Objective  To explore impact factors of depression tendency among high school students for providing references to the development of relevant interventions in adolescents.

  Methods  The multicenter study was carried out in Hefei city of Gansu province and Hangzhou city of Zhejiang province from September 11, 2019 to December 31, 2020. First, on-site self-administered surveys were conducted among 6 197 students (13 – 18 years old) recruited from 16 high schools with multistage complex sampling; a self-designed questionnaire was used to collect demographic information; Symptom Check List-90 (SCL-90) and Beck′s Depression Inventory (BDI) were adopted for mental status assessment and depression tendency screening. Then, a 1 : 2 age-, gender- and class-matched case-control study was carried out in 296 students assessed as with depression tendency based on BDI scores and diagnostic consultation of three psychiatrists for each case and in 597 students with normal mental status and without psychiatric disease history matched to the cases. Univariate analysis and conditional multivariate logistic regression analysis were performed to examine impact factors of adolescents′ depression tendency.

  Results  The overall detection rate of depression tendency was 4.78% (95% confidence interval CI: 2.31% – 6.59%) among all the students surveyed. Totally 23 significant impact factors for depression tendency were identified with univariate analysis (P < 0.05). The results of conditional multivariate logistic regression analysis revealed following independent predictors of depression tendency for the adolescents: family history of mental illness (β = 0.9942, odds ratio OR = 3.59, 95% CI: 1.59 – 5.98), non-parental rearing (β = 0.2654, OR = 1.69, 95% CI: 1.14 – 2.95), being only child (β = 0.1359, OR = 1.31, 95% CI: 1.02 – 2.57), poor relationship with family members (β = 0.2885, OR = 1.76, 95% CI: 1.12 – 3.05), learning problems (β = 0.2305, OR = 1.51, 95% CI: 1.03 – 2.91), mental health education (β = – 0.2049, OR = 0.69, 95% CI: 0.24 – 0.96), interpersonal sensitivity factor score (β = 0.4621, OR = 2.21, 95% CI: 1.42 – 4.77), depression factor score (β = 1.2658, OR = 4.81, 95% CI: 2.01 – 7.05), anxious factor score (β = 0.3429, OR = 1.88, 95% CI: 1.16 – 3.84), hostile factor score (β = 0.2452, OR = 1.65, 95% CI: 1.09 – 3.06), horrible factor score (β = 0.2109, OR = 1.46, 95% CI: 1.08 – 2.94), and spirituality factor score (β = 0.4594, OR = 2.15, 95% CI: 1.24 – 3.89).

  Conclusion  The occurrence of depression tendency is influenced by multiple psychological, hereditary heredity, school and family environment factors among high school adolescents and surveillance for early detection and intervention on the mental health problem should be strengthened in the students.