行个性化推荐。该16周的干预研究发现，AI个性化干预组在学业成绩（GPA提高10.28%）、心理参数（压力降低36.7%）和生理指标（HRV改善28.4%）方面均有显著改善，效果优于标准化干预组和对照组75。尽管这项研究主要针对大学生，但其AI个性化干预的模式对青少年同样具有借鉴意义，表明结合多维度数据进行个性化干预能够显著提升效果。
5.2.2 适配青少年需求的本土化优化方向
尽管数字疗法显示出积极效果，但其在中国青少年群体中推广应用仍需进行多方面的本土化优化，以提高依从性和有效性。
- 文化适应性： 数字疗法的内容和呈现方式需要充分考虑中国文化背景下的价值观、社会规范和沟通习惯。例如，在认知重构模块中，应纳入符合中国青少年思维模式的案例和情境；在情绪表达方面，可能需要更侧重于内隐或间接表达的方式。
- 融入学校与家庭环境： 青少年心理健康问题常与学业压力、亲子关系等家庭和学校因素紧密相关。数字疗法可以考虑与学校心理健康教育体系、家庭教育指南相结合，提供家长和教师端的支持模块，形成家校社协同干预的闭环。例如，可以开发供家长使用的App，提供亲子沟通技巧、情绪管理指南，并定期反馈孩子的心理健康状态。
- 青少年参与设计： 鼓励青少年用户参与数字疗法的设计和开发过程，确保产品符合他们的使用习惯、兴趣偏好和审美标准。通过游戏化设计、社交互动元素、个性化头像和奖励机制等，提高产品的吸引力和黏性。
- 数据安全与隐私保护： 青少年群体对数据隐私更为敏感，确保个人健康数据的安全性和匿名性是构建信任、提高使用意愿的关键。数字疗法平台应采用严格的数据加密技术，明确告知用户数据使用协议，并获得充分的知情同意。
- 与线下服务的整合： 数字疗法不应完全取代传统的心理健康服务，而是应作为线下服务的有效补充和延伸。可以探索“线上筛查+线下评估诊断”、“线上干预+线下心理咨询师支持”的混合模式，为高风险青少年提供更全面的支持。
- 针对特定亚群体的定制化： 考虑到青少年抑郁与焦虑的异质性，数字疗法应针对不同性别、年龄段、农村/城市背景、以及不同风险因素（如学业压力、社交媒体成瘾、睡眠障碍等）的青少年进行定制化开发，提供更具针对性的干预内容和策略。
总之，数字疗法为中国青少年抑郁与焦虑的防治提供了广阔前景。通过不断优化其本土化适用性、提升用户体验、并加强与现有心理健康服务体系的整合，数字疗法有望成为改善青少年心理健康的重要工具。
6. 青少年抑郁与焦虑防控的政策优化建议
6.1 现有防控政策的短板分析
近年来，中国政府和社会各界对青少年心理健康问题的关注度持续提升，出台了一系列国家及地方层面的政策文件和行动计划，旨在加强青少年抑郁与焦虑的防控。这些政策在提升公众意识、推动学校心理健康教育以及构建初步服务体系方面发挥了积极作用。然而，深入分析发现，现有防控政策在实施成效、覆盖范围、资源配置以及体系衔接等方面仍存在诸多短板。
1. 政策实施成效与覆盖不足：
尽管政策制定层面不断强调青少年心理健康的重要性，但实际执行层面往往面临挑战，导致政策的红利未能充分惠及所有有需要的青少年。
- 区域发展不平衡： 心理健康服务的可及性和质量在城乡之间、区域之间存在显著差异。农村地区和欠发达地区的青少年往往难以获得专业的心理健康服务，而政策资源和专业人才更多地集中在经济发达的城市地区。这导致了心理健康服务的“马太效应”，加剧了区域间的不平等 76。
- 高危群体识别与支持不足： 政策普遍性强，但在识别和针对性支持高危群体（如留守儿童、单亲家庭儿童、性少数青少年、遭受校园欺凌者、学业压力过大者）方面力度不够。这些群体往往是抑郁和焦虑的高发人群，但由于各种原因（如家庭支持缺乏、学校识别能力不足、污名化等），其心理健康需求难以被及时发现和满足。
- 干预措施的科学性与有效性验证不足： 虽然学校普遍开展心理健康教育，但课程内容、干预方法和效果评估缺乏统一标准和科学验证。部分干预措施可能流于形式，甚至存在潜在的负面影响。
2. 资源配置不均与专业人才匮乏：
心理健康服务的有效开展离不开充足的资源投入和专业的队伍建设，然而，这正是当前政策实施面临的主要制约。
- 专职心理教师数量和质量双重不足： 尽管政策要求学校配备心理健康教师，但实际配备比例仍偏低，且许多教师缺乏专业的心理学背景和临床实践经验。这使得心理咨询室的利用率不高，服务质量难以保障。
- 专业服务机构与人才缺口大： 能够为青少年提供高质量心理治疗和咨询的专业机构数量有限，尤其是具备儿童青少年心理障碍诊治经验的医生和心理治疗师更是稀缺。这导致即使青少年被识别出心理问题，也难以获得及时、有效的转介和治疗。一项全球性研究指出，精神障碍患者接受治疗的比例远低于实际需求，在中低收入国家尤为突出 77。中国作为中等收入国家，同样面临这一挑战。
- 资金投入不足： 心理健康领域的资金投入与其日益增长的需求不匹配，尤其是在预防和早期干预方面，投入相对较少。这限制了创新性干预方案的研发和推广。
3. 体系衔接不畅与多主体协同不足：
青少年心理健康问题是一个复杂的系统工程，需要家庭、学校、医疗、社区和社会等多方面的协同配合。然而，现有政策在促进多主体协同方面仍存在薄弱环节。
- 家校医社衔接断裂： 政策往往侧重于学校或医疗机构单方面的职责，缺乏一个有效、畅通的转介和信息共享机制。学校发现的问题可能无法及时转介至专业医疗机构，医疗机构的治疗方案也难以与学校和家庭的日常支持有效结合。这种“碎片化”的服务模式使得青少年在不同服务环节之间“失联”，影响干预的连续性和有效性。
- 家长参与度与心理素养不足： 政策对家长的心理健康教育和参与度的重视不够。许多家长对青少年心理健康的认知有限，缺乏识别孩子心理问题和提供恰当支持的能力，甚至可能成为压力的来源。
- 社会支持系统不完善： 社区在青少年心理健康支持方面的作用尚未充分发挥，缺乏社区层面的心理健康服务网络和支持资源。社会组织和公众对心理健康的污名化态度也阻碍了青少年寻求帮助。
4. 政策监测与评估机制不健全：
现有政策在实施后的监测、评估和反馈机制不够完善，难以有效追踪政策的实际效果，并根据评估结果进行动态调整和优化。缺乏基于证据的政策评估，使得政策制定者难以准确把握现有政策的优缺点，进而影响未来政策的科学性和针对性。
综上所述，尽管中国在青少年心理健康政策制定方面取得了一定进展，但在实施层面仍存在诸多短板，包括覆盖不足、资源匮乏、体系衔接不畅以及评估机制不健全等。这些问题共同制约了青少年抑郁与焦虑防控的整体效果，亟需在未来的政策优化中加以解决。
6.2 多主体协同防控的政策建议
鉴于当前中国青少年抑郁与焦虑防控政策存在的短板，构建一个多主体协同、全方位覆盖的防控体系至关重要。以下从筛查普及、干预供给、保障机制和社会支持等维度，提出适配我国国情的青少年抑郁焦虑防控政策优化方向。
6.2.1 健全筛查普及机制
- 推行常态化、标准化心理健康筛查：
- 政策建议： 建议教育部门联合卫健委，制定全国统一的青少年心理健康筛查指南和工具包，明确筛查周期、筛查工具（如PHQ-A、GAD-7等标准化量表结合新型AI筛查技术），并强制要求中小学每年开展至少一次全员心理健康筛查。筛查结果应由专业人员评估，并建立风险分级管理制度。
- 具体措施： 鼓励各地教育行政部门与精神卫生机构合作，定期对学校心理健康教师进行筛查工具使用和结果判读的专业培训。推广利用非侵入式筛查技术，提高筛查效率和早期预警能力，例如，利用智能设备监测青少年睡眠模式和社交媒体使用习惯，结合AI算法进行风险评估。
- 加强高危群体精准识别：
- 政策建议： 针对留守儿童、单亲家庭儿童、贫困家庭青少年、遭受校园欺凌者、学业困难学生等特定高危群体，实施更为频繁和深入的心理健康评估，并建立动态风险档案。
- 具体措施： 建立学校、社区、民政等多部门联动机制，定期开展针对高危群体的入户访视和心理支持。将心理健康筛查结果与教育管理系统互联，实现高风险学生的早期预警和优先关注。
6.2.2 拓宽多层次干预供给渠道
- 强化学校作为主阵地的干预能力：
- 政策建议： 大幅提升学校心理健康教育的战略地位，将心理健康课程纳入必修课，确保课时和教学质量。显著增加专职心理健康教师的编制和配备比例，并设立心理健康教学与实践专项经费。
- 具体措施： 制定心理健康教师专业能力标准，定期开展岗前培训和在职继续教育，提升其在识别、评估、咨询和危机干预等方面的专业水平。鼓励学校与高校、科研机构合作，引入经过本土化验证的团体认知行为辅导、人际关系疗法等循证干预方案，并定期评估干预效果。
- 发展多形式数字疗法干预：
- 政策建议： 将数字疗法纳入国家心理健康服务体系，鼓励研发和推广具有中国文化适应性的线上认知行为疗法（CBT）、情绪管理APP以及沉浸式干预（VR/AR）等数字产品。
- 具体措施： 设立专项资金支持数字疗法创新研发，建立健全数字疗法审批和监管机制，确保产品有效性和安全性。推动数字疗法与学校、社区心理健康服务的融合，例如，将数字疗法平台嵌入学校心理咨询室，或作为线上家庭作业辅导青少年情绪管理。
- 优化医疗机构专业服务承接：
- 政策建议： 健全青少年心理健康转介和绿色通道机制，确保有重度抑郁焦虑症状的青少年能够及时获得专业的精神科诊断和治疗。
- 具体措施： 增加儿童青少年精神科医生和心理治疗师的培养数量，优化儿少精神科床位设置。将符合条件的青少年心理治疗服务纳入医保支付范围，减轻家庭经济负担。鼓励综合医院开设青少年心理门诊，并加强与学校的协作，提供会诊、转介和指导服务。
6.2.3 完善全链条保障机制
- 建立家校社医协同联动机制：
- 政策建议： 顶层设计层面，建立由教育、卫健、民政、公安、共青团、妇联等多部门组成的青少年心理健康工作协调小组，定期召开联席会议，统筹规划和解决青少年心理健康问题。
- 具体措施： 明确各方职责，打通信息壁垒，建立青少年心理健康信息共享平台。推广“家庭-学校-社区-医疗”四位一体的协同服务模式，例如，学校定期向家长提供心理健康教育指导，社区组织心理健康志愿服务，医疗机构为学校提供专业培训和技术支持。
- 强化政策法规支持与伦理保障：
- 政策建议： 完善《未成年人保护法》等相关法律法规中关于青少年心理健康的条款，明确各方责任。加强对青少年心理健康服务伦理的规范和监督，保障青少年隐私权。
- 具体措施： 制定青少年心理健康服务伦理指南，规范心理咨询和治疗行为。严格管理心理健康信息，未经同意不得泄露。设立青少年心理健康服务质量监督举报平台。
- 保障必要经费投入：
- 政策建议： 将青少年心理健康工作纳入各级政府财政预算重点支持范围，逐步提高人均青少年心理健康经费投入。
- 具体措施： 设立青少年心理健康专项基金，用于支持心理健康人才培养、服务体系建设、创新项目研发和科普宣传。鼓励社会力量参与青少年心理健康公益事业，形成多元化投入格局。
6.2.4 构建积极的社会支持系统
- 营造全社会理解和支持氛围：
- 政策建议： 加大心理健康科普宣传力度，破除对精神疾病的污名化，提升公众对青少年心理健康的认知水平和重视程度。
- 具体措施： 充分利用主流媒体、新媒体平台，制作青少年喜闻乐见的心理健康科普内容。将心理健康教育融入家庭教育、社区教育，提高家长和社会成员识别和应对青少年心理问题的能力。倡导积极健康的亲子关系和家庭氛围，减轻学业压力对青少年的负面影响。
- 鼓励青少年参与社会活动：
- 提升家庭心理健康素养：
- 政策建议： 制定并推广家庭心理健康教育指南，提升家长心理健康素养，引导家长关注青少年情绪变化，掌握科学的沟通和支持技巧。
- 具体措施： 组织面向家长的心理健康讲座和工作坊，提供线上线下相结合的家庭心理辅导资源。鼓励家长与学校心理教师保持密切沟通，共同为青少年成长创造良好的家庭环境。
通过上述多主体协同的政策建议，有望在我国形成一个更为完善、高效的青少年抑郁与焦虑防控体系，从而更好地保障青少年的身心健康发展。
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参考文献
1Prevalence 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.
2The association between urbanization and adolescent depression in China.PubMed
Degong Pan, Ning Yan, Lining Pu, et al.
PeerJ. 2024 Feb 22;12:e16888. doi: 10.7717/peerj.16888. eCollection 2024.
BACKGROUND: With the rapid urbanization in many countries, more attention is being paid to the relationship between urbanization and mental health, especially depression. However, in countries with rapid urbanization, few empirical studies exist on the relationship between urbanization and adolescent depression. METHODS: Nationally representative survey data from the China Family Panel Studies in 2012, 2016 and 2018 were used. Data of 1,588 adolescents were obtained from 25 provinces. Depression was measured using the Center for Epidemiology Studies of Depression 20-item score. The urbanization rate was obtained from the National Bureau of Statistics of China. The generalized estimating equation was used to estimate the statistical relationship. RESULTS: The participants' mean age at baseline was 15 years, and 51.2% (813/1,588) of participants were male. After adjusting for all covariates (gender, age, ethnicity, level of education, marital status, urban/rural areas, body mass index, self-rated health, academic pressure, smoking, drinking and exercise), the rate of urbanization was monotonically and negatively associated with adolescent depression (odds ratio 0.34, 95% CI [0.14-0.79]). Compared with female adolescents, male adolescents had a lower risk of depression (odds ratio 0.80, 95% CI [0.67-0.97]). CONCLUSION: In the context of China, urbanization has a positive effect on the mental health of adolescents. Female adolescents are more likely to experience depression than male adolescents.
3Homework, sleep insufficiency and adolescent neurobehavioral problems: Shanghai Adolescent Cohort.PubMed
Ting Yu, Dongqing Xu, Jue Fan, et al.
J Affect Disord. 2023 Jul 1;332:273-282. doi: 10.1016/j.jad.2023.04.008. Epub 2023 Apr 12.
BACKGROUND: The prospective associations between homework burdens and adolescent neurobehavioral problems, and whether sleep-durations mediated and sex modified such associations remained unclear. METHODS: Using Shanghai-Adolescent-Cohort study, 609 middle-school students were recruited and investigations took place at Grade 6, 7 and 9. Information on homework burdens (defined by homework completion-time and self-perceived homework difficulty), bedtime/wake-up-time and neurobehavioral problems was collected. Two patterns of comprehensive homework burdens ('high' vs. 'low') were identified by latent-class-analysis and two distinct neurobehavioral trajectories ('increased-risk' vs. 'low-risk') were formed by latent-class-mixture-modeling. RESULTS: Among the 6th-9th graders, the prevalence-rates of sleep-insufficiency and late-bedtime ranged from 44.0 %-55.0 % and 40.3 %-91.6 %, respectively. High homework burdens were concurrently associated with increased-risks of neurobehavioral problems (IRRs: 1.345-1.688, P < 0.05) at each grade, and such associations were mediated by reduced sleep durations (IRRs for indirect-effects: 1.105-1.251, P < 0.05). High homework burden at the 6th-grade (ORs: 2.014-2.168, P < 0.05) or high long-term (grade 6-9) homework burden (ORs: 1.876-1.925, P < 0.05) significantly predicted increased-risk trajectories of anxiety/depression and total-problems, with stronger associations among girls than among boys. The longitudinal associations between long-term homework burdens and increased-risk trajectories of neurobehavioral problems were mediated by reduced sleep-durations (ORs for indirect-effects: 1.189-1.278, P < 0.05), with stronger mediation-effects among girls. LIMITATIONS: This study was restricted to Shanghai adolescents. CONCLUSIONS: High homework burden had both short-term and long-term associations with adolescent neurobehavioral problems, with stronger associations among girls, and sleep-insufficiency may mediate such associations in a sex-specific manner. Approaches targeting appropriate homework-load/difficulty and sleep restoration may help prevent adolescent neurobehavioral problems.
