Welcome to visit Zhongnan Medical Journal Press Series journal website!

Development of "comorbidity—co-causes—joint-prevention" comprehensive intervention strategy for adolescent depression and obesity

Published on Jun. 25, 2025Total Views: 70 timesTotal Downloads: 22 timesDownloadMobile

Author: GUI Pingping 1 ZHANG Xiaorui 2, 3 WANG Xinxin 4 ZHAO Yanjie 2, 3 LIN Junkang 5 SONG Yi 5 MENG Linghui 1, 2, 3

Affiliation: 1. Capital Institute of Pediatrics, Beijing 100020, China 2. Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China 3. Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100069, China 4. Linyi University, Linyi 276000, Shandong Province, China 5. Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, China

Keywords: Adolescent Depression Obesity Comorbidity Intervention strategy Delphi Analytic hierarchy process

DOI: 10.12173/j.issn.1004-5511.202502009

Reference: Gui PP, Zhang XR, Wang XX, Zhao YJ, Lin JK, Song Y, Meng LH. Development of "comorbidity—co-causes—joint-prevention" comprehensive intervention strategy for adolescent depression and obesity[J]. Yixue Xinzhi Zazhi, 2025, 35(6): 631-641. DOI: 10.12173/j.issn.1004-5511.202502009. [Article in Chinese]

  • Abstract
  • Full-text
  • References
Abstract

Objective  To develop a comprehensive intervention strategy for "comorbidity—co-causes—joint-prevention" of depression and obesity among adolescents, providing strategy and basis for subsequent interventions for the comorbidity of depression and obesity.

Methods  Through a review of past guidelines, literatures and policy documents, and combining with existing effective intervention measures, an intervention strategy framework of "comorbidity—co-causes—joint-prevention" was preliminarily constructed. The Delphi method was employed to conduct two rounds of expert consultation, and the analytic hierarchy process was used to rank the importance of the intervention measures.

Results  The preliminary “comorbidity—co-causes—joint-prevention” intervention strategy framework included 7 intervention concepts and 91 corresponding intervention measures. A total of 14 experts were consulted. After two rounds of expert consultation, the expert positive coefficients were both 100%, the average familiarity coefficients were 0.76 and 0.80 respectively, and the average authority coefficients were 0.85 and 0.90 respectively. The Kendall’s  W coordination coefficients of the intervention concepts in the two rounds were 0.21 and 0.25 respectively, and those of the intervention measures were 0.18 and 0.27 respectively. Items with an average feasibility and importance score ≥ 3.5 and a coefficient of variation ≤ 0.25 were retained. The final "comorbidity—co-causes—joint-prevention" intervention strategy for adolescent depression and obesity includes 7 intervention concepts (controlling sugar intake, reducing sedentary time/increasing sun exposure, reducing screen time, ensuring adequate sleep, providing social support, surveillance and supervision), as well as 63 intervention measures in different dimensions, such as students, parents, schools, and medical institutions.

Conclusion  The developed comprehensive intervention strategy for “comorbidity—co-causes—joint-prevention” of depression and obesity among adolescents is highly scientific and reliable, and provides support for the intervention of the comorbidity of depression and obesity in adolescents, which can promote the physical and mental health development of adolescents.

Full-text
Please download the PDF version to read the full text: download
References

1.Lister NB, Baur LA, Felix JF, et al. Child and adolescent obesity[J]. Nat Rev Dis Primers, 2023, 9(1): 24. DOI: 10.1038/s41572-023-00435-4.

2.Zhou M, Fan Y, Xu L, et al. Microbiome and tryptophan metabolomics analysis in adolescent depression: roles of the gut microbiota in the regulation of tryptophan-derived neurotransmitters and behaviors in human and mice[J]. Microbiome, 2023, 11(1): 145. DOI: 10.1186/s40168-023-01589-9.

3.Latzer Y, Stein D. A review of the psychological and familial perspectives of childhood obesity[J]. J Eat Disord, 2013, 1: 7. DOI: 10.1186/2050-2974-1-7.

4.Fulton S, Décarie-Spain L, Fioramonti X, et al. The menace of obesity to depression and anxiety prevalence[J]. Trends Endocrinol Metab, 2022, 33(1): 18-35. DOI: 10.1016/j.tem.2021.10.005.

5.Franko DL, Striegel-Moore RH, Thompson D, et al. Does adolescent depression predict obesity in black and white young adult women?[J]. Psychol Med, 2005, 35(10): 1505-1513. DOI: 10.1017/S0033291705005386.

6.Rao WW, Zhang JW, Zong QQ, et al. Prevalence of depressive symptoms in overweight and obese children and adolescents in mainland China: a Meta-analysis of comparative studies and epidemiological surveys[J]. J Affect Disord, 2019, 250: 26-34. DOI: 10.1016/j.jad.2019.02.045.

