{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T18:28:03Z","timestamp":1790015283026,"version":"4.0.1"},"reference-count":63,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T00:00:00Z","timestamp":1760572800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Adolescent depression has emerged as a significant public health concern globally, including in China, and grasping a better understanding of adolescents\u2019 views on depression could help design more adapted policies. This study aims to assess the prevalence of depressive symptoms among adolescents and examine their knowledge, attitudes, and practices (KAP) related to depression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A cross-sectional survey was conducted between September 23, 2024, and December 3, 2024, in primary and middle schools in Shuangliu District, Chengdu. Data were collected through self-administered questionnaires, which included demographic information, assessments of KAP regarding depression, and the Self-Rating Depression Scale (SDS). The possible attitude and practice scores ranged from 9 to 45, interpreted as negative (9-22), moderate (23-31), and positive (32-45).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 541 valid questionnaires were analyzed. Of the respondents, 308 (56.93%) were female, and 109 (20.15%) were from single-parent households. SDS scores indicated that 18 participants (3.33%) exhibited depressive symptoms. The mean knowledge, attitude, practice, and SDS scores were 9.07\u00b15.08 (possible range: 0-18), 33.37\u00b14.28 (possible range: 9-45), 35.77\u00b16.84 (possible range: 9-45), and 37.35\u00b19.07, respectively. Mediation analysis showed that knowledge directly affected attitude (\u03b2 = 0.128, P=0.019), attitude directly affected practice (\u03b2 = 0.250, P=0.011), while SDS directly affected both attitude (\u03b2 = -0.366, P=0.007) and practice (\u03b2 = -0.637, P=0.008). Meanwhile, SDS has an indirect negative effect on practice (\u03b2 = -0.090, P=0.005), and knowledge has an indirect positive effect on practice (\u03b2 = 0.032, P=0.012).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Adolescents in Chengdu had insufficient knowledge about depression while exhibiting positive attitudes and proactive practices, and most of them were without depressive symptoms. The study identified knowledge items that should be reinforced through educational interventions on adolescent depression. These findings emphasize the need for enhanced mental health education to improve adolescents\u2019 understanding of depression, reinforce positive attitudes, and support proactive mental health practices.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpsyt.2025.1607695","type":"journal-article","created":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T07:00:36Z","timestamp":1760684436000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Prevalence of depressive symptoms and knowledge, attitude, and practice among adolescents in Chengdu, China: a cross-sectional study"],"prefix":"10.3389","volume":"16","author":[{"given":"Xinze","family":"Jiang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qinqin","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruiying","family":"Zeng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nisha","family":"Lei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liping","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,16]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1111\/bjc.12333","article-title":"Global prevalence of depression and elevated depressive symptoms among adolescents: A systematic review and meta-analysis","volume":"61","author":"Shorey","year":"2022","journal-title":"Br J Clin Psychol"},{"key":"B2","article-title":"Adolescent mental health in the twenty-first century adolescent mental health in the twenty-first centur","volume-title":"Center for brain, biology, and behavior: faculty and staff publications","author":"Maerlander","year":"2025"},{"key":"B3","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1111\/jcpp.13445","article-title":"Prevalence of mental disorders in school children and adolescents in China: diagnostic data from detailed clinical assessments of 17,524 individuals","volume":"63","author":"Li","year":"2022","journal-title":"J Child Psychol Psychiatry"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.9740\/mhc.2018.11.275","article-title":"Major depressive disorder in children and adolescents","volume":"8","author":"Mullen","year":"2018","journal-title":"Ment Health Clin"},{"key":"B5","doi-asserted-by":"publisher","first-page":"E739","DOI":"10.1503\/cmaj.220966","article-title":"Diagnosis and management of depression in adolescents","volume":"195","author":"Korczak","year":"2023","journal-title":"Can Med Assoc J"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2023.1182024","article-title":"Prevalence of depression in junior and senior adolescents","volume":"14","author":"Zhang","year":"2023","journal-title":"Front Psychiatry"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2019.00543","article-title":"Child and adolescent depression: A review of theories, evaluation instruments, prevention programs, and treatments","volume":"10","author":"Bernaras","year":"2019","journal-title":"Front