Extreme heat exposure and depressive symptoms among adolescents: evidence from China

Frequent extreme heat events have become a prominent feature of climate change. However, their potential impact on adolescent mental health and the underlying pathways remain unclear. This study aimed to examine the association between extreme heat exposure and depressive symptoms among Chinese adolescents, and to explore whether sleep duration, physical exercise, and self-rated health may represent potential behavioral and health-related pathways underlying this association.

This study used adolescent samples from four waves of the China Family Panel Studies (CFPS) conducted between 2016 and 2022. Individual-level CFPS data were matched with the standardized extreme heat exposure index, namely extreme hot days (HTD), from the Chinese Climate Physical Risk Index (CCPRI). Regression models were used to examine the association between HTD and depressive symptoms among adolescents.

Baseline regression results showed that HTD was significantly and positively associated with higher levels of depressive symptoms among adolescents. This association remained robust across a series of sensitivity analyses. Exploratory pathway analyses suggested that HTD was associated with shorter sleep duration, reduced participation in physical exercise, and lower levels of self-rated health, all of which were in turn associated with higher depressive symptom scores. Heterogeneity analyses showed that the association was more pronounced among rural adolescents and male adolescents.

Extreme heat exposure was significantly associated with increased depressive symptoms among Chinese adolescents. Sleep duration, physical exercise, and self-rated health may represent important behavioral and health-related pathways linking extreme heat exposure to adolescent depressive symptoms. These findings suggest that schools, families, and public health agencies should incorporate extreme heat into adolescent mental health risk management and provide targeted support for vulnerable groups, particularly rural and male adolescents.