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. 2024 Apr 17;12:1358210. doi: 10.3389/fpubh.2024.1358210

Table 2.

The summary information of the selected articles.

Author and year Sample characteristics Study design Prevalence Assessment tools and stress level Risk factors Outcomes Limitation
Zhou et al. (20) Sample: 1,860
Grade: 7–12
Site: Shanghai China		 Cross-sectional study 12.9–23.2% Strengths and Difficulties Questionnaire (SDQ)
(25.5 ± 15.5)
Severe

  1. Academic stress

  2. Criticism from others

  3. Family conflict and peer bullying and discrimination or interpersonal conflict

 Negative life events are one of many factors associated with perceived stress and level of pro-social behavior in secondary school students

  1. Sample cannot represent other area

  2. Cannot explain causation
Yang et al. (21) Sample: 1,258
Age: 14–20
Site: Southern China		 Cross-sectional study Not given DASS-21 (5.21 ± 4.11)
Moderate		 Mobile phone addiction Mobile phone addiction has been identified as a salient risk factor for adolescents’ psychological stress

  1. Cannot explain causation

  2. The generalizability of these findings is limited
Jinchang and Wei (17) Sample: 350
Grade: 7–9
Site: Henan, China		 Cross-sectional study Not given Mental stress scale
(2.57 ± 0.68)
Moderate		 Campus safety atmosphere The improvement of the campus safety atmosphere level can effectively mitigate the mental health Cannot explain causation
Wen et al. (23) Sample: 900
Grade: 9–12
Age:14.14 ± 1.32
Site: Jiang xi China		 Cross-sectional study 24.78% Mental Health Test (MHT)
Low-severe

  1. Academic pressure

  2. School mental health work

 Students with extreme academic pressure are more likely to develop psychological stress

  1. Cannot explain causation

  2. Anxiety and school-related factors were assessed using self-report surveys
Quach et al. (18) Sample: 997
Grade: 10–12
Age: 16–19
Site: Beijing China		 Cross-sectional study Not given Revised Children’s Manifest Anxiety Scale (RCMAS)
Boys anxiety (38.22 ± 5.99)
Girls anxiety (38.76 ± 5.85)
Severe		 Parent-child conflict Greater parental warmth generally reduced adolescents’ psychopathology symptoms

  1. Cannot explain causation

  2. Reliance on adolescents’ reports for information about both their parents’ behavior and their own symptoms
Lu and Liu (35) Sample: 14,356
Age: 13–18
Site: China		 Cross-sectional study The psychological symptom detection rate of Chinese middle school students was 21.37% Multidimensional Sub-health Questionnaire of Adolescents (MSQA)
Not given		 Unhealthy lifestyle There was a positive correlation between unhealthy lifestyle and the occurrence of psychological symptoms, and boys are more easily influenced by lifestyles than girls

  1. Cannot explain causation

  2. The questionnaire to estimate psychological symptoms, which are susceptible to the level of recall
Lian et al. (42) Sample: 754
Age: 11–15
Grade: 7–9
Site: Shang Qiu and Wuhan, China		 Cross-sectional study Not given DASS-21 (0.759 ± 0.497)
Low		 Mobile phone addiction Mobile phone addiction was significantly and positively associated with psychological stress

  1. Cannot be generalized to adolescents in other cultural backgrounds

  2. Cannot explain causation
Li et al. (40) Sample: 1,440
Grade: 4–9
Site: Xiu Shui, China		 Cross-sectional study Not given Social Anxiety Scale for Children (SASC)
(2.4084 ± 0.7065)
Low		 Poverty Poverty had a significantly direct effect on children’s anxiety and depression

  1. Cannot explain causation

  2. Students’ mental health conditions may be underreported or overreported
Li et al. (44) Sample: 19,487
Grade: 7–9
Site: China		 Cross-sectional study Not given Not given

  1. Martial conflicts

  2. Parent-child relationship

  3. Family income

 Parental marital and parent-child relationships positively affected children’s mental health

  1. Cannot explain causation

  2. Some limitations in the variable measurement
Guo et al. (41) Sample: 1,228
Grade: 7–12
Age: 11–20
Site: Tong Ling and Wuhu from Anhui Province in China		 Cross-sectional study Not given DASS-21
Anxiety (0.93 ± 0.60)
Stress (1.11 ± 0.61)
Low		 Teacher-student relationship Teacher support, as a kind of social support, can keep adolescents healthy by reducing the influence of negative emotions on the body and mind

  1. Cannot explain causation

  2. Results cannot be generalized to students in other grades or adolescents from other cultural backgrounds
Geng and He (43) Sample: 24,66
Age: 10–15
Site: China		 Cross-sectional study Not given Kessler 6 rating scale (1.516 ± 0.584)
Low

  1. Academic pressure

  2. Parent-child conflict

 Academic pressure and parent-child conflict was detrimental to the psychological health of all children

  1. Could not examine how children’s relatedness with peers influenced their psychological well-being

  2. Could not control for the influence of regional heterogeneity

  3. Cannot explain causation
Zhang et al. (39) Sample: 2,139
Age:14.67 ± 1.53
Grade: 10–12
Site: Southeast China		 Cross-sectional study Not given DASS21 (13.80 ± 13.42)
Moderate

  1. Childhood trauma

  2. Social support

  3. Family functioning

 Childhood trauma was positively associated with general distress among Chinese adolescents

  1. Cannot explain causation

  2. Subjective self-report and recall bias should be interpreted cautiously
Li et al. (34) Sample: 6,173
Age: 6–17
Site: Liaoning Province, located in northeast China		 Cross-sectional study 26.6% Strengths and Difficulties Questionnaire (SDQ)
Moderate

  1. Mother’s and father’s poor mental health

  2. Teacher’s poor mental health

 All three caretakers have a significant negative influence on schoolchildren’s emotional well-being, in the order of mother > father > teacher

  1. Cannot explain causation

  2. Not all teachers were measured
Chen et al. (38) Sample: 938
Age: 13–18
Site: Guangzhou in southern China		 Cross-sectional study Not given DASS-21 (14.82 ± 10.14)
Moderate

  1. Parents-child relationship

  2. Peer relationship

 The results suggest that attachment, especially parent attachment, is helpful in enhancing students’ dispositional mindfulness, which in turn reduces psychological distress in secondary school students

  1. Cannot explain causation

  2. This study only used self-report data from a single source
Chen (37) Sample: 1,932
Grade: 7–9
Site: Taiwan and Tianjin in Mainland China		 Cross-sectional study Not given BSRS-5 (33.45 ± 14.82)
Severe		 Cyber victimization Cyber victimization, and parental support are important factors contributing to psychological distress among Taiwanese and Mainland Chinese adolescents

  1. Cannot explain causation

  2. Sample may not be representative of the PRC

  3. Data were derived from students’ self-reports
Fu et al. (36) Site: mainland China Report 12.9–26.6% Not given Not given Not given Not given