Understanding and Addressing Youth Depression: Risk Factors, Resources, and Promoting Mental Health and Well-Being ()
1. Introduction
Depression and anxiety are highly prevalent mental health disorders that impact a significant number of individuals worldwide. Depression, characterized by persistent feelings of sadness, can manifest with varying symptoms and severity among individuals. Common symptoms include hopelessness, low energy, and diminished interest in once enjoyable activities. The World Health Organization (WHO) recognizes depression as a leading cause of disability, affecting millions globally. In teenagers, depression is particularly widespread, with conservative estimates suggesting that approximately 12.5% of 12 to 17-year-old experience symptoms of a major depressive episode within a year, as reported by the National Institute of Mental Health (NIMH).
Research conducted by Taliaferro & Muehlenkamp (2013) and Barker et al. (2019) has provided evidence for the association between adolescent depression and an increased risk of developing other mental health disorders, as well as experiencing suicidal ideation and attempts, which tend to worsen over time. The impact of depression on young individuals extends beyond their mental well-being and has significant repercussions on their social, academic, and personal development (Taliaferro & Muehlenkamp, 2013) . Moreover, Clayborne et al. (2019) have emphasized the negative psychosocial outcomes associated with adolescent depression, such as lower educational attainment, impaired social functioning, increased substance uses and abuse, and an elevated likelihood of depression and anxiety in adulthood. Therefore, it is crucial to address the mental health needs of young individuals, particularly during childhood and adolescence, through early interventions to prevent or alleviate anxiety and depression symptoms. Drawing upon the insights gleaned from previous studies, the objective of this review is to make significant contributions to the field by exploring various potential risk factors that influence adolescent depression, examining the current resources and support systems available for youth depression in both China and the United States, and providing valuable insights into strategies for promoting and addressing youth depression. By delving into these multifaceted connections, we aim to enhance our understanding of the intricate interplay between adolescent depression, its consequences, and the factors that shape its trajectory. This knowledge is of utmost importance for effectively addressing the mental health needs of young individuals, particularly during adolescence, and implementing timely interventions to prevent or alleviate symptoms of depression. Furthermore, it underscores the critical role of education in equipping young people, parents, and caregivers with a comprehensive understanding of the signs, symptoms, and significance of seeking help for depression.
2. Risk Factors for Youth Depression
The issue of depression among young people is multifaceted, with various factors influencing its development. One significant risk factor is having a family history of depression or other mental health conditions, as genetics play a role in increasing an individual’s susceptibility to this condition. Family history is recognized as one of the most reliable indicators of future mental illness (Rasic et al., 2013) . Research by van Dijk et al. (2021) supports the notion that young people with a family history of depression tend to experience more severe symptoms and have longer durations of depression compared to those without such a history. The study also revealed that offspring of depressed parents face a significantly higher risk of developing major depression compared to those without a parental history of depression. The period of highest risk for the initial onset of depression was observed between the ages of 15 and 25 in both groups. Importantly, the high-risk offspring exhibited over a 10-fold increased risk of experiencing major depression before reaching puberty.
In addition to the genetic aspect, the research demonstrated that the offspring of depressed parents experienced more recurrent episodes of depression over time (Weissman et al., 2016) . While both groups are at risk of experiencing major depression during adolescence, offspring with a family history are more prone to recurring episodes of depression and encountering negative outcomes as they progress into adulthood (Weissman et al., 2016) . These individuals were more likely to encounter multiple bouts of depression throughout their lives, indicating a chronic and recurring nature of the disorder. Depression often emerges in childhood or adolescence and persists across the lifespan, featuring recurrences, remission periods, and impaired social functioning (Weissman et al., 2016) . The early onset of major depression in the offspring of depressed parents persisted into adulthood and was not offset by later first onsets observed in the low-risk group. The high-risk group exhibited higher rates of major depression, primarily attributable to early onsets, but also experienced significantly increased rates of later recurrences. Therefore, the presence of a family history of depression raises concerns, as it can significantly impact the social, academic, and personal functioning of young individuals, potentially leading to long-term consequences. Importantly, offspring of depressed parents continue to be highly vulnerable to depression, illness, and premature mortality well into middle age.
