From Single-Point Assessment to Process Management: Cumulative Effects of Family and School Dual Environments on Adolescent Depressive Symptoms.

PURPOSE: This study aimed to examine how dynamic changes in family conflict and school satisfaction relate to the onset of depressive symptoms in adolescents, elucidating the temporal and cumulative mechanisms of dual microsystem influences on depressive symptoms risk.

METHODS

Using 4 waves of data from the China Family Panel Studies from 2016-2022, we constructed 2 longitudinal submodels using generalized linear mixed-effects models and a survival submodel using a Cox proportional hazards model. We further developed Bayesian multivariate joint models for 3 types of association structures: current value, slope, and cumulative effects (area under the curve).

RESULTS

A total of 377 adolescents aged 10-15 years were included, of whom 111 (29.44%) developed significant depressive symptoms during follow-up. The joint model with area parameterization demonstrated the best fit. The area under the curve of family conflict was associated with an elevated risk of incident depressive symptoms (HR = 1.55, 95% CI: 1.18-2.23, p = .002). The area under the curve of school satisfaction was associated with a reduced risk of incident depressive symptoms (HR = 0.58, 95% CI: 0.31-0.95, p = .031).

DISCUSSION: Adolescent depressive symptoms are linked to the cumulative effects of family conflict and school satisfaction. Mental health efforts for adolescents should shift from focusing on single-point assessments to managing long-term processes, including continuous monitoring, process-oriented support, and coordinated governance across family and school systems.