7.Rao WW, Zong QQ, Zhang JW, et al. Obesity increases the risk of depression in children and adolescents: results from a systematic review and Meta-analysis[J]. J Affect Disord, 2020, 267: 78-85. DOI: 10.1016/j.jad.2020.01.154.

8.Milaneschi Y, Simmons WK, Van Rossum EFC, et al. Depression and obesity: evidence of shared biological mechanisms[J]. Mol Psychiatry, 2019, 24(1): 18-33. DOI: 10.1038/s41380-018-0017-5.

9.柴鑫,崔佳,叶丽红,等. 基于德尔菲法探讨中国人群健康长寿定义[J]. 中华预防医学杂志, 2024, 58(5): 629-635. [Chai X,Cui J,Ye LH, et al. Exploring a definition of healthy longevity in Chinese population based on Delphi method[J]. Chinese Journal of Preventive Medicine, 2024, 58(5): 629-635.] DOI: 10.3760/cma.j.cn112150-20230924-00220.

10.曾光. 现代流行病学方法与应用[M]. 北京: 北京医科大学、中国协和医科大学联合出版社, 1994. [Zeng G. Modern Epidemiological Methods and Applications[M]. Beijing: Beijing Medical University and Peking Union Medical College United Press, 1994.]

11.黄国鑫,曹启龙,陶华,等. 以临床问题解决效果为核心的骨科循证研究质量评价指标体系构建[J]. 数理医药学杂志, 2023, 36(9): 680-688. [Huang GX, Cao  QL, Tao  H, et al. Construction of an index system for evaluating the quality of orthopaedic evidence-based research centered on the effectiveness of clinical problem solving[J]. Journal of Mathematical Medicine, 2023, 36(9): 680-688.] DOI: 10.12173/j.issn.1004-4337.202309104.

12.吴洁琪,李晓荟,蒋理添,等. 基于德尔菲法及层次分析法构建免疫规划疫苗遴选评估框架[J]. 中国公共卫生, 2023, 39(8): 1038-1042. [Wu JQ, Li XH, Jiang LT, et  al. Establishment of an evaluation framework for selecting vaccines to be included into planned immunization of Shenzhen city using Delphi method and analytic hierarchy process[J]. Chinese Journal of Public Health, 2023, 39(8): 1038-1042.] DOI: 10.11847/zgggws1140362.

13.俞婧,罗佳,姚淑敏,等. 广泛性焦虑障碍认知行为治疗技术成分应用现状的专家德尔菲法调查[J]. 中华精神科杂志, 2024, 57(8): 502-511. [Yu J, Luo J, Yao SM, et al. The application status of cognitive behavioral therapy techniques for generalized anxiety disorder: a Delphi study[J]. Chinese Journal of Psychiatry, 2024, 57(8): 502-511.] DOI: 10.3760/cma.j.cn113661-20231030-00169.

14.张旭,宫雪,徐沙沙,等. 基于德尔菲法和层次分析法的中国助理全科医生岗位胜任力模型构建研究[J]. 中国全科医学, 2024, 27(31): 3946-3952. [Zhang X, Gong X, Xu SS, et al. Construction of competency model for Chinese assistant general practitioners based on Delphi and analytic hierarchy process[J]. Chinese General Practice, 2024, 27(31): 3946-3952.] DOI: 10.12114/j.issn.1007-9572.2023.0205.

15.Shrivastava B, Bajracharya O, Shakya R, et al. Prioritizing intervention measures to prevent inappropriate self-medication practices using the analytical hierarchy process[J]. Explor Res Clin Soc Pharm, 2022, 5: 100-117. DOI: 10.1016/j.rcsop.2022.100117.

16.张传文,朱羽硕,李坤,等. 基于层次分析法的高血压病肝阳上亢证疗效评价体系的构建[J]. 广州中医药大学学报, 2021, 38(6): 1077-1085. [Zhang CW, Zhu YS, Li K, et al. Establishment of the efficacy evaluation system for hypertension of liver-yang hyperactivity type by using analytic hierarchy process[J]. Journal of Guangzhou University of Traditional Chinese Medicine, 2021, 38(6): 1077-1085.] DOI: 10.13359/j.cnki.gzxbtcm.2021.06.001.

17.McPherson S, Reese C, Wendler MC. Methodology update: Delphi studies[J]. Nurs Res, 2018, 67(5): 404-410. DOI: 10.1097/NNR.0000000000000297.

18.Corvin JA, Chan I, Aguado Loi CX, et al. Analytic hierarchy process: an innovative technique for culturally tailoring evidence-based interventions to reduce health disparities[J]. Health Expect, 2021, 24 Suppl 1(Suppl 1): 70-81. DOI: 10.1111/hex.13022.

