Frequency of depression and correlates among Chinese children and adolescents living in poor areas under the background of targeted poverty alleviation: results of a survey in Weining county

The study addresses the prevalence and determinants of depression among children and adolescents in impoverished rural China under the targeted poverty alleviation (TPA) policy context. Prior research shows high adolescent depression prevalence in China and links between low socioeconomic status and greater depression risk. Rural youth often experience parental absence, which may adversely impact mental health. The research question is to estimate the frequency of depressive symptoms and identify associated factors among 9–18-year-old students in Weining County to guide prevention, detection, and policy responses.

The paper notes a meta-analysis estimating a 24.3% prevalence of depression among Chinese adolescents and highlights socioeconomic inequalities in mental health, with lower-income groups bearing higher depression burdens. It references the TPA policy's health equity aims but a paucity of mental health data in rural poor populations. Literature indicates parental absence among rural children is prevalent and linked to emotional and behavioral problems via attachment theory. Prior studies also show associations between academic stress (key schools/classes), internet addiction, and depression, while supportive relationships and higher parental education/occupation are protective.

Design: Cross-sectional online survey conducted April 20–May 10, 2022, via the National Clinical Research Center for Mental Disorders network. Setting and sampling: Snowball sampling in Weining County, Guizhou, China, using the WeChat-based Wenjuanxing platform. Participants: School students aged 9–18 years residing in Weining. Exclusion: Completion time <120 seconds or age outside 9–18. Administration: Questionnaires completed under guidance of teachers/guardians. Measures: Socio-demographic/academic/family variables (age, gender, school type, grade/class type, school record, parental education and occupation, parental absence—absence of at least one parent, family/classmate/teacher-student relationships). Definitions: Key schools/classes indicate higher academic standards and resources; well-educated parents defined as college degree or above; sound parental occupation defined as formal, steady-income professions (e.g., teachers, medical staff, civil servants, self-employed with good income). Depression: CES-D Chinese version, total 0–60, cut-off >15 (reported sensitivity 100%, specificity 76%). Internet addiction: Young’s IAT (20 items; 20–100), categorized as no IA (0–30), mild (31–49), moderate (50–79), severe (80–100). Statistical analysis: Categorical variables compared with Pearson’s chi-squared; continuous with Mann–Whitney U. Univariate and multivariable logistic regression to identify correlates of depression; for closely related variables (e.g., age and grade), only one entered in multivariable model. Enter method used. Significance p<0.05 (two-tailed). Software: SPSS 22.0.

- Sample: 23,596 invited; 416 excluded (106 <120 s, 310 out of age range); final n=23,180; median age 12 years (range 9–18). - Prevalence: 8,261/23,180 (35.6%) had CES-D >15. - Bivariate patterns: Higher depression in ages 12–18 (37.4% vs 33.3%, p<0.001), junior middle school (46.3% vs 32.5%, p<0.001), females (36.4% vs 34.9%, p=0.013), parental absence (42.4% vs 33.9%, p<0.001), attending key schools (41.2% vs 34.6%, p<0.001), attending key classes (43.4% vs 34.3%, p<0.001), moderate/severe IA (86.3% vs 29.8% among non-IA, p<0.001). Lower depression with well-educated parents (31.0% vs 36.1%, p<0.001), sound parental occupation (30.3% vs 36.6%, p<0.001), good school record (24.6% vs 38.8%, p<0.001), good family/student/teacher-student relationships (all p<0.001). - Univariate logistic regression (selected): age 12–18 OR 1.194 (95% CI 1.131–1.261, p<0.001); female OR 1.071 (1.015–1.130, p=0.013); junior middle school OR 1.790 (1.681–1.906, p<0.001); parental absence OR 1.433 (1.342–1.530, p<0.001); key schools OR 1.325 (1.233–1.425, p<0.001); key classes OR 1.471 (1.366–1.583, p<0.001); moderate/severe IA OR 14.891 (13.203–16.796, p<0.001). Protective: well-educated parents OR 0.795 (0.725–0.873, p<0.001); sound parental occupation OR 0.752 (0.697–0.813, p<0.001); good school record OR 0.514 (0.479–0.552, p<0.001); good family relationship OR 0.363 (0.329–0.402, p<0.001); good student relationship OR 0.371 (0.335–0.411, p<0.001); good teacher-student relationship OR 0.442 (0.398–0.490, p<0.001). - Multivariable logistic regression: female OR 1.175 (1.108–1.247, p<0.001); junior middle school OR 1.487 (1.380–1.601, p<0.001); parental absence OR 1.272 (1.183–1.367, p<0.001); attending key schools OR 1.221 (1.120–1.332, p<0.001); attending key classes OR 1.099 (1.001–1.207, p=0.048); moderate/severe IA OR 13.593 (12.028–15.361, p<0.001). Protective: sound parental occupation OR 0.838 (0.760–0.925, p<0.001); good school record OR 0.540 (0.500–0.584, p<0.001); good family relationship OR 0.544 (0.464–0.637, p<0.001); good student relationship OR 0.574 (0.487–0.678, p<0.001). Good teacher-student relationship not significant in multivariable model (OR 1.154, 0.971–1.371, p=0.104).

Findings indicate a notably higher depression frequency (35.6%) among children and adolescents in a poor rural county than national pooled estimates, underscoring poverty as a significant risk context. Multiple factors independently associated with depression include being female, attending junior middle school (older age/higher grade), parental absence, academic environment pressures (key schools/classes), and especially moderate-to-severe internet addiction. Protective factors include good school performance, supportive family and peer relationships, and sound parental occupations, suggesting that socioeconomic resources and social support mitigate risk. The results align with prior literature on socioeconomic disparities, the psychological impact of parental migration/absence, adolescent developmental transitions, and the adverse mental health associations of internet addiction. These findings support targeted interventions in impoverished rural areas focusing on early detection, psychosocial support, academic stress reduction, IA prevention/treatment, and family engagement to reduce depression risk.

Depression is common among school-aged children and adolescents in Weining County despite targeted poverty alleviation policies. Independent correlates include female gender, higher school grade, parental absence, attendance at key schools/classes, and moderate-to-severe internet addiction, while good academic performance, supportive relationships, and sound parental occupation are protective. The study contributes large-scale, rural, poverty-context epidemiological data and highlights modifiable targets (e.g., IA, academic stress, social support). Future research should employ longitudinal designs to clarify causal pathways, evaluate interventions tailored to left-behind children and high-stress academic settings, and assess mental health outcomes across stages of poverty alleviation implementation.

- Selection bias toward participants with internet access; the most deprived without access may be underrepresented. - Important variables (e.g., physical health, broader social support) were unavailable; CES-D screening cannot confirm clinical depression or distinguish transient symptoms. - Cross-sectional design precludes causal inference; snowball sampling may introduce sampling bias. - Inability to compare pre- vs post-TPA depression prevalence. - CES-D cut-off of 16 may yield false positives in younger children (9–11 years); appropriateness of threshold requires further validation. - Need for longitudinal studies to better establish prevalence trends and causal relationships.