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

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 (http://www.crd.york.ac.uk/PROSPERO/) under ID CRD42017062343.