4Suicidality and correlates among rural adolescents of China.PubMed
Xianchen Liu, Jenn-Yun Tein, Zhongtang Zhao, et al.
J Adolesc Health. 2005 Dec;37(6):443-51. doi: 10.1016/j.jadohealth.2004.08.027.
PURPOSE: Despite high rates of suicide in rural youths of China, little is known about the epidemiological characteristics of suicidal behaviors among this group of population. This study examined the prevalence and correlates of suicidality among Chinese adolescents. METHODS: An epidemiological survey was conducted in a sample of 1,362 adolescents from 5 high schools in a prefecture of Shandong, China. We obtained data using a structured questionnaire asking about suicidal behaviors, life stress, locus of control, depression, aggression, and individual and family characteristics. Data were analyzed using logistic regression models. RESULTS: Overall, 19% of the sample reported having suicidal ideation, and 7% reported having made a suicide attempt during the past 6 months. The prevalence rates of suicidal behaviors significantly increased over age. Female adolescents were more likely to report suicidal ideation than males, and older females (ages 16-18) were more likely to report suicide attempts than older males. Multivariate logistic regression models showed that female gender, older age, boarding in school, life stress, depression, and external locus of control were significantly associated with increased risk for suicidal ideation, while older age, life stress, external locus of control, poor academic performance, depression, and aggression were related to suicide attempts. CONCLUSIONS: Suicidal behaviors are common problems in rural adolescents of China. Female adolescents are particularly prone to report suicidal ideation and suicide attempts as they age. Multiple psychosocial factors are associated with suicidal behaviors, and psychopathology and life stress may play major roles in suicidal behaviors among rural adolescents of China.
5The Factors of Adolescent Depression in Jiangsu Province, China, from the Perspective of Social Ecosystem: A Case-Control Study.PubMed
Hua Xu, Zhao-Hong Chen, Jin-Jie Ji, et al.
Depress Anxiety. 2023 Nov 11;2023:2861629. doi: 10.1155/2023/2861629. eCollection 2023.
BACKGROUND: The prevalence of adolescent depression is continuously increasing, impacting the cognitive, emotional, and behavioral development of adolescents. Therefore, it is crucial to comprehend depression from the perspective of the social ecosystem, necessitating further empirical evaluation. METHODS: This study utilized a case-control study design. The cases consisted of adolescents with depression (aged 13-18 years) admitted to a psychiatric hospital in Nanjing, Jiangsu Province, China, from November 2021 to July 2022, meeting the diagnostic criteria for depression in the 11th Edition of the International Classification of Diseases. Control group students, with a matching gender ratio in the same region, were randomly recruited. Logistic regression analysis was employed to investigate the factors associated with depression, with gender and age as covariates. RESULTS: The study comprised 200 participants, with 44 (22.0%) males and 156 (78.0%) females. Multiple logistic regression analysis revealed that increased adolescent depression was associated with being an only child (AOR = 2.680, 95% CI: 1.106-6.492), living in urban areas (AOR = 3.324, 95% CI: 1.077-10.267), experiencing school bullying (AOR = 9.087, 95% CI: 2.044-40.408), having severe family dysfunction (AOR = 6.491, 95% CI: 1.109-37.995), and possessing low core self-evaluation (AOR = 11.746, 95% CI: 3.305-41.746). Odds ratios for each factor were statistically significant. CONCLUSIONS: Our results improve the evidence for associations between adolescent depression and core self-evaluation, school bullying, family function, living in urban areas, and being an only child. These findings should be taken into consideration in the assessment, intervention, and related policies for adolescent depression.
6Depressive symptoms among rural left-behind children and adolescents in China: a large-scale cross-sectional study.PubMed
Qian-Nan Ruan, Guang-Hui Shen, Su Xu, et al.
BMC Public Health. 2024 Nov 14;24(1):3160. doi: 10.1186/s12889-024-20699-z.
BACKGROUND: Left-behind children(LBC) in rural China are at increased risk for mental health problems, including depression. This study aimed to estimate the prevalence of depression and identify key associate factors among Chinese rural LBC. METHODS: A cross-sectional study was conducted using data from 36,612 LBC aged 6 to 18 years old across 596 data collection sites in Nanchong, Sichuan Province, China. Participants completed questionnaires assessing individual factors, family parenting situation, living events, and health-related data. Depression was measured using the Center for Epidemiological Studies-Depression Scale (CES-D). T-tests, chi-square, and logistic regression were performed to identify factors associated with depression. RESULTS: The overall prevalence of depression among LBC was 6.75%. Logistic regression analysis revealed that family parenting situations, such as being from blended families (OR = 1.45) or being cared for by other family members (OR = 1.64), and dissatisfaction with the parenting situation (OR = 1.57) were significantly associated with higher odds of depression. Living events, including being misunderstood (OR = 1.82) and having disputes (OR = 1.48), and health-related factors, such as chronic diseases and regular medication use (OR = 2.38), also increased the risk of depression. CONCLUSIONS: This study highlights the high prevalence of depression among Chinese rural LBC and identifies key associate factors, including family parenting situation, negative living events and health-related factors. Targeted interventions and policies addressing these factors are needed to promote the mental health of this vulnerable population.
7Burden 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.
8Advances in the prevalence and treatment of depression for adolescents: a review.PubMed
Chunyu Yin, Mengting Xu, Zhiyuan Zong
Front Pharmacol. 2025 May 6;16:1574574. doi: 10.3389/fphar.2025.1574574. eCollection 2025.
BACKGROUND: Depression is a psychological condition in adolescents caused by various factors. Many serious consequences can be associated with depression, such as irritability, emotional instability, and suicide. Meanwhile, the incidence of depression and suicide among adolescents was also affected during the pandemic of COVID-19 in 2019. This phenomenon of adolescent depression should be drawn extensive concern by the community, which affects their physical and mental health. MAIN BODY: This review describes the epidemiology, high-risk factors, and treatment of adolescent depression. The onset of depression is probably attributable to preterm birth, growth environment, genetic. We also identify that the COVID-19 pandemic, initiated in late 2019,affects adolescent mental health. Antidepressants and psychotherapy are conventional treatments for depressive disorders. However, it is controversial whether antidepressants are as effective and safer as psychotherapy, and a combination of the two could provide more benefit to this population than antidepressants alone. We also summarize some antidepressants developed for novel targets. Improving the efficacy and safety of treatment to reduce the suicide rate among adolescents is the primary goal of clinical research. Existing treatment modalities and drugs are not sufficient to achieve clinical demands, so that new therapeutic targets will be promising for such patients. CONCLUSION: A variety of factors can contribute to depression in adolescents. Adolescent depression should be mainly treated with non-pharmacological. A combination of guideline-recommended antidepressants should be used if uncontrolled with non-pharmacological, but adverse drug reactions and suicidal ideation should be closely monitored.
9Impact of COVID-19 on the Mental Health of Children and AdolescentsOpenAlex
Kaushal Shah, Shivraj Mann, Romil Singh, et al.
The coronavirus disease 2019 (COVID-19) outbreak was first reported in Wuhan, China, and was later reported to have spread throughout the world to create a global pandemic. As of August 18th, 2020, the coronavirus had spread to more than 216 countries with at least 21,756,357 confirmed cases, resulting in 771,635 deaths globally. Several countries declared this pandemic as a national emergency, forcing millions of people to go into lockdown. This unexpected imposed social isolation has caused enormous disruption of daily routines for the global community, especially children. Among the measures intended to reduce the spread of the virus, most schools closed, canceled classes, and moved it to home-based or online learning to encourage and adhere to social distancing guidelines. Education and learnings of 67.6% of students are impacted globally due to coronavirus in 143 countries. The transition away from physical classes has significantly disrupted the lives of students and their families, posing a potential risk to the mental well-being of children. An abrupt change in the learning environment and limited social interactions and activities posed an unusual situation for children's developing brains. It is essential and obligatory for the scientific community and healthcare workers to assess and analyze the psychological impact caused by the coronavirus pandemic on children and adolescents, as several mental health disorders begin during childhood. Countries across the globe, including the United States, are in the dilemma of determining appropriate strategies for children to minimize the psychological impact of coronavirus. The design of this review is to investigate and identify the risk factors to mental health and propose possible solutions to avoid the detrimental consequence of this crisis on the psychology of our future adult generations.
10Age- and sex-dependent increase in self-harm among adolescents with mental health problems in East China during COVID-19 related society-wide isolationOpenAlex
Wenjing Liu, Zhishan Hu, Zhen Liu, et al.
Objective: The COVID-19 pandemic has raised concerns about child and adolescent mental health issues, such as self-harm. The impact of society-wide isolation on self-harming behaviors among adolescents in China is unclear. In addition, adolescents of different ages and sexes have varying abilities to cope with environmental changes. However, these differences are rarely considered in self-harm studies. We aimed to characterize the age- and sex-dependent effects of COVID-19-related society-wide isolation on self-harm among adolescents in East China. Methods: We collected 63,877 medical records of children and adolescents aged 8-18 who had an initial visit to Shanghai Mental Health Center in China between 2017 and 2021 and charted annual self-harm rates for each age and sex. Using interrupted time series analysis, we modeled global and seasonal trends and the effect of COVID-19-related society-wide isolation on self-harm rates. Results: = 0.0031], while males were less affected. Further, females with emotional disorders dominated the increased self-harm rates. Conclusion: Society-wide isolation has had a significant impact on early adolescent females in East China, especially for those with emotional disturbances, and has brought forward the peak in adolescent self-harm rates. This study calls for attention to the risk of self-harm in early adolescents.
11Prevalence of anxiety symptom and depressive symptom among college students during COVID-19 pandemic: A meta-analysis.PubMed
Jun-Jie Chang, Yan Ji, Yong-Han Li, et al.
J Affect Disord. 2021 Sep 1;292:242-254. doi: 10.1016/j.jad.2021.05.109. Epub 2021 Jun 4.
BACKGROUND: The global pandemic of COVID-19 has brought huge changes to people's lifestyles, college students have also been affected seriously. Evidence about these significant changes indicated that college students were more prone to feel anxious and depressed. To derive a precise assessment of the prevalence of anxiety symptom and depressive symptom among college students worldwide, we conducted this meta-analysis. METHODS: Based on the guidance of PRISMA, literature was searched in Pubmed, Web of Science, Embase, and PsycArticles (last search November 6, 2020). These articles after the screening were analyzed by a random-effects model to estimate the pooled prevalence of anxiety symptom and depressive symptom. Also, subgroup analysis, sensitivity analysis, and publication bias were performed in this meta-analysis. RESULTS: The results showed that the pooled anxiety symptom prevalence was 31% (95% CI: 23-39%), pooled depressive symptom prevalence was 34% (95% CI: 27-41%). Subgroup analysis showed that the prevalence of anxiety symptom and depressive symptom among different countries' college students were different, and the pooled depressive symptom prevalence of females was higher compared with males. LIMITATIONS: The prevalence of anxiety symptom and depressive symptom in worldwide college students could be better assessed by a standard and reliable questionnaire. CONCLUSIONS: The results suggest that the prevalence of anxiety symptom and depressive symptom during the COVID-19 pandemic is relatively high. Except for interventions that should be taken to control the pandemic urgently, mental health services are also needed to decrease the risk of anxiety and depression among college students.
12Influence of The COVID-19 Pandemic on Parenting Stress Across Asian Countries: A Cross-National StudyOpenAlex
Sawa Kurata, Daiki Hiraoka, Aida Syarinaz Ahmad Adlan, et al.
Abstract Background In a previous study, we demonstrated that the accumulation of parenting stress during prolonged school closures and restrictions on daily activities due to the COVID-19 pandemic in Japan indicates the need for mental health intervention for parents at higher risk of parenting stress. However, few studies have focused on parenting stress in other Asian countries, although they have experienced higher numbers of COVID-19 infections. Methods We conducted an online survey immediately after the number of new cases in India significantly increased (September to November 2020). We measured parenting stress, anxiety, and fear associated with the COVID-19 crisis, as evaluated by the Parenting Stress Index, Short-Form (PSI-SF) and the Coronavirus Anxiety Scale (CAS), across three Asian countries—India ( n = 142), Malaysia ( n = 69), and Japan ( n = 182)—in addition to the US ( n = 203). We also investigated whether respondents had adverse childhood experiences (ACE) as a risk factor for parenting stress. Results For all countries, we found significant increases in participants’ current parenting stress levels, compared to what they recalled regarding their lives before COVID-19-related restrictions and school closures were enacted. Textual analysis qualitatively identified common terms related to parenting stress across all countries. We also found a statistical model that indicated ACE in parents was a critical risk factor for higher parenting stress via increasing anxiety and fear related to the pandemic. Conclusions These results indicate the need to improve the mental health of caregivers who are at risk for higher levels of parenting stress during the COVID-19 pandemic in Asian countries as well as Western countries. These results indicate that there is a need to improve the mental health of caregivers who are at risk for higher levels of parenting stress during the COVID-19 pandemic globally.
13Anxiety, concerns and COVID-19: Cross-country perspectives from families and individuals with neurodevelopmental conditions.PubMed
Vassilis Sideropoulos, Jo Van Herwegen, Ben Meuleman, et al.
J Glob Health. 2023 Jul 28;13:04081. doi: 10.7189/jogh.13.04081.
BACKGROUND: The COVID-19 pandemic had a major impact on the mental health and well-being of children with neurodevelopmental conditions (NDCs) and of their families worldwide. However, there is insufficient evidence to understand how different factors (e.g., individual, family, country, children) have impacted on anxiety levels of families and their children with NDCs developed over time. METHODS: We used data from a global survey assessing the experience of 8043 families and their children with NDCs (mean of age (m) = 13.18 years, 37% female) and their typically developing siblings (m = 12.9 years, 45% female) in combination with data from the European Centre for Disease Prevention and Control, the University of Oxford, and the Central Intelligence Agency (CIA) World Factbook, to create a multilevel data set. Using stepwise multilevel modelling, we generated child-, family- and country-related factors that may have contributed to the anxiety levels of children with NDCs, their siblings if they had any, and their parents. All data were reported by parents. RESULTS: Our results suggest that parental anxiety was best explained by family-related factors such as concerns about COVID-19 and illness. Children's anxiety was best explained by child-related factors such as children's concerns about loss of routine, family conflict, and safety in general, as well as concerns about COVID-19. In addition, anxiety levels were linked to the presence of pre-existing anxiety conditions for both children with NDCs and their parents. CONCLUSIONS: The present study shows that across the globe there was a raise in anxiety levels for both parents and their children with NDCs because of COVID-19 and that country-level factors had little or no impact on explaining differences in this increase, once family and child factors were considered. Our findings also highlight that certain groups of children with NDCs were at higher risk for anxiety than others and had specific concerns. Together, these results show that anxiety of families and their children with NDCs during the COVID-19 pandemic were predicted by very specific concerns and worries which inform the development of future toolkits and policy. Future studies should investigate how country factors can play a protective role during future crises.
14Academic Burden and Emotional Problems Among Adolescents: A Longitudinal Mediation Analysis.PubMed
Jingyi Wang, Ziyao Wang, Yuting Yang, et al.
