Prevalence, severity, and risk factors for depressive and anxiety symptoms among adolescents: A cross-sectional study

doi:10.5498/wjp.v16.i2.112996

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Feb 19, 2026 (publication date) through Feb 2, 2026

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World Journal of Psychiatry

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2220-3206

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Psychiatry. Feb 19, 2026; 16(2): 112996
Published online Feb 19, 2026. doi: 10.5498/wjp.v16.i2.112996

Prevalence, severity, and risk factors for depressive and anxiety symptoms among adolescents: A cross-sectional study

Hai-Dong Yang, Jing Zhang, Man Yang, Ling-Shu Luan, Jun-Jie Liu, Xiao-Bin Zhang

Hai-Dong Yang, Jing Zhang, Man Yang, Ling-Shu Luan, Department of Psychiatry, The Fourth People’s Hospital of Lianyungang, The Affiliated Kangda College of Nanjing Medical University, Lianyungang 222003, Jiangsu Province, China

Hai-Dong Yang, Xiao-Bin Zhang, Department of Psychiatry, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu Province, China

Jing Zhang, Medical College of Yangzhou University, Yangzhou 225003, Jiangsu Province, China

Jun-Jie Liu, Science and Education Section, The Fourth People’s Hospital of Lianyungang, The Affiliated Kangda College of Nanjing Medical University, Lianyungang 222003, Jiangsu Province, China

Co-first authors: Hai-Dong Yang and Jing Zhang.

Co-corresponding authors: Jun-Jie Liu and Xiao-Bin Zhang.

Author contributions: Yang HD and Zhang J wrote the manuscript, they contributed equally to this article, they are the co-first authors of this manuscript; Yang HD and Zhang XB performed the statistical analysis; Zhang J, Yang M, and Luan LS were responsible for collecting the data; Liu JJ maintaining the online survey platform; Liu JJ and Zhang XB were responsible for study design, they contributed equally to this article, they are the co-corresponding authors of this manuscript; and all authors have contributed to and have approved the final manuscript.

Supported by the Suzhou Clinical Medical Center for Mood Disorders, No. Szlcyxzx202109; Suzhou Key Laboratory, No. SZS2024016; Multicenter Clinical Research on Major Diseases in Suzhou, No. DZXYJ202413; and General Program of Lianyungang Health Committee, No. 202336.

Institutional review board statement: This study was approved by the Medical Ethics Committee of the Fourth People’s Hospital of Lianyungang, approval No. 2023 LSYYXLL-P21.

Informed consent statement: Informed consent was obtained from all participants or, if participants are under 16 years old, from a parent and/or legal guardian.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Xiao-Bin Zhang, Professor, Department of Psychiatry, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, No. 11 Guangqian Road, Suzhou 215137, Jiangsu Province, China. zhangxiaobim@163.com

Received: August 12, 2025
Revised: August 20, 2025
Accepted: October 21, 2025
Published online: February 19, 2026
Processing time: 171 Days and 16.5 Hours

Abstract

BACKGROUND

Depressive and anxiety symptoms among adolescents have become significant public health concerns, yet comprehensive studies examining their prevalence and associated factors are limited. Functional constipation (FC), as a common gastrointestinal disorder potentially linked to brain-gut axis dysfunction, along with other modifiable factors such as physical activity and electronic device use, may influence adolescent mental health, though these relationships remain understudied.

AIM

To examine depressive/anxiety symptoms prevalence and their associations with FC and other potential risk factors among adolescents in Lianyungang, Jiangsu Province, China.

METHODS

We conducted a cross-sectional survey of 22925 adolescents using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 for depressive and anxiety symptoms, respectively. FC was evaluated using the Rome IV criteria, and social support using the Perceived Social Support Scale.

RESULTS

Depressive symptoms were reported by 16.0%, anxiety symptoms by 24.1%, with 13.1% experiencing both. Among the total group, 27.5% reported mild, 10.0% moderate, 4.0% moderately severe, and 2.0% severe depressive symptoms, while 23.0% reported mild, 7.2% moderate, and 3.8% severe anxiety symptoms. Female sex, smoking, FC, parental conflict, lower household income, lower levels of physical activity, and longer weekly electronic device use time were identified as significant risk factors for depressive and anxiety symptoms (all P < 0.05), while age and body mass index were identified as additional significant risk factors for anxiety symptoms (all P < 0.05). In contrast, received support was identified as a significant protective factor against depressive and anxiety symptoms.

CONCLUSION

Targeting modifiable risk factors (physical activity, smoking, excessive device use) and improving mental health support access are priorities to address the high prevalence of depression and anxiety symptoms.

Keywords: Adolescent; Depression; Anxiety; Risk factors; Functional constipation; Patient Health Questionnaire-9; Generalized Anxiety Disorder-7

Core Tip: This large-scale cross-sectional study of 22925 Chinese adolescents reveals concerning rates of depression (16.0%) and anxiety (24.1%) symptoms, with approximately 10% reporting moderate to severe symptoms. The study uniquely identifies functional constipation as a significant risk factor for both conditions, potentially reflecting brain-gut axis dysfunction. Female sex, smoking, parental conflict, lower household income, reduced physical activity, and excessive electronic device use were also identified as risk factors, while social support emerged as protective. These findings underscore the urgent need for comprehensive screening and targeted interventions addressing modifiable risk factors to improve adolescent mental health outcomes.