19.Cao B, Shao X, Xiao Y, et al. Potential biopsychosocial factors mediating/moderating the relationship between depressive symptoms and body size among children and adolescents: a systematic review[J]. Obes Rev, 2024, 25(1): e13645. DOI: 10.1111/obr.13645.

20.Garber J, Frankel SA, Herrington CG. Developmental demands of cognitive behavioral therapy for depression in children and adolescents: cognitive, social, and emotional processes[J]. Annu Rev Clin Psychol, 2016, 12: 181-216. DOI: 10.1146/annurev-clinpsy-032814-112836.

21.Kelly AS, Armstrong SC, Michalsky MP, et al. Obesity in adolescents: a review[J]. JAMA, 2024, 332(9): 738-748. DOI: 10.1001/jama.2024.11809.

22.Lytle LA, Pasch KE, Farbakhsh K. The relationship between sleep and weight in a sample of adolescents[J]. Obesity (Silver Spring), 2011, 19(2): 324-331. DOI: 10.1038/oby.2010.242.

23.Gouider R, Souissi A, Mrabet S, et al. Environmental factors related to multiple sclerosis progression[J]. J Neurol Sci, 2024, 464: 123161. DOI: 10.1016/j.jns.2024.123161.

24.米文芳,董强利,张兰. 青少年抑郁症认知功能损害及影响因素的研究进展[J]. 新医学, 2023, 54(1): 13-16. [Mi WF, Dong QL, Zhang L. Research progress on cognitive impairment and influencing factors in adolescents with depression[J]. New Medicine, 2023, 54(1): 13-16.] DOI: 10.3969/j.issn.0253-9802.2023.01.003.

25.徐洪吕, 陶芳标. 关注多民族青少年饮食行为与心理健康 [J]. 中国学校卫生, 2024, 45(2): 153-156, 167. [Xu  HL, Tao FB. Focus on the dietary behaviors and mental health among multi-ethnic adolescents[J]. Chinese Journal of School Health, 2024, 45(2): 153-156, 167.] DOI: 10.16835/j.cnki.1000-9817.2024047.

26.Jacques A, Chaya N, Beecher K, et al. The impact of sugar consumption on stress driven, emotional and addictive behaviors[J]. Neurosci Biobehav Rev, 2019, 103: 178-199. DOI: 10.1016/j.neubiorev.2019.05.021.

27.Itani O, Jike M, Watanabe N, et al. Short sleep duration and health outcomes: a systematic review, Meta-analysis, and Meta-regression[J]. Sleep Med, 2017, 32: 246-256. DOI: 10.1016/j.sleep.2016.08.006.

28.Tubbs AS, Khader W, Fernandez F, et al. The common denominators of sleep, obesity, and psychopathology[J]. Curr Opin Psychol, 2020, 34: 84-89. DOI: 10.1016/j.copsyc.2019.11.003.

29.Yasugaki S, Okamura H, Kaneko A, et al. Bidirectional relationship between sleep and depression[J]. Neurosci Res, 2025, 211: 57-64. DOI: 10.1016/j.neures.2023.04.006.

30.Matenchuk BA, Mandhane PJ, Kozyrsky AL, et al. Sleep, circadian rhythm, and gut microbiota[J]. Sleep Med Rev, 2020, 53: 101340. DOI: 10.1016/j.smrv.2020.101340.

31.梁果,王丽娟,周玉兰,等. 睡眠时长与中国6~19岁儿童青少年肥胖风险的关系: 基于系统综述与Meta分析[J]. 中国体育科技, 2023, 59(7): 61-70. [Liang G, Wang LJ, Zhou YL, et  al. The risk relationship between sleep duration and childhood obesity in Chinese children and adolescents aged 6 to 19: a systematic review and Meta-analysis[J]. China Sport Science and Technology, 2023, 59(7): 61-70.] DOI: 10.16470/j.csst.2021014.

32.刘松,柳鸣毅,敬艳. 多种运动方式对儿童青少年抑郁和焦虑干预效果的网状Meta分析[J]. 中国循证医学杂志, 2024, 24(8): 910-920. [Liu S, Liu MY, Jing Y. Intervention effects of multiple exercise methods on depression and anxiety in children and adolescents:a network Meta-analysis[J]. Chinese Journal of Evidence-Based Medicine, 2024, 24(8): 910-920.] DOI: 10.7507/1672-2531.202307091.

33.郁建华,由丽,王强,等. 有氧运动对青少年抑郁症患者心率变异性的影响及其临床意义[J]. 陕西师范大学学报(自然科学版), 2024, 52(6): 114-123. [Yu JH, You L, Wang Q, et al. The impact of aerobic exercise on heart rate variability in adolescents with depression and its clinical significance[J]. Journal of Shaanxi Normal University (Natural Science Edition), 2024, 52(6): 114-123.] DOI: 10.15983/j.cnki.jsnu.2024318.

