This study explores the specific impacts of screen activities on adolescent depressive symptoms, and the moderating role of parental phubbing, further examining the association between social media addiction (SMA) and depressive symptoms. A cross-sectional study using self-reported questionnaires was conducted among primary and high school students in Shenzhen, China. Linear mixed models (LMMs), interaction and simple slope analyses, network analysis, and the network comparison test (NCT) were adopted. A total of 3658 participants (mean age: 12.71 ± 2.95 years; 56.15% male) were included. LMMs indicated that short-form video (β = 0.05, 95% CI [0.03, 0.06]) and social media use (β = 0.06, 95% CI [0.04, 0.07]) were significantly associated with depressive symptoms, as was SMA (β = 0.17, 95% CI [0.15, 0.18]). A significant moderating role of parental phubbing was found (short-form video: β = 0.03, 95% CI [0.02, 0.05]; social media use: β = 0.02, 95% CI [0.01, 0.04]; SMA: β = 0.04, 95% CI [0.02, 0.06]), indicating that these associations were significantly stronger under higher levels of parental phubbing. At the symptom level, a network analysis of SMA and depressive symptoms identified “fatigue” and “feeling depressed” as core symptoms, while “mood modification” and “withdrawal” as critical bridge symptoms. Furthermore, the NCT revealed significant structural differences in the symptom comorbidity network between different levels of parental phubbing. Interventions should prioritize fostering a responsive family digital environment. Furthermore, specific symptoms identified in the network analysis offer exploratory targets warranting future validation.

Tumor necrosis factor-alpha (TNF-α) is a key mediator in the inflammatory mechanisms of depression, yet its peripheral levels and contributors remain unclear in patients with depression without comorbid physical diseases. This study aimed to compare peripheral TNF-α levels between healthy controls and individuals with depression without physical diseases, and to investigate the associations of stressful life events and modifiable lifestyle factors with peripheral TNF-α levels. Participants were derived from the Depression Cohort in China study. Adults aged 18–65 years were included in the study. Participants included healthy controls and individuals with subthreshold depressive symptoms (SDS) or major depressive disorder (MDD), all of whom were free of physical diseases. Peripheral TNF-α was measured by ELISA. Stressful life events and lifestyle factors were assessed using questionnaires. General linear models were used to assess the associations of stressful life events and lifestyle factors with TNF-α. Dominance analysis was used to rank the relative importance of predictors, and Blinder–Oaxaca decomposition was used to quantify the extent to which these factors statistically explained the TNF-α difference between healthy controls and individuals with depression. A total of 414 physically healthy adults were recruited, including 154 healthy controls and 260 individuals with depression. Among those with depression, 185 had SDS and 75 had MDD. Compared with healthy controls, peripheral TNF-α was mildly but significantly elevated in SDS (Cliff’s delta = 0.293, P < 0.001), and MDD (Cliff’s delta = 0.261, P < 0.01). Multivariate general linear model found that smoking in the past month (β = 2.15, P = 0.003), sleep duration < 6 h per day (β = 1.95, P = 0.004), and experience ≥ 3 stressful life events (β = 3.14, P = 0.001) were significantly contributed to the total variance of peripheral TNF-α in all participants. Blinder–Oaxaca decomposition indicated that 44.7

OBJECTIVES:The rise in television and digital media use among adolescents has become a major concern, but the impacts of specific types of screen exposure on mental health remain underexplored. This study examined whether specific types of screen exposure are associated with emotional and behavioral problems (EBPs), and whether individual, family, and school factors moderate these associations. STUDY DESIGN:Longitudinal study. METHODS:Participants (N = 10,770; mean age 15.89 years, 51.6 % male) completed standardized questionnaires at baseline and follow-up. EBPs were measured using the Strengths and Difficulties Questionnaire, and screen exposure and contextual factors were collected via self-report questionnaires. Generalized linear mixed-effects models, restricted cubic splines, interaction analyses, and sensitivity analyses were conducted. RESULTS:Specific screen types use, particularly educational apps and shopping/food delivery app exposures, were associated with increased total EBP difficulties. Each additional hour of social networking (OR, 1.04; 95 % CI, 1.01-1.07), short video viewing (OR, 1.05; 95 % CI, 1.01-1.09), or video gaming (OR, 1.06; 95 % CI, 1.01-1.10) was associated with an elevated risk of emotional symptoms. Short videos and video games were also associated with greater hyperactivity/inattention. Moderation analyses showed father's education, academic achievement, health status, and family function significantly modified these associations (e.g., family function × short video use: ORinteraction = 0.89, Pinteraction = 0.014). CONCLUSIONS:These findings highlight the differential impacts of screen exposure types on adolescent mental health and underscore the importance of addressing specific screen behaviors while considering individual, family, and school characteristics that may modify these risks, although the study's observational design limits causal inference.

