{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T22:49:58Z","timestamp":1788562198775,"version":"build-2803163510"},"update-to":[{"DOI":"10.12688\/wellcomeopenres.22685.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000}}],"reference-count":151,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["204403"],"award-info":[{"award-number":["204403"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["wellcomeopenresearch.org"],"crossmark-restriction":false},"short-container-title":["Wellcome Open Res"],"abstract":"<ns3:p>Background Adolescent depression and anxiety are highly prevalent, recurrent, and disabling mental health conditions. Current treatment outcomes are suboptimal, often leaving young people with residual symptoms and high relapse rates. To inform future development of more effective preventative strategies, the Emotional Vulnerability in Adolescents (EVA) study aimed to identify vulnerability markers for adolescent depression and anxiety. Specifically, it examined the associations between mental health outcomes and potentially modifiable biopsychosocial factors. The present report provides an overview of the study design and methodology, summarised the demographic, clinical, and mechanistic characteristics of the sample, and examined individual differences by age, gender, and personal and familial history of mental health at baseline. Methods Data collection was conducted across three-time points (baseline, 6-months and a 60-month follow-up). A total of 425 adolescents (60.5% female) aged 12 -18 years (Mean = 15.06, SD = 1.75) were recruited at baseline. A comprehensive battery of measures to assess a range of bio-psycho-social factors was employed. Results We replicated previous findings in suggesting that females and those with a personal or familial history of mental health difficulties have higher levels of depression and anxiety and lower levels of well-being. These vulnerable sub-groups were also found to differ from their counterparts in a number of biopsychosocial factors; specifically they showed poorer sleep quality, lower levels of resilience, and higher levels of rumination, stress, neuroticism, external shame, bullying experiences, neural-cognitive biases, and dysfunctional attitudes. Furthermore, symptoms of depression and anxiety increased with age and peaked around age 15; age was also associated with an increased risk for eating disorders. Conclusions The present findings highlight the importance of considering individual differences in developing future preventative and intervention strategies by targeting underlying mechanisms that are more specifically prominent in each individual subgroup of the population.<\/ns3:p>","DOI":"10.12688\/wellcomeopenres.22685.2","type":"journal-article","created":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T16:15:06Z","timestamp":1756743306000},"page":"510","update-policy":"https:\/\/doi.org\/10.12688\/wellcomeopenres.crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Emotional Vulnerability in Adolescents (EVA) Longitudinal Study: Identifying individual differences in symptoms of adolescent depression and anxiety and their biopsychosocial mechanisms based on demographic and mental health characteristics"],"prefix":"10.12688","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5000-9810","authenticated-orcid":false,"given":"Asnea","family":"Tariq","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elaine","family":"Gray","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2222-7823","authenticated-orcid":false,"given":"Alice","family":"M.  Gregory","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stella","family":"W. Y. Chan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2025,9,1]]},"reference":[{"key":"ref-1","doi-asserted-by":"publisher","first-page":"1423-1436","DOI":"10.1016\/j.psyneuen.2009.06.011","article-title":"Assessing salivary cortisol in large-scale, epidemiological research.","volume":"34","author":"E Adam","year":"2009","journal-title":"Psychoneuroendocrinology."},{"key":"ref-2","doi-asserted-by":"publisher","first-page":"271-279","DOI":"10.1016\/j.jad.2023.07.014","article-title":"Longitudinal trajectories of sickness absence among young adults with a history of depression and anxiety symptoms in Sweden.","volume":"339","author":"I Alaie","year":"2023","journal-title":"J Affect Disord."