J Adolesc. 2025 Jun;97(4):989-1001. doi: 10.1002/jad.12471. Epub 2025 Jan 21.
INTRODUCTION: Existing research indicates high prevalence of emotional problems among adolescents with excessive academic burden, yet the underlying reasons are not well understood. This study aimed to explore loneliness, physical activity, and sleep as potential mediating pathways between academic burden and emotional problems in adolescents. METHODS: A longitudinal cohort study was conducted among middle and high school students in Taizhou City, Zhejiang Province, China, with data collected at three time points. The study included 2965 adolescents, with a mean age of 15.2 years (SD = 1.7), of whom 48.0% were female. Most participants came from families with middle to high economic status (94.8%). Structural equation modeling was employed to analyze the direct associations between academic burden (measured by study time and academic stress) and depressive and anxiety symptoms. Additionally, the indirect associations were explored through three mediators: loneliness, physical activity, and sleep. RESULTS: Higher academic stress at T1 was directly associated with more severe depressive symptoms at T3. Sleep (indirect effect 0.11, 95% CI 0.09-0.13), loneliness (0.10, 0.08-0.11) and physical activity (0.01, 0.002-0.012) at T2 mediated the relationship, accounting for 31.0%, 26.8%, and 1.8% of the total association of academic stress, respectively. For anxiety symptoms, sleep (0.11, 0.09-0.14) and loneliness (0.07, 0.05-0.08) mediated the association of academic stress with longitudinal mediation effect sizes of 34.1% and 20.6%, respectively. Study time was only associated with the outcomes indirectly via academic stress. CONCLUSIONS: Our results highlight the importance of behavioral and psychosocial differences related to academic burden in understanding the severity of mental health problems in adolescents.
15Gender difference in anxiety and related factors among adolescents.PubMed
Chengzhen Bao, Lili Han
Front Public Health. 2025 Jan 3;12:1410086. doi: 10.3389/fpubh.2024.1410086. eCollection 2024.
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.
16Exploring the Relationship Between Social Media Use and Symptoms of Depression and Anxiety Among Children and Adolescents: A Systematic Narrative Review.PubMed
Naila Saleem, Paul Young, Saman Yousuf
Cyberpsychol Behav Soc Netw. 2024 Nov;27(11):771-797. doi: 10.1089/cyber.2023.0456. Epub 2024 Oct 24.
Social media use is ubiquitous to the lives of children and adolescents. The body of research investigating its potential impact on mental health has risen exponentially. We systematically reviewed the present literature exploring potential linkages between social media use and symptoms of depression and anxiety in this vulnerable group. Using the Preferred Reporting Items for Systematic Reviews and Meta-analyses framework, articles were searched across Medline, EMBASE, CINAHL, and PsycINFO databases from inception to February 2024. Quantitative studies with social media as exposure and anxiety/depressive symptoms as outcomes in children and adolescents 5-18 years of age were included. Of the 4850 studies retrieved, 67 fulfilled the inclusion criteria. The most frequent measures of social media were "time spent on social media" and "frequency of use." Depressive symptoms were the outcome of 61 studies, whereas anxiety was measured in 27 studies. Most studies were of fair quality ( = 53). A meta-analysis was not possible due to study heterogeneity. Our review shows that (1) problematic social media use is associated with depressive and anxiety symptoms among children and adolescents, (2) duration of social media use was more consistently linked with anxiety and depression in girls compared with boys, and (3) mediating and moderating mechanisms were sleep deprivation, social comparison, and feedback-seeking behaviors, exercise, social support, and type of social media use. Qualitative work and robust large-scale longitudinal observations using a person-specific approach are needed to further our understanding of the impact of social media use on depression and anxiety in children and adolescents.
17Social Media Use and Mental Health Risk among Chinese Adolescents: Based on Qualitative Research on Second-Year Undergraduate in One UniversityOpenAlex
Yuanxi Zhou
This study aims to explore the impact of social media use on mental health risk among Chinese adolescents. Through a qualitative study of second-year undergraduates at a university, this paper analyzed their reflections on high school and freshman life during adolescence, focusing on the relationship between the frequency and quality of social media use, content type, degree of addiction, and mental health risk. The study found that social media use was positively associated with the risk of depression, anxiety and psychological distress, especially in the behavioral patterns of social comparison and approval seeking. In addition, this study explored the possibility of mitigating the negative effects of social media by enhancing digital literacy and mental health awareness. The findings of this study provide a scientific basis for the development of targeted interventions aimed at promoting the mental health of adolescents in China. This study sheds light on the complex role of social media in adolescent mental health problems, accentuating the importance of families and schools in guiding adolescents to healthy use of social media.
18Mental health of college students and associated factors in Hubei of China.PubMed
Xiaosheng Lei, Chaojie Liu, Heng Jiang
PLoS One. 2021 Jul 2;16(7):e0254183. doi: 10.1371/journal.pone.0254183. eCollection 2021.
BACKGROUND: Although many studies have analyzed mental health problems in college students in China, the associations of mental health with individual and family circumstances, academic performance, and social support were rarely discussed. OBJECTIVES: The study aimed to determine the mental health status and its associated factors among college students in China. METHODS: An online survey was conducted on 300 students selected through a cluster sampling strategy in a university in Hubei, China, tapping into sociodemographic characteristics of the participants, their mental health status measured by the modified Symptom Checklist-90 (SCL-90), and social support measured by the Social Support Rating Scale. Multivariate linear regression models were established to identify predictors of the SCL-90 scores. RESULTS: Mental health disorders were found in 8% of the respondents, with obsessive compulsive, interpersonal sensitivity and depression as the top three reported problems. Compared with the national population norms of university students in 2014, our study participants had higher scores in SCL-90. There were statistically significant difference in the Global Severity index (GSI) and all nine subscales scores (p<0.05). Poorer self-rated health, higher study pressure, and lower social support were significant predictors of higher SCL-90 scores (p<0.05) after adjustment for variations in other variables. CONCLUSIONS: College students in Hubei, China may experience a range of different mental health problems, which are associated with their individual, study, and social circumstances.
19Role of rs454214 in Personality mediated Depression and Subjective Well-being.PubMed
Binyin Hou, Lei Ji, Zhixuan Chen, et al.
Sci Rep. 2020 Mar 30;10(1):5702. doi: 10.1038/s41598-020-62486-x.
Happiness and depression are interlinked and both heritable, while personality, as an important predictor of them, shares the genetic basis with them. We conjecture that genetic factors of depression can affect both depressive symptoms (DS) and subjective well-being (SWB), while personality traits play important roles in mediating this process. In this study, 878 Han Chinese college freshmen and 384 Han Chinese patients with the major depressive disorder (MDD) were included. SNPs were genotyped using AGENA MassARRAY iPLEX technology and we investigated an important MDD variant rs454214. Correlation, association and mediation analysis were employed, aiming to decipher the complex relationship between SWB, DS, personality traits and the genetic variant. Association study indicated that rs454214 was not only associated with both SWB and DS (P < 0.05), but also possibly linked to MDD. Mediational analysis showed that rs454214 had no direct effect on SWB and DS, but had a significant indirect effect through personality traits, i.e., Extraversion, Neuroticism, Agreeableness and Openness to Experience or SWB, Extraversion, Neuroticism and Agreeableness for DS. This study found a shared genetic basis for happiness and depression; the causal process could be better explained if personality traits are taken as mediating factors.
20BDNF Val66Met, stress, and positive mothering: Differential susceptibility model of adolescent trait anxiety.PubMed
Jie Chen, Jing Yu, Yujie Liu, et al.
J Anxiety Disord. 2015 Aug;34:68-75. doi: 10.1016/j.janxdis.2015.06.001. Epub 2015 Jun 15.
Etiological research has indicated the gene-environment interaction (G × E) on adolescent anxiety. This study aimed to examine how the BDNF Val66Met polymorphism interacted with stressful life events and positive mothering to influence youth trait anxiety. The study sample included 780 community adolescents of Chinese Han ethnicity (M = 13.6, 51.3% females). Participants' trait anxiety, exposure to stressful life events, and mother's warmth-reasoning were assessed by self-reported questionnaires. We found that BDNF Val66Met polymorphism significantly moderated the influences of stressful life events and mother's warmth-reasoning on adolescent anxiety. The influences were significantly greater in adolescents carrying one or two Val allele than those with Met/Met genotype. Moreover, the G × E interactions were more consistent with the differential susceptibility than the diathesis-stress model. Adolescents carrying Val allele who were more susceptible to adversity were also more likely to benefit from supportive experiences. These findings provide novel evidence for the role of BDNF Val66Met as a genetic susceptibility modulating the influences of stressful life events and mother's warmth-reasoning on adolescent anxiety. We speculate that BDNF Val66Met may moderate anxious youths' responses to mindfulness-based stress reduction program and family-based treatment targeting the enhancement of positive parenting.
21Microbiome and tryptophan metabolomics analysis in adolescent depression: roles of the gut microbiota in the regulation of tryptophan-derived neurotransmitters and behaviors in human and mice.PubMed
Manfei Zhou, Yichun Fan, Liuting Xu, et al.
Microbiome. 2023 Jun 30;11(1):145. doi: 10.1186/s40168-023-01589-9.
BACKGROUND: Adolescent depression is becoming one of the major public health concerns, because of its increased prevalence and risk of significant functional impairment and suicidality. Clinical depression commonly emerges in adolescence; therefore, the prevention and intervention of depression at this stage is crucial. Recent evidence supports the importance of the gut microbiota (GM) in the modulation of multiple functions associated with depression through the gut-brain axis (GBA). However, the underlying mechanisms remain poorly understood. Therefore, in the current study, we aimed to screen the microbiota out from healthy and depressive adolescents, delineate the association of the targeted microbiota and the adolescent depression, address the salutary effects of the targeted microbiota on anti-depressive behaviors in mice involving the metabolism of the tryptophan (Trp)-derived neurotransmitters along the GBA. RESULTS: Here, we found the gut microbiota from healthy adolescent volunteers, first diagnosis patients of adolescent depression, and sertraline interveners after first diagnosis displayed significant difference, the relative abundance of Faecalibacterium, Roseburia, Collinsella, Blautia, Phascolarctobacterium, Lachnospiraceae-unclassified decreased in adolescent depressive patients, while restored after sertraline treatment. Of note, the Roseburia abundance exhibited a high efficiency in predicting adolescent depression. Intriguingly, transplantation of the fecal microbiota from healthy adolescent volunteers to the chronic restraint stress (CRS)-induced adolescent depressed mice significantly ameliorated mouse depressive behaviors, in which the Roseburia exerted critical roles, since its effective colonization in the mouse colon resulted in remarkably increased 5-HT level and reciprocally decreased kynurenine (Kyn) toxic metabolites quinolinic acid (Quin) and 3-hydroxykynurenine (3-HK) levels in both the mouse brain and colon. The specific roles of the Roseburia were further validated by the target bacteria transplantation mouse model, Roseburia intestinalis (Ri.) was gavaged to mice and importantly, it dramatically ameliorated CRS-induced mouse depressive behaviors, increased 5-HT levels in the brain and colon via promoting tryptophan hydroxylase-2 (TPH2) or -1 (TPH1) expression. Reciprocally, Ri. markedly restrained the limit-step enzyme responsible for kynurenine (indoleamine2,3-dioxygenase 1, IDO1) and quinolinic acid (3-hydroxyanthranilic acid 3,4-dioxygenase, 3HAO) generation, thereby decreased Kyn and Quin levels. Additionally, Ri. administration exerted a pivotal role in the protection of CRS-induced synaptic loss, microglial activation, and astrocyte maintenance. CONCLUSIONS: This study is the first to delineate the beneficial effects of Ri. on adolescent depression by balancing Trp-derived neurotransmitter metabolism and improving synaptogenesis and glial maintenance, which may yield novel insights into the microbial markers and therapeutic strategies of GBA in adolescent depression. Video Abstract.
22Micronutrient-Fortified Milk and Academic Performance among Chinese Middle School Students: A Cluster-Randomized Controlled Trial.PubMed
Xiaoqin Wang, Zhaozhao Hui, Xiaoling Dai, et al.
Nutrients. 2017 Mar 2;9(3):226. doi: 10.3390/nu9030226.
Many children suffer from nutritional deficiencies that may negatively affect their academic performance. This cluster-randomized controlled trial aimed to test the effects of micronutrient-fortified milk in Chinese students. Participants received either micronutrient-fortified (n = 177) or unfortified (n = 183) milk for six months. Academic performance, motivation, and learning strategies were estimated by end-of-term tests and the Motivated Strategies for Learning Questionnaire. Blood samples were analyzed for micronutrients. In total, 296 students (82.2%) completed this study. Compared with the control group, students in the intervention group reported higher scores in several academic subjects (p < 0.05), including languages, mathematics, ethics, and physical performance at the end of follow-up. Students in the intervention group showed greater self-efficacy and use of cognitive strategies in learning, and reported less test anxiety (p < 0.001). Moreover, vitamin B2 deficiency (odds ratio (OR) = 0.18, 95% confidence interval (CI): 0.11~0.30) and iron deficiency (OR = 0.34, 95% CI: 0.14~0.81) were less likely in the students of the intervention group, whereas vitamin D, vitamin B12, and selenium deficiencies were not significantly different. "Cognitive strategy" had a partial mediating effect on the test scores of English (95% CI: 1.26~3.79) and Chinese (95% CI: 0.53~2.21). Our findings suggest that micronutrient-fortified milk may improve students' academic performance, motivation, and learning strategies.
23Food Insecurity and Mental Health: A Moderated Mediation Analysis.PubMed
Lei Chai
Can Rev Sociol. 2025 Nov;62(4):313-323. doi: 10.1111/cars.70009. Epub 2025 May 8.
Extensive research has demonstrated the negative impact of food insecurity on mental health; however, the mediating and moderating mechanisms underlying this relationship remain underexplored. Using data from the 2022 National Health Interview Survey (N = 25,703), this study investigates whether sleep problems mediate the relationship between food insecurity and mental health outcomes-specifically depressive and anxiety symptoms-and whether marital status moderates this relationship. The findings indicate that sleep problems partially mediate the effects of food insecurity on depressive and anxiety symptoms. In addition, the impact of sleep problems on these mental health outcomes is less severe among married individuals compared to their unmarried counterparts. However, marital status does not moderate the relationship between food insecurity and sleep problems, nor the relationship between food insecurity and mental health outcomes. The analysis of conditional indirect effects reveals a more pronounced mediation effect of sleep problems among unmarried individuals. These results suggest a partial protective role of marriage in mental health and underscore the importance of addressing sleep problems, particularly among unmarried individuals, in understanding the interplay between food insecurity, sleep problems, and mental health.
24Childhood trauma, stressful life events, and depression: Exploring the mediating effect of cognitive flexibility.PubMed
Wanqi Huang, Yuan Fang, Xiao Tan, et al.
Psychol Trauma. 2024 Apr;16(Suppl 1):S45-S52. doi: 10.1037/tra0001337. Epub 2022 Aug 4.
OBJECTIVE: Childhood trauma and stressful life events have been identified as risk factors for the development of depression. However, little is known about the potential cognitive mechanisms underlying these associations. This study aims to investigate the associations among childhood trauma, stressful life events, and depression and to test a mediating model to examine the roles of cognitive flexibility in these associations. METHOD: First-year university students ( = 2627; = 18.29, = .86) were recruited from a medical university in Guangzhou, China. A total of 1,600 (60.9%) females and 1,027 (39.1%) males participated in the survey. Participants were administered self-report measures assessing childhood trauma, stressful life events, cognitive flexibility, and depression. RESULTS: Childhood trauma and stressful life events were both negative predictors of cognitive flexibility (β = -.32, β = -.19, respectively; s < .01), which in turn was a negative predictor of depression (β = -.50, < .01). Cognitive flexibility partially mediated the relationship between childhood trauma and depression (with the indirect effect = .161, 95% confidence interval, CI [.139, .185]) as well as the relationship between stressful life events and depression (with the indirect effect = .097, 95% CI [.078, .118]). CONCLUSIONS: This study reveals that childhood trauma and stressful life events not only have a direct effect on depression but also increase individuals' risk of depression by decreasing their cognitive flexibility. These findings shed light on the possible potential mechanism underlying the suicide process and highlight the important role of cognitive flexibility in suicide prevention and intervention. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
25Childhood trauma and social anxiety in adolescents: Mediating role of cardiovascular response to social stress.PubMed
Huayu Ji, Yiji Wang, Wei Lü
Psychophysiology. 2024 Dec;61(12):e14688. doi: 10.1111/psyp.14688. Epub 2024 Oct 2.