In addition to family history, traumatic life experiences, such as abuse, neglect, or loss, have been identified as potential risk factors for depression (Li et al., 2007) . Chronic stress, difficult life circumstances, physical illness or chronic pain, substance abuse or addiction, lack of social support, and academic or interpersonal difficulties are also common risk factors (Li et al., 2007) . Individuals who have experienced abuse may develop negative beliefs about themselves, others, and the world, while those who have faced neglect may struggle with attachment and emotion regulation. Furthermore, traumatic experiences can lead to the development of Post-Traumatic Stress Disorder (PTSD), characterized by symptoms like re-experiencing the traumatic event, avoidance behaviors, and hyperarousal (Li et al., 2007) . Kuo et al. (2005) conducted a study focusing on detained adolescents and their use of the Short Mood and Feelings Questionnaire to detect depression. They argue that symptoms of PTSD, such as hypervigilance, avoidance, and re-experiencing traumatic events, can hinder a young person’s ability to form and maintain positive relationships, cope with stress, and engage in positive activities. These difficulties can ultimately lead to feelings of hopelessness and despair, which are core symptoms of depression. The authors also note that youth who have experienced traumatic life events may be more likely to be detained or incarcerated, further exacerbating their mental health issues (Kuo et al., 2005) . The interaction between trauma, depression, and involvement in the criminal justice system creates a complex and challenging situation for these young individuals.
Chronic stressors, such as poverty and family conflict, also contribute to the risk of depression in young people. Poverty can lead to a lack of resources and opportunities, resulting in social isolation, inadequate nutrition, limited access to healthcare, education, and employment prospects. Family conflict, characterized by arguments, fights, and difficulties in getting along, generates instability and uncertainty, thereby inducing anxiety and stress. These stressors have a profound impact on the mental health of young individuals, fostering feelings of hopelessness, helplessness, and entrapment.
3. Supports and Resources for Addressing Youth Depression in China
In China, a 2013 epidemiological survey in the general population found that the prevalence of depression was 6.8% (Huang et al., 2019) . In order to help the youth depression in China, the National Health Commission of China issued the first action plan for preventing and managing depression on September 11, 2020, entitled “The Action Plan to Develop Specialized Services for the Prevention and Treatment of Depressive Disorders”. This Plan emphasizes six primary national-level aspects: public education on prevention, depression screening and evaluation, early diagnosis and standardized treatment, psychological assistance hotlines, psychological interventions, and vulnerable subpopulations. These initiatives aim to target high-risk individuals and those with pre-existing depression at risk of relapse, ensuring prompt identification and treatment of depression and reducing the treatment gap, progression of the illness, and suicide risk.
However, the Action Plan on depression in China encounters several challenges that need to be addressed. According to Li et al. (2021) , one of the primary challenges is the shortage of mental health experts, particularly in rural areas, which hinders the effective implementation of the plan and restricts access to mental health services for individuals in these regions. Furthermore, additional funding is required to adequately support and provide comprehensive mental health services as outlined in the action plan. Confidentiality and privacy concerns pose another obstacle to the plan’s implementation. Stigmatization and discrimination towards individuals with mental health disorders in Chinese society may deter individuals from seeking help and participating in the screening process, potentially hindering the plan’s effectiveness. The limitations of the screening tool recommended in the action plan also need to be addressed. It is important to consider the diverse needs of different subpopulations and develop specific screening tools that are more accurate and sensitive in detecting depression across various groups. Additionally, there is a lack of guidelines for referral to mental health services based on the severity of the condition, which may lead to confusion and inefficient utilization of resources (Li et al., 2021) .
Notwithstanding these challenges, the Action Plan on depression in China represents a significant stride towards addressing the mental health needs of the population. It has successfully implemented routine depression screening nationwide, allowing for early identification and treatment of depression in youth. Additionally, the Plan has raised public awareness of depression and its impacts on individuals and society, reducing mental illnesses stigma and encouraging more people to seek help (Li et al., 2021) . The Plan’s focus on vulnerable subpopulations, such as those living in poverty or experiencing family conflict, has also helped to address disparities in access to mental health services. By recognizing and actively working to overcome the challenges, the implementation of the plan can lead to improved mental health outcomes and well-being for individuals across the country.
