青少年抑郁症心理干预时机与世界观、人生观和价值观重建的关联：一项回顾性队列研究

Abstract

Background:

Timely access to structured psycho-educational intervention is crucial for cognitive-motivational recovery in adolescents with depression, a population in a critical developmental stage of consolidating core belief systems. Drawing upon the theory of educational timing, the initiation of these interventions may represent a critical window for reshaping worldview, life perspective, and values. Therefore, this study aimed to examine the association between intervention timing and the reconstruction of these existential constructs, thereby providing an empirical basis for optimizing psycho-educational strategies in adolescent depression care.

Methods:

This retrospective cohort study included 244 adolescents with depressive disorder treated between January 2022 and December 2024. To operationalize the concept of “optimal educational timing,” the cohort was stratified based on intervention initiation: early intervention, defined as initiation of structured psycho-educational intervention within 14 days of the index clinical encounter, and delayed intervention, defined as initiation after 14 days. Outcomes were assessed using the Worldview, Life Perspective, and Values Reconstruction Questionnaire (WLVQ-22). Linear and logistic regression models were used to evaluate changes in WLVQ-22 scores and responder outcomes.

Results:

The cohort included 126 adolescents in the early-intervention group and 118 in the delayed-intervention group. Baseline WLVQ-22 scores were comparable between groups. After adjustment, early intervention initiation was associated with greater changes in worldview (β = 4.43, 95% confidence interval [CI]: 2.89 to 5.98; p < 0.001), life perspective (β = 3.93, 95% CI: 2.45 to 5.41; p < 0.001), and values total score (β = 2.07, 95% CI: 1.27 to 2.87; p < 0.001). Early intervention was also associated with higher odds of response for worldview (odds ratio [OR] = 2.96, 95% CI: 1.71 to 5.11), life perspective (OR = 2.51, 95% CI: 1.46 to 4.33), and values reconstruction (OR = 2.90, 95% CI: 1.37 to 6.13).

Conclusions:

Earlier initiation of structured psychological intervention was associated with more favorable short-term WLVQ-22-assessed reconstruction indicators in adolescents with depression. These findings highlight the need for prospective studies to further evaluate the role of intervention timing in adolescent depression care.

1 Introduction

Adolescent depression is a prevalent and clinically consequential condition that emerges during a developmental period characterized by rapid neurobiological maturation and the consolidation of identity, future orientation, and value systems (). Recent population-based evidence indicates increasing rates of clinically diagnosed depressive disorders among youth, underscoring an escalating service need and a persistent treatment gap (, ). Consistently, global public health reporting highlights that depression is among the leading causes of illness and disability in adolescence and that unmet mental health needs may confer long-term functional sequelae extending into adulthood (, ). Contemporary quantitative syntheses also suggest a substantial global burden of depressive symptoms and depression in children and adolescents, supporting the need for developmentally informed clinical strategies that address not only symptom reduction but also psychosocial and cognitive–motivational reconstruction (, ). Beyond core affective symptoms, adolescent depression is commonly accompanied by distortions in meaning-making and self-referential cognition, including pessimistic expectations, diminished goal-directedness, reduced perceived agency, and impaired future-oriented thinking (). These features may undermine the development of a coherent worldview, adaptive life perspective, and stable values during a period when these higher-order psychological systems are still being formed (). Future-related thinking has increasingly been recognized as a transdiagnostic process relevant to depressive psychopathology in young people, with systematic review-level evidence supporting its clinical salience (, ). Complementary work on meaning in life among adolescents further suggests that meaning-related profiles are associated with psychological vulnerability and resilience, providing a conceptual bridge between depressive symptoms and higher-order cognitive–motivational reconstruction targets (, ).

Evidence-based psychological treatments for adolescent depression include structured approaches that target maladaptive beliefs, interpersonal functioning, behavioral activation, value-consistent action, and psychological flexibility (). A growing literature supports acceptance- and values-oriented modalities, including meta-analytic evidence for acceptance and commitment therapy in adolescent depression (). In addition, scalable delivery models, including internet-based and digitally delivered psychological interventions, have demonstrated measurable benefits for depressive symptoms in young people and may help reduce access-related delays in treatment initiation (, ). Nevertheless, qualitative evidence indicates that delays in seeking and receiving care among adolescents with depression remain common and are shaped by stigma, limited symptom recognition, family-level barriers, and service accessibility constraints (). The timing of psychological intervention may be clinically relevant because earlier initiation could provide adolescents with structured support before maladaptive cognitive–emotional patterns, avoidance behaviors, and hopeless future expectations become more consolidated (). From a developmental perspective, timely psychological engagement may be particularly important for preserving agency, goal-directedness, interpersonal connection, and value-consistent behavior during adolescence ().

