What Factors Are Most Closely Associated With Mood Disorders in Adolescents During the COVID-19 Pandemic? A Cross-Sectional Study Based on 1,771 Adolescents in Shandong Province, China

Abstract

Background and Aims: COVID-19 has been proven to harm adolescents' mental health, and several psychological influence factors have been proposed. However, the importance of these factors in the development of mood disorders in adolescents during the pandemic still eludes researchers, and practical strategies for mental health education are limited.Methods: We constructed a sample of 1,771 adolescents from three junior high middle schools, three senior high middle schools, and three independent universities in Shandong province, China. The sample stratification was set as 5:4:3 for adolescent aged from 12 – 15, 15 – 18, 18 – 19. We examined the subjects' anxiety, depression, psychological resilience, perceived social support, coping strategies, subjective social/school status, screen time, and sleep quality with suitable psychological scales. We chose four widely used classification models-k-nearest neighbors, logistic regression, gradient-boosted decision tree (GBDT), and a combination of the GBDT and LR (GBDT + LR)-to construct machine learning models, and we utilized the Shapley additive explanations value (SHAP) to measure how the features affected the dependent variables. The area under the curve (AUC) of the receiver operating characteristic (ROC) curves was used to evaluate the performance of the models.Results: The current rates of occurrence of symptoms of anxiety and depression were 28.3 and 30.8% among the participants. The descriptive and univariate analyses showed that all of the factors included were statistically related to mood disorders. Among the four machine learning algorithms, the GBDT+LR algorithm achieved the best performance for anxiety and depression with average AUC values of 0.819 and 0.857. We found that the poor sleep quality was the most significant risk factor for mood disorders among Chinese adolescents. In addition, according to the feature importance (SHAP) of the psychological factors, we proposed a five-step mental health education strategy to be used during the COVID-19 pandemic (sleep quality-resilience-coping strategy-social support-perceived social status).Conclusion: In this study, we performed a cross-sectional investigation to examine the psychological impact of COVID-19 on adolescents. We applied machine learning algorithms to quantify the importance of each factor. In addition, we proposed a five-step mental health education strategy for school psychologists.

The Role of Self-Care Activities (SASS-14) in Depression (PHQ-9): Evidence From Slovakia During the COVID-19 Pandemic

“…In this context, it was possible to support the idea that good SLP is inversely associated with higher levels of depression ( 40 ). In contrast, poor SLP can be considered one of the most significant risk factors for mood disorders during the COVID-19 pandemic ( 70 ). Lee et al ( 71 ) also emphasized that individuals with poor SLP are more likely to have some or severe problems not only with depression or anxiety, but also with physical activity, self-control and daily activity, and this may be reflected in an impaired quality of life.…”

The relationship between adolescent risk perception and emotions during the COVID-19: a short-term longitudinal study

“…For adolescents who are at a critical stage of cognitive development, the COVID-19 epidemic easily leads to various negative emotions and mental disorders. For example, Ren et al ( 2021 ) implemented a study with the sample of 1771 adolescents from junior high middle school, senior high middle school, and university in China and found that symptoms of anxiety and depression were 28.3 and 30.8% among the participants. Of course, this phenomenon of adolescents showing negative emotions during the COVID-19 epidemic also exists in American college students (Kecojevic et al, 2020 ).…”

“…Based on the above discussion, a large number of studies have explored the emotional experience of adolescents (Ren et al, 2021 ) at different academic stages, such as children (Shorer & Leibovich, 2020 ) and college students (Charles et al, 2021 ) during the COVID-19 pandemic, and it also includes follow-up studies of Liang et al ( 2021 ) and Li et al ( 2021 ). At the same time, some studies have even found the correlation between the adolescents’ emotional experience and their risk perception during the epidemic (Li et al, 2020a ), but they did not reveal whether there are causal relationships between the risk perception and emotions for the adolescents at different academic stages.…”

Mental Health Implications of the COVID-19 Pandemic Among Children and Adolescents: What Do We Know so Far?

“… 9 A second study performed in China supported these results and demonstrated through survey use that out of 1771 adolescents, 28.3% experienced anxious symptoms and 30.8% experienced depressive symptoms. 10 Additionally, studies in the UK have shown that there has been an increase in depressive symptoms by 75% among children in assessments taken before and during lockdown. 11 Symptoms of anxiety also increased during quarantine.…”