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

Table 1 Social demography and clinical characteristics of adolescents included in the study (n = 22925), n (%)

Characteristic	Depressive symptoms			Anxiety symptoms
	With (n = 3678)	Without (n = 19247)	P value	With (n = 5515)	Without (n = 17410)	P value
Age (year), mean ± SD	14.36 ± 1.42	14.25 ± 1.54	< 0.001	14.45 ± 1.46	14.21 ± 1.54	< 0.001
Sex			< 0.001	-		< 0.001
Male	1548 (12.8)	10567 (87.2)		2395 (19.8)	9720 (80.2)
Female	2130 (19.7)	8680 (80.3)		3120 (28.9)	7690 (71.1)
Educational levels			0.475	-		< 0.001
Junior high school	2836 (16.0)	14944 (84.0)		4091 (23.0)	13689 (77.0)
Senior high school	842 (16.4)	4303 (83.6)		1424 (27.7)	3721 (72.3)
Regions			< 0.001	-		< 0.001
Urban	3183 (15.4)	17545 (84.6)		4856 (23.4)	15872 (76.6)
Suburban	495 (22.5)	1702 (75.5)		659 (30.0)	1538 (70.0)
BMI (kg/m2), mean ± SD	21.13 ± 3.89	21.02 ± 3.78	0.109	21.19 ± 3.86	20.99 ± 3.78	0.001
Smoking			< 0.001	-		< 0.001
Yes	566 (22.4)	1956 (77.6)		772 (30.6)	1750 (69.4)
No	3112 (15.3)	17291 (84.7)		4743 (23.2)	15660 (76.8)
PSSS total scores, mean ± SD	49.50 ± 14.92	66.14 ± 14.49	< 0.001	52.21 ± 14.71	67.04 ± 14.39	< 0.001
Family support	15.70 (5.94)	22.23 (5.37)	< 0.001	16.85 (5.87)	22.56 (5.31)	< 0.001
Friend support	17.46 (5.97)	21.86 (5.18)	< 0.001	18.03 (5.66)	22.15 (5.15)	< 0.001
Significant others	16.34 (5.59)	22.04 (5.10)	< 0.001	17.33 (5.42)	22.33 (5.08)	< 0.001
Parental relationship			< 0.001	-		< 0.001
Harmony	1604 (10.0)	14412 (90.0)		2742 (17.1)	13274 (82.9)
Moderate	1647 (27.7)	4303 (72.3)		2277 (38.3)	3673 (61.7)
Conflict	427 (44.5)	532 (55.5)		496 (51.7)	463 (48.3)
Annual household income			< 0.001	-		< 0.001
Better	1169 (11.7)	8851 (88.3)		1882 (18.8)	8138 (81.2)
Good	1954 (17.7)	9068 (82.3)		2927 (26.6)	8095 (73.4)
Fair	555 (29.5)	1328 (70.5)		706 (37.5)	1177 (62.5)
Physical activity level			< 0.001	-		< 0.001
High	502 (11.5)	3866 (88.5)		804 (18.4)	3564 (81.6)
Medium	1274 (14.3)	7666 (85.7)		1936 (21.7)	7004 (78.3)
Low	1902 (19.8)	7715 (80.2)		2775 (28.9)	6842 (71.1)
WEDUT			< 0.001	-		< 0.001
High	1014 (26.0)	2882 (74.0)		1365 (35.0)	2531 (65.0)
Moderate	1330 (17.0)	6477 (83.0)		2048 (26.2)	5759 (73.8)
Low	1334 (11.9)	9888 (88.1)		2102 (18.7)	9120 (81.3)
FC			< 0.001	-		< 0.001
Yes	384 (21.6)	1396 (78.4)		540 (30.3)	1240 (69.7)
No	3294 (15.6)	17851 (84.4)		4975 (23.5)	16170 (76.5)

Independent samples t-tests were used to compare age, body mass index, Perceived Social Support Scale total score and subscale scores across symptom status groups (with/without) for both depression and anxiety, while χ² tests were used for other between-group comparisons. BMI: Body mass index; PSSS: Perceived Social Support Scale; WEDUT: Weekly electronic device usage time; FC: Functional constipation.

