Psychological risk and protective factors associated with depressive symptoms among adolescents in secondary schools in China: A systematic review and meta-analysis

Xinfeng Tang, Suqin Tang, Zhihong Ren, Daniel Fu Keung Wong*

*Corresponding author for this work

Research output: Contribution to journalJournal articlepeer-review

12 Citations (Scopus)


Depressive symptoms are prevalent among adolescents in Chinese secondary schools. The aim of the meta-analysis is to provide an overall estimate of psychological risk/protective factors associated with depressive symptoms among this population. English and Chinese databases were searched. Journal articles and theses which reported at least one risk/protective factor for depressive symptoms among secondary school students in mainland China were included for screening. The Newcastle–Ottawa Scale (NOS) adapted for cross-sectional studies was used to rate the quality of each study. A random effects model was used to combine the effect sizes. Twenty-one psychological factors were identified in a total of 140 articles. The absolute values of the effect sizes ranged from 0.08 to 0.63. Among them, automatic thoughts (r = 0.63), negative self-evaluation (r = 0.57), neuroticism (r = 0.57), self-esteem (r = −0.53) and resilience (r = −0.50) were associated with depressive symptoms with large effect sizes. Further analysis revealed that study quality, sample size and publication year were significant moderators of certain associations. However, grade, mean age and gender were not significant moderators. The limitations of the meta-analysis included unexplained large heterogeneity, significant publication bias, and inability to investigate the interactions of different factors and to determine the direction of causal relationships between them and depression. The study suggests that several cognitive factors, personality traits and coping strategies have strong correlations with depressive symptoms among Chinese adolescents. Further research is required to identify specific strategies to target these risk factors and to develop effective prevention and treatment programs.
Review registration: PROSPERO ( under ID CRD42017062343.
Original languageEnglish
Article number104680
Number of pages10
JournalChildren and Youth Services Review
Publication statusPublished - Jan 2020

Scopus Subject Areas

  • Education
  • Developmental and Educational Psychology
  • Sociology and Political Science

User-Defined Keywords

  • Adolescent
  • China
  • Depression
  • Meta-analysis
  • Risk/protective factor
  • Secondary schools


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