},{"key":"ref-3","doi-asserted-by":"publisher","DOI":"10.1038\/s41394-019-0149-0","article-title":"Actigraphy-based evaluation of sleep quality and physical activity in individuals with spinal cord 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We have resubmitted a revised manuscript, addressing your comments point by point below. Our responses are highlighted in blue for your convenience. &nbsp;  \n<b>Reviewer Comment:<\/b> \n<i>\u201cThe article would be improved with editing to ensure support readability and precision. For example, there are minor grammatical errors, the use of past and future tense is mixed, several times the phrase 'on the contrary' is used where the point is not contrary to the prior one\u2026 There is repetition and confusing detail in the introduction. For example, widely contrasting estimates of the prevalence of mental health problems are cited at several points in the opening paragraphs. The authors have noted BMI is a risk factor. I assume this is high or low BMI - just make sure all these details are clear\u2026 There is a complex literature regarding associations between social media use and mental wellbeing. Are the authors confident they have summarized this in an accurate way?\u201d<\/i> &nbsp; \n<b>Response:<\/b> Thank you for your constructive feedback. In response, we have made substantial revisions throughout the Introduction to improve clarity, readability, and precision. These changes include:  We have carefully reviewed and corrected grammatical errors, punctuation, and inconsistencies in tense use across the sections to enhance precision. We have replaced instances of \u201con the contrary\u201d with more appropriate connectors to ensure alignment with the logical flow of the argument. We have streamlined the opening sections (1.1 and 1.2) to avoid repetitive or overly contrasting prevalence estimates and have now provided more contextualised statistics to support the rationale without confusion. We have now specified that both high (overweight\/obese) and low (underweight) BMI are considered risk factors and defined BMI percentiles (top or bottom 5%) using appropriate references. We have revised the subsection on social media use (Section 1.5.2) to more accurately reflect the current evidence base and acknowledged the complexity and limitations of the literature. We have exercised caution in interpreting causal claims and ensured that gender-specific findings were appropriately contextualised. Throughout the introduction (Section 1), we have refined sentence structure and vocabulary for improved readability without altering the substantive content or structure. Redundancies have been eliminated, and clearer transitions have been added between paragraphs to enhance readability.  &nbsp; \n<b>Reviewer Comment: <\/b> \n<i>\u201cA little more detail in the methods is needed. How were the areas, schools and participants selected? What was the response rate for schools and participants? How was personal and family mental health history assessed? Given the % reporting a 'family mental health history' and that findings are reported by this factor, it is important to explain what it is. Was social media use based on self-report? How was ethnicity assessed? Were the young people seen alone in the face-to-face meetings? About how long did the assessments take?\u201d<\/i> &nbsp; \n<b>Response: <\/b> We have now clarified these details in the Methods section. Specifically, we have added details in Sections 2.2, 2.3, and 2.4.6 regarding the study procedure, assessment duration, and the assessment of mental health history, ethnicity, and social media use. &nbsp;  \n<b>Reviewer Comment: <\/b> \u201c\n<i>\u2022 In the figures, make sure each label is clear. I was a little confused by the label about 'depressive symptoms &lt; the level of concern'. Could this be any clearer?<\/i> \n<i>\u2022 When you are describing the results (e.g., 70.6% White), also report the % missing.<\/i> \n<i>\u2022 It would be helpful to understand differences in symptoms by ethnicity and SES.<\/i> \n<i>\u2022 In 3.1.3 you report that the adolescents were relatively healthy with relatively low levels of depression and anxiety symptoms. However, over 20% indicate depressive symptoms, and only 38% indicate 'normal' scores on anxiety. This does not seem relatively healthy.\u201d<\/i> &nbsp; \n<b>Response: <\/b> Thank you for these helpful suggestions. We have addressed each point as follows:  We agree that the label &quot;depressive symptoms &lt; the level of concern&quot; was ambiguous. As we were unable to edit the embedded text within the image directly, we have updated the figure title and caption to clearly reflect that scores above a specified threshold indicate clinical concern for depressive symptoms (Mood and Feelings Questionnaire; SMFQ; Angold et al., 1995). Similar clarifications have also been applied to the anxiety (Generalised Anxiety Disorder Screener; Spitzer et al., 2006) and well-being (Short Warwick-Edinburgh Mental Well-being Scale; SWEMWBS) figures. The percentage of missing data is already included in the demographic table (Table 2), which reports the proportion of participants for whom each