Introduction

Depressive symptoms and overweight or obesity (OWO) often co-occur among children and adolescents, extremely complicating the design of effective intervention strategies. However, few studies have developed predictive models for this comorbidity using longitudinal data.

Methods

This study used data from the China Family Panel Studies (2012–2022), including children and adolescents aged 10–19 years without comorbidity at baseline (in 2012). Comorbidity was defined as co-occurring depressive symptoms (the Center for Epidemiologic Studies Depression Scale, CES-D score ≥ 17) and OWO (for 10–17 years, OWO was defined by BMI z-score criteria; for 18–19 years, OWO was defined by BMI ≥24.0 kg/m2). We constructed five linear and non-linear predictive models using 22 pre-specified, evidence-based predictors covering behavioral, mental health, family, and early-life characteristics. We randomly split the data into a training set (80%) and a testing set (20%). Model performance was evaluated on the testing set using the Area Under the Receiver Operating Characteristic Curve (AUROC) and the Area Under the Precision-Recall Curve (AUPRC). We assessed predictor importance using model coefficients or permutation importance. Pre-specified subgroup analyses were conducted by gender, age, depression type, and baseline health status.

Results

A total of 8,227 children and adolescents were included, with an average age of 15.00±2.87 years, including 4,167 females (50.67%). Among the baseline healthy individuals, 4.03% developed comorbidity over an average of 8.26 years. The Cox Proportional Hazards Model performed best (AUROC=0.918, AUPRC=0.649). Important predictors included ever had OWO (HR = 33.181, 95% CI: 24.819–44.359), ever had depressive symptoms (HR = 16.785, 95% CI: 12.717–22.154), growth mindset (HR = 0.395, 95% CI: 0.200–0.781), personality traits with high emotional instability (HR = 2.468, 95% CI: 1.364–4.467), neglectful parenting style (HR = 0.541, 95% CI: 0.314–0.930) and age (HR = 1.690, 95% CI: 1.166–2.450). Subgroup analyses indicated that females, late adolescence, and the high negative symptoms groups exhibited a higher cumulative risk than the counterparts.

Conclusion

Ever had OWO, ever had depressive symptoms, low level of growth mindset, personality traits with high emotional instability, neglectful parenting style and older age are important predictors for the comorbidity of depressive symptoms and OWO among Chinese children and adolescents. These findings support early identification and targeted interventions to improve mental and physical health in this population.