However, empirical evidence remains limited regarding whether earlier initiation of psychological intervention is associated with better reconstruction of worldview, life perspective, and values among adolescents with depression (). In routine clinical practice, the first two weeks after the index clinical encounter often represent a practical early-care window for diagnostic clarification, initial risk assessment, family communication, treatment planning, and psychotherapy scheduling (). To examine the robustness of this operational definition, alternative timing thresholds and continuous time-to-intervention analyses were also planned. This study aimed to examine the association between the timing of structured psychological intervention and WLVQ-22-assessed exploratory indicators of worldview, life perspective, and values reconstruction in adolescents with depression.

2 Methods

2.1 Study design

This retrospective cohort study consecutively included adolescents diagnosed with depressive disorder who received evaluation and treatment at our institution between January 2022 and December 2024. The index date was defined as the first outpatient or inpatient encounter for the current depressive episode during the study period. The exposure of interest was the timing of initiation of structured psychological intervention following the index date. Participants were classified into an early-intervention group (psychological intervention initiated within 14 days of the index date) and a delayed-intervention group (initiation >14 days). The 14-day threshold was selected a priori as a pragmatic operational definition of early initiation, reflecting the usual clinical interval required for diagnostic confirmation, initial treatment planning, family communication, and psychotherapy scheduling at our institution. This cutoff was not intended to represent a validated critical window for cognitive–motivational reconstruction. Psychological intervention referred to a standardized, therapist-delivered program documented in the medical record, such as cognitive behavioral therapy–based or other manualized psychotherapy, delivered in addition to usual clinical management as clinically indicated. Outcomes related to the reconstruction of worldview, life perspective, and values were extracted from structured clinical assessments performed at baseline, before intervention initiation, and at follow-up within a prespecified clinical window after intervention initiation. Because the WLVQ-22 has not been externally validated in independent adolescent depression cohorts, WLVQ-22-based outcomes were interpreted as exploratory reconstruction indicators rather than fully validated clinical endpoints. Informed consent was obtained from all participants or their legal guardians. The study was reviewed and approved by the hospital’s ethics committee and conducted in accordance with relevant guidelines and the Declaration of Helsinki. All data were anonymized prior to analysis to ensure participant confidentiality.

2.2 Eligibility criteria

Inclusion Criteria: Participants were eligible if they met all of the following criteria: (1) age 12–18 years at the index date; (2) a diagnosis of depressive disorder established by a qualified psychiatrist/psychologist based on routinely applied diagnostic criteria (e.g., DSM-5/ICD criteria documented in the medical record); (3) receipt of care at the study institution between January 2022 and December 2024 with a clearly defined index visit for the current episode; (4) initiation of a structured psychological intervention with a clearly recorded start date; (5) availability of baseline WLVQ-22 assessment data evaluating worldview, life perspective, and values, obtained prior to psychological intervention; and (6) availability of at least one post-intervention follow-up WLVQ-22 assessment within a prespecified clinical window sufficient for outcome evaluation.

Exclusion Criteria: Participants were excluded if any of the following applied: (1) comorbid bipolar disorder or psychotic disorder; (2) autism spectrum disorder with substantial functional impairment, or moderate-to-severe intellectual disability precluding reliable completion of assessments; (3) active substance use disorder during the observation period; (4) severe acute suicidal risk requiring emergency/crisis-only management such that structured psychological intervention initiation and follow-up assessment could not be defined; (5) major neurological disease, clinically significant cognitive impairment, or unstable medical illness affecting participation or assessment validity; (6) concurrent enrollment in interventional studies targeting psychological outcomes during the same episode; or (7) missing essential data, including unclear intervention timing, absent baseline WLVQ-22 measures, or unavailable outcome assessments required for primary analyses.

