Factors that affect the resilience of young adults to depression: a systematic review.

Depression among young people (aged 18-29 years) transitioning to adulthood is becoming more widespread. Knowing which factors in which systems co-enable resilience to depression is crucial, but there is no comprehensive synthesis of the physiological, psychological, social, economic, institutional, cultural, and environmental system factors associated with no or minimal emerging adult depression, or combinations of these factors. We have therefore conducted a preregistered systematic review (Prospero, CRD42023440153). We searched eight databases for observational studies reporting factors associated with depression symptomology that is mild, minimal, or absent among emerging adults with exposure to risk factors for depression; independently screened titles, abstracts, and full texts; extracted data; and assessed study quality. From 1824 unique citations, we included 139 papers (N=17721; in study populations that are majority female, cisgender, and in North America) and conducted a multisystemic resilience-informed narrative synthesis and quantitative summary. Personal (eg, psychological resilience and positive cognition) or social factors (eg, social support and family support) were frequently linked to reduced depression symptomology, followed by combinations of these. Economic, institutional, cultural, and environmental factors, or combinations of factors from three or more systems, were rarely reported. Low-income and middle-income countries, in which most young people live, were under-represented, which suggests inadequate understanding of emerging adult resilience to depression. Future studies should include more diverse populations and redress the tendency to reduce resilience to depression to a psychological or limited social phenomenon.