Prevalence of comorbidity symptoms of anxiety and depression and importance of influencing factors among adolescents in Shaanxi Province: a large-scale school-based survey

Comorbidity symptoms of anxiety and depression disorders (CAD) is common among adolescents and threaten the health and safety of adolescents. This study estimated the prevalence of CAD and examined its relative important influencing factors for formulating targeted intervention programs. Data were from the National Student Common Disease and Risk Factors Surveillance program in Shaanxi province, Northwestern China in 2023.

Anxiety and depressive symptoms were assessed using the Generalized Anxiety Disorder-7 (GAD-7) and the Center for Epidemiologic Studies Depression Scale (CES-D) respectively. An Extreme Gradient Boosting algorithm (XGBoost) model combined with Shapley additive explanations (SHAP) was applied to explore the relative predictive contribution of behavioral factors by school grade. A total of 94 472 students were included, in whom 15 113 (16.00%) had CAD, and the prevalence of CAD in senior high school students (22.08%) was higher than junior high students (12.01%).

There was a gender specific difference in the prevalence of CAD, the proportion of CAD in boys was lower than in girl in junior high school (10.22% vs. 13.87%) and senior high school (20.45% vs. 23.64%). The all health-risk behaviors included in this study can influence the CAD among students, but there importance varied with gender and academic stage. The top three contributing factors were unhealthy diet, internet addiction and bully in junior high school boys.

The top three contributing factors were sleep deprivation, internet addiction and unhealthy diet in both senior high school boys and girls. CAD is common among adolescents in Shaanxi Province, the prevalence of CAD increased with academic stage, while the junior high school students also screen-positive for CAD risk. The prevalence of CAD both in junior high school and senior high school students was mainly related to unhealthy life behaviors, such as unhealthy diet, internet addiction and sleep deprivation, and bully.

Integrating behavioral risk surveillance with adolescent mental health services may help improve early identification and targeted intervention. We sincerely thank all the volunteers for their support and contributions to this research. This work was supported by National Natural Science Foundation of China (Grant Number: 81230016) and Scientific Research Fund Project of the Shaanxi Provincial Health Commission (Grant Number: 2022E014).

The funders had no involvement in or influence on this study. Shaanxi Provincial Center for Disease Control and Prevention, Xi’an, 710054, China Minmin Li, Yongbing Cheng, Jingjun Zhao, Yanxin Wang & Wei Shi Experimental Teaching Center, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, 710061, China Department of Clinical medical Research Center, Children’s Hospital of Nanjing Medical University, Nanjing, China The authors declare no competing interests. This study has been approved by the ethics committee of Shaanxi Provincial Center for Disease Control and Prevention (2025-002-01).