Influencing factors and changing trends of depressive symptoms among middle and junior high school students in Eastern China from 2019 to 2023: a cross-sectional study

Background: The emergence of the COVID-19 pandemic led to increased levels of depression among adolescents in 2019. However, the situation regarding adolescent depression in the later stages of the pandemic remains unclear. This study investigated depressive symptoms status and changing trends among middle and junior high school students from 2019 to 2023.

Methods: Data were collected from 9,920 middle and junior high school students between 2019 and 2023 via multistage stratified cluster sampling. Students were administered an online survey, completed the Chinese version of the Center for Epidemiologic Studies Depression Scale, and answered questions regarding basic information, such as birth date. Univariate and multivariate analyses were performed to examine the factors that influenced depressive symptoms. Furthermore, Trend X² Test and Logistic regression was employed to analyze the changing trends of depressive symptoms among the participants.

Results: Of the students, 14.5% and 5.8% could have and had definitely experienced depressive symptoms, respectively. Junior high school students (AOR = 1.409, 95%CI = 1.164-1.706) had a higher risk of definite depressive symptoms. Males (possible depressive symptoms: AOR = 0.803, 95%CI = 0.716-0.902; definite depressive symptoms: AOR = 0.829, 95%CI = 0.695-0.988) were less likely to experience depressive symptoms. Families with parental absence (single-parent families, reconstituted families, and families where both parents are absent), less than one hour of outdoor activity and less than eight hours of sleep, increased the risk of both possible and definite depressive symptoms. Detection rate of depressive symptoms among middle school students followed an inverted U-shape trend; it rose in 2020 and 2021 and declined in 2022 and 2023. Detection rates of depressive symptoms among junior high school students in 2020, 2022, and 2023 decreased compared with 2019 (p < 0.05).

Conclusion: Educational stage, sex, family type, and duration of outdoor activities and sleep were factors that influenced depressive symptoms among middle and junior high school students. A proportion of middle school students with depressive symptoms exhibited an increasing and decreasing trend from 2019 to 2023. Students exposed to risk factors require additional attention, with timely early intervention to mitigate the impact of environmental stress and prevent the further development of depressive symptoms into a more severe and less manageable state.