Factors influencing person-centered care among nurses in long-term care hospitals in South Korea: a cross-sectional study.

The prevalence of depressive symptoms among Korean adolescents increased for both males (from 22.4% in 2021 to 24.2% in 2022) and females (from 31.4% in 2021 to 33.5% in 2022) []. Considering that depressive symptoms are a major psychological risk factor leading to suicide [], it is essential to identify the factors contributing to elevated levels of depressive symptoms in adolescents in order to reduce the risk of suicide among this population. During adolescence, individuals experience significant changes in social development and physical growth, leading to difficulties in emotional regulation and psychological distress []. Various personal, familial, and social factors contribute to depressive symptoms. High academic stress and low academic achievement in adolescents are associated with increased depression. Intimacy and attachment with peers, as well as maladaptive relationships with teachers, are also closely linked to depression []. Anxiety, another emotional difficulty faced by adolescents, is closely related to depression; it not only manifests, in severe cases, as problems such as interpersonal difficulties, delinquency, self-harm, and suicide [], but also has a direct positive effect on depression, indicating that higher levels of anxiety are associated with more severe depression []. In addition, higher levels of stress perception and greater experiences of loneliness are associated with more severe depressive symptoms, suggesting that adolescents who feel more stressed or isolated are at increased risk of depression []. In particular, Korean adolescents experience considerable psychological difficulties due to the university entrance exam–centered education system and the stress associated with college admissions. This situation is well reflected in the results of the 2020 Korean Youth Risk Behavior Web-based Survey (KYRBS), in which 34.2% of adolescents reported stress perception, 25.2% experienced depressive symptoms, and 10.9% had suicidal ideation []. KYRBS has been conducted annually since 2005 to assess the health behaviors of adolescents in Korea and to produce national health and health-related indicators. The survey targets students from the first year of middle school through the third year of high school nationwide, and covers a total of 106 items, including smoking, alcohol consumption, physical activity, and mental health []. Previous studies have shown that sleep patterns and quality are related to adolescent depression. A study of Australian adolescents reported that short sleep duration and poor subjective sleep quality mediated the relationship between age and depressive symptoms, suggesting that sleep-related developmental changes contribute to increased depression during adolescence []. Delayed sleep onset has also been identified as a risk factor for depressive symptoms in young people aged 12~25 years []. In Korean adolescents, these associations are particularly concerning given the intense academic environment. Supporting this, Shin [] reported that inadequate sleep duration was significantly associated with depressive symptoms.