Predictors of Probable Depression Onset and Remission in Hong Kong Adolescents: A Population-Based Longitudinal Study of Shared and Unique Modifiable Factors

Background: The onset and remission of probable depression may be influenced by shared modifiable factors; however, direct comparisons of their predictors within the same cohort are lacking. Methods: A one-year, two-wave longitudinal survey was conducted among 9222 Hong Kong secondary school students (grades 1– 4) at baseline, with 7106 followed up. Data were collected using paper questionnaires in classrooms. Generalized linear mixed models, adjusted for age, gender, and school-level clustering, examined associations between baseline predictors at individual, interpersonal, and environmental levels and incidence/remission of probable depression. False discovery rate adjustments were applied. Subgroup analyses by age and gender were conducted for significant interactions. Sensitivity analyses using multiple imputation and inverse probability weighting were performed. Results: Most predictors across three levels (eg, negative life events, interpersonal conflict, academic stress) showed opposing effects on incidence and remission (all p < 0.01). Interpersonal conflict and academic stress were key risk factors for incidence (AOR = 1.397) and barriers to remission (AOR = 0.742), respectively. School satisfaction and social capital were unique protective factors for incidence (AOR = 0.796 and 0.872). Negative life events and academic expectation stress had stronger adverse effects among older adolescents (≥ 15 years). Findings were robust in sensitivity analyses. Conclusion: Incidence and remission of adolescent probable depression shared several common predictors with opposing effects. The unique protective effect of school satisfaction and social capital on incidence suggests their value in prevention. Age-specific interventions, such as enhancing coping skills and stress management, may promote depression remission among older adolescents. Keywords: depression, incidence, remission, adolescents