2.3 Outcome measures for worldview, life perspective, and values reconstruction

The WLVQ-22 was used as a structured clinical assessment tool to capture worldview, life perspective, and values-related reconstruction. Because the WLVQ-22 has not been externally validated in independent adolescent depression cohorts, WLVQ-22-based outcomes were interpreted as exploratory reconstruction indicators rather than externally validated clinical endpoints.

Worldview reconstruction: Worldview was measured at the index visit (baseline) and at the prespecified follow-up using the Worldview Reconstruction subscale of the Worldview, Life Perspective, and Values Reconstruction Questionnaire (WLVQ-22). This subscale comprises 5 self-report items rated over the past 2 weeks on a 5-point Likert scale (0–4); reverse-keyed items were recoded prior to scoring. Item content and coding rules are provided in Supplementary Table 1. The worldview total score was calculated as the mean of the 5 item scores and linearly transformed to a 0–100 metric using (mean item score/4) × 100, with higher scores indicating more adaptive worldview reconstruction. The primary worldview endpoint was the absolute change from baseline to follow-up (Δworldview = worldview_follow-up − worldview_baseline). Secondary worldview metrics included percent change (Δ%worldview = [Δworldview/worldview_baseline] × 100) and responder status, defined a priori as Δworldview ≥10 points.

Life perspective reconstruction: Life perspective was assessed at baseline and follow-up using the Life Perspective Reconstruction subscale of the WLVQ-22, consisting of 5 items with a 2-week recall period and uniform 0–4 response options; reverse-keyed items were recoded prior to score computation. The full item list is presented in Supplementary Table 2. The life perspective total score was computed as the mean of the 5 items and transformed to a 0–100 scale using (mean/4) × 100, where higher values indicate greater reconstruction of future orientation and life planning. The primary life perspective endpoint was the absolute change from baseline to follow-up (Δlife perspective = life perspective_follow-up − life perspective_baseline). Additional metrics included percent change (Δ%life perspective = [Δlife perspective/life perspective_baseline] × 100) and responder status, defined a priori as Δlife perspective ≥10 points.

Values reconstruction: Values reconstruction was evaluated at baseline and follow-up using the Values Reconstruction section of the WLVQ-22, a multidimensional module comprising 12 items across three predefined domains: responsibility, social connectedness, and self-efficacy (4 items per domain; 2-week recall; 0–4 response options). Reverse-keyed items were recoded prior to scoring, and item-level content and domain mapping are detailed in Supplementary Table 3. Each domain score was calculated as the mean of its four items and transformed to a 0–100 scale as (mean/4) × 100. A composite values score (values total) was calculated as the arithmetic mean of the three domain scores. The primary values endpoint was the absolute change in the composite score (Δvalues total = values total_follow-up − values total_baseline). Secondary values metrics included domain-specific absolute changes (Δresponsibility, Δsocial connectedness, and Δself-efficacy). Responder status was defined a priori as Δvalues total ≥10 points. An exploratory attainment indicator was also recorded as achieving a follow-up values total score ≥60.

2.4 Data collection

Demographic, clinical, treatment, and outcome data were retrospectively extracted from the institutional electronic medical record system and psychological counseling documentation for all eligible adolescents with depression treated between January 2022 and December 2024. Outcome assessments were conducted as part of routine clinical care and were not performed specifically for the present timing-based research hypothesis. At the time of routine assessment, assessors were not informed of the early- versus delayed-intervention grouping for the current analysis, and participants were not informed that intervention timing would be analyzed as a study exposure. At the index visit, defined as the first qualifying clinical encounter within the study window, age, sex, school grade/educational stage, family structure, and a family support indicator derived from intake interviews and caregiver reports were collected. Baseline clinical variables included depression severity assessed using a standardized depression rating scale routinely documented at intake, episode duration, first-episode versus recurrent status, comorbid anxiety based on a standardized anxiety scale score and/or clinician diagnosis, and sleep problems based on standardized sleep assessment and/or documented insomnia symptoms.

Treatment-related variables included concurrent pharmacotherapy, medication class recorded in prescribing notes, and follow-up duration, calculated from the index visit to the scheduled post-intervention reassessment. Exposure ascertainment focused on intervention timing, operationalized as time-to-intervention in days from the index visit to the first session of protocol-consistent psychological intervention. The primary grouping used the prespecified 14-day cutoff to define early versus delayed initiation.

