Depressive Symptoms In Chinese Adolescents Research Articles

PTSD and depressive symptoms in Chinese adolescents exposed to multiple stressors from natural disasters, stressful life events, and maltreatment: A dose-response effect.

Little is known about the effects and the extent that childhood adversity has on post-traumatic stress disorder (PTSD) and depression. A population-based, epidemiological study from the Wenchuan earthquake. A total of 5,195 Wenchuan Earthquake adolescent survivors aged 11-18 years from nine high schools in southwest China completed questionnaires that assessed their PTSD and depression symptoms due to childhood maltreatment, stressful life events, and childhood earthquake exposure. The PTSD and depression prevalences were 7.1 and 32.4%. After controlling for age and gender, the multiple linear regressions revealed that stressful life events had the most significant direct effect on depression (β = 0.491), followed by childhood emotional abuse (β = 0.085), and earthquake exposure (β = 0.077). Similarly, stressful life events (β = 0.583) were found to have more significant direct effects on PSTD, followed by earthquake exposure (β = 0.140); however, childhood emotional abuse was not found to have an effect. The structural equation modeling (SEM) revealed that there were interactions between the three childhood adversities, with all three concurrently affecting both PTSD and depression. These findings add weight to the supposition that psychological maltreatment, negative life events, and earthquake exposure contribute to PTSD and depression. In particular, the identification of subgroups that have a high prevalence of these childhood adversities could assist professionals to target populations that are at high risk of mental health problems.

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

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

The associations between sleep duration, cognitive function, and depressive symptoms: An analysis of Chinese adolescents from China Family Panel Studies

BackgroundThe adverse impact of depressive symptoms on adolescents' physical and psychological health is becoming increasingly prominent. This study aims to examine the association between sleep duration, cognitive function, and depressive symptoms among Chinese adolescents. MethodsThis study used data on a sample of 3724 adolescents collected from the China Family Panel Studies (CFPS). The multivariate logistic regression was conducted to estimate the association between sleep duration, cognitive function (measured by mathematics and vocabulary), and depressive symptoms among Chinese adolescents; the mediating effects of cognitive function were calculated by mediating model. ResultsThe study found that approximately 6.49 % of Chinese adolescents had depressive symptoms, with an average CES-D8 score of 4.27 (SD: 3.11). Adolescents who reported a sleep duration of <6 h/night (OR = 2.34; 95 % CI = 1.30, 4.24) were at a higher risk of depressive symptoms, and the adolescents who had higher mathematics scores (>75 %) were more likely to be at a lower risk of depressive symptoms. Besides, the cognitive function competitively mediated the effect of sleep duration on depressive symptom (indirect effect = 0.043; 95 % CI = 0.023, 0.064). LimitationsThis is a cross-sectional study; all questions were self-reported; the sleep variable only included the sleep duration. ConclusionsOur study highlights that short sleep duration might increase the risk of depressive symptoms, and increasing cognitive function might reduce the occurrence of depressive symptoms in Chinese adolescents. The results displayed that sleep duration had a negatively direct effect on depressive symptoms, but the indirect effects of sleep duration on depressive symptoms via the cognitive function (i.e., mathematics and vocabulary tests) were significantly positive, indicating that the relationship between sleep duration and depressive symptoms was competitively mediated by cognitive function.

Bullying victimization and depressive symptoms in Chinese adolescents: A moderated mediation model of self-esteem and friendship intimacy

BackgroundDepression is a major mental disorder and poses a serious threat to public health. Bullying victimization is identified as one of the major risk factors for depression in adolescence. Understanding the mechanism that explain why bullying victimization leads to depression, and identifying protective factors that could alleviate the negative effects of bullying victimization are pivotal to developing effective intervention programs. MethodsA sample of Chinese adolescents in junior high schools (N = 458, 50.58 % girls, M age = 11.63 years at T1) was followed for three years. The data on depression, bullying victimization, self-esteem, and friendship intimacy were collected from adolescents' self-report. ResultsAfter controlling related variables, T1 bullying victimization positively predicted T3 depressive symptoms. T2 self-esteem mediated the link between T1 bullying victimization and T3 depressive symptoms when T1 friendship intimacy was low. More specifically, only for youth who reported low friendship intimacy, bullying victimization would lead to a lower level of self-esteem, which in turn, was associated with a higher level of depression. LimitationsThe study only considered the roles of self-esteem as the mediator and friendship intimacy as the moderator. All measures were based on self-report. ConclusionsThe results highlighted the role of friendship intimacy and self-esteem in the longitudinal relation between bullying victimization and depressive symptoms. The results suggest that intervention programs aiming at reducing victimized adolescents' depressive symptoms should consider the buffering effect of friendship intimacy.

