Age-Stratified Analysis of Social Environmental Drivers of Depression Among Chinese Young People Aged 10-24 Years

This study aimed to evaluate the effect of key social environmental determinants on trends in depression burden amongst Chinese adolescents aged 10-24 years and to examine the age- and gender-specific variations and lagged effects of these factors.

Nationwide data spanning 2003-2021 were collected from the Global Burden of Disease database for depression burden indicators, World Bank socioeconomic datasets and the Chinese General Social Survey for education and social metrics. The primary variables analysed were gross domestic product (GDP) per capita, higher education enrolment rate (HEER), per capita current health expenditure and urban population percentage. Descriptive statistics and Pearson correlations were used to explore variable distributions and associations. Mixed-effects regression models quantified relationships between social factors and depression burden, and autoregressive distributed lag models assessed short-term lagged effects across age groups(10-14, 15-19 and 20-24 years). Interaction terms (HEER × total public expenditure on education (TPEE); unemployment × dependency ratio) were included on the basis of theoretical and empirical support from prior studies.

Between 2003 and 2021, the overall burden of depression amongst young Chinese people decreased, but the 10- to 14-year age group showed a notable upward trend in disability‑adjusted life‑years since 2017. High GDP per capita, urbanisation and per capita health expenditure were significantly associated with reduced depression burden (p < 0.05). Conversely, increasing HEER- indicative of rising educational competition-was associated with a high disease burden, particularly amongst females aged 15-19 and 20-24 years. Short-term lagged effects revealed that the psychological burden of education competition manifested within 1 year, particularly amongst younger adolescents. Economic improvements and health investments exerted protective lagged effects. Age-stratified analyses underscored distinct vulnerability patterns: 10- to 19-year-olds were highly sensitive to family and educational support, and 20- to 24-year-olds were greatly affected by social structural pressures. Pearson correlation analysis identified significant negative associations between several social factors and depression burden. The mechanisms were explained by China-specific social contexts and data characteristics.

This nationwide longitudinal study reveals that multidimensional social determinants exert age- and gender-specific influences on depression burden amongst young Chinese people aged 10-24 years. The findings emphasise the urgent need for stratified policies, including enhancing family and educational support for individuals under 20 years old and reducing structural social pressures on young adults. Public mental health interventions should target these modifiable social determinants to reduce the depression burden and improve well-being.