Non-governmental organizations (NGOs) in China play a vital role in providing support and resources for youth experiencing depression. One such organization is the Beijing Suicide Research and Prevention Center (BSRPC), which offers crisis intervention and counseling services to individuals, particularly young people, who are at risk of suicide or struggling with mental health issues (Tong et al., 2023) . The BSRPC operates a 24-hour crisis hotline that provides immediate assistance and directs individuals to appropriate mental health services. This hotline has proven to be a feasible, cost-effective, and efficient measure for suicide prevention (Busby et al., 2020) . Additionally, the BSRPC has developed a comprehensive suicidal risk assessment scale, implemented within the Beijing Psychological Support Hotline, which is the largest suicide prevention hotline in China (Tong et al., 2020) .
In addition to crisis intervention, the BSRPC offers face-to-face counseling and group therapy to individuals and families affected by suicide or mental health concerns. Their approach emphasizes a collaborative and culturally sensitive model that establishes trust and rapport with clients. Through their efforts, the BSRPC has contributed to identifying risk factors for suicide, enhancing understanding of suicide prevention strategies, and developing culturally appropriate interventions for at-risk individuals and communities (Tong et al., 2020) . Furthermore, the BSRPC has played a significant role in raising awareness about mental health and suicide prevention in China, reducing the stigma associated with mental illness, and increasing access to mental health services for those in need.
In China, addressing the mental health needs of young people has become a priority, leading to the emergence of various mental health services and resources provided by universities, hospitals, and online platforms. However, despite these efforts, accessibility to mental health support remains a significant challenge, especially in rural areas. Tan et al. (2021) conducted a study on the accessibility of mental health services in China and found that web-based platforms have the potential to improve access to care for mood disorders, as they offer convenience, privacy, and anonymity, which are particularly appealing to young people. However, the study also recognizes that web-based services may not be suitable for everyone, and in-person services are still necessary for those requiring more intensive treatment. The study emphasizes the importance of increasing awareness and education about mental health issues and promoting help-seeking behaviors among individuals experiencing mood disorders like depression.
By providing mental health resources and services through online platforms, the accessibility of care can be enhanced, especially in rural areas where traditional in-person services may be limited. It is crucial, however, to recognize that a combination of in-person and online mental health services can effectively meet the diverse needs of young people in China. This integrated approach ensures that individuals receive appropriate care based on their specific requirements. The ongoing efforts to address the mental health needs of young people in China represent a positive step forward.
4. Resources for Youth Depression at United Nations in United States
In both China and the United States, there is a recognition of the importance of addressing mental health issues, particularly youth depression, at the global level. The United Nations (UN) has implemented policies, such as the Sustainable Development Goals (SDGs), to promote mental health and well-being worldwide. SDG 3, titled “Ensure healthy lives and promote well-being for all at all ages,” includes a specific target, 3.4, which aims to reduce premature mortality from non-communicable diseases, including mental health conditions, by one-third by 2030 (United Nations, 2023) .
To achieve this target, countries need to focus on improving their healthcare systems and implementing preventive measures. This includes the establishment of early detection and screening programs, promoting healthy lifestyles, ensuring access to affordable and quality healthcare services, and raising awareness about mental health issues. Additionally, addressing the social determinants of mental health, such as poverty, discrimination, and social exclusion, is crucial to create a supportive environment for mental well-being (United Nations, 2023) . By aligning with the SDGs and taking significant steps to improve mental healthcare and preventive measures, policymakers in both China and the United States can contribute to the global efforts of promoting mental health and well-being.
In line with global efforts, the United Nations (UN) emphasizes the integration of mental health services into primary healthcare systems as a means to enhance accessibility, diminish stigma, and facilitate early detection and treatment of mental health concerns (United Nations, 2023) . Moreover, the UN has designated the period from 2021 to 2030 as the Decade of Healthy Ageing, with the goal of promoting well-being and healthy aging for individuals of all age groups, encompassing mental health (Chen et al., 2022) . This initiative recognizes the pivotal role of mental health in overall well-being and endeavors to advance mental health through diverse policies and initiatives, including improved access to mental health services and the promotion of community-based mental health programs.