variable was not available. We appreciate the suggestion to examine differences in symptoms by ethnicity and socioeconomic status (SES). Unfortunately, SES information was not collected in the present study, which we now acknowledge as a limitation in the revised manuscript. However, in line with the reviewer\u2019s recommendation, we conducted additional analyses to examine ethnic group differences (Section 3.2.6). Independent samples t-tests were conducted to compare White and non-White participants across all key study variables. These analyses revealed no statistically significant differences between groups, and the results are now summarized in Table 10. We appreciate the reviewer highlighting the inconsistency in describing the sample as \u201crelatively healthy.\u201d In response, we have revised the text in Section 3.1.3 to provide a more accurate reflection of the data. The updated interpretation acknowledges that while many participants scored below clinical thresholds, a substantial proportion reported elevated symptoms, particularly for anxiety and depression, in line with population-level community samples.  &nbsp; \n<b>Reviewer Comment:<\/b> \u201c\n<i>\u2022 In your consideration of strengths and weaknesses, include the response rates (and reasons for non-participation if possible) and any impact on the study. You have included a high number of measures. <\/i> \n<i>Might this have influenced accuracy?<\/i> \n<i>\u2022 There is a quite a lot of missing data \u2013 e.g. nearly 20% do not report an ethnicity and about 20% are missing for family and personal mental health history. This should be commented on. Do you have any plans to address this in future rounds?<\/i> \n<i>\u2022 Is it possible to comment on findings by participant ethnicity or SES?<\/i> \n<i>\u2022 Might lower rates of depression among teens over 15 reflect any methodological issues? E.g., less healthy teens leaving school earlier or being more likely to be absent on the day of the study?<\/i> \n<i>\u2022 A key feature of depression is feeling negatively about self, others, past, present and future. Might this impact on report of self or family mental health history? I would expect this would be likely. This means statements such as 'those with personal or family mental illnesses are likely to be three to four times more susceptible to developing depression or anxious symptoms' need to be interpreted with caution. At baseline you do not know the direction of this relationship\u201d.<\/i> &nbsp; \n<b>Response: <\/b> We thank the reviewer for these thoughtful and constructive comments, which have led to several important additions and clarifications in \n<b>Section 4.1 (Strengths and Limitations)<\/b> of the revised manuscript. We have now reflected on the potential impact of administering a large number of measures and acknowledged that participant burden may have influenced response accuracy. The levels of missing data have now been explicitly addressed. &nbsp; We appreciate the reviewer\u2019s suggestion regarding the observed lower depressive symptom scores among older adolescents. We now acknowledge that this trend may be influenced by methodological factors, such as selective school dropout or absence among more vulnerable students. This possibility has been incorporated into Section 4.1 as a potential limitation of the current cross-sectional baseline findings. Finally, we agree that depressive cognitive distortions may affect how individuals report their own or their family members\u2019 mental health histories. Accordingly, we have revised the relevant interpretations to reflect this potential reporting bias and to emphasise the exploratory and non-causal nature of these baseline associations. As above, we have now added results around differences by ethnicity in the Results section.","URL":"https:\/\/wellcomeopenresearch.org\/articles\/9-510\/v2#referee-comment-6205","order":1,"name":"referee-comment-6205","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/wellcomeopenres.27370.r136773, Stephanie Ameis, University of Toronto Department of Psychiatry, Toronto, Ontario, 20 Nov 2025, version 2, indexed","URL":"https:\/\/wellcomeopenresearch.org\/articles\/9-510\/v2#referee-response-136773","order":2,"name":"referee-response-136773","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/wellcomeopenres.27370.r136770, Unaiza Iqbal, HELP University, Kuala Lumpur, 22 Nov 2025, version 2, indexed","URL":"https:\/\/wellcomeopenresearch.org\/articles\/9-510\/v2#referee-response-136770","order":3,"name":"referee-response-136770","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"This work was supported by Wellcome [204403]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":4,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}