Adolescents exposed to childhood trauma are at an elevated risk for social anxiety. However, the physiological mechanisms linking childhood trauma and adolescents' social anxiety remain poorly understood. This study examined whether cardiovascular reactivity to acute social stress was a mechanism underlying this association. Participants were Chinese adolescents (N = 172; M = 12.95). They first reported their childhood trauma and social anxiety using the Childhood Trauma Questionnaire and the Social Interaction Anxiety Scale. They then participated in a social stress task, during which their cardiovascular data [heart rate (HR) and systolic and diastolic blood pressure (SBP, DBP)] were monitored. The results showed that high levels of childhood trauma were associated with blunted HR, SBP, and DBP reactivity, which in turn were associated with high levels of social anxiety. Mediation analysis indicated that childhood trauma was indirectly associated with social anxiety via blunted cardiovascular reactivity. The findings suggest that blunted cardiovascular reactivity may serve as a physiological pathway linking childhood trauma and adolescents' social anxiety.
26The co-occurrence of depression and dissociation: The relevance of childhood trauma.PubMed
Hong Wang Fung, Grace Wing Ka Ho, Stanley Kam Ki Lam, et al.
J Psychiatr Res. 2025 Mar;183:157-163. doi: 10.1016/j.jpsychires.2025.02.026. Epub 2025 Feb 17.
Recent studies showed that dissociation may be common and persistent in people with depression. Dissociation also predicts subsequent depressive symptoms. Both conditions have been linked with trauma exposure. Yet, little is known about the co-occurrence of depression and dissociation. This multi-sample study investigated the co-occurrence of depressive and dissociative symptoms and its relationship with different types of childhood trauma. We analyzed available data from five samples of Chinese adults (N = 2737 in total). Participants completed the same set of measures of depressive and dissociative symptoms and childhood betrayal and non-betrayal trauma. Across samples, between 22.0% and 50.6% of participants with depression exhibited co-occurring dissociation; the majority of participants with dissociation (67.0%-90.2%) presented with depression too. One-way ANCOVA showed that participants who presented with both depression and dissociation reported a statistically significantly higher number of childhood betrayal and non-betrayal trauma types compared to those who had only one or none of these conditions. Exploratory mediation analysis also revealed that dissociative symptoms partly mediated the relationship between childhood trauma and depressive symptoms, regardless of the type of trauma. Findings suggest that the co-occurrence of depressive and dissociative symptoms is associated with childhood trauma. Individuals who report depressive symptoms or seek treatments for a depressive disorder should be screened for dissociation. Further studies on the reliability, validity, clinical features, and intervention needs of the possible dissociative subtype of depression are required.
27Entropy-based risk network identification in adolescent self-injurious behavior using machine learning and network analysis.PubMed
Zheng Zhang, Honghui Chen, Yanyue Ye, et al.
Transl Psychiatry. 2025 Aug 20;15(1):299. doi: 10.1038/s41398-025-03511-3.
Adolescent Self-Injurious Behavior (SIB) is a significant global public health issue, with a lifetime prevalence rate of approximately 13.7%. As awareness of SIB rises, there is an urgent need for effective prediction mechanisms to enable early identification and intervention, reducing the risk of suicide and self-harm attempts. This study, grounded in Psychopathological Network Theory, uses machine learning and network analysis to explore the multidimensional structure of risk factors for adolescent SIB. A survey of 2047 adolescents aged 11 to 17 years in China analyzed 19 variables across physiological, psychological, and social domains. The Entropy Weight Method (EWM) was applied to combine network analysis and machine learning outcomes for a comprehensive risk evaluation. The study identified key risk factors for SIB, including loneliness, ADHD symptoms, Internet addiction, anxiety, depression, affinity for solitude, autistic traits, being bullied. These factors interact within a complex network structure, influencing the occurrence of SIB both directly and indirectly. The integration of EWM, network analysis, and machine learning provides a more precise risk assessment approach for adolescent SIB. The findings offer valuable insights into the causal mechanisms of SIB and emphasize the importance of targeted prevention and intervention strategies.
28Latent class analysis on mental health and associated factors in medical and non-medical college students.PubMed
Li-Ying Wen, Liu Zhang, Li-Jun Zhu, et al.
J Affect Disord. 2025 Nov 1;388:119593. doi: 10.1016/j.jad.2025.119593. Epub 2025 Jun 5.
BACKGROUND: This study aimed to identify latent classes of mental health status among Chinese college students and to explore the influencing factors that differ between medical and non-medical students. METHODS: A cross-sectional survey was conducted among 4768 students from four institutions located in Anhui Province, China, utilizing stratified cluster sampling. The survey assessed depressive symptoms, anxiety symptoms, sleep chronotypes, sleep disorders, and suicidal behaviors. Latent class analysis was employed to identify mental health subgroups, and multinomial logistic regression was utilized to analyze the influencing factors. RESULTS: Three latent classes were identified: C1 (Low Depression/Anxiety - Low Suicidal Behavior, 88.1 %), C2 (High Depression/Anxiety - Low Suicidal Behavior, 8.6 %), and C3 (Moderate Depression/Anxiety - High Suicidal Behavior, 3.3 %). Alcohol consumption, sleep disorders, academic burden, gender, grade, and daily online time significantly predicted these classes. Students with alcohol consumption and sleep disorders were more likely in C2 and C3. Medical students with heavy academic burdens were more likely in C2, while those with light burdens were more likely in C3. Male medical students were more likely in C2 and C3. Non-medical students with heavy and light academic burdens, as well as those in higher grades, were more likely in C2. Non-medical students with 1.5-3 h of daily online time were more likely in C2, and those with <1.5 h were more likely in C3. CONCLUSIONS: College students' mental health demonstrates significant heterogeneity, with factors such as alcohol consumption, sleep disorders, academic burden, gender, grade, and daily online time serving as key predictors. These findings highlight the pressing need for targeted interventions aimed at addressing specific risk factors, thereby enhancing mental health support services.
29Academic Stress, Physical Activity, Sleep, and Mental Health among Chinese Adolescents.PubMed
Xihe Zhu, Justin A Haegele, Huarong Liu, et al.
Int J Environ Res Public Health. 2021 Jul 7;18(14):7257. doi: 10.3390/ijerph18147257.
UNLABELLED: The purpose of this study was to examine the impacts of academic stress on physical activity and sleep, and subsequently their impacts on anxiety and depression. METHODS: This cross-sectional study collected data from a convenience sample of 1533 adolescents in an eastern province in China. Surveys were used to collect data on academic stress, anxiety, depression, sleep, physical activity, and demographics. Descriptive statistics, correlation analysis, and path analysis were used to analyze data. RESULTS: The participants reported about 6.77 ± 0.89 h of sleep per day and 1.62 ± 1.79 days of 60 min of physical activity each week. Academic stress was positively correlated with anxiety and depression, which were negatively correlated with physical activity and sleep. The path analysis showed that academic stress directly predicted anxiety (β = 0.54) and depression (β = 0.55), and hours of sleep (β = 0.024) and the number of days of 60 min physical activity (β = 0.014) mediated the relation. CONCLUSION: The results largely supported our hypotheses and supported the need to lessen academic stress experienced by Chinese adolescents, in effort to enhance mental health indices directly, and by allowing for engagement in health-related behaviors such as physical activity and sleep.
30Sources of stress and worry in the development of stress-related mental health problems: A longitudinal investigation from early- to mid-adolescence.PubMed
M K Anniko, K Boersma, M Tillfors
Anxiety Stress Coping. 2019 Mar;32(2):155-167. doi: 10.1080/10615806.2018.1549657. Epub 2018 Nov 22.
BACKGROUND AND OBJECTIVES: Stress and stress-related mental health complaints are common and increasing among adolescents, especially girls. Identifying typical sources of stress as well as central intervention targets is an important effort in the development of effective prevention and treatment protocols. This study investigated worry as potential mediator in the development of mental health problems in response to common stressors in adolescence. We also examined to what sources adolescents ascribe their stress over the years from the 7th through the 9th grade. DESIGN: Prospective cohort study. METHODS: Self-reported subjective stressor load, worry, anxiety and depressive symptoms were assessed in a sample of Swedish 7th graders (N = 1137; 46% girls, mean age 13.2) with follow-up assessments one and two years later. RESULTS: School was the most common source of stress across all time-points, with girls reporting considerable more stress than boys. Worry mediated the relationship between overall stressor load and depressive symptoms and anxiety over time and was not moderated by gender. CONCLUSIONS: Worry may be an important target in stress prevention and efforts to prevent stress-related problems would benefit from focusing on early adolescence as especially school stress is already relatively common in grade 7.
31Changes and relevant factors in depressive and anxiety symptoms among Chinese adolescents after the "Double Reduction" policy: A repeated cross-sectional survey with a nested longitudinal subsample.PubMed
Dongfang Wang, Huolian Li, Xiangting Zhang, et al.
J Affect Disord. 2024 Dec 15;367:88-95. doi: 10.1016/j.jad.2024.08.191. Epub 2024 Aug 31.
BACKGROUND: The Chinese government has enacted the "Double Reduction" Policy, which aims to reduce students' academic burden and promote their mental health, but there is limited research examining the policy's impact on students' well-being. This study aims to evaluate changes in students' mental health problems before and after the "Double Reduction" Policy and explore relevant influential factors. METHODS: A total of 101,976 elementary and junior high school students were recruited before the "Double Reduction" Policy, and 91,832 students were recruited one year later. Through data integration, a total of 36,637 students participated in both web-based surveys and provided complete data on all measures. RESULTS: As a whole, we found that the prevalence of students' depression (12.1 % to 9.2 %) and anxiety (8.9 % to 6.2 %) tended to decline after the "Double Reduction" Policy. Attending private school, reduced homework, more extracurricular activities, more time with parents, reduced academic stress, and sleep duration ≥8 h/n were associated with the decrease in the likelihood of mental health problems in students. Female gender, negative life events, and negative impact of COVID-19 as risk factors for mental health. CONCLUSIONS: These findings indicated that the "Double Reduction" Policy has improved the well-being of Chinese students. Reducing students' homework burden and alleviating their academic pressure are beneficial for their mental health. Increasing time for extracurricular activities and interaction with parents, as well as ensuring sufficient sleep for students, are also effective ways to prevent the onset and exacerbation of mental health symptoms in adolescents.
34Individual characteristics of adolescent psychiatric patients accessing psychotherapy in China.PubMed
Jinping Ma, Hai Zhou, Xinwei Li, et al.
Sci Rep. 2022 Oct 9;12(1):16943. doi: 10.1038/s41598-022-21320-2.
Most mental health problems develop during childhood and adolescence, so identifying the mental health needs and care pathways of adolescents is crucial to improving prevention. This study aimed to understand the characteristics of adolescent patients with mental disorders receiving psychotherapy in China. Data were collected retrospectively from the psychotherapy records of 116 patients at the Weifang Mental Health Centre. Information collected included demographics, stressors, duration of psychotherapy, and clinical diagnosis. Chi-square tests and negative binomial regression models were used to explore the relationship between demographic and clinical variables. The results showed that depression was the most common diagnosis, followed by anxiety and stress-related disorders and bipolar and related disorders. Rural patients were more likely to report family stress, while urban patients were more likely to report school stress. Female patients were more likely to report family stress and to be diagnosed with depression. Family stress, social stress, school stress, patient origin and economic conditions were all significant predictors of the duration of psychological treatment. This study helps to understand the characteristics and psychotherapeutic needs of adolescents with mental disorders who receive psychotherapy in China so that the positive role of psychotherapy in the prevention, treatment and rehabilitation of mental disorders can be better utilised.
35Family structure and depression in Chinese adolescents: the mediating role of resilience.PubMed
Yun Du, Yujia Cao, Xiaoxuan Duan, et al.
J Affect Disord. 2026 Mar 15;397:120982. doi: 10.1016/j.jad.2025.120982. Epub 2025 Dec 19.
BACKGROUND: The family structure has undergone significant changes worldwide, with an increasing proportion of adolescents living in single-parent or grandparent-headed households, which may affect adolescent mental health, particularly depression, while psychological resilience may alleviate the negative impact of environment. Nevertheless, comprehensive research on the depression status of adolescents in various family structures and the role of resilience is still insufficient. METHODS: A large-scale, multi-region cross-sectional study, involving 29,405 Chinese middle school students, was conducted to assess demographic, family structure, depression and resilience. Based on who adolescents live with, the family structure was divided into nuclear family, single-parent family, extended family and skip-generation family. The Patient Health Questionnaire for depression (Chinese version) and the Connor Davidson Resilience Scale were employed to assess depression symptoms and resilience. SPSS software was used to analyze the prevalence, risk factors and mediating effects. RESULTS: 46.9 % of nuclear families, 46.6 % of extended families, 59.3 % of skip-generation families, and 64.8 % of single-parent families adolescents reported depression. Adolescents living in extended families and nuclear families scored higher resilience, in contrast with single-parent families, and skip-generation families. Resilience was protective factor of depression among four types of family structure. The resilience partially mediated the relationship between skip-generation and single-parentfamilies and adolescent depression (respectively 51.0 % and 17.1 %). Resilience exerted a competitive mediation effect between extended families and adolescent depression. CONCLUSION: Adolescents living with parents or in extended families have good psychological status. Priority should be given to the mental health of adolescents from single-parent or skip-generation households.
37Network analysis links adolescent depression with childhood, peer, and family risk environment factors.PubMed
Kangcheng Wang, Yufei Hu, Qiang He, et al.
J Affect Disord. 2023 Jun 1;330:165-172. doi: 10.1016/j.jad.2023.02.103. Epub 2023 Feb 23.
BACKGROUND: Adolescent mental health is influenced by various adverse environmental conditions. However, it remains unclear how these factors jointly affect adolescent depression. This study aimed to use network analysis to assess the associations between different environmental factors and depressive symptoms in adolescents and to identify key pathways between them. METHODS: This study included 610 adolescents with depression from inpatient and outpatient units recruited between March 2020 and November 2021. The mean age was 14.86 ± 1.96, with no significant difference between males (n = 155, 15.10 ± 2.19) and females (n = 455, 14.78 ± 1.88). Depressive symptoms were measured using the Children's Depression Inventory, and individual risk environment factors included childhood trauma, social peer and family risk factors. Network features, including network centrality, stability, and bridge centrality, were investigated. RESULTS: Anhedonia and self-esteem were found to be more central in depressive symptoms. Insult experiences from the social peer and emotional abuse experience from childhood were more central environmental factors. Childhood trauma experiences were more related to adolescent depressive symptoms compared to family and peer factors. Bridge analyses identified emotional abuse, emotional neglect and physical neglect as the main bridges linking environment risk to depressive symptoms. LIMITATIONS: This was a cross-sectionally designed study, which limited its ability to examine longitudinal dynamic interactions between environmental factors and adolescent depressive symptoms. CONCLUSIONS: Our findings suggested that childhood trauma experiences might have greater psychological impacts on adolescent depression than family and social peer environments, and should be considered as crucial targets for preventing severe depressive moods.
39#Sleepyteens: Social media use in adolescence is associated with poor sleep quality, anxiety, depression and low self-esteem.PubMed
Heather Cleland Woods, Holly Scott
J Adolesc. 2016 Aug;51:41-9. doi: 10.1016/j.adolescence.2016.05.008. Epub 2016 Jun 10.
