Of the initial 11,603 adolescents, 11,069 questionnaires (95.4%) were valid after ruling out invalid questionnaires. The comparisons of demographic and psychological characteristics between the two groups are shown in Table 1. There were 5592 boys (50.5%) and 5477 girls (49.5%). The average age of all students was 14.3 years old. The rate of depressive symptoms in adolescents was 37.5% (4,156/11,069) and the rate of anxiety symptoms was 23.4% (2,590/11,069). The depressive symptoms were related to the sex, marital status of parents, parent-child relationship, psychological resilience, and childhood abuse (all p < 0.001).
|
Total adolescents
n = 11,069
|
Religious group
n = 847
|
Non-religious group
n = 10222
|
p value
|
Table 1
Demographic and Psychological Characteristics of adolescents
Demographic Characteristics
|
|
|
|
|
Age, mean ± SD
|
14.3 ± 1.1
|
14.3 ± 1.1
|
14.5 ± 1.0
|
0.001
|
Boys, n (%)
|
5592 (50.5)
|
432(51.0)
|
5160(50.5)
|
0.77
|
Marital status of parents
|
|
|
|
0.13
|
Married
|
10082(91.1)
|
775(91.5)
|
9307(91.0)
|
|
Divorced
|
487(4.4)
|
26(3.1)
|
461(4.5)
|
|
Remarried
|
278(2.5)
|
27(3.2)
|
251(2.5)
|
|
Single
|
222(2.0)
|
19(2.2)
|
203(2.0)
|
|
Parent-child relationship, n (%)
|
|
|
|
0.008
|
Poor
|
284(2.6)
|
28(3.3)
|
256(2.5)
|
|
Moderate
|
2696(24.4)
|
238(28.1)
|
2458(24.0)
|
|
Good
|
8089(73.1)
|
581(68.6)
|
7508(73.4)
|
|
Live with parents, n (%)
|
10579(95.6)
|
789(93.2)
|
9790(95.8)
|
< .0001
|
Infection exposure risk, n (%)
|
249(2.2)
|
24(2.8)
|
225(2.2)
|
0.23
|
Psychological Characteristics
|
|
|
|
|
PHQ-9, median (IQRs)
|
3(0, 7)
|
4(1, 9)
|
3(0, 7)
|
< .0001
|
With symptoms, n (%)
|
4156(37.5)
|
371(43.8)
|
3785(37.0)
|
< .0001
|
GAD-7, median (IQRs)
|
1(0, 4)
|
1(0, 6)
|
1(0, 4)
|
< .0001
|
With symptoms, n (%)
|
2590(23.4)
|
261(30.8)
|
2329(22.8)
|
< .0001
|
Resilience Score, mean ± SD
|
3.4 ± 0.7
|
3.3 ± 0.8
|
3.4 ± 0.7
|
< .0001
|
Emotional abuse score, mean ± SD
|
7.8 ± 3.1
|
3.5 ± 01
|
3.1 ± 0.03
|
0.16
|
With experience ( > = 13), n (%)
|
907(8.2)
|
96(11.3)
|
811(7.9)
|
0.001
|
Physical abuse score, mean ± SD
|
5.7 ± 1.8
|
6.1 ± 2.3
|
5.7 ± 1.7
|
< .0001
|
With experience ( > = 13), n (%)
|
164(1.5)
|
23(2.7)
|
141(1.4)
|
0.004
|
Sex abuse score, mean ± SD
|
5.1 ± 0.9
|
5.3 ± 1.2
|
5.1 ± 0.8
|
< .0001
|
With experience ( > = 8), n (%)
|
221(2.0)
|
36(4.3)
|
185(1.8)
|
< .0001
|
Emotional neglect score, mean ± SD
|
15.0 ± 6.6
|
17.0 ± 6.2
|
14.9 ± 6.6
|
< .0001
|
With experience ( > = 15), n (%)
|
6128(55.4)
|
574(67.8)
|
5554(54.3)
|
< .0001
|
Physical neglect score, mean ± SD
|
9.9 ± 3.3
|
10.9 ± 3.0
|
9.8 ± 3.3
|
< .0001
|
With experience ( > = 10), n (%)
|
6092(55.0)
|
584(68.9)
|
5508(53.9)
|
< .0001
|
Abbreviations: PHQ-9, 9-item Patient Health Questionnaire; GAD-7, 7-item Generalized Anxiety Disorder. |
3.1 Prevalence of religious belief and its association with mental status
The rate of religious belief among adolescents was 7.7% (847/11,069). The average age of the religious group was slightly younger than that of the non-religious group (p = 0.001). Adolescents with religious beliefs had poor parent-child relationships, did not live with their parents, and had less psychological resilience (Bonferroni corrected all p < 0.05). In addition, adolescents with religious beliefs had higher levels of emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect (Bonferroni corrected all p < 0.01) (Table 1).