RPS6KA5 methylation predict response to 6-week treatment for adolescent MDD patients

ObjectiveWe aimed to investigate the effect of differentially methylated genes and chronic childhood stress on the development of depressive symptoms in Chinese adolescents, as well as to test whether methylation at baseline can be used as a predictor of remission at follow-up after six weeks of treatment.MethodsAfter recruiting 87 MDD patients and 53 healthy controls, we compared demographic and baseline clinical characteristics. The Childhood Chronic Stress Questionnaire was used to assess stress caused by early-life events. MDD patients underwent six weeks of treatment, and response to treatment was assessed using the Beck Depression Inventory-II. In addition, four MDD patients and five controls were randomly chosen for genome-wide methylation analysis.ResultsThe gene RPS6KA5 showed significant methylation differences between the two groups. Severity of chronic childhood stress was significantly associated with increased risk of depression in adolescents, but not with treatment response. Baseline RPS6KA5 methylation can predict remission after six weeks of treatment. We did not observe any interaction between RPS6KA5 methylation and chronic childhood stress.ConclusionsOur results suggest that RPS6KA5 methylation can be used as a predictor of response to treatment in adolescent MDD patients. Here we offer new evidence for the role of epigenetics in early response to treatment of depression.Trial registrationChiCTR, ChiCTR2000033402, 31/05/2020, http://www.chictr.org.cn/index.aspx

Bullying victimization and depressive symptoms in Chinese adolescents: the roles of belief in a just world and classroom-level victimization.

Studies have demonstrated that bullying victimization is a risk factor for depressive symptoms; however, little is known about the underlying processes that may mediate or moderate this relationship. To address this research gap, this study examined the mediating effects of personal and general belief in a just world (BJW) and the moderating effect of classroom-level victimization on the relationship between bullying victimization and depressive symptoms. Using a short-term longitudinal design, two-wave data were obtained from 2,551 Chinese adolescents (initial age = 12.99 ± 0.61, 52.2% boys) from 47 classes over 6months. The results indicated that Time 1 personal BJW mediated the relationship between Time 1 bullying victimization and Time 2 depressive symptoms. Furthermore, the mediating effect of Time 1 personal BJW was moderated by Time 1 classroom-level victimization; this effect was stronger for adolescents in classrooms with low levels of victimization. These findings contribute to our understanding of how and when bullying victimization impacts youth depressive symptoms. Education practitioners should pay special attention to personal BJW in victimized adolescents, especially when classroom-level victimization is low.

Exposure to domestic violence and depressive symptoms in Chinese adolescents: Sleep problems as a mediator

IntroductionExposure to domestic violence has been shown to be an important risk factor of depression in western studies, but has received less attention in Chinese context. Additionally, the underlying mechanism of its link with depression has not been fully studied. With a longitudinal design, we examined the mediating role of sleep problems between exposure to domestic violence and depressive symptoms in Chinese adolescents, and further considered potential age and gender differences in the direct and indirect pathways. MethodsParticipants were recruited from primary and junior high schools in China and were surveyed across two waves with a 6-month interval. There were 1949 participants at Wave 1 and 1283 at Wave 2. Structural equation model was conducted to examine the mediating role of sleep problems in the association between exposure to domestic violence and depressive symptoms. Multigroup analyses were applied to test potential age and gender differences in the process. ResultsParticipants' exposure to domestic violence predicted increasing sleep problems, which further predicted more depressive symptoms. Age and gender moderated the indirect pathway from exposure to domestic violence to depressive symptoms through sleep problems, such that the mediating effects of sleep problems were significantly stronger in early-age adolescents and girls than middle-age ones and boys. ImplicationParents should avoid the use of corporal punishment and protect their children from domestic violence. For adolescents who have underwent domestic violence, parents and clinicians might consider to decrease their depressive symptoms by ameliorating sleep problems, especially for the early-age adolescents and girls.

