JMIR Publications

ABSTRACT

Background:

Yunnan is a border province that is one of the longest borders in China and borders Myanmar, Laos, and Vietnam. We aimed to determine the prevalence trends and COVID-19 impact of depressive symptoms among 12- to 18-year-old school-aged adolescents from 2018 to 2022 in Yunnan, Southwest China.

Objective:

To evaluate the impact of the epidemic of COVID-19 epidemic on the mental health of adolescents, reduce the affect or harm of psychological emergency syndrome, and promote the healthy and happy growth of adolescents in the COVID-19 era, we carried out this study.

Methods:

We conducted a longitudinal observational study by using data from the Students’ Health Surveys of 2018, 2019, 2020, 2021 and 2022 in Yunnan, Southwest China. We collected adolescent data on depressive symptoms of pre-COVID-19, and early, and during the COVID-19 pandemic in Yunnan through multistage-stratified sampling in 3 prefectures in 2018 and 16 prefectures from 2019 to 2022. In each prefecture, the study population was classified by gender and residence (urban or rural), and each group had an equal size. The diagnostic criteria of depressive symptoms were set with the Center for Epidemiological Studies Depression Scale (CES-D) score. ANOVA was adopted to measure the differences in the mean CES-D score stratified by gender, age, residence, grade, and ethnicity. The chi-square test was used to compare the percentages of depressive symptoms in different variate. For comparability, the age-standard and gender-standard population prevalence was calculated by directly using the China Census in 2010 as a standard population. The association of COVID-19 with the risk of standardized depressive symptom prevalence was identified using unconditional logistic regression analysis.

Results:

The standardized prevalence of depressive symptoms in all participants was 32.98% in Yunnan, Southwest China. Accordingly, from 2018 to 2022, the standardized prevalence of depressive symptoms was 28.26%, 30.89%, 29.81%, 28.77% and 36.33%, respectively. The prevalence in pre-COVID-19 was 30.49%, that of early COVID-19 was 29.29%, and that of the COVID-19 pandemic was 36.33%. The risk of depressive symptoms in early COVID-19 was 0.793 (95% CI 0.772~0.814) times that in pre-COVID-19; the risk of depressive symptoms in the COVID-19 pandemic was 1.071 (95% CI 1.042~1.100) times that in pre-COVID-19 in Yunnan. The average annual increase in adolescents’ depressive symptoms was 1.61%. The epidemic characteristics showed the following: First, the prevalence of depressive symptoms in girls (36.87%) was higher than that in boys (28.64%). The acceleration rate of girls was also quicker than that of boys. Second, the prevalence of 12-13 years was 27.14%, that of 14-15 years was 33.99%, and that of 16-18 years was 36.59%. This assumed that with increasing age, the standardized prevalence increased. The acceleration rate was the fastest in adolescents aged 14-15 years (1.80%), followed by adolescents aged 16-18 years (1.65%). Third, there were no differences in prevalence between Han (32.89%) and minority (33.10%) populations. However, the acceleration rate of the Han population was quicker than that of the minority population. Fourth, the rate of senior high school students was the highest (34.94%). However, the acceleration rate of vocational high school students was the quickest (34.58%), followed by that of junior high school students (34.58%). Finally, the rate of rural residence (35.10%) was higher than that of urban residence (30.16%). The acceleration rate of rural residence was also quicker than that of urban residence.

Conclusions:

From 2018 to 2022, there was a significant and continuous increase in the prevalence of depressive symptoms among 12- to 18-year-old school-aged adolescents in Yunnan, Southwest China, especially during the COVID-19 pandemic. It is an emergency public health problem of adolescents’ depressive symptoms in Yunnan, and the epidemic remains at a relatively high level in the COVID-19 era. The problem of depressive symptoms in Yunnan adolescents should be given more attention. We should take effective and comprehensive psychological and lifestyle intervention measures to reduce the prevalence of mental health issues in adolescents.