Economic and Social Council (ECOSOC) at UN for Children and Youth is also an important organization that promotes mental health and well-being among young people. One of the ways that the ECOSOC promotes mental health and well-being among young people is by engaging in policy dialogue with governments and other stakeholders at the national and international levels (United Nations, 2022) . This includes advocating for increased funding for mental health services and promoting policies that support early intervention and prevention of mental health issues among young people. It also works to raise awareness of mental health issues among young people by organizing campaigns, events, and workshops that promote mental health literacy and encourage young people to seek help if they are experiencing mental health issues. The ECOSOC also advocates for including mental health education in school curricula to promote mental health literacy among young people and promotes community-based mental health initiatives by supporting the development of grassroots mental health programs and services accessible to young people in their communities. By supporting the training of community health workers and peer support programs that provide young people with increased access to mental health services, it also can include increasing funding for mental health services, promoting the development of community-based mental health initiatives, supporting the training of mental health professionals, and raising awareness of mental health issues (United Nations, 2022) . Additionally, encouraging early intervention and prevention can include promoting early detection and treatment of mental health issues and promoting initiatives that focus on prevention and early intervention, such as stress reduction programs in schools. This intervention can include promoting mental health literacy through education campaigns and providing information and resources to young people and their families about mental health issues.
5. Promoting and Supporting Youth with Depression
In addition to related organizations and communities, helping adolescents with depression necessitates the collective efforts of individuals from various spheres of influence. Recognizing that the well-being of young individuals is a shared responsibility, we must foster a supportive environment where everyone plays an active role in addressing this pressing issue.
The first thing we could do is to educate people about depression. When we expand the knowledge of depression, we provide them with knowledge and understanding about the pathology. This knowledge can help them identify the symptoms, causes, and risk factors associated with depression, making it easier to recognize when someone they know may be struggling. For example, some common symptoms of depression include persistent sadness or hopelessness, loss of interest in activities, changes in appetite or sleep patterns, fatigue or low energy, and difficulty concentrating. This knowledge can empower individuals to offer appropriate support and guidance to someone who may be struggling with depression. By educating people about these symptoms, they can better recognize when someone they know is exhibiting signs of depression and encourage them to seek professional help.
Secondly, providing people with information about depression through reputable sources like the National Institute of Mental Health (NIMH) and the Clinic can help them learn about evidence-based treatments and support resources available to those struggling with depression. Also, connecting young people struggling with depression with mental health resources can be crucial in getting the help they need. Various types of mental health resources are available, including counseling services in the hospital, school counseling, family counseling, support groups, and crisis hotlines. Licensed mental health professionals, such as psychologists, social workers, or counselors, provide counseling services. It can help young people learn how to manage their symptoms, develop coping skills, and explore the underlying causes of their depression. Support groups are usually led by individuals who have experienced depression or other mental health issues. These groups offer a safe and supportive environment for young people to share their experiences and receive support from others who understand what they are going through. Crisis hotlines provide immediate support and assistance for individuals experiencing a mental health crisis, such as suicidal thoughts or self-harm. Addressing youth depression requires a multi-faceted approach that includes increasing access to mental health services, raising awareness of mental health issues, and encouraging early intervention and prevention.
Promoting mental health and well-being among youth is indeed crucial in preventing depression, and one highly effective approach is to encourage and support healthy lifestyle choices. A holistic approach to mental health includes not only addressing emotional well-being but also attending to physical, social, and cognitive aspects of an individual’s life. By promoting healthy lifestyle choices, we can enhance resilience, foster positive coping strategies, and reduce the risk of developing depression.
Eating a healthy and balanced diet is crucial for maintaining good mental health. Studies have shown a link between what we eat and our mood (Cairns, 2020) . For example, consuming foods high in vitamins and minerals, like fruits and vegetables, can help reduce the risk of depression (Cairns, 2020) . Additionally, consuming omega-3 fatty acids found in fish and other sources have also been linked to a reduced risk of depression (Cairns, 2020) . Besides, getting enough sleep is also crucial for preventing depression. Sleep is essential for maintaining a healthy mood, and studies have shown that people who do not get enough sleep are more likely to experience symptoms of depression (Cairns, 2020) . It is recommended that teenagers get around 8 - 10 hours of sleep each night to maintain good mental health. Moreover, engaging in physical activity and sports is another important aspect of a healthy lifestyle that can help prevent depression. Exercise has been shown to release endorphins, natural mood-boosting chemicals in the brain (Cairns, 2020) .