Lifestyle Behaviors and Depressive Symptoms in Chinese Adolescents Using Regression and fsQCA Models.

The study was to compare the performance of the regression models and fuzzy set qualitative comparative analysis (fsQCA) models in analyzing the possible effects of sociodemographic variables (age and sex) and lifestyle behaviors (physical activity, sedentary time, sleep duration, physical education class and screen time) on depressive symptoms in adolescents. This cross-sectional surgery was conducted among 726 adolescents in Jilin Province of China, selected by random cluster sampling. The regression model showed that age, physical education (PE) class and sleep duration were associated with depressive symptoms. Meanwhile, the fsQCA models showed that shorter physical activity, PE class and sleep duration as well as longer sedentary and screen time were related to higher levels of depressive symptoms. Both regression and fsQCA models indicated that promoting lifestyle behaviors could affect depressive symptoms. Considering the differences between the two methods, they are not superior to the other method, but complementary and should be used in other studies at the same time.

Adolescents' Physical Activity and Depressive Symptoms: A Psychosocial Mechanism.

Guided by the Theory of Planned Behavior (TPB; Ajzen, 1991), this study aimed to test a hypothesized path model of TPB variables (i.e., attitude toward behavior, subjective norm, perceived behavioral control, and intention) with physical activity (PA) and depressive symptoms. A total of 792 Chinese adolescents (Mage = 16.9; SD = 0.82; 54.5% females) completed previously validated questionnaires assessing their TPB variables, PA, and depressive symptoms. Correlation analysis revealed TPB variables were positively associated with PA (p < 0.01), and negatively correlated to depressive symptoms (p < 0.01). The path analyses indicated that the hypothesized model produces a goodness of fit (χ2/df = 16.14/5, CFI = 0.99, RMSEA = 0.06). The findings support the theoretical tenets of TPB and provide empirical evidence of the psychosocial mechanism of PA and depressive symptoms in Chinese adolescents. It suggests that building PA intervention strategies while considering the TPB framework may promote adolescents’ physical and mental health.

Specific Types of Screen-Based Sedentary Time and Depressive Symptoms in Adolescents

Purpose: Screen-based sedentary behavior (SSB) has been identified as risk factor for mental disorders in most of adolescents. However, there is little literature pertaining to the specific kinds of SSB and its connections with depressive symptoms in most of adolescents. In the present study, we are going to find out the connections between specific types of SSB and depressive symptoms in Chinese adolescents. Methods: A cross-sectional data based on 996 study participants of middle school students in Guangdong Province. SSB was evaluated by distributing the questionnaire of Health Behavior in School-aged Children, while depressive symptoms were evaluated using Chinese version of Children’s Depressive symptoms Inventory (CDI). SSB was categorized into TV/movie time, video games time and other electronic devices-based time (e.g., mobile phone, computer use). Generalized linear models was used to explore the connections between specific kinds of SSB and depressive symptoms. Results: After controlling for variables of sex, ethnicity, grade, residence, siblings, perceived family affluence, father educational level, mother educational background, body mass index (BMI), physical exercise, duration of sleep, other electronic devices-based time was positively correlated with depressive symptoms in Chinese adolescents (B = 0.557%, 95%CI: 0.187–0.926, p = 0.003). This significant connection was also found in girls (B = 0.728%, 95%CI: 0.230–1.225, p = 0.004) instead of boys (p > 0.05). The other types of SSB were not significantly in relation to depressive symptoms in adolescents regardless of sex. Conclusion: This study suggested that it might be effective in reducing or preventing depressive symptoms through limiting electronic devices-based time, like computer use or mobile phone use time. This strategy would be particularly useful in girls. Future studies should negate or replicate the research results by introducing more improved study design, which is beneficial to better understand the connections between SSB and depressive symptoms as well as then design more efficient interventions in adolescents.