The rate of depressive symptoms was different between the adolescents with religious beliefs and non-religious beliefs (37.0% vs 43.8%; X2 = 15.3, p < 0.001). The rate of anxiety was also significantly different between the adolescents with religious beliefs and non-religious beliefs (22.8% vs 30.8%; X2 = 28.1, p < 0.001). Logistic regression analysis found that religious belief was a risk factor for depressive symptoms (OR = 1.37, 95%CI: 1.16–1.61, p < 0.001) and anxiety symptoms (OR = 1.49, 95%CI: 1.23–1.79, p < 0.001) after controlling for confounding factors (Table 2 and Table 3). Further analysis found that compared to those non-religious adolescents, religious adolescents had a higher severity of depressive symptoms (F = 28.8, p < 0.001) and anxiety symptoms (F = 31.9, p < 0.001). After controlling for age, sex, parent-child relationship, resilience, and child abuse experience, the differences between the two groups remained significant (Bonferroni corrected all p < 0.01).
Table 2
Comparisons of depressive and anxiety symptoms between adolescents with and without religious belief and potential risk of exposure to COVID-19
|
Religious believers
|
Non-Believers
|
Religious
belief
|
Exposure
risk
|
Interaction*
|
|
With risk
|
without risk
|
With risk
|
without risk
|
p value
|
p value
|
p value
|
|
n = 24
|
n = 823
|
n = 225
|
n = 9997
|
|
|
|
PHQ-9 Score
|
5(2, 11)
|
3(1, 8)
|
6(2, 9)
|
3(0, 7)
|
2.1(0.15)
|
14.7(< 0.001)
|
0.05(0.83)
|
GAD-7 Score
|
3.5(1, 11)
|
1(0, 6)
|
2(0, 7)
|
1(0, 4)
|
6.5(0.011)
|
18.5(< 0.001)
|
0.69(0.41)
|
Note: * controlling for age, sex, BMI, resilience score and CTQ score. |
![](https://myfiles.space/user_files/122228_c8a1650c59388082/122228_custom_files/img1679423174.png)
![](https://myfiles.space/user_files/122228_c8a1650c59388082/122228_custom_files/img1679423440.png)
3.2 Associations between infection exposure to COVID-19, religious belief, and mental status.
All adolescents were divided into two groups, according to whether their relatives or someone in their community were infected. We found significant differences in depressive symptoms (F = 24.6, p < 0.001) and anxiety symptoms (F = 18.8, p < 0.001) between the two groups, after controlling for the confounding variables. We further analyze the interaction effects of infection exposure and religious beliefs on depressive symptoms and anxiety symptoms. The results showed that there was no significant interactive effect of infection exposure and religious belief on depressive symptoms (F = 0.10, p = 0.76) and anxiety symptoms (F = 0.55, p = 0.46) (Table 4).
Multiple regression analysis and logistic regression were carried out to identify the association between religious belief and depressive symptoms, after controlling for demographic and psychological characteristics that were related to depressive symptoms. In the model, the religious belief, age, sex, marital status of parents, parent-child relationship, living with parents or not, child abuse, psychological resilience, and infection exposure were used as dependent variables and depressive symptoms were added as independent variables. We found that religious belief, older age, girl, infection exposure, poor parent-child relationship, child abuse,e, and low psychological resilience score were associated with depressive symptoms (p < 0.05, R2 = 0.41) (Table 3).
Then, the same analyse was performed to determine the key risk and protective factors for the anxiety symptoms of adolescents. We found that religious belief, girl, older age, infection exposure, poor parent-child relationship, the low score of resilience, and child abuse experiences were associated with anxiety symptoms (p < 0.01, R2 = 0.34). The coefficients of the variables are shown in Table 4.
3.3 Factors associated with psychiatric symptoms in adolescents with religious belief
Multivariable logistic regression analysis revealed that in adolescents with religious belief, greater resilience was protective in preventing depressive (OR, 0.60; 95% CI, 0.47 to 0.75; p < 0.0001) and anxiety symptoms (OR, 0.51; 95% CI, 0.39 to 0.65; p < 0.0001). Adolescents reporting emotional abuse were more likely to develop depressive (OR, 1.39; 95% CI, 1.30 to 1.50; p < 0.0001) and anxiety symptoms (OR, 1.37; 95% CI, 1.27 to 1.47; p < 0.0001) (Table 5). Another factor related to depressive symptoms was the parent-child relationship (OR, 1.52; 95% CI, 1.04 to 2.21; p = 0.029). Adolescents reporting emotional neglect were likely to develop anxiety symptoms (OR, 1.07; 95% CI, 1.02–1.12; p = 0.002), not depressive symptoms (Table 5).