This study examined how social media use related to sleep quality, self-esteem, anxiety and depression in 467 Scottish adolescents. We measured overall social media use, nighttime-specific social media use, emotional investment in social media, sleep quality, self-esteem and levels of anxiety and depression. Adolescents who used social media more - both overall and at night - and those who were more emotionally invested in social media experienced poorer sleep quality, lower self-esteem and higher levels of anxiety and depression. Nighttime-specific social media use predicted poorer sleep quality after controlling for anxiety, depression and self-esteem. These findings contribute to the growing body of evidence that social media use is related to various aspects of wellbeing in adolescents. In addition, our results indicate that nighttime-specific social media use and emotional investment in social media are two important factors that merit further investigation in relation to adolescent sleep and wellbeing.
40The relationship between addictive use of social media and video games and symptoms of psychiatric disorders: A large-scale cross-sectional study.PubMed
Cecilie Schou Andreassen, Joël Billieux, Mark D Griffiths, et al.
Psychol Addict Behav. 2016 Mar;30(2):252-62. doi: 10.1037/adb0000160.
Over the last decade, research into "addictive technological behaviors" has substantially increased. Research has also demonstrated strong associations between addictive use of technology and comorbid psychiatric disorders. In the present study, 23,533 adults (mean age 35.8 years, ranging from 16 to 88 years) participated in an online cross-sectional survey examining whether demographic variables, symptoms of attention-deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), anxiety, and depression could explain variance in addictive use (i.e., compulsive and excessive use associated with negative outcomes) of two types of modern online technologies: social media and video games. Correlations between symptoms of addictive technology use and mental disorder symptoms were all positive and significant, including the weak interrelationship between the two addictive technological behaviors. Age appeared to be inversely related to the addictive use of these technologies. Being male was significantly associated with addictive use of video games, whereas being female was significantly associated with addictive use of social media. Being single was positively related to both addictive social networking and video gaming. Hierarchical regression analyses showed that demographic factors explained between 11 and 12% of the variance in addictive technology use. The mental health variables explained between 7 and 15% of the variance. The study significantly adds to our understanding of mental health symptoms and their role in addictive use of modern technology, and suggests that the concept of Internet use disorder (i.e., "Internet addiction") as a unified construct is not warranted.
41ASSOCIATION BETWEEN SOCIAL MEDIA USE AND DEPRESSION AMONG U.S. YOUNG ADULTS.PubMed
Liu Yi Lin, Jaime E Sidani, Ariel Shensa, et al.
Depress Anxiety. 2016 Apr;33(4):323-31. doi: 10.1002/da.22466. Epub 2016 Jan 19.
BACKGROUND: Social media (SM) use is increasing among U.S. young adults, and its association with mental well-being remains unclear. This study assessed the association between SM use and depression in a nationally representative sample of young adults. METHODS: We surveyed 1,787 adults ages 19 to 32 about SM use and depression. Participants were recruited via random digit dialing and address-based sampling. SM use was assessed by self-reported total time per day spent on SM, visits per week, and a global frequency score based on the Pew Internet Research Questionnaire. Depression was assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Depression Scale Short Form. Chi-squared tests and ordered logistic regressions were performed with sample weights. RESULTS: The weighted sample was 50.3% female and 57.5% White. Compared to those in the lowest quartile of total time per day spent on SM, participants in the highest quartile had significantly increased odds of depression (AOR = 1.66, 95% CI = 1.14-2.42) after controlling for all covariates. Compared with those in the lowest quartile, individuals in the highest quartile of SM site visits per week and those with a higher global frequency score had significantly increased odds of depression (AOR = 2.74, 95% CI = 1.86-4.04; AOR = 3.05, 95% CI = 2.03-4.59, respectively). All associations between independent variables and depression had strong, linear, dose-response trends. Results were robust to all sensitivity analyses. CONCLUSIONS: SM use was significantly associated with increased depression. Given the proliferation of SM, identifying the mechanisms and direction of this association is critical for informing interventions that address SM use and depression.
42Ten Myths About the Effect of Social Media Use on Well-Being.PubMed
Jeffrey A Hall
J Med Internet Res. 2024 Nov 25;26:e59585. doi: 10.2196/59585.
This viewpoint reviews the empirical evidence regarding the association between social media use and well-being, including life satisfaction and affective well-being, and the association between social media use and ill-being, including loneliness, anxiety, and depressive symptomology. To frame this discussion, this viewpoint will present 10 widely believed myths about social media, each drawn from popular discourse on the topic. In rebuttal, this viewpoint will offer a warranted claim supported by the research. The goal is to bring popular beliefs into dialogue with state-of-the-art quantitative social scientific evidence. It is the intention of this viewpoint to provide a more accurate and nuanced claim to challenge each myth. This viewpoint will bring attention to the importance of using rigorous scientific evidence to inform public debates about social media use and well-being, especially among adolescents and young adults.
43Relationships Among Cyberbullying, School Bullying, and Mental Health in Taiwanese AdolescentsOpenAlex
Fong‐Ching Chang, Ching‐Mei Lee, Chiung‐Hui Chiu, et al.
BACKGROUND: This study examined the relationships among cyberbullying, school bullying, and mental health in adolescents. METHODS: In 2010, a total of 2992 10th grade students recruited from 26 high schools in Taipei, Taiwan completed questionnaires. RESULTS: More than one third of students had either engaged in cyberbullying or had been the target (cybervictim) of it in the last year. About 18.4% had been cyberbullied (cybervictim); 5.8% had cyberbullied others (cyberbully); 11.2% had both cyberbullied others and been cyberbullied (cyberbully-victim). About 8.2% had been bullied in school (victim); 10.6% had bullied others (bully); and, 5.1% had both bullied others and had been bullied in school (bully-victim). Students with Internet risk behaviors were more likely to be involved in cyberbullying and/or cybervictimization; students who had cyberbullying or victimization experiences also tended to be involved in school bullying/victimization. After controlling for sex, academic performance, and household poverty, cyber/school victims and bully-victims were more likely to have lower self-esteem, and cyber/school victims, bullies and bully-victims were at a greater risk for serious depression. CONCLUSIONS: Both cyberbullying and school bullying and/or victimization experiences were independently associated with increased depression.
47Reliability and validity of the Chinese version of the Patient Health Questionnaire (PHQ-9) in the general population.PubMed
Wenzheng Wang, Qian Bian, Yan Zhao, et al.
Gen Hosp Psychiatry. 2014 Sep-Oct;36(5):539-44. doi: 10.1016/j.genhosppsych.2014.05.021. Epub 2014 Jun 6.
OBJECTIVE: Depression is one of the most common mental illnesses. The reliability and the validity of the Patient Health Questionnaire (PHQ)-9, a depression screening tool, have not been examined in the general population in China. Thus, this study evaluated the reliability and the validity of the Chinese version of the PHQ-9 in detecting major depression in residents of a Chinese community. METHODS: A total of 1045 participants from a Shanghai community were enrolled in our study. Participants completed the Chinese versions of the PHQ-9, the Self-Rating Depression Scale (SDS), the 36-item Short Form Health Survey (SF-36), and the Mini International Neuropsychiatric Interview. One hundred participants were randomly selected to complete the PHQ-9 again 2 weeks after the initial assessment. The reliability, the validity and the receiver operating characteristic (ROC) curve of the PHQ-9 were analyzed. RESULTS: Cronbach's alpha for the internal consistency reliability of the Chinese version of the PHQ-9 was 0.86 for the entire scale. The correlation coefficient for the 2-week test-retest of the total score was 0.86. The PHQ-9 scale correlated positively with the SDS (r=0.29, p<0.001) and correlated negatively with all subscale scores of the SF-36 (correlation coefficients ranged from -0.11 to -0.47, p<0.001). The area under the curve of the ROC was 0.92 (95% confidence interval: 0.86-0.97). A cutoff score of 7 or higher on the PHQ-9 had a sensitivity of 0.86 and a specificity of 0.86. CONCLUSIONS: In the general Chinese population, the Chinese version of the PHQ-9 is a valid and efficient tool for screening depression, with a recommended cutoff score of 7 or more.
48A Chinese adaptation of the Patient Health Questionnaire for Adolescents (PHQ-A): factor structure and psychometric properties.PubMed
Yu-Qi Chen, Xiao-Jie Huang, Fan Yang, et al.
BMC Psychiatry. 2024 Apr 30;24(1):331. doi: 10.1186/s12888-024-05783-3.
BACKGROUND: To examine the factor structure and psychometric properties of the Patient Health Questionnaire for Adolescents (PHQ-A) in Chinese children and adolescents with major depressive disorder (MDD). METHODS: A total of 248 MDD patients aged between 12 and 18 years were recruited and evaluated by the Patient Health Questionnaire for Adolescents (PHQ-A), the Center for Epidemiological Survey Depression Scale (CES-D), the Mood and Feelings Questionnaire (MFQ), and the improved Clinical Global Impression Scale, Severity item (iCGI-S). Thirty-one patients were selected randomly to complete the PHQ-A again one week later. Confirmatory factor analysis (CFA) was used to test the construct validity of the scale. Reliability was evaluated by Macdonald Omega coefficient. Pearson correlation coefficient was used to assess the item-total correlation and the correlation of PHQ-A with CES-D and MFQ respectively. Spearman correlation coefficient was used to assess test-retest reliability. The optimal cut-off value, sensitivity, and specificity of the PHQ-A were achieved by estimating the Receiver Operating Characteristics (ROC) curve. RESULTS: CFA reported adequate loadings for all items, except for item 3. Macdonald Omega coefficient of the PHQ-A was 0.87. The Spearman correlation coefficient of the test-retest reliability was 0.70. The Pearson correlation coefficients of the PHQ-A with CES-D and MFQ were 0.87 and 0.85, respectively (p < 0.01). By taking the iCGI-S as the remission criteria for MDD, the optimal cut-off value, sensitivity and specificity of the PHQ-A were 7, 98.7%, 94.7% respectively. CONCLUSION: The PHQ-A presented as a unidimensional construct and demonstrated satisfactory reliability and validity among the Chinese children and adolescents with MDD. A cut-off value of 7 was suggested for remission.
49Cross-cultural validation of the Depression Anxiety Stress Scale-21 in China.PubMed
Kui Wang, Hai-Song Shi, Fu-Lei Geng, et al.
Psychol Assess. 2016 May;28(5):e88-e100. doi: 10.1037/pas0000207. Epub 2015 Nov 30.
The gap between the demand and delivery of mental health services in mainland China can be reduced by validating freely available and psychometrically sound psychological instruments. The present research examined the Chinese version of the 21-item Depression Anxiety Stress Scales (DASS-21). Study 1 administered the DASS-21 to 1,815 Chinese college students and found internal consistency indices (Cronbach's alpha) of .83, .80, and .82 for the Depression, Anxiety, and Stress subscales, respectively, and .92 for the total DASS total. Test-retest reliability over a 6-month interval was .39 to .46 for each of the 3 subscales and .46 for the total DASS. Moderate convergent validity of the Depression and Anxiety subscales was demonstrated via significant correlations with the Chinese Beck Depression Inventory (r = .51 at Time 1 and r = .64 at Time 2) and the Chinese State-Trait Anxiety Inventory (r = .41), respectively. Confirmatory factor analyses supported the original 3-factor model with 1 minor change (nonnormed fit index [NNFI] = .964, comparative fit index [CFI] = .968, and root mean square error of approximation [RMSEA] = .079). Study 2 examined the clinical utility of the Chinese DASS-21 in 166 patients with schizophrenia and 90 matched healthy controls. Patients had higher Depression and Anxiety but not Stress subscale scores than healthy controls. A discriminant function composed of the linear combination of 3 subscale scores correctly discriminated 69.92% of participants, which again supported the potential clinical utility of the DASS in mainland China. Taken together, findings in these studies support the cross-cultural validity of the DASS-21 in China. (PsycINFO Database Record
50Application of DASS-21 in Chinese students: invariance testing and network analysis.PubMed
Zheng Zhang, Ruoheng Lin, Andi Qiu, et al.
BMC Public Health. 2024 Oct 23;24(1):2934. doi: 10.1186/s12889-024-20123-6.
BACKGROUND: The Depression Anxiety Stress Scale-21 Items (DASS-21) is commonly used to assess the mental health of students, but there is a need for further clarification regarding its equivalence, structure, and core items. METHODS: We conducted a confirmatory factor analysis (CFA) on a sample of 7943 Chinese students to examine the performance of the DASS-21 and assess measurement invariance. Additionally, we utilized network analysis to investigate the structure and centrality of students' mental health. RESULTS: Our findings revealed a stable three-factor structure for the DASS-21, characterized by high correlations among depression, anxiety, and stress. The DASS-21 demonstrated strict invariance across genders and weak invariance across levels of education. Network analysis indicated that symptoms of depression, anxiety, and stress form clusters, with some symptoms exhibiting strong correlations with each other. CONCLUSION: Our study highlights a substantial interrelation among depression, anxiety, and stress, revealing a structurally clustered pattern. Network analysis underscores the interconnectedness and centrality of these symptoms, recommending a shorter version of the DASS, and emphasizing the imperative for targeted interventions aimed at improving the psychological well-being of students.
51Factor structure and psychometric properties of the Connor-Davidson Resilience Scale among Chinese adolescents.PubMed
Xiao-Nan Yu, Joseph T F Lau, Winnie W S Mak, et al.
Compr Psychiatry. 2011 Mar-Apr;52(2):218-24. doi: 10.1016/j.comppsych.2010.05.010.
OBJECTIVES: Resilience refers to psychological characteristics that promote effective coping and positive adaptation in adversity. This study investigated the factor structure and psychometric properties of the Chinese version of the Connor-Davidson Resilience Scale (CD-RISC) among adolescents. METHODS: A total of 2914 Chinese adolescents living in Chengdu, Sichuan, completed the CD-RISC 1 month after the 2008 Sichuan earthquake. They also self-administered the Multidimensional Scale of Perceived Social Support, the Children's Depression Inventory, and the Screen for Child Anxiety Related Emotional Disorders. With confirmatory factor analysis, various factor structures of the CD-RISC reported in previous studies (eg, the 5- and 3-factor models) were examined at the first-order level; and a single factor of resilience was investigated at the second-order level in this sample. The internal consistency and concurrent validity were investigated. Sex and age differences were also examined. RESULTS: Confirmatory factor analysis results showed that the 5-factor model originally derived among US community adults was replicated in our sample, and these 5 factors also loaded on a higher-order "resilience" factor. The Cronbach α coefficient was 0.89. The resilience scores demonstrated expected positive correlation with social support (r = 0.44) and negative correlations with depression (r = -0.38) and anxiety (r = -0.25) (Ps < .001). Male participants reported higher resilience scores than female participants, and younger participants also reported higher resilience scores than older participants. CONCLUSIONS: The Chinese version of the CD-RISC was demonstrated to be a reliable and valid measurement in assessing resilience among Chinese adolescents.
52Understanding the role of coping in the development of depressive symptoms: symptom specificity, gender differences, and cross-cultural applicability.PubMed
Randy P Auerbach, John R Z Abela, Xiongzhao Zhu, et al.
Br J Clin Psychol. 2010 Nov;49(Pt 4):547-61. doi: 10.1348/014466509X479681. Epub 2010 Jan 22.
OBJECTIVES: The primary aim examined whether coping deficits, a greater tendency to utilize maladaptive as opposed to adaptive coping strategies, was associated with increases in depressive symptoms following negative events. The secondary goals examined: the common vulnerability hypothesis, sex differences, and the cross-cultural generalizability. DESIGN: Following the initial assessment, Canadian adolescents completed three follow-up assessments every 6 weeks. The Chinese adolescents completed an initial assessment and six follow-up assessments occurring monthly. METHODS: At Time 1, 150 Canadian and 397 Chinese adolescents completed self-report measures assessing depressive symptoms, anxious symptoms, negative events, and coping. During each of the follow-up assessments, participants completed self-report measures assessing depressive symptoms, anxious symptoms, and negative events. RESULTS: In both samples, higher levels of coping deficits were associated with increases in depressive, but not anxious, symptoms following negative events. Gender differences did not emerge. CONCLUSIONS: The present study provides a theoretically driven model to examine the impact of broad-based coping on the development of depressive symptoms.