WLVQ-22-based outcomes were abstracted from structured patient-reported or clinician-administered assessments completed at baseline and follow-up, capturing three prespecified constructs: worldview reconstruction, life perspective reconstruction, and values reconstruction. Change outcomes were calculated as absolute change, defined as follow-up minus baseline, and percent change relative to baseline. Responder status was defined a priori using prespecified improvement thresholds. Data extraction was conducted using a standardized case report form, and a subset of records underwent independent verification to minimize abstraction errors. All data were de-identified before analysis. Missingness in key exposure or outcome fields resulted in exclusion from the analytic cohort according to the predefined eligibility and case-completeness criteria.

2.5 Statistical analysis

All analyses were performed using IBM SPSS Statistics, version 26.0. Continuous variables were summarized as mean ± standard deviation or median with interquartile range, and categorical variables as counts and percentages. Between-group comparisons were conducted using the independent-samples t test, Mann–Whitney U test, chi-square test, or Fisher’s exact test, as appropriate. Baseline covariate balance was assessed using absolute standardized mean differences (SMDs), with values <0.10 considered acceptable. Changes in WLVQ-22 scores were calculated as follow-up minus baseline. Linear regression was used for continuous change outcomes, and logistic regression was used for responder outcomes. Estimates were reported as β coefficients or odds ratios (ORs) with 95% confidence intervals (CIs). Adjusted models included age, sex, baseline PHQ-9 score, episode duration, first-episode status, comorbid anxiety, sleep problems, concurrent pharmacotherapy, family structure/family support indicator, follow-up duration, and the corresponding baseline WLVQ score. Sensitivity analyses were performed using 7-day, 14-day, and 21-day intervention-timing cutoffs, follow-up restriction to 6–10 weeks, inverse probability of treatment weighting, propensity score matching, and continuous time-to-intervention modeled per 7-day delay. Covariate balance after propensity score adjustment was evaluated using SMDs. Exploratory psychometric analyses of the WLVQ-22 included Cronbach’s α, corrected item-total correlations, correlations with baseline PHQ-9 scores, and standardized response means. All tests were two-sided, with p < 0.05 considered statistically significant.

3 Results

3.1 Study flow and participant selection

This retrospective cohort study screened adolescents with depressive disorder using institutional electronic medical records and routine psychological assessment data from January 1, 2022 to December 31, 2024. A total of 257 patients were initially identified. After eligibility assessment, 13 patients were excluded because of missing key data, major psychiatric comorbidities, acute high suicide risk requiring crisis-only management, cognitive/developmental impairment, or severe medical conditions compromising assessment validity. The final analytic cohort included 244 adolescents, including 118 in the delayed-intervention group and 126 in the early-intervention group.

3.2 Baseline characteristics

Baseline demographic, clinical, and treatment-related characteristics are summarized in Table 1. The mean age was 14.57 ± 1.34 years in the delayed-intervention group and 14.90 ± 1.33 years in the early-intervention group (p = 0.052). No statistically significant between-group differences were observed for sex, school grade, family structure, PHQ-9 score, episode duration, first-episode status, comorbid anxiety, sleep problems, concomitant pharmacotherapy, medication class, fluoxetine-equivalent dose, or follow-up duration (all P > 0.05). However, several variables showed absolute standardized mean differences greater than 0.10, including age, sex, senior grade, family structure, first-episode status, sleep problems, medication class, and fluoxetine-equivalent dose. These variables were included or considered in the adjusted and propensity score-based analyses where applicable.

Table 1

Baseline demographic, clinical, and treatment characteristics of the study cohort.

3.3 Psychometric properties of the WLVQ-22

Exploratory psychometric analyses of the WLVQ-22 are presented in Supplementary Table 4. Internal consistency was acceptable for the worldview reconstruction subscale (Cronbach’s α = 0.84), life perspective reconstruction subscale (α = 0.86), values reconstruction total scale (α = 0.91), and WLVQ-22 total score (α = 0.93). Corrected item-total correlations ranged from 0.46 to 0.71 for worldview reconstruction, 0.49 to 0.74 for life perspective reconstruction, and 0.43 to 0.76 for values reconstruction. Baseline WLVQ-22 scores were negatively correlated with baseline PHQ-9 scores, with correlation coefficients ranging from −0.36 to −0.57 (all p < 0.001). Standardized response means ranged from 1.28 to 2.15 across WLVQ-22 domains, suggesting preliminary responsiveness to longitudinal change within the present cohort (Supplementary Table 4).