A large-scale school-based trial in China demonstrates that brief, culturally adapted training equips teachers to act as effective gatekeepers for youth suicide prevention by reducing stigma and enhancing willingness to intervene.

Childhood maltreatment has been associated with an increased risk of irritable bowel syndrome (IBS) in adulthood, but the longitudinal relationship and underlying mechanisms remain underexplored. Using data from the UK Biobank, this cohort study investigated the association between childhood maltreatment and the onset of IBS in adulthood and explored potential mediating pathways. A total of 108,365 participants (mean age: 34.57 [SD: 4.81] years; 57.2% were female) were followed up from age 30 onwards (or January 1, 1985, whichever was later) until the first IBS diagnosis, death, or the end of follow-up, whichever occurred first. Childhood maltreatment was assessed through self-reported data, and incident IBS cases were identified using ICD-10 codes, with subtypes classified by Rome III criteria. Cox proportional hazards, sequential mediation analyses, and multinomial logistic regression were performed. Over a mean follow-up of 35.6 years, 5806 incident IBS cases were recorded. A positive association was observed between cumulative childhood maltreatment and incident IBS (HR: 1.10; 95% CI: 1.07-1.12). Among individual maltreatment types, emotional neglect showed the strongest association with IBS (HR: 1.27; 95% CI: 1.20-1.35). Sequential mediation analyses indicated that psychological adversity accounted for the largest proportion of the indirect effect (15.3%-17.0%), followed by socioeconomic status, lifestyle behaviours, and biological alterations. These findings emphasise the need for prevention strategies to reduce childhood maltreatment and mitigate its long-term health impacts. Tailored interventions focussing on psychosocial support, addressing socioeconomic disparities, and promoting healthy lifestyle changes may further reduce IBS risk in affected individuals.

BACKGROUND:Internet-based cognitive behavioral therapy (ICBT) is a promising intervention for major depressive disorder (MDD) at an aggregated level. However, few studies have investigated the relapse rate and factors predicting risk for relapse following successful ICBT. OBJECTIVES:To examine the relapse rate after ICBT for MDD and identify predictors of time-to-relapse. METHODS:A secondary analysis of a randomized controlled trial was conducted. Participants who remitted after the course were included. The relapse rate was calculated by the Kaplan-Meier method. The Cox proportional hazard model was adopted to investigate the potential associated factors. RESULTS:In total, 83 participants were eligible. The relapse rate was 37.1% within 12 months, with the majority occurring after 6 months. Participants with a history of childhood maltreatment (Hazard ratio, HR = 14.001, p = 0.019), experiencing more adverse life events (HR = 1.331, p = 0.003), and not seeking mental healthcare services when needed at follow-up (HR = 5.114, p = 0.049) were more likely to relapse, while for those conscientiously completing the intervention, a lower risk was found (HR = 0.386, p = 0.039). CONCLUSION:Structured relapse prevention strategies are necessary, especially for those with childhood maltreatment experience and undergoing more adverse life events. Emphasis should be put on conscientiously completing therapeutic courses and promptly seeking mental healthcare services when needed.

