{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:44:41Z","timestamp":1787013881910,"version":"build-2736575974"},"reference-count":69,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T00:00:00Z","timestamp":1767657600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T00:00:00Z","timestamp":1767657600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100021171","name":"Basic and Applied Basic Research Foundation of Guangdong Province","doi-asserted-by":"publisher","award":["2025A1515010630"],"award-info":[{"award-number":["2025A1515010630"]}],"id":[{"id":"10.13039\/501100021171","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Asia-Pacific Psychiatry"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Adolescent depressive episodes exhibit significant symptom complexity and heterogeneity, necessitating an integrated approach to identify distinct subtypes. Cultural orientations (individualism and collectivism) and loneliness are crucial factors impacting adolescent mental health. This study identifies symptom complexity subtypes in Chinese adolescents with depressive episodes, investigates cultural orientation differences between these subtypes, and explores the role of loneliness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 110 adolescents were included. K\u2010means clustering was used to generate symptom complexity subtypes based on disease duration, self\u2010injury, mood disorder, depressive, and anxiety symptoms. Cultural orientations were assessed using the Individualism\u2013Collectivism Scale, loneliness using the UCLA Loneliness Scale, and other relevant variables were collected via self\u2010report. Structural equation modeling (SEM) was used to explore associations among cultural orientations, loneliness, and symptom complexity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Two subtypes were identified: low\u2010complexity and high\u2010complexity. The high\u2010complexity subtype exhibited elevated loneliness levels (t\u2009=\u2009\u22126.16,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), more severe childhood trauma and bullying, and greater social media addiction. This group also reported higher vertical individualism (t\u2009=\u2009\u22122.02,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.046) and lower vertical collectivism (t\u2009=\u20092.05,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.043). SEM revealed a significant indirect association between higher individualism tendency and increased symptom complexity mediated by loneliness (\u03b2\u2009=\u20090.21,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001 and \u03b2\u2009=\u20090.53,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001, respectively).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Incorporating cultural orientation assessments into clinical practice may improve treatment outcomes for adolescents with depressive episodes by identifying those at risk for complex symptom presentations and informing subsequent culturally\u2010tailored therapeutic interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/appy.70011","type":"journal-article","created":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T06:46:32Z","timestamp":1767768392000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Symptom Complexity Subtypes Show Distinct Individualism\u2013Collectivism Orientations in Adolescents With Depressive Episodes, With Loneliness Mediating Their Relationship"],"prefix":"10.1111","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0198-1050","authenticated-orcid":false,"given":"Rui","family":"Zhou","sequence":"first","affiliation":[{"name":"Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6618-3142","authenticated-orcid":false,"given":"Yi\u2010Hui","family":"Liu","sequence":"additional","affiliation":[{"name":"Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7383-4153","authenticated-orcid":false,"given":"Yong\u2010Yi","family":"He","sequence":"additional","affiliation":[{"name":"Department of Psychiatry The Third Affiliated Hospital, Sun Yat\u2010Sen University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia\u2010Rong","family":"Liang","sequence":"additional","affiliation":[{"name":"Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University  Guangzhou China"},{"name":"The Third People's Hospital of Zhuhai  Zhuhai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mu\u2010Tong","family":"Chen","sequence":"additional","affiliation":[{"name":"Cancer Hospital of Shantou University Medical College  Shantou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nan","family":"Chen","sequence":"additional","affiliation":[{"name":"Psychiatry\/Psychology Department Guangzhou Red Cross Hospital  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8762-370X","authenticated-orcid":false,"given":"Fu\u2010Jun","family":"Jia","sequence":"additional","affiliation":[{"name":"Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7789-5602","authenticated-orcid":false,"given":"Cai\u2010Lan","family":"Hou","sequence":"additional","affiliation":[{"name":"Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,1,6]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.3390\/electronics9081295"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.2466\/pr0.1983.53.3.883"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/0898264320943336"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/00004583\u2010199703000\u201000012"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1017\/s0033291714003109"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/pchj.62"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2021.04.016"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2024.04.065"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-981-15-1209-4_1"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12888\u2010017\u20101489\u20106"},{"key":"e_1_2_11_12_1","unstructured":"Feng Y. andG. R.Jiang.2008.The Relation of Adolecents' Self\u2010Harm Behaviors Individual Emotion Characteristics and Family Environment Factors[D]. Academic Department Central China Normal University."