Another essential aspect of preventing youth depression is encouraging physical activity and sports. According to Singh et al. (2023) , physical activity interventions can effectively prevent depression among youth. Moreover, the study of Singh et al. (2023) found that physical activity interventions tailored to young people’s specific needs and preferences were particularly effective in preventing depression. For example, interventions that incorporated team sports or other group activities may have been more engaging and enjoyable for some youth, which could increase adherence and lead to better mental health outcomes (Singh et al., 2023) .
Moreover, regular exercise has been shown to release endorphins, natural chemicals in the brain that can improve mood and reduce stress and anxiety (Cairns, 2020) . Physical activity can help reduce inflammation and promote the growth of new brain cells, which are both factors associated with better mental health outcomes. Participating in sports or other physical activities can promote achievement, build self-esteem, and foster community and social support (Singh et al., 2023) . Physical activity can also improve overall health, including cardiovascular health, which can help prevent the development of chronic illnesses linked to depression, such as heart disease and diabetes (Cairns, 2020) .
Maintaining open communication with parents and other trusted adults is another effective way to promote mental health and prevent depression. The Centers for Disease Control and Prevention (CDC) recommends ways parents can communicate openly with their teens. Adolescents who feel they can talk to their parents or other trusted adults about their feelings and experiences are more likely to have positive mental health outcomes. Open communication also helps to reduce stigma and promote awareness of mental health issues (CDC, 2021) . By talking openly about mental health and well-being, parents can help break down the barriers that prevent many youths from seeking help when needed. This can include talking about the signs and symptoms of depression and other mental health conditions and discussing the importance of seeking professional help when needed. Parents should make it clear to their teens that they are available to talk at any time, whether through phone calls, text messages, or face-to-face conversations, but they also should listen actively and without judgment when teens do come to them to talk. This means giving them their full attention, acknowledging their feelings, and avoiding dismissive or critical comments. Finally, parents need to normalize struggles and acknowledge that struggling with mental health is a normal part of life and that seeking help is a sign of strength, not weakness. Research shows that having a supportive and understanding adult figure to talk to can help youth process difficult emotions and work through problems healthily (CDC, 2021) . It can also help parents and caregivers identify potential issues early on and seek professional help. Focusing on these factors can help promote mental health and well-being among youth and prevent the onset of depression.
6. Current Limitations and Future Direction
Although research on youth depression has contributed to significant progress in understanding the symptoms and contributing factors, there is still a lack of understanding of the underlying mechanisms that cause depression in young people. Without a comprehensive understanding of the underlying mechanisms, interventions for youth depression are often limited to treating symptoms rather than addressing the condition’s root causes (Remes et al., 2021) . Therefore, there is a pressing need for continued research to deepen our understanding of the mechanisms that trigger youth depression, leading to the development of more effective and targeted interventions.
According to Remes et al. (2021) , biological determinants of depression include genetic predisposition, hormonal imbalances, and brain chemistry imbalances. Research has shown that certain genetic variations may increase the risk of developing depression in young people. Additionally, cognitive distortions, such as negative thinking patterns and self-blame, can contribute to depression (Remes et al., 2021) . Social determinants of depression in youth include social support, family dynamics, and socioeconomic status. Young people who lack social support, have low-income family relationships, or live in poverty may be at higher risk of developing depression (Remes et al., 2021) . There is also a need for further research to determine the relationship between the different factors contributing to depression in young people and how they interact to influence the development and severity of the condition.
