Review pinpoints factors tied to teen depression in SG

A systematic review of eight studies identified a range of factors associated with depression among adolescents in Singapore.

The four factors were sociodemographic factors, psychological factors, co-existing chronic medical conditions, and lifestyle factors. [Singapore Med J 2025;66:2-14]

Sociodemographic factors

In one study, ~17 percent of children aged 8–12 years reported depressive symptoms. Despite the minimal clinically significant difference in Children’s Depression Inventory scores between Malay, Indian, and Chinese kids, the latter group had lower scores for depressive symptoms vs the former two groups. [Asia-Pac Psychiatry 2015;7:91-104]

The researchers attributed the lower scores among Chinese kids to the adversity experienced by ethnic minority groups and the potential underreporting of symptoms. [Am J Public Health 2009;99:878-884; Singapore Med J 2007;48:1100-1106]

There was no clinically significant difference in total depression scores between males and females, but Indian girls appeared to report emotional symptoms more than Indian boys, which may be reflective of the increasing influence of traditional gender roles during adolescence. [Dev Psychol 2010;46:842-852] “Nonetheless, the full effects of sociocultural differentiation on wellbeing may not be well-reflected in one paper, as school-aged participants would have just been at the cusp of assuming their sociocultural and gender roles,” the researchers noted.

Psychological factors

A study on adolescents aged 14–19 years from a psychiatric hospital reported increased depressive symptoms in patients with more severe exposure to childhood maltreatment. Three-quarters of participants reported at least one episode of self-harm, while half reported ≥10 episodes in the past 12 months. [Child Abuse Negl 2017;67:383-390] “[This] study identified emotional dysregulation as a mediator between childhood maltreatment exposure and the risk of self-harm,” said the researchers.

Another study assessed the discriminant validity of ‘hope’ and ‘optimism’ on depression and life satisfaction in secondary school students. According to the investigators, both constructs were geared towards positive outcome expectancies, correlating positively with life satisfaction and negatively with depression. [Personal Individ Differ 2009;46:648-652] “This concurs with [evidence showing] how lack of goal-directed energy (agency thinking) was more predictive of depression than lack of pathway thinking,” they said.

Chronic comorbidities

One study found that adolescents with poorly controlled asthma had higher depression scores vs healthy controls and those with well-controlled asthma. [J Adolesc Health 2014;55:267-275] The findings underscore the importance of exploring mental wellness of adolescents presenting to the clinic with poorly controlled asthma.

“Given the bidirectional relationship of chronic disease control and depression, the patient with poor chronic disease control should as much be screened for depressive symptoms as a patient with depressive symptoms is asked about the control of his/her chronic disease condition,” said the researchers.

Lifestyle factors

Evidence shows that not achieving age‑appropriate sleep duration (8–10 h) on school nights was tied to significantly increased odds for depressive symptoms. Delaying school start time by 45 minutes was associated with improvements in depression scores and alertness and a drop in depressive symptoms. [Sleep Med 2019;60:96-108; Sleep 2018;doi:10.1093/sleep/zsy052]

The sleep inadequacy may have been driven by local school start times earlier than the recommended time. [Sleep Med 2017;30:164-170; J Clin Sleep Med 2017;13:623-625] They added that this may also be reflective of the East Asian preference of prioritizing academic achievement over sleep, with students staying up late often to complete school tasks.

“Sleep deprivation is both a harbinger and symptom of distress and depression. Primary care physicians should enquire about sleep patterns and sleep hygiene of an adolescent patient during consultation and encourage a healthy sleep routine,” they said.

One study showed that excessive internet use (ie, >5h daily) correlated with feelings of sadness and depression, lower odds of having a confidante, perceived poorer grades in school, and lack of home rules on internet use. Another study reported that the severity of pathological gaming was associated with depression, anxiety, social phobia, and poorer grades. [Ann Acad Med Singapore 2008;37:9-14; Pediatrics 2011;127:e319-e329]

The researchers said that excessive internet use and pathologic gaming may prompt a downward spiral that heightens social isolation and depression. “The accessibility of primary care in the community makes it an excellent venue to enquire about internet use and the adolescents’ experience of stress and coping and to provide opportunistic advice on healthy gaming and internet use, particularly for sleep‑deprived gamers.”

Boost mental health literacy

The findings should prompt clinicians to further explore mental wellness among adolescents and underscore the value of blanket efforts to boost mental health literacy in the population to stem the inordinate number of teen suicides in recent years, the researchers said.

“Further research should focus on current and prospective interventions to improve mental health literacy, targeting sleep duration, internet use and gaming, and mitigating the risk of depression in patients with chronic disease in the primary care and community setting,” the researchers said.

Of the eight studies included in the review, seven were cross‑sectional and one was an interventional study. All studies were conducted in Singapore, with sample sizes ranging between 108 and 2,998.