Relationships among adverse childhood experience patterns, psychological resilience, self-esteem and depressive symptoms in Chinese adolescents: A serial multiple mediation model

Adverse childhood experiences (ACEs) and adolescent depression are both prevalent social problems that can increase the risk of several negative health consequences throughout life. The original definition of ACEs misdirects the focus of intervention efforts for ACEs to only family dysfunction and parenting practices. We used a broader definition of ACEs and a latent class analysis (LCA) model to examine ACE patterns, aiming to overcome the shortcomings of cumulative and single adversity approaches based on the special social context of China. The data were derived from a middle school in Huaibei City of Anhui Province in 2019 and 2020, which was a prospective study involving 1687 junior high school students. At the initial evaluation (T1), ACEs, psychological resilience, self-esteem, and depressive symptoms were assessed by the students. At Time 2 (T2), the depressive symptoms of students were assessed. LCA and mediation analyses were conducted with Mplus version 8.2. The LCA identified the following three heterogeneous ACE classes: “low adversity” (36.4%), “moderate adversity” (44.2%), and “high adversity” (19.4%). The mediation analysis showed that the ACE patterns affected depressive symptoms through the following two mediation paths only in the moderate but not in the high adversity class: self-esteem alone and a path combining psychological resilience and self-esteem. Psychological resilience separately did not mediate the association between ACE patterns and depressive symptoms. To reduce depressive symptoms, interventions for students with ACEs need to improve self-esteem through many channels.

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

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

Nightmare distress as a mediator between frequent nightmares and depressive symptoms in Chinese adolescents

BackgroundFrequent nightmares are related to depressive symptoms in adolescents. Little is known about pathways from frequent nightmares to depressive symptoms. This study aimed to examine the mediation effect of nightmare distress in the association between frequent nightmares and depressive symptoms in a large sample of Chinese adolescents. MethodsA total of 11,831 adolescents who participated in the baseline survey of Shandong Adolescent Behavior and Health Cohort were included in the analysis. A self-administered questionnaire was used to measure nightmare frequency, nightmare distress, depressive symptoms, sleep duration, insomnia, and demographic characteristics. Linear regressions and mediation analyses were performed to examine the associations between frequent nightmares, nightmare distress and depressive symptoms. ResultsOf 11,831 participates, 50.9% were males and the mean age was 14.97 ± 1.45. Adolescents with frequent nightmares scored significantly higher on nightmare distress (t = 29.87, P < 0.001) and depressive symptoms (t = 20.05, P < 0.001) than those adolescents without frequent nightmares. Frequent nightmares (β = 1.04, 95% CI: 0.48–1.60) and nightmare distress (β = 0.30, 95% CI: 0.28–0.32) were associated with depressive symptoms. Mediation analyses showed that nightmare distress accounted for 63.76% of the total effects in the entire sample, 51.17% in males and 80.00% in females, respectively. LimitationNo causality could be made from the cross-sectional data and possible information bias due to self-report. ConclusionsThe association between frequent nightmares and depressive symptoms appears to be substantially mediated by nightmare distress. Assessing and intervening distress associated with frequent nightmares may have important clinical implications for reducing the risk of depression in adolescents.

Effects of Father-Adolescent and Mother-Adolescent Relationships on Depressive Symptoms among Chinese Early Adolescents

Parent–adolescent relationships play an important role in protecting adolescents from depressive symptoms. However, there are no consistent conclusions about the extent to which fathers and mothers uniquely contribute to adolescents’ depressive symptoms. The present study aimed to acquire knowledge in this research area in two ways. First, this study separated the potential impacts of father–child and mother–child relationships on depressive symptoms in Chinese adolescents. Second, this study used a longitudinal design with nationally representative samples from the China Education Panel Survey. A total of 8794 middle school students in grade 7 completed measures of father–adolescent and mother–adolescent relationships, and depressive symptoms twice (T1 and T2; one-year interval). Results indicated that both positive father–adolescent and mother–adolescent relationships had negative effects on depressive symptoms in female adolescents. However, positive father-adolescent, not mother-adolescent, relationships had a negative effect on depressive symptoms in male adolescents. These findings suggest that positive parent–adolescent relationships could reduce early adolescents’ depressive symptoms, but positive father–adolescent and mother–adolescent relationships might have different protective effects on early adolescents’ depressive symptoms among male and female adolescents in China.