53Machine learning identifies prominent risk factors for depressive symptoms among Chinese children and adolescents.PubMed
Tingting Lei, Huiling Qiu, Xueer Liu, et al.
J Affect Disord. 2025 Nov 15;389:119678. doi: 10.1016/j.jad.2025.119678. Epub 2025 Jun 14.
BACKGROUND: Identifying key risk factors for depressive symptoms in children and adolescents is crucial for prevention. However, few studies have explored this topic. This study aimed to examine the prevalence of depressive symptoms in Chinese children and adolescents and rank prominent risk factors. METHODS: A total of 198,062 children and adolescents were recruited from Chongqing, China. The Center for Epidemiological Studies Depression Scale for Children was used to assess depressive symptoms. Covariates were collected via single-item questions and scales. Logistic regression and three machine learning (ML) methods (Random Forest, Random Ferns, and Extreme Gradient Boosting) were used to identify and rank risk factors. Subgroup analysis was conducted to examine variations among different demographics. RESULTS: The prevalence of depressive symptoms among children and adolescents was 29.6%. Risk factors included socio-demographics, family background, lifestyle, academic performance, trauma experiences, relationships, and personality traits (adjusted odds ratio = 1.03-1.88, all p < 0.05). ML analysis highlighted nine key risk factors: psychological resilience, age, sleep satisfaction, self-expectations, gender, relationship with father, academic performance, relationship with classmates, and breakfast frequency. A minimal model was established to identify depressive symptoms, achieving an AUC value of 0.844. Subgroup analysis showed similar factor rankings pattern in the overall sample. CONCLUSION: Our study identified psychological resilience, age, sleep satisfaction, self-expectations, gender, relationship with father, academic performance, relationship with classmates, and breakfast frequency may be the prominent factors for Chinese children and adolescents. These factors should be prioritized in the prevention process of depressive symptoms.
54A neuroimaging-based precision medicine framework for depression.PubMed
Yao Xiao, Fay Y Womer, Shuai Dong, et al.
Asian J Psychiatr. 2024 Jan;91:103803. doi: 10.1016/j.ajp.2023.103803. Epub 2023 Oct 27.
BACKGROUND: Symptom-based diagnostic criteria of depression leads to notorious heterogeneity and subjectivity. METHODS: The study was conducted in two stages at two sites: development of a neuroimaging-based subtyping and precise repetitive transcranial magnetic stimulation (rTMS) strategy for depression at Center 1 and its clinical application at Center 2. Center 1 identified depression subtypes and subtype-specific rTMS targets based on amplitude of low frequency fluctuation (ALFF) in a cohort of 238 major depressive disorder patients and 66 healthy controls (HC). Subtypes were identified using a Gaussian Mixture Model, and subtype-specific rTMS targets were selected based on dominant brain regions prominently differentiating depression subtypes from HC. Subsequently, one classifier was employed and 72 hospitalized, depressed youths at Center 2 received two-week precise rTMS. MRI and clinical assessments were obtained at baseline, midpoint, and treatment completion for evaluation. RESULTS: Two neuroimaging subtypes of depression, archetypal and atypical depression, were identified based on distinct frontal-posterior functional imbalance patterns as measured by ALFF. The dorsomedial prefrontal cortex was identified as the rTMS target for archetypal depression, and the occipital cortex for atypical depression. Following precise rTMS, ALFF alterations were normalized in both archetypal and atypical depressed youths, corresponding with symptom response of 90.00% in archetypal depression and 70.73% in atypical depression. CONCLUSIONS: A precision medicine framework for depression was developed based on objective neurobiomarkers and implemented with promising results, actualizing a subtyping-treatment-evaluation closed loop in depression. Future randomized controlled trials are warranted.
55Universal school-based intervention: personal competence among public school children.PubMed
Elie G Karam, Josleen Al Barathie, Ingrid Kabalan, et al.
Eur Child Adolesc Psychiatry. 2025 Sep;34(9):2887-2897. doi: 10.1007/s00787-025-02710-z. Epub 2025 Apr 7.
Childhood adversities profoundly affect mental and physical well-being. Effective psychosocial interventions in schools are crucial for mitigating adversities' impacts. Despite availability, many children lack access to those interventions in low-income countries. This study evaluates a universal school-based intervention in Lebanon for children, including refugees, aimed at improving personal competence and reducing mental health symptoms including anxiety, depression, posttraumatic stress disorder, and attention-deficit/hyperactivity disorder. The study involved 1,920 Lebanese and Syrian children in grades 4 to 7, attending public schools in Lebanon. The program comprised 13 sessions administered in classrooms by teachers supervised by fieldworkers. Data collection included pre- and post-intervention assessments using standardized measures to evaluate outcomes. We used linear mixed models to test for intervention effect. Moderators such as childhood adversity, positive home environment, and environmental sensitivity were also tested using three-way interaction. Our intervention led to significant improvements in personal competence and secondary outcomes such as depression, anxiety, posttraumatic stress disorder, and attention-deficit/hyperactivity disorder symptoms. Childhood adversity and environmental sensitivity influenced intervention effects on some secondary outcomes. However, personal competence improvements were consistent across all student subgroups, highlighting the intervention's broad efficacy, even among students with various risk or protective factors. Our study emphasizes the significance of school-based interventions for addressing childhood personal competence and mental health symptoms, especially in low-income countries with limited access to mental health services.
56Reduction in adolescent depression after contact with mental health services: a longitudinal cohort study in the UKOpenAlex
Sharon Neufeld, Valerie Dunn, Peter B. Jones, et al.
BACKGROUND: Evidence regarding the association between service contact and subsequent mental health in adolescents is scarce, and previous findings are mixed. We aimed to longitudinally assess the extent to which depressive symptoms in adolescents change after contact with mental health services. METHODS: As part of a longitudinal cohort study, between April 28, 2005, and March 17, 2010, we recruited 1238 14-year-old adolescents and their primary caregivers from 18 secondary schools in Cambridgeshire, UK. Participants underwent follow-up assessment at months 18 and 36. Trained researchers assessed the adolescents for current mental disorder using the Schedule for Affective Disorders and Schizophrenia for School-Age Children Present and Lifetime version (K-SADS-PL). Caregivers and adolescents reported contact with mental health services in the year before baseline. Adolescents self-reported depressive symptoms (Mood and Feelings Questionnaire [MFQ]) at each timepoint. We assessed change in MFQ sum scores from baseline contact with mental health services using multilevel mixed-effects regression adjusted for sociodemographic, environmental, individual, and mental health confounders, with multiple imputation of missing data. We used propensity score weighting to balance confounders between treatment (users of mental health services) and control (non-users of mental health services) groups. We implemented an MFQ clinical cutoff following the results of receiver operating characteristic analysis. FINDINGS: 14-year-old adolescents who had contact with mental health services in the past year had a greater decrease in depressive symptoms than those without contact (adjusted coefficient -1·68, 95% CI -3·22 to -0·14; p=0·033). By age 17 years, the odds of reporting clinical depression were more than seven times higher in individuals without contact than in service users who had been similarly depressed at baseline (adjusted odds ratio 7·38, 1·73-31·50; p=0·0069). INTERPRETATION: Our findings show that contact with mental health services at age 14 years by adolescents with a mental disorder reduced the likelihood of depression by age 17 years. This finding supports the improvement of access to adolescent mental health services. FUNDING: Wellcome Trust, National Institute for Health Research.
57Scoping review: potential harm from school-based group mental health interventions.PubMed
Carolina Guzman-Holst, Rowan Streckfuss Davis, Jack L Andrews, et al.
Child Adolesc Ment Health. 2025 Sep;30(3):208-222. doi: 10.1111/camh.12760. Epub 2025 Mar 18.
BACKGROUND: A growing body of evidence demonstrates that school-based mental health interventions may be potentially harmful. We define potential harm as any negative outcome or adverse event that could plausibly be linked to an intervention. In this scoping review, we examine three areas: the types of potential harms and adverse events reported in school-based mental health interventions; the subgroups of children and adolescents at heightened risk; and the proposed explanations for these potential harms. METHODS: We searched eight databases (1960-2023), performed an author search and hand-searched for published and unpublished studies that evaluated controlled trials of school-based group mental health interventions based on cognitive-behavioural therapy and/or mindfulness techniques, with the aim of reducing or preventing internalising symptoms or increasing wellbeing. Two independent raters screened studies for eligibility and assessed study quality using Cochrane tools. From eligible studies, we reviewed those that reported at least one negative outcome. RESULTS: Ten out of 112 (8.93%) interventions (described in 120 studies) reported at least one negative outcome such as a decrease in wellbeing or an increase in depression or anxiety. Three out of 112 interventions (2.68%) reported the occurrence of specific adverse events, none of which were linked to the intervention. Of the 15/120 studies rated as high quality (i.e. those with low risk of bias), 5/15 (33.33%) reported at least one negative outcome. Negative outcomes were found for a number of subgroups including individuals deemed at high risk of mental health problems, male participants, younger children and children eligible for free school meals. About half (54.5%) of the studies acknowledged that the content of the intervention itself might have led to the negative outcome. CONCLUSION: To design and implement effective school-based mental health interventions, the issues of potential harm and their related measurement and reporting challenges must be addressed.
59Comprehensive School Mental Health: An integrated “School-Based Pathway to Care” model for Canadian secondary schoolsOpenAlex
Yifeng Wei, Stan Kutcher, Magdalena Szumilas
Adolescence is a critical period for the promotion of mental health and the treatment of mental disorders. Schools are well-positioned to address adolescent mental health. This paper describes a school mental health model, “School-based Pathway to Care,” for Canadian secondary schools that links schools to primary care providers, mental health services, and the wider community, enabling them to address youth mental health in a collaborative manner. The model highlights the fundamental role of mental health literacy, gatekeeper training, and education/health system integration in improving adolescent mental health, and enhancing learning environments and academic outcomes.
60Long-Term Effects of School-Based CBT in Low-Risk Children and Adolescents: A Bayesian Meta-Analysis.PubMed
Xiangying Zhang, Zhide Liang, Jihye Kang
J Clin Psychol. 2026 Mar;82(3):248-259. doi: 10.1002/jclp.70069. Epub 2025 Nov 24.
BACKGROUND: Depression and anxiety are increasingly common among children and adolescents. While school-based cognitive behavioral therapy (CBT) is a promising intervention, most research has focused on its effects in high-risk or symptomatic populations. This leaves a critical gap in our understanding of its effectiveness as a universal prevention strategy for the general, low-risk student population. Establishing whether CBT can benefit low-risk students is crucial for developing proactive, school-wide mental health systems aimed at preventing future problems before they emerge. This study aimed to fill this gap by evaluating the short- and long-term effects of universal school-based CBT on low-risk children and young people, providing insights for optimizing intervention programs. METHODS: Systematic searches of MEDLINE, Embase, the Cochrane Library, Web of Science, and PsyInfo were conducted from inception to January 15, 2025 to identify randomized controlled trials (RCTs) of school-based CBT for depression and anxiety in low-risk populations. Paired and regression meta-analyses of these results were conducted using Bayesian hierarchical models. RESULTS: The 31 RCTs included a total of 19,865 children and young people. Compared to the control group, school-based CBT produced a statistically significant but very small improvement in depressive symptoms (SMD: -0.06, 95% CrI: -0.08 to -0.04) and a small reduction in anxiety symptoms (SMD: -0.19, 95% CrI: -0.22 to -0.17). These effects appeared to be maintained for up to 1 year. Exploratory analyses suggested that males may benefit more from anxiety interventions. CONCLUSION: This study provides the first meta-analytic evidence that universal school-based CBT can produce small but durable, long-term preventive effects in low-risk youth. Although the very low quality of the underlying evidence means the findings are not robust enough to support widespread implementation at this time, they establish a crucial signal of effectiveness. The primary implication is that universal CBT is a promising strategy that warrants significant investment in future high-quality, large-scale trials to confirm its real-world value.
61Group acceptance and commitment therapy for promoting mental health in schools: a feasibility study.PubMed
J Y M Tang, J Q Xu, Q Wang
East Asian Arch Psychiatry. 2025 Jun;35(2):71-76. doi: 10.12809/eaap2546.
OBJECTIVES: To determine the effectiveness of a group acceptance and commitment therapy (ACT) programme on improving psychological flexibility, resilience, and other psychological outcomes in adolescents with subclinical mental health issues in secondary schools in Hong Kong. METHODS: This study used a single-group, pretest-posttest, quasi-experimental design. The group ACT programme comprised four 1.5-hour sessions delivered weekly by a psychologist and an assistant. Students with subclinical levels of anxiety symptoms, depressive symptoms, or perceived stress were recruited from seven schools. Participants were asked to complete a self-report questionnaire before and after intervention to evaluate the effectiveness of the group ACT programme. Psychological flexibility was assessed using the Chinese version of the Acceptance and Action Questionnaire II. Resilience was assessed using the Short Resilience Scale. Anxiety and depressive symptoms were assessed using the Patient Health Questionnaire-9 and Generalised Anxiety Disorder-7, respectively. Life satisfaction was assessed using the Satisfaction with Life Scale. Sleep quality over the previous month was assessed using the Pittsburgh Sleep Quality Index. RESULTS: In total, 61 students of grades 7 to 12 were included; 53 (86.9%) attended ≥3 sessions. No significant changes were observed in psychological flexibility or resilience. Participants reported significantly reduced stress (p = 0.003) and depressive symptoms (p = 0.036), with a small-to-moderate effect size (Cohen's d = 0.36 and 0.28, respectively). CONCLUSION: This school-based ACT programme appeared feasible and could significantly reduce stress and depressive symptoms among secondary school students with subclinical mental health issues.
62Effectiveness of an integrated motivational cognitive-behavioral group intervention for adolescents with gaming disorder: a randomized controlled trial.PubMed
Yinan Ji, Daniel Fu Keung Wong
Addiction. 2023 Nov;118(11):2093-2104. doi: 10.1111/add.16292. Epub 2023 Jul 12.
AIMS, DESIGN AND SETTING: The aim of this study was to test the efficacy of the integrated cognitive-behavioral therapy with a strength-based motivational approach [integrated cognitive-behavioral therapy (ICBT)] intervention to change gaming disorder (GD) symptoms and other outcomes and to study the therapeutic mechanism. A two-arm parallel randomized waiting-list controlled trial with 3- and 6-month follow-ups were conducted in a secondary vocational school in mainland China. PARTICIPANTS: Participants comprised 77 Chinese adolescents with GD symptoms with a mean age of 16.36 years [standard deviation (SD) = 0.93]; 88.3% were male INTERVENTIONS: Participants were randomized into an ICBT group (n = 38) and a waiting-list control (WLC, n = 39) group. ICBT intervention comprised eight weekly sessions to encourage participants to identify their interests and strengths and set goals for developing personally meaningful real-life activities. MEASUREMENTS AND FINDINGS: The outcomes were measured at pre-treatment (t ), post-treatment (t ), 3-month (t ) and 6-month (t ) follow-ups. The primary outcome was GD symptoms at t3. Secondary outcomes included GD symptoms at t and t , and gaming motivation, maladaptive gaming cognition, depression and anxiety symptoms at t , t and t . With the intention-to-treat principle, the GD scores at t were significantly different between the CBT and WLC groups [mean difference 62.08 (SD = 10.48) versus 73.64 (SD = 11.70); Hedges' g = 1.15, 95% confidence interval = 0.67-1.62]. Linear mixed-effects modeling showed significant group × time interaction for the secondary outcomes (P < 0.01), with a moderate to strong between-group effect size in the reduction in depression symptoms (g = 0.67-0.84) and anxiety symptoms (g = 0.6-0.64). Path analysis shows ICBT leads to GD reduction through reducing gaming motivation and maladaptive gaming cognition. CONCLUSIONS: An integrated cognitive-behavioral therapy with strength-based motivational approach intervention reduced gaming disorder symptoms and time spent gaming over a 6-month period by decreasing maladaptive gaming motivation and cognition.
