Severity profiles of co-occurring depressive and anxiety symptoms in adolescents: The indirect role of emotion dysregulation.

BACKGROUND: Co-occurring depressive and anxiety symptoms in adolescents are associated with functional impairment. However, few studies have examined how family functioning, peer problems, emotion dysregulation, and mental health knowledge relate to the severity profiles of these symptoms. METHODS: A total of 3981 adolescents completed the PHQ-9, GAD-7, DERS-16, APGAR, SDQ peer-problems subscale, and a mental health knowledge questionnaire. Latent profile analysis identified symptom severity profiles. R3STEP and BCH procedures, adjusted for school-level clustering, examined predictors and distal outcomes. Multi-group analyses tested cross-sectional indirect associations through emotion dysregulation. RESULTS: Three severity profiles of co-occurring depressive and anxiety symptoms were identified (entropy = 0.945): low/no (64.48%), moderate (29.29%), and severe (6.23%). The severe profile showed the lowest family functioning and mental health knowledge, more peer problems than the low/no profile, and the greatest emotion dysregulation. Family functioning showed negative indirect associations with depressive and anxiety symptoms through emotion dysregulation in the low/no and moderate profiles (all p < 0.001), and with depressive symptoms only in the severe profile (B = -0.148, p = 0.018). Peer problems showed significant indirect associations in the low/no profile for both outcomes (p = 0.003) and in the severe profile for depressive symptoms only (B = 0.196, p = 0.005), but not in the moderate profile. CONCLUSIONS: Emotion dysregulation was consistently involved in the cross-sectional indirect associations between family and peer factors and depressive and anxiety symptoms. These findings provide preliminary evidence for emotion-regulation-focused, stratified interventions for adolescents in Huangpu District, Shanghai, pending longitudinal confirmation.