Sleep disordered breathing symptoms are associated with depressive symptoms: A longitudinal study of Chinese adolescents

BackgroundLittle is known about the prospective association between sleep disordered breathing (SDB) and depressive symptoms in Chinese adolescents. This study examined the independent predictive role of SDB symptoms in depressive symptoms in a large sample of adolescents. MethodsA total of 11831 adolescents who participated in the baseline survey of Shandong Adolescent Behavior and Health Cohort and 7072 adolescents who were resurveyed 1 year later were included for the analyses. Adolescents completed a self-administered questionnaire about demographics, mental health, sleep problems, and family environment. SDB symptoms were assessed by 3 items about loud snoring, breathing pauses, and snorting/gasping. The Chinese Youth Self-Report anxious/depressed subscale was used to assess depressive symptoms. ResultsIn the cross-sectional analyses, 11.8% adolescents had depressive symptoms, and elevated frequency of SDB symptoms were significantly associated with depressive symptoms. In the longitudinal study, 4.5% of adolescents had persistent depressive symptoms, the incidence rate of depressive symptoms at 1-year follow-up was 6.5%, and elevated frequency of any SDB symptoms (often: OR=2.23, 95%CI:1.50-3.32) at baseline was significantly associated with incident depressive symptoms after adjusting for potential confounders. The associations between SDB symptoms and depressive symptoms were similar for boys and girls. LimitationSDB symptoms and depressive symptoms were measured by self-report. ConclusionSDB symptoms are an independent and significant predictor of depressive symptoms in adolescents. Further research is needed to understand the biological mechanisms between SDB and mood dysregulation in adolescents.

The Interaction Between Peer Social Support and Stressors Predicts Somatic and Psychological Depressive Symptoms in Chinese Adolescents

The major goal of this study was to investigate the diathesis-stress model in predicting depressive symptoms in Chinese high school students. A total of 613 students from a community-based sample of two high schools completed self-report measures of social support, depressive symptoms, and daily stressors. Over a period of 12 months, the students reported on social support from parents and peers, somatic and psychological depressive symptoms, and the occurrence of daily stressors on five occasions, 3 months apart. The results revealed neither a main effect of parental or peer support nor a significant daily stressor × parent support interaction effect. Nevertheless, a statistically significant daily stressors × peer support effect was revealed in the prediction of both somatic symptoms and psychological symptoms. These findings suggested that low levels of peer support (but not parent support) among Chinese high school students act as a diathesis with respect to the development of both somatic symptoms and psychological symptoms of depression in the face of high frequencies of daily stressors.

Effects of polygenic risk score, childhood trauma and resilience on depressive symptoms in Chinese adolescents in a three-year cohort study

BackgroundPolygenic risk score (PRS) is a method of revealing multiple genes effect. The study of PRS and childhood trauma (CT) and resilience on adolescent depressive symptoms are fewer reported, especially the functional mechanism of resilience among them. Methods718 Chinese adolescents aged 10-14 years were surveyed including CT, resilience, depressive symptoms, and phenotype data in three years of the cohort study. PRS was calculated by the weighted accumulation effects of alleles on depressive symptoms. Their relationships were analyzed by the mediation and moderation models. ResultsPRS and CT were risk factors for depressive symptoms. Interaction (PRS × CT) on depressive symptoms had no statistical significance. Resilience acted as the protective mediator from CT (emotional abuse, emotional neglect, physical neglect) to depressive symptoms and moderator from CT (emotional abuse) to depressive symptoms. LimitationsThe sample size was a little small so that the inference were drawn prudently. Except gene data, other were collected by self-reported questionnaire instruments which inevitably brought recall bias. ConclusionsPRS and CT could have adverse impact on depressive symptoms, resilience could alleviate these risk effects as a moderator and a mediator. The findings have important implications for prevention and intervention in adolescent depressive symptoms.

Weight in the mind: Weight perception and depressive symptoms in Chinese adolescents