Psychol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/s1054-139x(02)00385-3","article-title":"Association of adolescent risk behaviors with mental health symptoms in high school students","volume":"31","author":"Brooks","year":"2002","journal-title":"J Adolesc Health"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.2147\/ppa.S207693","article-title":"A Chinese and Western medication adherence scale in patients with Chronic Kidney Disease","volume":"13","author":"Tan","year":"2019","journal-title":"Patient Prefer Adherence"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1155\/2020\/8527320","article-title":"Development, reliability, and validity of the\u201dKnowledge-attitude-practice\u201d Questionnaire of foreigners on traditional chinese medicine treatment","volume":"2020","author":"Li","year":"2020","journal-title":"Evid Based Complement Alternat Med"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1177\/21501319211063051","article-title":"Promoting health literacy about cancer screening among muslim immigrants in Canada: perspectives of imams on the role they can play in community","volume":"13","author":"Khalid","year":"2022","journal-title":"J Prim Care Community Health"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1111\/bjc.12339","article-title":"\u2018Faking it\u2019: Exploring adolescent perceptions of depression (in)authenticity and \u2018attention seeking\u2019","volume":"61","author":"Dixon-Ward","year":"2022","journal-title":"Br J Clin Psychol"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1177\/00207640211006155","article-title":"Mental health literacy among adolescents: Evidence from a community-based study in Delhi","volume":"68","author":"Ahmad","year":"2022","journal-title":"Int J Soc Psychiatry"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1002\/mhs2.70007","article-title":"Culturally adapting a mental health literacy intervention with youth (Stakeholders) for implementation in Malawi universities","volume":"3","author":"Nyali","year":"2025","journal-title":"Ment Health Sci"},{"key":"B15","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1007\/s00787-019-01469-4","article-title":"Why do children and adolescents (not) seek and access professional help for their mental health problems? A systematic review of quantitative and qualitative studies","volume":"30","author":"Radez","year":"2021","journal-title":"Eur Child Adolesc Psychiatry"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1016\/j.comppsych.2019.152152","article-title":"Stigma towards depression in a community-based sample in China","volume":"97","author":"Yang","year":"2020","journal-title":"Compr Psychiatry"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2024.1404819","article-title":"Knowledge, attitudes, and practices of adolescent depression among parents of children diagnosed with depression in Ningbo City, eastern China","volume":"12","author":"Gao","year":"2024","journal-title":"Front Public Health"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1002\/brb3.70030","article-title":"Knowledge, attitude, and practice of depression among university students","volume":"14","author":"Wang","year":"2024","journal-title":"Brain Behav"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.4103\/0301-4738.71692","article-title":"Principles of sample size calculation","volume":"58","author":"Gogtay","year":"2010","journal-title":"Indian J Ophthalmol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1016\/j.rcl.2021.05.013","article-title":"Clinical applications of PET\/MR imaging","volume":"59","author":"Moradi","year":"2021","journal-title":"Radiol Clin North Am"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2021.621389","article-title":"Diagnostic performance of CMR, SPECT, and PET imaging for the identification of coronary artery disease: A meta-analysis","volume":"8","author":"Xu","year":"2021","journal-title":"Front Cardiovasc Med"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1037\/amp0000904","article-title":"Summary of the clinical practice guideline for the treatment of depression across three age cohorts","volume":"77","year":"2022","journal-title":"Am Psychol"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1177\/089198879400700404","article-title":"The Zung Self-rating Depression Scale: screening for depression among the Hong Kong Chinese elderly","volume":"7","author":"Lee","year":"1994","journal-title":"J Geriatr Psychiatry Neurol"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.12659\/msm.916774","article-title":"Depressive symptoms among children and adolescents in China: A systematic review and meta-analysis","volume":"25","author":"Li","year":"2019","journal-title":"Med Sci Monit"},{"key":"B25","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1186\/s13034-024-00841-w","article-title":"Prevalence of depressive symptoms among children and adolescents in China: a systematic review and meta-analysis","volume":"18","author":"Zhou","year":"2024","journal-title":"Child Adolesc Psychiatry Ment Health"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2024.1436413","article-title":"Gender differences in the prevalence, correlated factors and comorbidity of depression in adolescents: a cross-sectional study in Shanghai, China","volume":"12","author":"Wang","year":"2024","journal-title":"Front Public Health"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2019.01344","article-title":"Positive education interventions prevent depression in chinese adolescents","volume":"10","author":"Zhao","year":"2019","journal-title":"Front Psychol"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1111\/fare.12761","article-title":"Chinese adolescents\u2019 depression, anxiety, and family mutuality before and after COVID-19 lockdowns: Longitudinal cross-lagged relations","volume":"72","author":"Shi","year":"2022","journal-title":"Fam Relat"},{"key":"B29","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1016\/s2215-0366(20)30518-6","article-title":"Treatment of depression in children and adolescents","volume":"8","author":"Diener","year":"2021","journal-title":"Lancet Psychiatry"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1097\/yco.0000000000000749","article-title":"Updates in treatment of depression in children and adolescents","volume":"34","author":"Hazell","year":"2021","journal-title":"Curr Opin Psychiatry"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2023-083374","article-title":"Knowledge of and attitude towards depression among urban and rural residents in Beijing: a cross-sectional study","volume":"14","author":"Cong","year":"2024","journal-title":"BMJ Open"},{"key":"B32","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1186\/s12888-023-04706-y","article-title":"Knowledge and attitudes on medication adherence and residual symptoms in individuals with depression: a survey at a University Hospital","volume":"23","author":"Pitanupong","year":"2023","journal-title":"BMC Psychiatry"},{"key":"B33","doi-asserted-by":"publisher","first-page":"3432","DOI":"10.3390\/ijerph18073432","article-title":"Mental health of children and adolescents amidst COVID-19 and past pandemics: A rapid systematic review","volume":"18","author":"Meherali","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1097\/yco.0000000000000741","article-title":"Resilience and mental health in children and adolescents: an update of the recent literature and future directions","volume":"34","author":"Mesman","year":"2021","journal-title":"Curr Opin Psychiatry"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsmc.2023.01.006","article-title":"Sleep and mental health problems in children and adolescents","volume":"18","author":"Morales-Mu\u00f1oz","year":"2023","journal-title":"Sleep Med Clin"},{"key":"B36","doi-asserted-by":"publisher","first-page":"9500","DOI":"10.3390\/ijerph18189500","article-title":"Promotion of mental health literacy in adolescents: A scoping review","volume":"18","author":"Nobre","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"B37","article-title":"Understanding and dealing with mental health problems of migrant children","volume":"72","author":"Minassian","year":"2022","journal-title":"Rev Prat"},{"key":"B38","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1186\/s41043-021-00279-2","article-title":"Perceived stress, eating behavior, and overweight and obesity among urban adolescents","volume":"40","author":"Roy","year":"2021","journal-title":"J Health Popul Nutr"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2021.106612","article-title":"The positive influence of sense of control on physical, behavioral, and psychosocial health in older adults: An outcome-wide approach","volume":"149","author":"Hong","year":"2021","journal-title":"Prev Med"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-021-12414-z","article-title":"Parental perceptions of the food environment and their influence on food decisions among low-income families: a rapid review of qualitative evidence","volume":"22","author":"Ravikumar","year":"2022","journal-title":"BMC Public Health"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1007\/s10802-024-01195-9","article-title":"Developmental trajectories of mental health in chinese early adolescents: school climate and future orientation as predictors","volume":"52","author":"Gao","year":"2024","journal-title":"Res Child Adolesc Psychopathol"},{"key":"B42","doi-asserted-by":"publisher","first-page":"1695","DOI":"10.1186\/s12889-019-8018-0","article-title":"School climate and mental health among Swedish adolescents: a multilevel longitudinal study","volume":"19","author":"L\u00e1szl\u00f3","year":"2019","journal-title":"BMC Public Health"},{"key":"B43","doi-asserted-by":"publisher","first-page":"782","DOI":"10.1111\/bjop.12426","article-title":"Evaluating the interplay between subclinical levels of mental health symptoms and coordination dynamics","volume":"111","author":"Macpherson","year":"2020","journal-title":"Br J Psychol"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1111\/eip.12974","article-title":"Cognitive behavioural therapy for help-seeking adolescents and young adults with at-risk-mental state: Effects on subclinical positive symptoms","volume":"15","author":"Pozza","year":"2021","journal-title":"Early Interv Psychiatry"},{"key":"B45","doi-asserted-by":"publisher","first-page":"13190","DOI":"10.3390\/ijerph192013190","article-title":"Physical activity and body image perception in adolescents: A