63Enhancing resilience in single-parent family adolescents in China: a randomized controlled trial based on home-school collaborative intervention.PubMed
Binrong Dai, Yujie He, Mei Peng
BMC Public Health. 2025 Apr 28;25(1):1573. doi: 10.1186/s12889-025-22662-y.
BACKGROUND: It remains unknown whether home-school collaborative strategies can improve the resilience of adolescents and children from single-parent families in China. OBJECTIVES: This study addresses the gap in resilience interventions for single-parent family students by validating a 7-week home-school collaborative intervention strategy. METHODS: The participants were 89 primary and secondary school children from China, randomly assigned to either the experimental group (20 single-parent and 27 non-single-parent students) or the control group (20 single-parent and 22 non-single-parent students). Both groups used the Adolescent Psychological Resilience Scale to report their resilience levels during the pre-test and post-test phases. Single-parent family parents also reported their collaborative participation using a behavior checklist. RESULTS: The experimental group exhibited higher resilience gain scores compared to the control group. The intervention effects in the experimental group remained stable for one month after the intervention ended. Additionally, the intervention at the school level fostered greater collaborative involvement from single-parent families, particularly in terms of family support participation. CONCLUSIONS: The Home-school collaborative intervention strategy is a valuable measure for enhancing the resilience of students from single-parent families and has the potential for application within both family and school contexts.
64Effectiveness of a Multifaceted Intervention for Prevention of Obesity in Primary School Children in China: A Cluster Randomized Clinical Trial.PubMed
Zheng Liu, Pei Gao, Ai-Yu Gao, et al.
JAMA Pediatr. 2022 Jan 1;176(1):e214375. doi: 10.1001/jamapediatrics.2021.4375. Epub 2022 Jan 4.
IMPORTANCE: A rapid nutritional transition has caused greater childhood obesity prevalence in many countries, but the repertoire of effective preventive interventions remains limited. OBJECTIVE: To determine the effectiveness of a novel multifaceted intervention for obesity prevention in primary school children. DESIGN, SETTING, AND PARTICIPANTS: A cluster randomized clinical trial was conducted during a single school year (from September 11, 2018, to June 30, 2019) across 3 socioeconomically distinct regions in China according to a prespecified trial protocol. Twenty-four schools were randomly allocated (1:1) to the intervention or the control group, with 1392 eligible children aged 8 to 10 years participating. Data from the intent-to-treat population were analyzed from October 1 to December 31, 2019. INTERVENTIONS: A multifaceted intervention targeted both children (promoting healthy diet and physical activity) and their environment (engaging schools and families to support children's behavioral changes). The intervention was novel in its strengthening of family involvement with the assistance of a smartphone app. The control schools engaged in their usual practices. MAIN OUTCOMES AND MEASURES: The primary outcome was the change in body mass index (BMI; calculated as weight in kilograms divided by height in square meters) from baseline to the end of the trial. Secondary outcomes included changes in adiposity outcomes (eg, BMI z score, prevalence of obesity), blood pressure, physical activity and dietary behaviors, obesity-related knowledge, and physical fitness. Generalized linear mixed models were used in the analyses. RESULTS: Among the 1392 participants (mean [SD] age, 9.6 [0.4] years; 717 boys [51.5%]; mean [SD] BMI, 18.6 [3.7]), 1362 (97.8%) with follow-up data were included in the analyses. From baseline to the end of the trial, the mean BMI decreased in the intervention group, whereas it increased in the control group; the mean between-group difference in BMI change was -0.46 (95% CI, -0.67 to -0.25; P < .001), which showed no evidence of difference across different regions, sexes, maternal education levels, and primary caregivers (parents vs nonparents). The prevalence of obesity decreased by 27.0% of the baseline figure (a relative decrease) in the intervention group, compared with 5.6% in the control group. The intervention also improved other adiposity outcomes, dietary, sedentary, and physical activity behaviors, and obesity-related knowledge, but it did not change moderate- to vigorous-intensity physical activity, physical fitness, or blood pressure. No adverse events were observed during the intervention. CONCLUSIONS AND RELEVANCE: The multifaceted intervention effectively reduced the mean BMI and obesity prevalence in primary school children across socioeconomically distinct regions in China, suggesting its potential for national scaling. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03665857.
65Review: School-based interventions to improve mental health literacy and reduce mental health stigma - a systematic review.PubMed
Karen Kei Yan Ma, Joanna K Anderson, Anne-Marie Burn
Child Adolesc Ment Health. 2023 May;28(2):230-240. doi: 10.1111/camh.12543. Epub 2022 Jan 10.
BACKGROUND: The steadily increasing prevalence of mental disorders in children and adolescents presents itself as a public health challenge, especially given the health, social and economic burden of mental disorders. School-based interventions aimed at improving mental health literacy and reducing mental health stigma have the potential to prevent mental disorders and promote mental well-being, thus reducing the burden of mental disorders. This review identified and synthesised evidence on the effectiveness of school-based interventions designed to improve mental health literacy and reduce mental health stigma. METHODS: Electronic bibliographic databases including MEDLINE, Embase, PsycINFO, Education Resources Information Center (ERIC), Child Development and Adolescent Studies, British Education Index and Applied Social Sciences Index and Abstracts (ASSIA) were searched. Randomised controlled trials (RCTs) were included if they assessed the effectiveness or cost-effectiveness of school-based intervention aimed at improving mental health literacy and reducing mental health stigma for children and young people aged 4-18 years. Quality of studies was appraised using the EPHPP tool. A numerical summary and a narrative description of the findings in relation to the research questions were synthesised. This systematic review was registered with PROSPERO (CRD42020191265). RESULTS: We identified 21 studies describing 20 unique school-based mental health interventions. Overall, there is moderate evidence suggesting that school-based mental health interventions can be effective in improving mental health literacy and reducing mental health stigma defined as attitudes and beliefs regarding mental disorders. However, there is less evidence for their long-term effectiveness, as most studies did not include follow-ups. CONCLUSIONS: Despite exclusively including studies with randomised designs, intervention and methodological heterogeneity poses uncertainties to any conclusions made. Future research should focus on resolving methodological issues concerning how outcomes are assessed and include process evaluations to better inform the design of an intervention in term of its delivery and implementation.
66Online Mindfulness-Based Cognitive Behavioral Therapy Intervention for Youth With Major Depressive Disorders: Randomized Controlled Trial.PubMed
Paul Ritvo, Yuliya Knyahnytska, Meysam Pirbaglou, et al.
J Med Internet Res. 2021 Mar 10;23(3):e24380. doi: 10.2196/24380.
BACKGROUND: Approximately 70% of mental health disorders appear prior to 25 years of age and can become chronic when ineffectively treated. Individuals between 18 and 25 years old are significantly more likely to experience mental health disorders, substance dependencies, and suicidality. Treatment progress, capitalizing on the tendencies of youth to communicate online, can strategically address depressive disorders. OBJECTIVE: We performed a randomized controlled trial (RCT) that compared online mindfulness-based cognitive behavioral therapy (CBT-M) combined with standard psychiatric care to standard psychiatric care alone in youth (18-30 years old) diagnosed with major depressive disorder. METHODS: Forty-five participants were randomly assigned to CBT-M and standard care (n=22) or to standard psychiatric care alone (n=23). All participants were provided standard psychiatric care (ie, 1 session per month), while participants in the experimental group received an additional intervention consisting of the CBT-M online software program. Interaction with online workbooks was combined with navigation coaching delivered by phone and secure text messaging. RESULTS: In a two-level linear mixed-effects model intention-to-treat analysis, significant between-group differences were found for the Beck Depression Inventory-II score (difference -8.54, P=.01), Quick Inventory of Depressive Symptoms score (difference -4.94, P=.001), Beck Anxiety Inventory score (difference -11.29, P<.001), and Brief Pain Inventory score (difference -1.99, P=.03), while marginal differences were found for the Five Facet Mindfulness Questionnaire-Nonjudging subscale (difference -2.68, P=.05). CONCLUSIONS: These results confirm that youth depression can be effectively treated with online CBT-M that can be delivered with less geographic restriction. TRIAL REGISTRATION: Clinical Trials.gov NCT03406052; https://www.clinicaltrials.gov/ct2/show/NCT03406052.
67Does an app designed to reduce repetitive negative thinking decrease depression and anxiety in young people? (RETHINK): a randomized controlled prevention trial.PubMed
Julia Funk, Johannes Kopf-Beck, Edward Watkins, et al.
Trials. 2023 Apr 25;24(1):295. doi: 10.1186/s13063-023-07295-z.
BACKGROUND: The first onset of common mental health disorders, such as mood and anxiety disorders, mostly lies in adolescence or young adulthood. Hence, effective and scalable prevention programs for this age group are urgently needed. Interventions focusing on repetitive negative thinking (RNT) appear especially promising as RNT is an important transdiagnostic process involved in the development of depression and anxiety disorders. First clinical trials indeed show positive effects of preventative interventions targeting RNT on adult as well as adolescent mental health. Self-help interventions that can be delivered via a mobile phone app may have the advantage of being highly scalable, thus facilitating prevention on a large scale. This trial aims to investigate whether an app-based RNT-focused intervention can reduce depressive and anxiety symptoms in young people at risk for mental health disorders. METHODS: The trial will be conducted in a sample (planned N = 351) of individuals aged 16-22 years with elevated levels of RNT but no current depression or anxiety disorder. In a randomized controlled between-subjects design, two versions of the app-based self-help intervention will be compared to a waiting list control condition. The full RNT-focused intervention encompasses a variety of RNT-reducing strategies, whereas the concreteness training intervention focuses on only one of these strategies, i.e., concrete thinking. The primary outcome (depressive symptoms) and secondary outcomes (anxiety symptoms and RNT) will be measured at pre-intervention, post-intervention (6 weeks after pre-intervention), and follow-up (18 weeks after pre-intervention). DISCUSSION: This trial aims to find out whether targeting RNT via an app is an effective and feasible way of preventing depression and anxiety disorders in adolescents. Since app-based interventions are highly scalable, this trial might contribute to tackling challenges related to the increasing rates of mental health disorders among young people. TRIAL REGISTRATION: https://www.drks.de , DRKS00027384. Registered on 21 February 2022-prospectively registered.
68Mental health app boost my mood (BMM) as preventive early intervention for adolescents with (sub)clinical depressive symptoms.PubMed
Linda Willems, Sanne P A Rasing, Dewi A M Heijs, et al.
BMC Public Health. 2024 Aug 5;24(1):2118. doi: 10.1186/s12889-024-19666-5.
BACKGROUND: Depression is a common mental disorder. Detecting (sub)clinical depressive symptoms in adolescents at an early stage and offering a low-threshold early intervention can minimize the risk of serious and/or long-term depression. As such, a digital intervention can be a low-threshold preventive and early intervention. This study aims to examine whether the Boost My Mood (BMM)-app is a suitable preventive early intervention for adolescents with (sub)clinical depressive symptoms. METHODS: This naturalistic single-arm evaluation study (N = 50) was conducted in adolescents aged 16-21 with (sub)clinical depressive symptoms. Furthermore, the BMM-app was studied in relation to anxiety, worrying, stress, and sleeping problems. An exploratory objective was to determine whether positive expectations and social support are related to app use. RESULTS: The study showed a significant decrease in not only depressive symptoms, but also anxiety, worrying and stress while using the BMM-app. Sleeping problems did not significantly decrease over time while using the BMM-app. The degree of use of the BMM-app and telling significant others about using the BMM-app were both not related to a decrease in depressive symptoms. The BMM-app was used significantly more when the adolescent had told relatives about their depressive symptoms. CONCLUSIONS: A digital intervention, such as the BMM-app, can be a low-threshold preventive and early intervention for adolescents with (sub)clinical depressive symptoms. Beneficial effects of the BMM-app were reported on depressive symptoms as well as other aspects of quality of life, such as anxiety, worrying, and stress. Whereas several factors may have played a role in the current findings on depressive symptoms, there are reasons to assume that part of the reduction in symptoms could be attributed to the BMM-app. Although no causality can be assumed, this study is a first step in the implementation of preventive apps in mental health care.
69Extended Reality Interventions for Health and Procedural Anxiety: Panoramic Meta-Analysis Based on Overviews of Reviews.PubMed
Tom Arthur, G J Melendez-Torres, David Harris, et al.
J Med Internet Res. 2025 Jan 8;27:e58086. doi: 10.2196/58086.
BACKGROUND: Extended reality (XR) technologies are increasingly being used to reduce health and procedural anxieties. The global effectiveness of these interventions is uncertain, and there is a lack of understanding of how patient outcomes might vary between different contexts and modalities. OBJECTIVE: This research used panoramic meta-analysis to synthesize evidence across the diverse clinical contexts in which XR is used to address common outcomes of health and procedural anxiety. METHODS: Review-level evidence was obtained from 4 databases (MEDLINE, Embase, APA PsycINFO, and Epistemonikos) from the beginning of 2013 until May 30, 2023. Reviews that performed meta-analysis of randomized controlled trials relating to patient-directed XR interventions for health and procedural anxiety were included. Studies that analyzed physiological measures, or focused on technologies that did not include meaningful immersive components, were excluded. Furthermore, data were only included from studies that compared intervention outcomes against no-treatment or treatment-as-usual controls. Analyses followed a preregistered, publicly available protocol. Trial effect sizes were extracted from reviews and expressed as standardized mean differences, which were entered into a 3-level generalized linear model. Here, outcomes were estimated for patients (level 1), studies (level 2), and anxiety indications (level 3), while meta-regressions explored possible influences of age, immersion, and different mechanisms of action. Where relevant, the quality of reviews was appraised using the AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews, Revised Instrument) tool. RESULTS: Data from 83 individual trials were extracted from 18 eligible meta-analyses. Most studies involved pediatric patient groups and focused on procedural, as opposed to general, health anxieties (eg, relating to needle insertion, dental operations, and acute surgery contexts). Interventions targeted distraction-, education-, and exposure-based mechanisms, and were provided via a range of immersive and nonimmersive systems. These interventions proved broadly effective in reducing patient anxiety, with models revealing significant but heterogeneous effects for both procedural (d=-0.75, 95% CI -0.95 to -0.54) and general health (d=-0.82, 95% CI -1.20 to -0.45) indications (when compared with nontreatment or usual-care control conditions). For procedural anxieties, effects may be influenced by publication bias and appear more pronounced for children (vs adults) and nonimmersive (vs immersive) technology interventions, but they were not different by indication. CONCLUSIONS: Results demonstrate that XR interventions have successfully reduced patient anxiety across diverse clinical contexts. However, significant uncertainty remains about the generalizability of effects within various unexplored indications, and existing evidence is limited in methodological quality. Although current research is broadly positive in this area, it is premature to assert that XR interventions are effective for any given health or procedural anxiety indication.
70Digital mandala coloring as a public mental health tool: psychophysiological benefits and the mediating role of flow in anxiety reduction among university students.PubMed
Xiangyu Li, Yinan Li, Xuan Zhang, et al.
Front Public Health. 2026 Apr 8;14:1743520. doi: 10.3389/fpubh.2026.1743520. eCollection 2026.
