Letter to the Editor: Adolescent mental health in transition - bridging neurobiological insights and modifiable risk factors for anxiety and depression

Abstract

Adolescence represents a neurobiologically dynamic phase, during which vulnerability to anxiety and depression markedly increases. Recent large-scale epidemiological data from Chinese adolescents reveal alarming rates of depressive (16%) and anxiety (24%) symptoms, with comorbidity in over 13%. Beyond established psychosocial determinants; such as gender, family conflict, and socioeconomic stressors, emerging evidence implicates functional constipation as a marker of brain-gut axis dysregulation, highlighting the interplay between neurobiology and lifestyle. Integrating current neuropsychiatric perspectives, inflammation, neurotransmitter imbalance, and aberrant neuroplasticity appear central to disease onset. The challenges lie in early identification, limited mental health literacy, and underdiagnosis in low-resource settings. Future perspectives demand precision prevention through integrative, school-based, and gut-brain-targeted interventions. A multidisciplinary framework combining neuroscientific insight, behavioral health strategies, and digital engagement is pivotal to reshape adolescent mental health outcomes globally.

Keywords: Adolescents; Functional constipation; Anxiety; Depression; Brain-gut axis; Neuropsychiatry; Neuroinflammation; Neuroplasticity

Core Tip: Yang et al’s large adolescent cohort suggests that functional constipation reflects gut-brain axis disruption associated with increased anxiety and depression risk. This letter integrates emerging evidence indicating that gut dysbiosis, altered microbial metabolites, systemic inflammation, microglial activation, and reduced brain-derived neurotrophic factor-mediated neuroplasticity converge on mood regulation. It further underscores the need for longitudinal, biomarker-informed studies and scalable school-based interventions targeting diet, lifestyle, and microbiome-modulating strategies to enable precision prevention in youth mental health.