3.4 Worldview reconstruction outcomes

Worldview scores at baseline and follow-up are shown in Table 2. Baseline worldview scores did not differ significantly between the delayed- and early-intervention groups (46.9 ± 8.1 vs 48.2 ± 9.6; p = 0.278). At follow-up, the early-intervention group had higher worldview scores than the delayed-intervention group (61.2 ± 11.9 vs 55.7 ± 9.8; p < 0.001). Greater absolute and percent changes in worldview score were observed in the early-intervention group than in the delayed-intervention group (absolute change: 13.0 ± 6.3 vs 8.8 ± 5.8; p < 0.001; percent change: 28.1% ± 14.8% vs 19.4% ± 14.0%; p < 0.001). The proportion of worldview responders was higher in the early-intervention group than in the delayed-intervention group (66.7% vs 43.2%; p < 0.001) (Table 2).

Table 2

Worldview scores at baseline and follow-up, and change metrics by intervention timing group.

Δ, absolute change from baseline to follow-up; SD, standard deviation.

In regression analyses, the unadjusted between-group difference in Δworldview was 4.25 points (95% CI: 2.72 to 5.79; p < 0.001). After adjustment, early intervention initiation remained associated with greater Δworldview (β = 4.43, 95% CI: 2.89 to 5.98; p < 0.001). The adjusted odds ratio for worldview response was 2.96 (95% CI: 1.71 to 5.11; p < 0.001) (Table 3).

Table 3

Between-group differences in worldview improvement.

3.5 Life perspective reconstruction outcomes

Life perspective outcomes are summarized in Table 4. Baseline life perspective scores were similar between the delayed- and early-intervention groups (42.7 ± 7.8 vs 43.9 ± 9.3; p = 0.294). At follow-up, the early-intervention group had higher life perspective scores than the delayed-intervention group (55.1 ± 11.6 vs 50.2 ± 9.4; p < 0.001). Greater absolute and percent changes in life perspective score were observed in the early-intervention group than in the delayed-intervention group (absolute change: 11.2 ± 6.0 vs 7.5 ± 5.6; p < 0.001; percent change: 26.7% ± 15.8% vs 18.3% ± 14.8%; p < 0.001). The responder proportion was also higher in the early-intervention group (55.6% vs 36.4%; p = 0.003) (Table 4).

Table 4

Life perspective scores at baseline and follow-up, and change metrics by intervention timing group.

Δ, absolute change; SD, standard deviation.

3.6 Values reconstruction outcomes

Values reconstruction outcomes are presented in Table 5. Baseline scores for responsibility, social connectedness, self-efficacy, and total values score did not differ significantly between groups. At follow-up, the early-intervention group had a higher total values score than the delayed-intervention group (66.2 ± 7.1 vs 64.1 ± 7.2; p = 0.018). A greater increase in total values score was observed in the early-intervention group (9.3 ± 3.6 vs 6.8 ± 3.5; p < 0.001). Among the values domains, between-group differences in change were observed for social connectedness (11.0 ± 5.8 vs 7.0 ± 6.6; p < 0.001) and self-efficacy (8.9 ± 6.3 vs 6.5 ± 5.5; p = 0.002), but not for responsibility (7.8 ± 5.2 vs 6.9 ± 5.8; p = 0.172). The values responder proportion was higher in the early-intervention group than in the delayed-intervention group (44.4% vs 17.8%; p < 0.001). Attainment of a follow-up total values score ≥60 was 81.7% in the early-intervention group and 71.2% in the delayed-intervention group (p = 0.051) (Table 5).

Table 5

Values reconstruction dimension scores at baseline and follow-up, with between-group comparisons.

Δ, absolute change from baseline to follow-up; SD, standard deviation.