BACKGROUND: Anxiety is becoming more common among young people globally. At the same time, digital mental health services are developing rapidly. Digital mandala coloring applications have become popular tools for managing anxiety. However, it remains unclear if they are effective as psychological tools, and their mechanism of action lacks scientific verification. This study aims to investigate the effectiveness of digital mandala coloring in relieving anxiety and the role of flow in its mechanism. METHODS: This study involved 60 university students across two experiments employing coloring intervention using physiological and psychological measurements. Experiment 1 compared the differences in anxiety relief and level of flow state between digital and traditional paper-based mandala coloring. Experiment 2 further explored the impact of two mainstream interaction modes, sliding coloring and gamified coloring, in digital mandala coloring on user experience and therapeutic effect. All participants underwent anxiety induction before a 30-min coloring activity. State anxiety and physiological indicators were measured at baseline (T1), after anxiety induction (T2), and after the coloring intervention (T3). Flow state level was measured at T3. RESULTS: Digital mandala coloring demonstrated efficacy in reducing self-reported state anxiety, with no significant difference to the traditional method. However, it induced a higher level of flow state and demonstrated stronger physiological calming effects, specifically greater reductions in heart rate and skin conductance level. Experiment 2 indicated that, compared to the gamified coloring condition, sliding digital mandala coloring led to greater anxiety reduction, a higher level of flow state, and more pronounced improvements in heart rate and skin conductance level recovery. Crucially, the flow state was found to fully mediate the relationship between the digital coloring mode and state anxiety level. These results suggest that the anxiety-reducing effect of digital mandala coloring can be enhanced by increasing immersion and fostering flow. CONCLUSION: Digital mandala coloring is an effective anxiety intervention for university students. Its therapeutic effect can be significantly enhanced by interaction designs that improve operational fluency, as such designs promote a deeper flow state. This study provides a key insight for developing digital mental health applications: optimizing interactive fluency to promote immersive flow experience is more important than pursuing entertainment for enhancing emotional healing value. This finding points the way for applying and developing digital interventions in public health.
71A virtual reality-based multimodal framework for adolescent depression screening using machine learning.PubMed
Yizhen Wu, Yuling Qiao, Licheng Wu, et al.
Front Psychiatry. 2025 Sep 17;16:1655554. doi: 10.3389/fpsyt.2025.1655554. eCollection 2025.
BACKGROUND: Major depressive disorder (MDD) in adolescents poses an increasing global health concern, yet current screening practices rely heavily on subjective reports. Virtual reality (VR), integrated with multimodal physiological sensing (EEG+ET+HRV), offers a promising pathway for more objective diagnostics. METHODS: In this case-control study, 51 adolescents diagnosed with first-episode MDD and 64 healthy controls participated in a 10-minute VR-based emotional task. Electroencephalography (EEG), eye-tracking (ET), and heart rate variability (HRV) data were collected in real-time. Key physiological differences were identified via statistical analysis, and a support vector machine (SVM) model was trained to classify MDD status based on selected features. RESULTS: Adolescents with MDD showed significantly higher EEG theta/beta ratios, reduced saccade counts, longer fixation durations, and elevated HRV LF/HF ratios (all p <.05). The theta/beta and LF/HF ratios were both significantly associated with depression severity. The SVM model achieved 81.7% classification accuracy with an AUC of 0.921. CONCLUSIONS: The proposed VR-based multimodal system identified robust physiological biomarkers associated with adolescent MDD and demonstrated strong diagnostic performance. These findings support the utility of immersive, sensor-integrated platforms in early mental health screening and intervention. Future work may explore integrating the proposed multimodal system into wearable or mobile platforms for scalable, real-world mental health screening.
72A Personalized, Transdiagnostic Smartphone App (Mello) Targeting Repetitive Negative Thinking for Depression and Anxiety: Qualitative Analysis of Young People's Experience.PubMed
Lee Valentine, Chelsea Arnold, Jennifer Nicholas, et al.
J Med Internet Res. 2024 Nov 27;26:e63732. doi: 10.2196/63732.
BACKGROUND: The increasing rates of mental health challenges among young people highlight an urgent need for accessible and effective treatment. However, current mental health systems face unprecedented demand, leaving most young people globally with unmet mental health needs. Smartphones present a promising solution to this issue by offering in-the-moment support through innovative just-in-time adaptive interventions, which provide support based on real-time data. OBJECTIVE: This study explores young people's experiences with Mello, a just-in-time adaptive intervention that focuses on the transdiagnostic mechanism of repetitive negative thinking (RNT), a significant factor contributing to youth depression and anxiety. METHODS: Semistructured qualitative interviews were conducted with 15 participants aged 16 to 25 years, all of whom had previously participated in a pilot randomized controlled trial of Mello. Of the 15 participants, 9 (60%) identified as women, 4 (27%) as men (including 1 transgender man), and 2 (13%) as nonbinary. Interviews focused on participants' experiences with the Mello app, factors influencing engagement, perceived benefits and limitations, and suggestions for future improvements. Thematic analysis was used to analyze the data. RESULTS: The analysis identified three superordinate themes: Mello as a tool for intentional reflection; doing therapy your own way; and barriers to engagement during low mood, anxiety, and RNT. Theme 1 explored young people's experiences of how the app facilitated active management of negative thoughts and supported the development of reflective habits, contrasting with their typical strategies of avoidance or resistance. Theme 2 highlighted the value of the app's self-guided nature, with a particular focus on its flexibility and accessibility, particularly when compared to traditional face-to-face therapy. Finally, theme 3 addressed barriers to engagement, particularly during emotionally difficult times, with participants reporting feeling "stuck" in their negative thoughts. To mitigate these challenges, participants suggested incorporating gamification elements, such as progress-tracking visuals, to enhance motivation and increase engagement with the app. CONCLUSIONS: Our findings underscored the value of Mello in promoting intentional engagement and reflection with RNT, consistent with prior research that emphasizes the effectiveness of tailored interventions. Although some users valued the self-guided nature of the application, others encountered difficulties with motivation. Future research should explore strategies to enhance engagement for young people with low mood and motivation, such as co-design methodologies, advanced personalization features, and gamification techniques.
73Mental Health Chatbot for Young Adults With Depressive Symptoms During the COVID-19 Pandemic: Single-Blind, Three-Arm Randomized Controlled Trial.PubMed
Yuhao He, Li Yang, Xiaokun Zhu, et al.
J Med Internet Res. 2022 Nov 21;24(11):e40719. doi: 10.2196/40719.
BACKGROUND: Depression has a high prevalence among young adults, especially during the COVID-19 pandemic. However, mental health services remain scarce and underutilized worldwide. Mental health chatbots are a novel digital technology to provide fully automated interventions for depressive symptoms. OBJECTIVE: The purpose of this study was to test the clinical effectiveness and nonclinical performance of a cognitive behavioral therapy (CBT)-based mental health chatbot (XiaoE) for young adults with depressive symptoms during the COVID-19 pandemic. METHODS: In a single-blind, 3-arm randomized controlled trial, participants manifesting depressive symptoms recruited from a Chinese university were randomly assigned to a mental health chatbot (XiaoE; n=49), an e-book (n=49), or a general chatbot (Xiaoai; n=50) group in a ratio of 1:1:1. Participants received a 1-week intervention. The primary outcome was the reduction of depressive symptoms according to the 9-item Patient Health Questionnaire (PHQ-9) at 1 week later (T1) and 1 month later (T2). Both intention-to-treat and per-protocol analyses were conducted under analysis of covariance models adjusting for baseline data. Controlled multiple imputation and δ-based sensitivity analysis were performed for missing data. The secondary outcomes were the level of working alliance measured using the Working Alliance Questionnaire (WAQ), usability measured using the Usability Metric for User Experience-LITE (UMUX-LITE), and acceptability measured using the Acceptability Scale (AS). RESULTS: Participants were on average 18.78 years old, and 37.2% (55/148) were female. The mean baseline PHQ-9 score was 10.02 (SD 3.18; range 2-19). Intention-to-treat analysis revealed lower PHQ-9 scores among participants in the XiaoE group compared with participants in the e-book group and Xiaoai group at both T1 (F=17.011; P<.001; d=0.51) and T2 (F=5.477; P=.005; d=0.31). Better working alliance (WAQ; F=3.407; P=.04) and acceptability (AS; F=4.322; P=.02) were discovered with XiaoE, while no significant difference among arms was found for usability (UMUX-LITE; F=0.968; P=.38). CONCLUSIONS: A CBT-based chatbot is a feasible and engaging digital therapeutic approach that allows easy accessibility and self-guided mental health assistance for young adults with depressive symptoms. A systematic evaluation of nonclinical metrics for a mental health chatbot has been established in this study. In the future, focus on both clinical outcomes and nonclinical metrics is necessary to explore the mechanism by which mental health chatbots work on patients. Further evidence is required to confirm the long-term effectiveness of the mental health chatbot via trails replicated with a longer dose, as well as exploration of its stronger efficacy in comparison with other active controls. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2100052532; http://www.chictr.org.cn/showproj.aspx?proj=135744.
74Effectiveness 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).
75Optimization of academic performance and mental health in college students through an AI-driven personalized physical exercise and mindfulness intervention system.PubMed
Ke Zhang, Meng Yang, Liying Li
Sci Rep. 2026 Jan 22;16(1):6024. doi: 10.1038/s41598-026-37028-6.
This research examines an artificial intelligence-driven personalized intervention system that integrates physical exercise and mindfulness practices to support academic performance and psychological wellbeing among university students in eastern China. A 16-week controlled intervention study enrolled 328 undergraduate students from three comprehensive universities, comparing three conditions: AI-personalized interventions (n = 110), standardized interventions (n = 108), and controls (n = 110). The AI system employed machine learning algorithms to analyze multidimensional student data and generate tailored recommendations. Results indicated that the AI-personalized group was associated with larger improvements across academic metrics (10.28% GPA increase, 95% CI [8.94, 11.62], d = 0.89, p < 0.001), psychological parameters (36.7% stress reduction, 95% CI [33.2, 40.1], d = 1.42, p < 0.001), and physiological indicators (28.4% HRV improvement, 95% CI [24.8, 32.0], d = 1.13, p < 0.001) compared to standardized interventions and controls. Regression analysis identified intervention adherence, sleep quality improvement, and stress reduction as factors associated with outcomes. The hybrid neural network architecture combining student feature analysis, exercise matching, and mindfulness adaptation offers a framework for personalized health interventions in academic settings. These findings, while promising, are specific to Chinese university contexts with particular cultural and technological characteristics, and cross-cultural validation remains necessary before broader generalization.
76Matching actions to needs: shifting policy responses to the changing health needs of Chinese children and adolescents.PubMed
Tian-Jiao Chen, Bin Dong, Yanhui Dong, et al.
Lancet. 2024 May 4;403(10438):1808-1820. doi: 10.1016/S0140-6736(23)02894-5. Epub 2024 Apr 18.
China is home to the second largest population of children and adolescents in the world. Yet demographic shifts mean that the government must manage the challenge of fewer children with the needs of an ageing population, while considering the delicate tension between economic growth and environmental sustainability. We mapped the health problems and risks of contemporary school-aged children and adolescents in China against current national health policies. We involved multidisciplinary experts, including young people, with the aim of identifying actionable strategies and specific recommendations to promote child and adolescent health and wellbeing. Notwithstanding major improvements in their health over the past few decades, contemporary Chinese children and adolescents face distinct social challenges, including high academic pressures and youth unemployment, and new health concerns including obesity, mental health issues, and sexually transmitted infections. Inequality by gender, geography, and ethnicity remains a feature of health risks and outcomes. We identified a mismatch between current health determinants, risks and outcomes, and government policies. To promote the health of children and adolescents in China, we recommend a set of strategies that target government-led initiatives across the health, education, and community sectors, which aim to build supportive and responsive families, safe communities, and engaging and respectful learning environments. TRANSLATION: For the Chinese translation of the abstract see Supplementary Materials section.
77Socio-economic variations in the mental health treatment gap for people with anxiety, mood, and substance use disorders: results from the WHO World Mental Health (WMH) surveys.PubMed
S Evans-Lacko, S Aguilar-Gaxiola, A Al-Hamzawi, et al.
Psychol Med. 2018 Jul;48(9):1560-1571. doi: 10.1017/S0033291717003336. Epub 2017 Nov 27.
BACKGROUND: The treatment gap between the number of people with mental disorders and the number treated represents a major public health challenge. We examine this gap by socio-economic status (SES; indicated by family income and respondent education) and service sector in a cross-national analysis of community epidemiological survey data. METHODS: Data come from 16 753 respondents with 12-month DSM-IV disorders from community surveys in 25 countries in the WHO World Mental Health Survey Initiative. DSM-IV anxiety, mood, or substance disorders and treatment of these disorders were assessed with the WHO Composite International Diagnostic Interview (CIDI). RESULTS: Only 13.7% of 12-month DSM-IV/CIDI cases in lower-middle-income countries, 22.0% in upper-middle-income countries, and 36.8% in high-income countries received treatment. Highest-SES respondents were somewhat more likely to receive treatment, but this was true mostly for specialty mental health treatment, where the association was positive with education (highest treatment among respondents with the highest education and a weak association of education with treatment among other respondents) but non-monotonic with income (somewhat lower treatment rates among middle-income respondents and equivalent among those with high and low incomes). CONCLUSIONS: The modest, but nonetheless stronger, an association of education than income with treatment raises questions about a financial barriers interpretation of the inverse association of SES with treatment, although future within-country analyses that consider contextual factors might document other important specifications. While beyond the scope of this report, such an expanded analysis could have important implications for designing interventions aimed at increasing mental disorder treatment among socio-economically disadvantaged people.
78Domain-Specific Physical Activity and Mental Health: A Meta-analysis.PubMed
Rhiannon Lee White, Mark J Babic, Philip D Parker, et al.
Am J Prev Med. 2017 May;52(5):653-666. doi: 10.1016/j.amepre.2016.12.008. Epub 2017 Jan 30.
CONTEXT: The mental health benefits of physical activity are well established. However, less is known about whether the relationship between physical activity and mental health is consistent across different life domains. It is important to understand how context may influence the relationship between physical activity and mental health so that interventions and policy guidelines can be tailored to maximize positive effects. EVIDENCE ACQUISITION: In 2015, systematic searches of four databases identified 13,435 records, of which 98 studies met the inclusion criteria. EVIDENCE SYNTHESIS: Included studies were published between 1988 and 2015 and had a combined sample size of 648,726. Of the 98 included studies, 93 examined leisure-time physical activity, 14 examined work-related physical activity, 15 examined transport physical activity, 16 examined household physical activity, three examined school sport, and three examined physical education. Multi-level meta-analyses showed that leisure-time physical activity (r =0.13) and transport physical activity (r =0.13) both had a positive association with mental health. Leisure-time physical activity (r = -0.11) and school sport (r = -0.09) both had an inverse association with mental ill-health. However, physical activity was not consistently associated with lower mental ill-health across domains, as work-related physical activity was positively associated with mental ill-health (r =0.09). Household physical activity and participation in physical education had no relationship with mental health or mental ill-health. CONCLUSIONS: The domain in which physical activity occurs influences the relationship between physical activity and mental health and should, therefore, be considered when developing interventions, treatment programs, and policy guidelines.
79Youth Cognitive Empowerment: Development and Evaluation of an Instrument.PubMed
Paul W Speer, N Andrew Peterson, Brian D Christens, et al.
Am J Community Psychol. 2019 Dec;64(3-4):528-540. doi: 10.1002/ajcp.12339. Epub 2019 May 22.
Psychological empowerment (PE) is a multicomponent construct that involves the mechanisms through which people and groups gain control over their lives and environments. Psychological empowerment has previously been operationalized using measures of sociopolitical control among young people, with findings indicating links between PE and other positive developmental outcomes. Sociopolitical control, however, is only an indicator for the emotional component of PE. Research has largely neglected the cognitive component of PE, particularly in studies of younger people. In fact, few studies to date have presented and empirically tested measurement instruments for the cognitive component of PE among youth. In this study, we adapted a measure, which previously had been validated and used among adults, for use among young people and tested it in a sample of high school students (53% female, 75% Hispanic) in an urban school in the northeastern U.S. Confirmatory factor analyses were used to assess the hypothesized three-factor structure of cognitive empowerment, and the measure was examined for association with the construct of social justice orientation. Results indicate an adequate fit for the second-order factor, and an expected relationship with the related construct.