What question did this study set out to answer?

This research aims to investigate the prevalence and risk factors of depressive and anxiety symptoms among secondary school students, focusing on maternal mental health.

May 24, 2026Open Access

Prevalence and attributable risk of depressive and anxiety symptoms among secondary school students: the role of maternal mental health and other risk factors

Key Points

This research aims to investigate the prevalence and risk factors of depressive and anxiety symptoms among secondary school students, focusing on maternal mental health.
Cross-sectional study with 7850 secondary school students
Assessment using Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7
Multivariable analysis for identifying significant risk factors.
11.6% reported depressive symptoms and 18.1% reported anxiety symptoms
Academic pressure was the largest contributor to depressive (PAR=34.5%, 95% CI: 23.6–47.8%) and anxiety symptoms (PAR=45.8%, 95% CI: 36.3–58.1%)
Maternal anxiety symptoms explained 23.4% of the prevalence of anxiety, and maternal depressive symptoms had an odds ratio of 5.497 for depression.

Abstract

Depressive and anxiety symptoms among secondary school students have become significant public health concerns; however, comprehensive studies examining their prevalences and associated factors (particularly regarding the influence of maternal mental health) are limited. A cross-sectional study was conducted among 7850 secondary school students. The Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Perceived Social Support Scale questionnaires were used to assess depressive symptoms, anxiety symptoms, and social support, respectively. The self-reported prevalences of depressive and anxiety symptoms were observed to be 11.6% and 18.1%, respectively, among secondary school students. Multivariable analysis revealed significant risk factors, including female sex, suburban region, and maternal depressive and anxiety symptoms (all P < 0.001), along with parental discord, academic stress, insufficient physical activity, excessive screen time, and moderate household income (all P < 0.05). Population attributable risk (PAR) analysis revealed that academic pressure accounted for the greatest contribution to both depressive (PAR%=34.5%, 95% CI: 23.6–47.8%) and anxiety symptoms (PAR%=45.8%, 95% CI: 36.3–58.1%). Suburban residence (33.2% for depression, 45.0% for anxiety), insufficient physical activity (26.0% for depression), and excessive screen time (25.4% for depression, 21.0% for anxiety) were substantial contributors. Maternal anxiety symptoms explained 20.4% (95% CI: 15.7–25.7%) of the prevalence of depressive symptoms and 23.4% (95% CI: 18.8–28.6%) of the prevalence of anxiety, whereas maternal depressive symptoms contributed 12.9% (95% CI: 8.7–18.8%) to student depression despite demonstrating the strongest individual-level association (aOR = 5.497). Social support demonstrated a protective effect against both conditions (P < 0.05). The findings highlight the considerable prevalences of depressive and anxiety symptoms among secondary school students and underscore the significant role of maternal mental health and other modifiable risk factors. Not applicable.

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