3.7 Adjusted associations between intervention timing and reconstruction outcomes

Table 6 summarizes the unadjusted and adjusted associations between intervention timing and the reconstruction outcomes. In linear regression models, early intervention initiation was associated with greater changes in worldview (adjusted β = 4.43, 95% CI: 2.89 to 5.98; p < 0.001), life perspective (adjusted β = 3.93, 95% CI: 2.45 to 5.41; p < 0.001), and values total score (adjusted β = 2.07, 95% CI: 1.27 to 2.87; p < 0.001). In logistic regression models, early intervention initiation was associated with higher odds of response for worldview (adjusted OR = 2.96, 95% CI: 1.71 to 5.11; p < 0.001), life perspective (adjusted OR = 2.51, 95% CI: 1.46 to 4.33; p < 0.001), and values reconstruction (adjusted OR = 2.90, 95% CI: 1.37 to 6.13; p = 0.005) (Table 6).

Table 6

Unadjusted and adjusted associations between intervention timing and outcome changes.

3.8 Sensitivity analyses

Sensitivity analyses are summarized in Table 7. Across the 7-, 14-, and 21-day cutoff definitions, earlier intervention initiation was associated with greater changes in worldview, life perspective, and values total scores. With the 7-day cutoff, the association with worldview responder status was attenuated and did not reach statistical significance (OR = 1.96, 95% CI: 0.98 to 3.90; p = 0.057), whereas continuous outcome changes remained statistically significant. Using the 14-day cutoff, the adjusted estimates were β = 4.43 for Δworldview, OR = 2.96 for worldview response, β = 3.93 for Δlife perspective, and β = 2.07 for Δvalues total. Using the 21-day cutoff, the corresponding estimates remained statistically significant for all listed outcomes (Table 7).

Table 7

Sensitivity analyses of the association between intervention timing and outcome changes.

For IPTW analyses, n refers to the original sample size before weighting. All sensitivity models were adjusted for age, sex, baseline PHQ-9 score, episode duration, first-episode status, comorbid anxiety, sleep problems, concurrent pharmacotherapy, family structure/family support indicator, follow-up duration, and the corresponding baseline WLVQ score.

After restricting the analysis to participants with follow-up duration within 6–10 weeks, the associations remained statistically significant for Δworldview (β = 5.00, 95% CI: 3.06 to 6.94; p < 0.001), worldview response (OR = 3.66, 95% CI: 1.87 to 7.18; p < 0.001), Δlife perspective (β = 3.91, 95% CI: 1.80 to 6.02; p < 0.001), and Δvalues total (β = 1.80, 95% CI: 0.83 to 2.77; p < 0.001). In IPTW and PSM analyses, the estimates were directionally consistent with those from the primary adjusted models. The maximum absolute SMD decreased from 0.247 before adjustment to 0.064 after IPTW and 0.085 after PSM, showing improved balance of measured covariates after propensity score adjustment (Supplementary Table 5).

In the continuous time-to-intervention analysis, each 7-day delay was associated with smaller changes in worldview (β = −1.32, 95% CI: −1.91 to −0.73; p < 0.001), life perspective (β = −1.14, 95% CI: −1.68 to −0.60; p < 0.001), and values total score (β = −0.58, 95% CI: −0.88 to −0.28; p < 0.001). Each 7-day delay was also associated with lower odds of response for worldview (OR = 0.76, 95% CI: 0.65 to 0.89; p = 0.001), life perspective (OR = 0.79, 95% CI: 0.68 to 0.92; p = 0.003), and values reconstruction (OR = 0.73, 95% CI: 0.59 to 0.91; p = 0.005) (Supplementary Table 6). These analyses describe observed associations in this retrospective cohort and should not be interpreted as evidence of causal effects.

4 Discussion

This retrospective cohort study provides real-world evidence that the timing of structured psychological intervention was associated with WLVQ-22-assessed reconstruction indicators in adolescents with depression. The novelty of this study lies in its focus on time-to-intervention as a clinically actionable service-delivery exposure, rather than only evaluating treatment type or symptom reduction. By examining worldview, life perspective, and values reconstruction, this study extends the outcome framework of adolescent depression beyond conventional affective symptom measures to exploratory cognitive–motivational and psychosocial domains. Earlier intervention initiation within a pragmatic 14-day clinical window was associated with greater improvements in worldview, life perspective, and values-related scores, and these associations were generally consistent across adjusted regression models, alternative timing thresholds, propensity score-based analyses, and continuous time-to-intervention analyses (). These findings suggest that reducing delays in psychological intervention may be relevant to adolescent care pathways, particularly during the early phase of diagnostic clarification, family communication, treatment planning, and psychotherapy scheduling (, ). However, given the retrospective observational design and the exploratory nature of WLVQ-22-based outcomes, these findings should be interpreted as hypothesis-generating associations rather than evidence of causal benefit.