Table 2 Depressive and anxiety symptom severity according to the Patient Health Questionnaire-9 and Generalized Anxiety Disorder 7-item scales

Characteristic	Depressive symptoms		Anxiety symptoms		Comorbid depressive and anxiety symptoms
	n (%)	mean ± SD	n (%)	mean ± SD	n (%)
Minimal	12941 (56.4)	1.32 ± 1.46	15136 (66.0)	1.0 ± 1.33	19916 (86.9)
Mild	6306 (27.5)	6.93 ± 1.45	5283 (23.0)	6.63 ± 1.18	-
Moderate	2288 (10.0)	11.59 ± 1.39	1646 (7.2)	11.84 ± 1.44	-
Moderately severe	923 (4.0)	16.67 ± 1.41	-	-	-
Severe	467 (2.0)	22.94 ± 2.39	860 (3.8)	17.89 ± 2.22	-
Overall prevalence	3678 (16.0)	-	5515 (24.1)	-	3009 (13.1)

Table 3 Risk factors for depressive and anxiety symptoms in adolescents

Characteristic	Depressive symptoms			Anxiety symptoms
	OR	95%CI	P value	OR	95%CI	P value
Age	1.034	0.992-1.079	0.116	1.078	1.040-1.117	< 0.001
Sex
Male	1	-	-	1	-	-
Female	1.511	1.391-1.641	< 0.001	1.525	1.421-1.636	< 0.001
Educational level
Junior high school	1	-	-	1	-	-
Senior high school	1.154	0.993-1.342	0.062	0.965	0.848-1.097	0.586
Regions
Urban	1	-	-	1	-	-
Suburban	1.102	0.963-1.261	0.159	0.981	0.869-1.106	0.751
BMI (kg/m2)	1.010	0.999-1.021	0.062	1.016	1.007-1.026	< 0.001
Smoking
No	1	-	-	1	-	-
Yes	1.704	1.440-2.017	< 0.001	1.843	1.589-2.138	< 0.001
PSSS
Family support	0.904	0.894-0.914	< 0.001	0.908	0.899-0.917	< 0.001
Friend support	0.999	0.988-1.010	0.864	0.978	0.968-0.987	< 0.001
Significant others	0.928	0.915-0.941	< 0.001	0.949	0.937-0.962	< 0.001
Parental relationship
Harmony	1	-	-	1	-	-
Moderate	1.619	1.482-1.770	< 0.001	1.521	1.407-1.643	< 0.001
Conflict	2.282	1.940-2.682	< 0.001	1.818	1.556-2.124	< 0.001
Annual household income
Better	1	-	-	1	-	-
Good	1.048	0.959-1.146	0.303	1.035	0.961-1.115	0.366
Fair	1.434	1.211-1.698	< 0.001	1.177	1.010-1.372	0.037
Physical activity level
High	1	-	-	1	-	-
Medium	1.188	1.047-1.349	0.008	1.106	0.996-1.229	0.060
Low	1.555	1.373-1.760	< 0.001	1.437	1.296-1.594	< 0.001
WEDUT
Low	1	-	-	1	-	-
Moderate	1.243	1.131-1.366	< 0.001	1.303	1.204-1.411	< 0.001
High	2.129	1.912-2.370	< 0.001	1.891	1.720-2.078	< 0.001
FC
No	1	-	-	1	-	-
Yes	1.261	1.101-1.444	0.001	1.195	1.060-1.348	0.004

CI: Confidence interval; OR: Odds ratio; BMI: Body mass index; WEDUT: Weekly electronic device usage time; FC: Functional constipation.