Depression, also known as depressive disorder, is the main type of mood disorder, with significant and persistent low mood as its main clinical feature [1]. In 2008, the World Health Organization ranked major depression as the third largest disease burden globally. It is projected that by 2030, the disease will become the first largest [2]. Depression is growing fastest among adolescents and young adults [3]. According to statistics, the prevalence of depression among adolescents was 37% from 2011 to 2020 [4]. Moreover, the prevalence of major depressive disorder increases significantly throughout adolescence, with the increase in females significantly greater than that in males [5]. At present, the effective treatment methods for adolescent depression include the combination of antidepressants, psychotherapy, and antidepressants and psychotherapy, among which the combined treatment is more effective [6]. However, the recurrence rate of adolescent depression is high, the treatment cost is expensive, and the medical quality is poor, which seriously affects the life and study of adolescent patients and places a heavy burden on families and society [7]. Therefore, it is essential to develop appropriate treatment options for depression in adolescents and to verify their effectiveness.
At present, most antidepressants for adolescents are selective serotonin reuptake inhibitors (SSRIs) [8]. Forty-nine percent of adolescents have adverse reactions to varying degrees after taking antidepressants [9]. Among them, the short-term manifestations are gastrointestinal and central nervous system problems. Long-term drug use will lead to metabolic and bone marrow-related disorders, accompanied by abnormal prolactin production [11] and common adverse reactions such as sedation and nausea [10]. At present, there is no evidence that SSRI drugs affect brain development or are associated with suicide, but this does not reduce the concern in this regard [12]. The above adverse reactions not only seriously affect patients' doctor orientation, prognosis and quality of life but are also closely related to the effect of drug treatment for depression [13]. In addition, nondrug treatment for adolescent patients is important, and pleasure perception groups are designed to support adolescents, provide a fun experience, and promote happiness [14]. Therefore, the selection of feasible, effective, suitable and active nondrug treatments for adolescents is of great importance for the treatment of adolescents with severe depressive symptoms [15].
Based on "German Fun Therapy", the Happiness Perception Group combines the concepts of cognition and mindfulness-based stress reduction and forms the Happiness Perception Group. The Happiness Perception Group takes the "Seven Principles of Happiness" as the foundation, and based on five classic sensory experiences, it carries out interesting theme groups of smell, sight, touch, hearing and taste. Members of the group share their own psychological problems, symptoms, conditions and development. In addition, they discuss, communicate, inspire and encourage each other through the observation, analysis and understanding of their own and others' psychological and behavioural responses. This leads to a deeper understanding of self and others, promotes self-physical and mental growth, and offers more medical knowledge about diseases. The Happiness Perception Group uses lively and engaging activities to increase the enthusiasm of patients and encourage participation to achieve the purpose of psychological treatment based on cognitive and mindfulness-based stress reduction techniques.
In summary, the purpose of our study was to verify the effectiveness of happiness-perception group treatment for adolescent depression to improve the treatment effect of adolescent depression and reduce its recurrence. It is hypothesized that participants in hedonic perception group therapy will relieve physical discomfort and symptoms of anxiety and depression and increase patient engagement to a greater extent. Our findings show differences and significant changes in depressive anxiety and somatic symptom outcomes.