The Prevalence of Depression and Anxiety Symptoms among Overweight/Obese and Non-Overweight/Non-Obese Children/Adolescents in China: A Systematic Review and Meta-Analysis
Open accessAbstract
With the dramatic growth of the Chinese economy, the number of children/adolescents with being overweight/having obesity is increasing, which has a certain impact on their psychology, such as depression and anxiety symptoms. Our purpose was to conduct a meta-analysis to assess the prevalence and odds ratios of depression and anxiety symptoms among overweight/obese children/adolescents and non-overweight/obese children/adolescents in China. As of July 2018, the three most comprehensive computerized academic databases in China have been systematically screened, namely China national knowledge infrastructure (CNKI) databases, Wanfang databases and Vip databases. The same operations are performed in PubMed and Web of Science (SCIE) databases without language restrictions. Case-control studies on prevalence of depression and anxiety symptoms in overweight/obese children/adolescents in China were analyzed. Study selection and evaluation were performed independently by three authors. Unweighted prevalence, pooled random-effects estimates of odds ratio (OR), and 95% confidence intervals (CI) were all calculated. A total of 11 eligible studies involving 17,894 subjects were included. The prevalence of depression and anxiety symptoms in overweight/obese children/adolescents was significantly higher than that in non-overweight/non-obese children/adolescents (depression: 21.73% vs. 17.96%, OR = 1.46, 95% CI: 1.14, 1.87, p = 0.003; anxiety: 39.80% vs. 13.99%, OR = 1.47, 95% CI: 1.21, 1.79, p < 0.001). Subgroup analyses conducted according to scale types showed that scale types have certain significance to evaluate the relationship between depression symptoms and overweight/obesity. The OR of depression symptoms between overweight/obese children/adolescents and non-overweight/non-obese children/adolescents was greatest on the Middle School Student Mental Health Scale (MSSMHS) was 2.06 (95% CI: 1.41, 3.02, I2 = 0.00%), Center for Epidemiologic Studies Depression Scale (CES-D) was 1.03 (95% CI: 0.84, 1.25, I2 = 0.00%), and Children’s Depression Inventory (CDI) was 1.21 (95% CI: 1.02, 1.42, I2 = 0.00%). We concluded that the prevalence of depression and anxiety symptoms in overweight/obese children/adolescents in China is higher than that in the non-overweight/obese children/adolescents. The results of the study indicate that the prevalence of depression and anxiety symptoms among overweight/obese children/adolescents in Chinese medical institutions should receive more attention. Physical exercise and psychological interventions should be strengthened to prevent psychological problems. However, because of some clear limitations (no clinical interview and few studies), these results should be interpreted with caution.
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Overweight and underweight adolescents have an increased risk of psychological problems and reduced quality of life.
“Overweight and underweight adolescents have an increased risk of psychological problems and reduced quality of life.”
From Psychopathological symptoms and well-being in overweight and underweight adolescents: A network analysis (2021) · cites this paper as [2]
The Results (§3.4; page unavailable) report significantly higher prevalence of depression and anxiety symptoms among overweight/obese children and adolescents in China than among their non-overweight/non-obese peers. The paper does not establish an increased risk for underweight adolescents or report reduced quality of life; its Discussion (§4; page unavailable) also cautions that a causal relationship cannot be inferred. (LLM, conf=0.88)
Experimental — accuracy not yet measuredOverweight/obesity and depression/anxiety very often overlap.
“Very often these conditions overlap”
From Mobile Apps for the Management of Comorbid Overweight/Obesity and Depression/Anxiety: A Systematic Review (2020) · cites this paper as [14]
The Discussion reports that depression and anxiety symptoms coexist with overweight/obesity among children and adolescents in China, with prevalences of 21.73% and 39.80%, respectively. That supports overlap, but the unqualified claim extends beyond the population studied. (LLM, conf=0.84)
Experimental — accuracy not yet measuredDepression and anxiety have a marked association with overweight/obesity.
“depression and anxiety stand out, not only for their higher prevalence but also for their marked association with overweight/obesity [13–15]”
From Mobile Apps for the Management of Comorbid Overweight/Obesity and Depression/Anxiety: A Systematic Review (2020) · cites this paper as [14]
The Results (§3.5; page unavailable) report significantly higher odds of both depression and anxiety symptoms among overweight/obese children and adolescents in China. The citing sentence leaves out that population and setting, while “marked association” is stronger than the paper’s qualified discussion of mixed findings. The paper does not establish the association for people generally. (LLM, conf=0.86)
Experimental — accuracy not yet measuredOverweight adolescents represent a specific risk group for mental health problems.
“Consistent with the literature e.g., [2,9], the present findings provide clear evidence that overweight adolescents represent a specific risk group for mental health problems.”
From Psychopathological symptoms and well-being in overweight and underweight adolescents: A network analysis (2021) · cites this paper as [2]
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References 58 · Cited by 164
Research works printed but not linked: 4
- [43]Que M. Mental Health Status among Overweight or Obese Adolescents: A Cross-Sectional Study Master’s Thesis Anhui Medical University Hefei City, China 2007
- [44]Liu Q.W. Epidemiological Study on Overweight, Obesity and Underweight among Students Aged 12–14 Years in Urban Chenzhou, Hunan Province Doctoral Thesis Central South University Changsha City, China 2009
- [49]Chu Q. Diagnosis in Fatness Condition and Psychological Factors of Changchun Elementary Student Master’s Thesis Jilin University Changchun City, China 2006
- [50]Yang H. Survey on the Obesity and Psychological Status of Students in Middle School of Changchun Master’s Thesis Jilin University Changchun City, China 2006
- Authors
- Wang, S., Sun, Q., Zhai, L., Bai, Y., Wei, W., & Jia, L.
- Affiliations
- China Medical University (CN)
- Corresponding author
- Jia, Lihong
- Venue
- International Journal of Environmental Research and Public Health
- Publisher
- MDPI AG
- Published
- 2019-01-26
- Volume
- 16
- Issue
- 3
- Pages
- 340
- ISSN
- 1660-4601 (ISSN-L)
- PMC
- PMC6388174
- OpenAlex
- W2915067353
- Cited by
- 164
- References
- 58
- Citations by year
- 2026: 13 · 2025: 31 · 2024: 25 · 2023: 29 · 2022: 28 · 2021: 23 · 2020: 13 · 2019: 2
- FWCI
- 2.70
- Type
- journal article
- Language
- en
- Open access
- gold
- dx.doi.org
- Licence
- Locations
- International Journal of Environmental Research and Public Health (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- The Liaoning Nature Science Foundation of China (2015020466)
- The National Natural Science Foundation of China (81673190)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Keywords
- childhood obesity, adolescent obesity, overweight, depressive symptoms, anxiety symptoms, prevalence, mental health, Chinese children and adolescents, CES-D, Children's Depression Inventory, case-control study, anxiety screening
- MeSH terms
- Adolescent, Anxiety, Child, China, Depression, Depressive Disorder, Humans, Obesity, Exercise, Prevalence, Odds Ratio, Case-Control Studies, Asian People, Overweight, Pediatric Obesity
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