systematic review","volume":"19","author":"Gualdi-Russo","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.18043\/ncm.81.2.116","article-title":"The impact of social media on youth mental health: challenges and opportunities","volume":"81","author":"Nesi","year":"2020","journal-title":"N C Med J"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2022.0609","article-title":"Association\u00a0between physical activity and risk of depression: A systematic review and meta-analysis","volume":"79","author":"Pearce","year":"2022","journal-title":"JAMA Psychiatry"},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2023.11.081","article-title":"Parental education level and adolescent depression: A multi-country meta-analysis","volume":"347","author":"Xiang","year":"2024","journal-title":"J Affect Disord"},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2024.03.074","article-title":"Global burden of depression or depressive symptoms in children and adolescents: A systematic review and meta-analysis","volume":"354","author":"Lu","year":"2024","journal-title":"J Affect Disord"},{"key":"B50","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(22)02080-3","article-title":"Novel and emerging treatments for major depression","volume":"401","author":"Marwaha","year":"2023","journal-title":"Lancet"},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.46234\/ccdcw2024.162","article-title":"Comprehensively strengthen and improve students\u2019 Mental health system in the new era","volume":"6","author":"Yuan","year":"2024","journal-title":"China CDC Wkly"},{"key":"B52","doi-asserted-by":"publisher","first-page":"e637","DOI":"10.1016\/S2468-2667(20)30094-3","article-title":"Adolescent mental health in China requires more attention","volume":"5","author":"Wang","year":"2020","journal-title":"Lancet Public Health"},{"key":"B53","doi-asserted-by":"publisher","DOI":"10.46234\/ccdcw2024.163","article-title":"The role of peer support in promoting mental health of chinese adolescents","volume":"6","author":"Jiang","year":"2024","journal-title":"China CDC Wkly"},{"key":"B54","doi-asserted-by":"publisher","DOI":"10.1136\/bmjment-2023-300861","article-title":"School-based Evaluation Advancing Response for Child Health (SEARCH): a mixed longitudinal cohort study from multifaceted perspectives in Jiangsu, China","volume":"26","author":"Zhang","year":"2023","journal-title":"BMJ Ment Health"},{"key":"B55","doi-asserted-by":"publisher","first-page":"778","DOI":"10.1037\/0033-2909.132.5.778","article-title":"Forming attitudes that predict future behavior: a meta-analysis of the attitude-behavior relation","volume":"132","author":"Glasman","year":"2006","journal-title":"Psychol Bull"},{"key":"B56","article-title":"The health belief model of behavior change","volume-title":"StatPearls","author":"Alyafei","year":"2025"},{"key":"B57","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-psych-020821-011744","article-title":"Attitudes, habits, and behavior change","volume":"73","author":"Verplanken","year":"2022","journal-title":"Annu Rev Psychol"},{"key":"B58","doi-asserted-by":"publisher","DOI":"10.1016\/j.ssmph.2024.101627","article-title":"Family socioeconomic status and adolescent depression in urban and rural China: A trajectory analysis","volume":"25","author":"Zeng","year":"2024","journal-title":"SSM Popul Health"},{"key":"B59","doi-asserted-by":"publisher","DOI":"10.7717\/peerj.16888","article-title":"The association between urbanization and adolescent depression in China","volume":"12","author":"Pan","year":"2024","journal-title":"PeerJ"},{"key":"B60","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2024.1370601","article-title":"An analysis of risk factors and current\u00a0status of depressive mood in mid-to-late adolescence and early adulthood in\u00a0northern China","volume":"15","author":"Yang","year":"2024","journal-title":"Front Psychiatry"},{"key":"B61","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(11)60871-4","article-title":"Depression in adolescence","volume":"379","author":"Thapar","year":"2012","journal-title":"Lancet"},{"key":"B62","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1016\/j.jad.2020.09.098","article-title":"Identifying risk factors and detection strategies for adolescent depression in diverse global settings: A Delphi consensus study","volume":"279","author":"Wahid","year":"2021","journal-title":"J Affect Disord"},{"key":"B63","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2024.1252964","article-title":"Effect of elevated depressive symptoms during adolescence on health-related quality of life in young adulthood-a six-year cohort study with repeated exposure measurements","volume":"12","author":"Wiehn","year":"2024","journal-title":"Front Pediatr"}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2025.1607695\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T07:00:38Z","timestamp":1760684438000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2025.1607695\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,16]]},"references-count":63,"alternative-id":["10.3389\/fpsyt.2025.1607695"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2025.1607695","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,16]]},"article-number":"1607695"}}