Mental toughness and gender differences in adolescent depression: development of a predictive nomogram for early identification

Abstract

Objective: Adolescent depression is a significant global health concern, with prevalence rates rising alarmingly in recent years. This study aimed to investigate the relationship between mental toughness and depressive symptoms among adolescents, with a focus on gender differences and the development of a predictive tool. Methods: A total of 734 high school students (59.81% male, 40.19% female) from Wenzhou, China, participated in the study. Mental toughness was assessed using the brief mental health diathesis scale, while depressive symptoms were measured using the center for epidemiological studies depression scale. Multivariate logistic regression analysis was conducted to identify protective factors, and a nomogram was developed to predict the probability of depressive symptoms. Results: Self-confidence, optimism, social adaptation, physiological adaptation, and interpersonal adaptation (p < 0.001) were significant protective factors against depressive symptoms for both genders. Meta cognition emerged as a significant protective factor for females (OR = 0.33, p < 0.01) but not for males (OR = 0.97, p > 0.05). The developed nomogram demonstrated excellent predictive performance with an area under the curve (AUC) of 0.906 (95% CI: 0.887–0.929) and a concordance index (C-index) of 0.90. Conclusion: This study highlights the importance of mental toughness in mitigating adolescent depression and reveals that meta cognition is a gender-specific protective factor. The developed nomogram offers a practical tool for early identification of adolescents at risk of depression, potentially enabling more targeted interventions. These findings contribute to our understanding of adolescent mental health and provide valuable insights for developing gender-specific prevention and intervention strategies. The nomogram can be implemented by public health and education professionals as part of school-based mental health programs, allowing non-invasive and stigma-free early screening.