},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.16128\/j.cnki.1005\u20103611.2005.01.012"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/aphw.12259"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.5742\/MEWFM.2018.93351"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/15248380211036393"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2023.11.062"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12160\u2010010\u20109210\u20108"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12888\u2010023\u201004808\u20107"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1177\/0146167218796793"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.157.11.1873"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.9707\/2307\u20100919.1014"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.5414\/cp202413"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2023.03.006"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12888\u2010025\u201006806\u20103"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00787\u2010014\u20100562\u20107"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijintrel.2025.102153"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/npr2.12449"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12887\u2010024\u201004986\u20107"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaac.2020.05.009"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2025.119819"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.20230574"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00127\u2010022\u201002261\u20107"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1037\/0022\u20103514.94.6.925"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1109\/TPAMI.2002.1114856"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1002\/j.2161\u20101912.2005.tb00009.x"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1556\/2006.6.2017.023"},{"key":"e_1_2_11_38_1","volume-title":"The Impact of Cultures of Origin on Attitudes Toward Mental Health Treatment","author":"Morris K.","year":"2011"},{"key":"e_1_2_11_39_1","volume-title":"The Revised Olweus Bully\/Victim Questionnaire","author":"Olweus D.","year":"1996"},{"key":"e_1_2_11_40_1","doi-asserted-by":"publisher","DOI":"10.10371\/0033\u20102909.128.1.3"},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.1037\/0033\u20102909.134.2.311"},{"key":"e_1_2_11_42_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14030844"},{"key":"e_1_2_11_43_1","doi-asserted-by":"publisher","DOI":"10.1080\/10826084.2017.1392983"},{"issue":"9","key":"e_1_2_11_44_1","first-page":"676","article-title":"Differential Validity of SAS and SDS Among Psychiatric Non\u2010Psychotic Outpatients and Their Partners","volume":"26","author":"Quan Q. D.","year":"2012","journal-title":"Chinese Mental Health Journal"},{"key":"e_1_2_11_45_1","doi-asserted-by":"publisher","DOI":"10.1027\/\/1016\u20109040.5.4.302"},{"issue":"7","key":"e_1_2_11_46_1","first-page":"279","volume":"6","author":"Saroj","year":"2016","journal-title":"International Journal of Computer Science Engineering and Technology"},{"key":"e_1_2_11_47_1","doi-asserted-by":"publisher","DOI":"10.1093\/schbul\/sbw154"},{"key":"e_1_2_11_48_1","doi-asserted-by":"publisher","DOI":"10.1097\/yco.0000000000000547"},{"key":"e_1_2_11_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0924\u20109338(97)83297\u2010X"},{"issue":"7","key":"e_1_2_11_50_1","first-page":"493","article-title":"Evaluation of the Reliability and Validity of Chinese Version of the Mini\u2010International Neuropsychiatric Interview in Patients With Mental Disorders","volume":"23","author":"Si T. M.","year":"2009","journal-title":"Chinese Mental Health Journal"},{"key":"e_1_2_11_51_1","doi-asserted-by":"publisher","DOI":"10.1177\/106939719502900302"},{"key":"e_1_2_11_52_1","doi-asserted-by":"publisher","DOI":"10.1177\/0022022116655963"},{"key":"e_1_2_11_53_1","doi-asserted-by":"publisher","DOI":"10.1177\/00207640231216924"},{"key":"e_1_2_11_54_1","doi-asserted-by":"publisher","DOI":"10.1111\/1467\u20106494.696169"},{"key":"e_1_2_11_55_1","doi-asserted-by":"publisher","DOI":"10.1037\/0022\u20103514.74.1.118"},{"key":"e_1_2_11_56_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40359\u2010024\u201001806\u20106"},{"key":"e_1_2_11_57_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jadohealth.2024.08.010"},{"key":"e_1_2_11_58_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2020.05.066"},{"key":"e_1_2_11_59_1","doi-asserted-by":"publisher","DOI":"10.13342\/j.cnki.cjhp.2018.04.035"},{"key":"e_1_2_11_60_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eurpsy.2019.03.004"},{"key":"e_1_2_11_61_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2025.1537331"},{"key":"e_1_2_11_62_1","doi-asserted-by":"publisher","DOI":"10.3760\/cma.j.issn.1006\u20107884.2010.04.008"},{"key":"e_1_2_11_63_1","doi-asserted-by":"publisher","DOI":"10.2147\/ndt.S457186"},{"key":"e_1_2_11_64_1","doi-asserted-by":"publisher","DOI":"10.1037\/emo0000689"},{"key":"e_1_2_11_65_1","doi-asserted-by":"publisher","DOI":"10.1037\/cou0000637"},{"key":"e_1_2_11_66_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.janxdis.2018.09.005"},{"key":"e_1_2_11_67_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12144\u2010021\u201001735\u20102"},{"key":"e_1_2_11_68_1","doi-asserted-by":"publisher","DOI":"10.2190\/OM.55.2.c"},{"key":"e_1_2_11_69_1","doi-asserted-by":"publisher","DOI":"10.1177\/08862605241244473"},{"key":"e_1_2_11_70_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12888\u2010023\u201004848\u2010z"}],"container-title":["Asia-Pacific Psychiatry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/appy.70011","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/appy.70011","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/appy.70011","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T08:53:04Z","timestamp":1774515184000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/appy.70011"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,6]]},"references-count":69,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1111\/appy.70011"],"URL":"https:\/\/doi.org\/10.1111\/appy.70011","archive":["Portico"],"relation":{},"ISSN":["1758-5864","1758-5872"],"issn-type":[{"value":"1758-5864","type":"print"},{"value":"1758-5872","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,6]]},"assertion":[{"value":"2025-09-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-15","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-06","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70011"}}