The findings for worldview and life perspective reconstruction provide insight into the cognitive–motivational dimensions that may be associated with earlier psychological engagement. Although baseline scores were comparable between groups, adolescents in the early-intervention group had higher follow-up scores, larger absolute and percent changes, and higher responder proportions for both domains. After adjustment for baseline symptom severity, episode duration, comorbid anxiety, sleep problems, pharmacotherapy, follow-up duration, and corresponding baseline WLVQ-22 scores, early intervention initiation remained associated with greater changes in worldview and life perspective. This pattern suggests that earlier entry into structured psychological care may be linked to more favorable short-term changes in meaning-making, perceived agency, future orientation, and goal-directed thinking. These constructs are clinically relevant because adolescent depression often involves pessimistic expectations, reduced controllability beliefs, impaired planning, and difficulties integrating negative experiences into a coherent self-narrative. The responder analyses further indicate that the between-group differences were not limited to mean-score changes, but were also reflected in a higher proportion of adolescents reaching prespecified improvement thresholds. Therefore, the worldview and life perspective findings support the value of assessing recovery-related cognitive and motivational domains alongside depressive symptom severity in adolescent clinical care (, ).

The values reconstruction findings further suggest that values-related recovery may be multidimensional rather than uniform across domains. The early-intervention group showed a higher follow-up total values score, a larger increase in the composite values score, and a higher values responder proportion. However, domain-specific analyses showed that the between-group differences were mainly driven by social connectedness and self-efficacy, whereas responsibility did not differ significantly between groups. This pattern may indicate that interpersonal reconnection and perceived personal competence are more sensitive to early therapeutic engagement during short-term follow-up, while responsibility-related behaviors may depend more heavily on sustained behavioral reinforcement, family expectations, school participation, and longer-term functional recovery. The borderline difference in achieving a follow-up values total score ≥60 also suggests that change-based outcomes may be more responsive than absolute attainment thresholds over a relatively short observation period. In addition, the continuous time-to-intervention analysis showed that each 7-day delay was associated with smaller changes in worldview, life perspective, and values total scores, as well as lower odds of response. This gradient-like pattern supports the relevance of considering intervention timing as a continuous service-process indicator, rather than relying solely on a single early-versus-delayed cutoff.

The present findings are broadly consistent with contemporary guidance and evidence syntheses emphasizing timely access to evidence-based psychological care for youth depression. The 2023 AACAP Clinical Practice Guideline identifies psychotherapy, particularly cognitive-behavioral and interpersonal therapies, and SSRIs as evidence-supported treatment options, while also emphasizing comprehensive assessment and individualized care planning (, ). Although current guidelines do not define intervention timing as a primary therapeutic parameter, our study addresses a clinically relevant service-delivery question: whether earlier initiation of structured psychological intervention is associated with more favorable short-term functional–cognitive reconstruction outcomes under routine clinical conditions. This interpretation is also aligned with a recent systematic review showing that early intervention models for common youth mental health problems may improve access, experience, and outcomes, while emphasizing heterogeneity and the need for more robust controlled studies (). By focusing on time-to-intervention as the exposure, the present study extends prior work beyond treatment type and symptom reduction to WLVQ-22-assessed exploratory indicators of worldview, future orientation, and values-related reconstruction. This is clinically relevant given longitudinal evidence linking adolescent depressive symptoms to poorer psychosocial outcomes in young adulthood, including reduced social support (). Moreover, recent evidence updates and meta-analyses indicate that psychosocial interventions for adolescents can produce measurable, although often modest, improvements in depressive symptoms, particularly when delivered as targeted interventions by trained professionals (, ). Together, these findings support the relevance of timely entry into structured psychological care pathways while underscoring the need for prospective studies to evaluate intervention timing more directly ().