34.冯连世,张漓,高炳宏,等. 不同环境下有氧运动对超重和肥胖青少年体重与体脂含量的影响[J]. 体育科学, 2013, 33(11): 58-65. [Feng LS, Zhang L, Gao BH, et al. Effects of aerobic exercise in different environments on body weight and body fat mass of obese and overweight adolescents[J]. China Sport Science, 2013, 33(11): 58-65.] DOI: 10.3969/j.issn.1000-677X.2013.11.007.

35.李春艳,封飞虎,熊晓玲,等. 运动与饮食干预诱导男性肥胖青少年的身体形态、身体成分及氧化应激的变化[J]. 武汉体育学院学报, 2016, 50(5): 90-95. [Li CY, Feng FH, Xiong XL, et al. Exercise coupled with dietary intervention in male obese adolescents[J]. Journal of Wuhan Institute of Physical Education, 2016, 50(5): 90-95.] DOI: 10.3969/j.issn.1000-520X.2016.05.015.

36.Kent ST, McClure LA, Crosson WL, et al. Effect of sunlight exposure on cognitive function among depressed and non-depressed participants: a REGARDS cross-sectional study[J]. Environ Health, 2009, 8: 34. DOI: 10.1186/1476-069X-8-34.

37.Irandoust K, Taheri M. The effect of vitamin D supplement and indoor vs outdoor physical activity on depression of obese depressed women[J]. Asian Journal of Sports Medicine, 2017, 8(3). DOI: 10.5812/asjsm.13311.

38.Herzer M, Zeller MH, Rausch JR, et al. Perceived social support and its association with obesity-specific health-related quality of life[J]. J Dev Behav Pediatr, 2011, 32(3): 188-195. DOI: 10.1097/DBP.0b013e318208f576.

39.傅兰英,王小引,王培勇,等. 青少年学生单纯性超重与肥胖的综合干预方法研究[J]. 中国体育科技, 2006, 42(2): 68-70. [Fu LY, Wang XY, Wang PY, et al. Study on comprehensive intervention therapy of simple obesity and overweight of young students[J]. China Sport Science and Technology, 2006, 42(2): 68-70.] DOI: 10.3969/j.issn.1002-9826.2006.02.019.

40.林涌超,郑名瀛,邹晔峰,等. 短程团体认知行为治疗联合计算机化认知行为治疗对青少年抑郁的改善作用[J]. 中外医疗, 2024, 43(3): 5-9. [Lin YC, Zheng MY, Zou YF, et al. Ameliorating effect of short-term group cognitive behavioral therapy combined with computerized cognitive behavioral therapy on adolescent depression[J]. China Foreign Medical Treatment, 2024, 43(3): 5-9.] DOI: 10.16662/j.cnki.1674-0742.2024.03.005.

41.Vogelzangs N, Beekman AT, Boelhouwer IG, et al. Metabolic depression: a chronic depressive subtype? Findings from the InCHIANTI study of older persons[J]. J Clin Psychiatry, 2011, 72(5): 598-604. DOI: 10.4088/JCP.10m06559.

42.Strawbridge R, Arnone D, Danese A, et al. Inflammation and clinical response to treatment in depression: a Meta-analysis[J]. Eur Neuropsychopharmacol, 2015, 25(10): 1532-1543. DOI: 10.1016/j.euroneuro.2015.06.007.

43.DiMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment: Meta-analysis of the effects of anxiety and depression on patient adherence[J]. Arch Intern Med, 2000, 160(14): 2101-2107. DOI: 10.1001/archinte.160.14.2101.

44.Cao B, Xu J, Li R, et al. Interventions targeting comorbid depression and overweight/obesity: a systematic review[J]. J Affect Disord, 2022, 314: 222-232. DOI: 10.1016/j.jad.2022.07.027.

45.Braet C, Tanghe A, Bode PD, et al. Inpatient treatment of obese children: a multicomponent programme without stringent calorie restriction[J]. Eur J Pediatr, 2003, 162(6): 391-396. DOI: 10.1007/s00431-003-1155-5.

46.傅兰英,刘小学,王小引,等. 超重与肥胖青少年减肥现状及干预效果研究[J]. 中国康复医学杂志, 2007, 22(1): 65-66. [Fu  LY, Liu XX, Wang XY, et al. Research on the current situation of weight loss and intervention effect in overweight and obese adolescents[J]. Chinese Journal of Rehabilitation Medicine, 2007, 22(1): 65-66.] DOI: 10.3969/j.issn.1001-1242.2007.01.007.