Temporal trends of disease burden of depressive disorders and depressive levels among adolescents in China, and influencing factors for depressive levels

<bold>Objective</bold>To analyze the distribution characteristics of disability-adjusted life years (DALYs) for depressive disorders among adolescents globally and in China, and to explore the dynamic evolution trajectory of depressive levels among Chinese adolescents and their associated influencing factors.<bold>Methods</bold>Based on data from the Global Burden of Disease Study (GBD) 2000–2021, Joinpoint regression models were used to analyze temporal trends in the disease burden of adolescent depressive disorders. Based on data from the China Family Panel Studies (CFPS) 2012–2022, the dynamic evolution of depressive levels among Chinese adolescents was examined. Using CFPS 2022 cross-sectional data (n=3,259), a multivariate hierarchical regression analysis was conducted to identify influencing factors across four dimensions: individual, family, school, and societal, with heterogeneity tests further stratified by gender and age group.<bold>Results</bold>GBD data showed that the DALY rates for depressive disorders among Chinese adolescents aged 10–&lt;15 and 15–19 years remained consistently below the global average throughout the study period, yet both exhibited a continuous upward trend, with average annual percentage changes (AAPC) of 1.85% and 1.99%, respectively (both <italic>P</italic>&lt;0.01), and females showing a faster increase than males. The corresponding global AAPCs for the same age groups were 2.30% and 1.89%, respectively (both <italic>P</italic>&lt;0.01). CFPS data analysis revealed that depressive levels among Chinese adolescents exhibited a fluctuating trajectory, with an initial decline followed by a subsequent increase during the observation period. The 15–19 age group consistently had higher depressive symptom scores than the 10–&lt;15 age group; females scored higher than males; rural residents scored higher than urban residents; and residents in the western region scored higher than those in the central and eastern regions. Hierarchical regression analysis showed that self-rated health, happiness, interpersonal relationships, school satisfaction, academic performance, and urban residence were protective factors (β=-0.144 to -1.104, all <italic>P</italic>&lt;0.05), while academic pressure, frequency of quarrels with parents, participation in tutoring classes, and western residence were risk factors (β=0.236 to 1.101, all <italic>P</italic>&lt;0.05). Heterogeneity analysis indicated that self-rated health, frequency of quarrels with parents, happiness, school satisfaction, and academic pressure had significant effects on both genders (all <italic>P</italic>&lt;0.01), with larger effect sizes for females; interpersonal relationships, participation in tutoring classes, and academic performance were significantly associated with depressive levels only in females (all <italic>P</italic>&lt;0.05), while urban-rural status was significantly associated with depressive levels only in males (P&lt;0.05). Happiness (β=-0.502 vs. -0.946) and academic pressure (β=0.951 vs. 1.309) had larger effect sizes for adolescents aged 15–19 years, while school satisfaction (β=-0.732 vs. -0.414) had a larger effect size for those aged 10–&lt;15 years. Interpersonal relationships were significantly negatively associated with depressive levels only in the 15–19 age group (β=-0.252, <italic>P</italic>&lt;0.05), while participation in tutoring classes (β=1.048, <italic>P</italic>&lt;0.01) and parental marital status (β=-4.153, <italic>P</italic>&lt;0.01) were significantly associated with depressive symptoms only in the 10–&lt;15 age group.<bold>Conclusion</bold>Although the overall disease burden of depressive disorders among Chinese adolescents remained below the global average, it showed a sustained upward trend during 2000–2021. Depressive symptoms demonstrated significant heterogeneity across age, gender, urban-rural residence, and geographic region, with influencing factors encompassing multiple dimensions including individual, family, school, and societal levels.