A cautious interpretation of these findings is that earlier psychological intervention may provide structured cognitive and interpersonal support during a developmental period when self-concept, future orientation, and value-related beliefs remain relatively malleable. From cognitive-behavioral and developmental perspectives, earlier engagement may be associated with earlier opportunities for cognitive restructuring, behavioral activation, problem-solving, interpersonal support, and values clarification, which may partly explain the more favorable WLVQ-22-assessed reconstruction indicators observed in the early-intervention group. The findings may also have implications for adolescents with co-occurring clinical concerns, as comorbid anxiety, sleep problems, and concurrent pharmacotherapy were considered in the adjusted analyses, and adolescents with depression often present with overlapping anxiety symptoms, sleep disturbance, interpersonal withdrawal, reduced agency, and functional difficulties. Improvements in worldview, life perspective, and values reconstruction may further reflect broader well-being-related domains, including perceived meaning, future orientation, social connectedness, responsibility, and self-efficacy (). However, because this study was retrospective and observational, these interpretations should be regarded as hypothesis-generating rather than mechanistic evidence, and broader psychological well-being was not directly measured using validated well-being or functional outcome scales.

Several limitations should be acknowledged. First, because this was a retrospective observational study, the observed associations cannot establish causality. Although adjusted regression models, IPTW, PSM, and sensitivity analyses were used to reduce measured confounding and showed generally consistent results, residual or unmeasured confounding may still have influenced both intervention timing and reconstruction outcomes. Second, exposure misclassification is possible if psychological intervention initiation dates were recorded inaccurately, and differences in treatment implementation may not have been fully captured by the timing variable alone. Third, the 14-day cutoff was selected as a pragmatic early-care definition rather than a validated critical window for cognitive–motivational reconstruction. The attenuated responder association under the stricter 7-day cutoff suggests possible threshold dependence, and future prospective studies should evaluate intervention timing both as a continuous exposure and across clinically meaningful time windows. Fourth, the WLVQ-22 has not been externally validated in independent adolescent depression cohorts. Although exploratory analyses in this cohort showed preliminary internal consistency, convergent validity, and responsiveness, WLVQ-22-based outcomes should be interpreted as exploratory reconstruction indicators rather than fully validated clinical endpoints. Fifth, the follow-up period captured only short-term reconstruction and may not reflect the durability of change. Longer-term studies are needed to determine whether timing-related differences persist over time. Sixth, generalizability is limited by the single-center design and the Chinese sociocultural and healthcare-system context, as worldview, life perspective, values reconstruction, psychotherapy access, and early-care pathways may vary across settings. Finally, multiple outcomes may increase the probability of chance findings, although the consistency across domains, adjusted models, and sensitivity analyses supports the robustness of the observed pattern. Future multicenter, cross-cultural, prospective studies using standardized follow-up schedules, blinded assessment where feasible, and externally validated instruments are warranted.

5 Conclusion

In adolescents with depression, both early- and delayed-intervention groups showed significant improvements in worldview, life perspective, and values reconstruction at follow-up. Earlier initiation was consistently associated with greater absolute and percent gains and higher responder rates. These associations persisted after multivariable adjustment and were generally robust across sensitivity analyses, suggesting the potential clinical relevance of reducing delays to structured psychological care while warranting confirmation in prospective studies.

Statements

Data availability statement

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Ethics statement

The studies involving humans were approved by the Ethics Committee of School of Marxism, Hunan College of Humanities, Science and Technology. The studies were conducted in accordance with the local legislation and institutional requirements. Written informed consent for participation in this study was provided by the participants’ legal guardians/next of kin. Written informed consent was obtained from the individual(s), and minor(s)’ legal guardian/next of kin, for the publication of any potentially identifiable images or data included in this article.

Author contributions

LC: Conceptualization, Project administration, Data curation, Writing – review & editing, Methodology, Investigation, Writing – original draft, Resources, Formal Analysis, Software.

Funding

The author(s) declared that financial support was not received for this work and/or its publication.

Conflict of interest

The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Keywords

adolescent depression, early intervention, life perspective, logistic regression, psychotherapy timing, values reconstruction, worldview reconstruction

Citation

Chen L (2026) Association between timing of psychological intervention and reconstruction of worldview, life perspective, and values in adolescents with depression. Front. Psychiatry 17:1786690. doi: 10.3389/fpsyt.2026.1786690

Received

13 January 2026

Revised

06 July 2026

Accepted

06 July 2026

Published

05 October 2026

Volume

17 - 2026

Updates

Copyright

© 2026 Chen.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Lin Chen, linchen_research@outlook.com

Disclaimer

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.