Another limitation is that the current research on youth depression has been conducted primarily in Western countries, which include Europe and North America. The study by Gopalkrishnan (2018) found that cultural differences can impact how depression is experienced and treated in youth. This means that the findings of these studies may only apply to some parts of the world due to cultural differences, environmental factors, and varying healthcare systems. For example, the causes and symptoms of depression may differ between Western and Eastern cultures, and interventions that work in one culture may not work in another. The article suggests that healthcare professionals should be aware of these cultural differences and tailor their interventions accordingly to ensure they are effective (Haque et al., 2010) . One way to address these cultural differences is to consider the unique social and environmental factors that may contribute to depression in different cultures (Frank, 2013) . The causes and symptoms of depression may differ between Western and Eastern cultures due to differences in family structures, values, and beliefs. Interventions should be adapted to the cultural context to address the specific needs of each community.
Moreover, the research participants in these studies are often not diverse regarding race, ethnicity, and socioeconomic status (Babacan & Gopalkrishnan, 2007) . This means the findings may not be generalizable to diverse populations who experience depression differently and require tailored interventions. Individuals from minority ethnic groups may experience higher rates of depression due to discrimination, stigma, and social disadvantage. Thus, understanding the unique challenges faced by these communities is essential in developing effective interventions.
Technology is a promising direction for addressing youth depression (Boydell et al., 2014) . With the increasing accessibility of technology, it can be a valuable tool in providing support and monitoring symptoms. For example, online therapy can provide access to mental health services for youth who may not have access to in-person therapy. Mobile applications can provide resources and tools for coping with depression, such as mindfulness exercises and guided meditations. Wearable devices can track physical activity, sleep patterns, and heart rate, providing insights into the physical symptoms of depression. Technology-based interventions have the potential to be cost-effective, convenient, and personalized, allowing youth to access support in a way that fits their lifestyle and preferences. However, it is important to note that technology cannot replace the human connection and support that comes with in-person therapy. Technology-based interventions should be used as a supplement to traditional therapy rather than a replacement. Online therapy, mobile applications, and wearable devices can be cost-effective, convenient, and personalized but should be used with in-person therapy. Integrating technology into treating youth depression can provide a valuable tool for supporting and monitoring symptoms.
Besides, long-term follow-up is crucial in ensuring the effectiveness of interventions for culturally diverse youth with depression (Hill et al., 2015) . Follow-up allows healthcare professionals to monitor the progress of the treatment plan and adjust as necessary to ensure that youth receive ongoing support. This is particularly important for culturally diverse youth who may experience depression differently and require tailored interventions. It helps to identify any relapses or new symptoms and enables healthcare professionals to adjust the treatment plan accordingly (Hill et al., 2015) . Moreover, depression can have long-lasting effects on a person’s life, such as impaired social and occupational functioning and an increased risk of developing other mental health disorders. Therefore, long-term follow-up can help to identify any persistent effects of depression and provide ongoing support to prevent these negative outcomes. Additionally, it helps to identify any relapses or persistent effects of depression and provides opportunities to adjust the treatment plan accordingly.
7. Conclusion
Depression is a prevalent mental health disorder that can significantly impact an individual’s quality of life and daily functioning. One notable resource in this review is the first action plan for the prevention and control of depression in China, which provides a strategic framework to address depression comprehensively. Non-governmental organizations (NGOs) such as the Beijing Suicide Research and Prevention Center play a crucial role in promoting mental health and suicide prevention. The UN’s emphasis on integrating mental health services into primary healthcare systems further strengthens accessibility, diminishes stigma, and facilitates early detection and treatment of mental health concerns. Additionally, the Economic and Social Council (ECOSOC) at the United Nations prioritizes the well-being of children and youth. Research on depression has led to the development of effective treatments, including psychotherapy, medication, and other forms of support. Studies have also shown the benefits of early intervention in preventing the onset of depression and reducing its severity. Through increased awareness, improved education, strengthened support networks, enhanced access to treatment, resilience-building programs, and family engagement, we can foster a society that prioritizes the mental health of its young individuals. By actively collaborating with NGOs, implementing action plans, addressing social determinants, and following the UN’s guidance on mental health integration, we can create a future where youth with depression receive the holistic support they need to thrive.
By consistently investing in these areas and adapting our approaches based on ongoing evaluation and feedback, we can create a future where youth with depression receive the care, understanding, and support they need to lead fulfilling lives.