BackgroundIncreasing evidence demonstrates the significant role of weight perception in shaping the mental health of adolescents. This study sought to extend previous literature by examining the associations of weight perception categories with depressive symptoms for both boys and girls in China, and further explored whether the associations varied between urban and rural areas. MethodsData were from a large-scale, national survey of Chinese middle school students. The analytical sample had 8568 respondents with a mean age of 13.9 years (SD=0.7). Bivariate and multiple regression analyses were adopted to examine the links between weight perception and depressive symptoms. ResultsOverweight perceptions were more prevalent in girls than in boys (47.0% vs. 29.3%), whereas underweight perceptions were less common in girls than in boys (15.7% vs. 29.3%). After adjusting for sociodemographic characteristics and health conditions, self-perceiving as “slightly overweight” and “very overweight” were significantly related to more depressive symptoms for both boys (p<0.05) and girls (p<0.05). A "very underweight" perception, however, was found to be only linked to greater depressive symptoms in boys (p<0.05). Notably, these patterns showed no significant rural-urban difference, as evidenced by the lack of significant interactive effects of all weight perceptions categories and region (urban/rural) on depressive symptoms. LimitationsThis study was based on a cross-sectional design, which essentially precludes the possibility to determine the causality of the observed associations. ConclusionFindings in this study indicated that the impacts of subjective physical attractiveness have been gendered and regionally pervasive in affecting emotional well-being of Chinese adolescents.

Association Between Screen Time, Fast Foods, Sugar-Sweetened Beverages and Depressive Symptoms in Chinese Adolescents.

ObjectiveAlthough previous studies have shown that screen time (ST), fast foods (FFs) and sugar-sweetened beverages (SSBs) consumption are associated with depressive symptoms in adolescents, research on these associations in Chinese adolescents is scarce. This study aimed to examine the association between ST, FFs, SSBs and depressive symptoms in Chinese adolescents, and explore the mediating effects of FFs and SSBs in the association between ST and depressive symptoms.MethodsThis school-based nationwide survey was carried out among 14,500 students in four provinces of China. The Children’s Depression Inventory was used to assess the participants’ depressive symptoms. ST, FFs and SSBs consumption was measured by a self-reported questionnaire. The Bayesian multiple mediation model was used to analyze the mediation effect.ResultsST, FFs and SSBs, were more likely to be associated with depressive symptoms, and ORs (95%CI) was 1.075 (1.036–1.116), 1.062 (1.046–1.078) and 1.140 (1.115–1.166), after we adjusted for sociodemographic variables. Additionally, in Bayesian multiple mediation model, direct effect, mediating effect, total effect, the ratio of mediating effect to total effect was 0.125, 0.034, 0.159, and 0.214, respectively. All path coefficients of the three mediation paths are statistically significant (p < 0.05).ConclusionsOur study demonstrates that ST, FFs and SSBs consumption are associated with depressive symptoms in Chinese adolescents. It is likely that FFs and SSBs partially mediate the association between ST and depressive symptoms by chain-mediating effects.

Depressive symptoms prevalence, associated family factors, and gender differences: A national cohort study of middle school students in China

BackgroundThis study examined prevalence and change in depressive symptoms in Chinese adolescents, and roles of inter-parental (I-P) relationship and parent-child (P-C) relationships in its etiology and gender differences. MethodsSurvey data on depressive symptoms, I-P relationship, and indicators of P-C relationships were collected in China Education Panel Survey (2013-2015) from a nationally representative sample of adolescents (n=9,869) at 7th (at baseline), 8th and 9th (follow-up) grades. ResultsPrevalence of depressive symptoms was 17.9% in 7th graders and higher at 25.7% for 9th graders, more remarkably in girls. Better I-P relationship could reduce the risk of depressive symptoms among all (OR=0.53, 95%CI: 0.48, 0.58), girls (OR=0.61, 95%CI: 0.54, 0.69), and boys (OR=0.54, 95%CI: 0.49, 0.61). Greater mother-child (M-C) and father-child (F-C) closeness were protective of depressive symptoms in all and girls (ORs=0.94 to 0.96, p<0.01). More P-C interactions was associated with reduced risk of depressive symptoms among all (OR=0.91, 95%CI: 0.89, 0.93), boys (OR=0.91, 95%CI: 0.89, 0.94), and girls (OR=0.93, 95%CI: 0.91, 0.96). Better I-P relationship increased M-C closeness, F-C closeness, and P-C interactions, which in turn reduced depressive symptoms risk (indirect effects: β=-0.03, 95% CI: -0.04, -0.03). LimitationsThe brief depressive inventory was only able to capture higher depressive symptoms, not clinical depression. ConclusionsDepressive symptoms are prevalent in Chinese adolescents with increases from early to middle adolescence. I-P and P-C relationships reduce depressive symptoms risk. P-C relationships mediated associations between I-P relationship and depressive symptoms. Future interventions may target these family factors to reduce depression among Chinese adolescents.