BackgroundThe Coronavirus Disease-19 (COVID-19) pandemic negatively impacts mental health. Some published studies have investigated the prevalence of depression among children and adolescents in China during the pandemic. However, the results vary widely. We aimed to systematically analyze and estimate the prevalence of depressive symptoms and attempted to reveal the reasons for prevalence variety in previous studies.MethodsPublished studies were searched in PubMed, Embase, Cochrane Central, the Chinese Scientific Journal Database (VIP Database), China National Knowledge database (CNKI), and the WanFang database from December 2019 to May 2021. The quality of all included studies was assessed by the Joanna Briggs Institute (JBI) checklist and the American Agency for Health Care Quality and Research’s (AHRQ) cross-sectional study quality evaluation items. Meta-analysis was performed using random-effects modeling.ResultsOf the 1,708 references screened, 13 related reports that involve 41,729 participants were included. The results suggested that the pooled prevalence of depressive symptoms among Chinese children and adolescents during the COVID-19 epidemic was 28.6%. Subgroup analyses showed that the pooled prevalence was highest among the studies using the Patient Health Questionnaire (PHQ)-9 (46.8%) and lowest among these using Depression Self-Rating Scale for Children (DSRSC) (11.4%). All studies using PHQ-9 set the cutoff at 5 points instead of 10. The pooled prevalence of studies that include primary school students was lower (16.5%) than that of studies excluding primary school students (39.1%).ConclusionThe meta-analysis suggests that depressive symptoms were relatively prevalent among Chinese children and adolescents during COVID-19, especially among the secondary school students. The suitable screening tools and cutoff should be carefully chosen in the survey.

There has been accumulating interest in the association of religion with mental status in adolescents. However, the impact of the interaction between religion and stress on adolescents remains unclear. This study aims to investigate the psychiatric symptoms among religious adolescents at the beginning of the COVID-19 epidemic in China. A total of 11,603 Chinese adolescents were recruited in this survey. The Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 Scale (GAD-7), the Connor-Davidson Resilience Scale (CD-RISC), and the Childhood Trauma Questionnaire (CTQ) were assessed for all adolescents. Of 11,069 valid questionnaires collected, 847 (7.7%) reported holding religious beliefs. Religious adolescents showed significantly more severe depressive and anxiety symptoms compared to non-religious adolescents. 249 (2.2%) reported exposure to COVID-19 and had more severe depressive and anxiety symptoms as compared to those without such exposure. Logistic regression analysis revealed that religiosity was a risk factor for the symptoms of depression (OR = 1.37, 95%CI: 1.16–1.61, p < 0.001) and anxiety (OR = 1.49, 95%CI: 1.23–1.79, p < 0.001). Our finding suggests that religious adolescents easily develop depressive and anxiety symptoms, compared to non-religious adolescents. Parents and education workers should regularly monitor adolescents with religious beliefs, especially those who had poor parent-child relationships and emotional or physical abuse.

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