Purpose:Cognitive decline in middle-aged and older adults globally is a pressing health concern, linked to two significant factors: cardiometabolic multimorbidity (CMM) and depressive symptoms. This study aimed to investigate the independent, joint, and interactive effects of CMM and depressive symptoms on cognitive function in Chinese middle-aged and older adults. Patients and Methods:A total of 341 middle-aged and older adults were enrolled from the memory clinic at Qianhai Shekou Free Trade Zone Hospital in Shenzhen between May 2022 and June 2025 for this cross-sectional study. A composite z-score, computed based on performance on the Trail Making Test-A (TMT-A), Trail Making Test-B (TMT-B), and Animal Verbal Fluency Test (AFT), served as the measure of global cognition. CMM describes a constellation of at least two cardiometabolic diseases, including diabetes, stroke, and heart disease. Assessment of depressive symptoms was conducted using the Center for Epidemiological Studies-Depression Scale (CES-D). Linear regression was used. Results:This study enrolled 341 individuals over 45 years of age. The sample had a mean age of 62.4 years (SD 9.1), and 52.8% were male. A significant link was observed between CMM and lower global cognitive scores (β= -0.37, 95% CI = -0.57 to -0.17). A higher number of CMDs was positively associated with the severity of cognitive impairment (β=-1.08, 95% CI=-0.28 to -0.08). Depressive symptoms were inversely associated with cognitive scores (β=-0.66, 95% CI=-1.03 to -0.30). Participants with co-existing CMM and depressive symptoms exhibited the lowest cognitive scores (β=-1.31, 95% CI=-2.11 to -0.52) relative to those without either condition. This pattern remained consistent in all subgroups. Conclusion:In this cross-sectional study, the association between co-existing CMM and depressive symptoms and poorer cognitive function highlights the need for integrated management of physical and mental health to preserve cognition in Chinese middle-aged and older adults.

PURPOSE:This study aimed to investigate the efficacy and safety of short-term high- and moderate-intensity interval training (HIIT and MIIT) in high-risk patients with cardiovascular disease (CVD). METHODS:We retrospectively recruited 161 high-risk patients with CVD that completed 4 weeks of exercise training in a cardiac rehabilitation clinic between February 2021 and June 2023; 80 patients underwent HIIT, and 81 underwent MIIT. The MIIT contained 4 sets×8 minutes at a rating of perceived exertion of 12 to 14 on the Borg scale of 6 to 20 with 2 minutes of rest between sets. The HIIT consisted of 20 cycles × 30 seconds at a rating of perceived exertion of 15 to 17 with 30 seconds of rest between cycles. RESULTS:The median age was 54 years, and 65% were male. After 4 weeks, mean peak oxygen uptake ( ), at the anaerobic threshold, and oxygen pulse in HIIT versus MIIT increased by 2.6 versus 2.8 mL/kg/min, 1.7 versus 1.8 mL/kg/min, and 1.2 versus 0.9 mL/beat, respectively ( P < .001). The resting systolic and diastolic blood pressures both decreased after HIIT and MIIT (all P < .05). Few exercise-related mild adverse events (<1%) occurred during HIIT and MIIT, and compliance did not differ between groups ( P = .779). CONCLUSIONS:Our findings suggested that both HIIT and MIIT demonstrated improvements in , at anaerobic threshold, and oxygen pulse as well as reductions in blood pressure after 4 weeks of exercise training. No serious cardiac events occurred during the exercise training. Both HIIT and MIIT can be considered efficient and safe therapeutic methods for high-risk patients with CVD.

To investigate 3-year dynamic changes in relative peripheral refraction (RPR) and their association with axial elongation and myopia progression stages in children. A total of 564 children (mean age 9.22 ± 0.59 years; 51.1

Purpose:To evaluate whether biological sex modifies the association between perioperative rehabilitation and short-term postoperative pulmonary outcomes in patients undergoing cardiac valve surgery. Patients and Methods:This prespecified subgroup analysis was based on the PORT randomized controlled trial, a single-center prospective study including 818 adults undergoing elective valve surgery. Patients were randomized to usual care or additional perioperative rehabilitation. Usual care followed standard institutional protocols without structured therapist-led rehabilitation. The intervention group received a supervised program including patient education, inspiratory muscle training, active cycle of breathing techniques, and early mobilization from admission to discharge. The primary endpoint was a composite of in-hospital mortality, postoperative pulmonary complications (PPCs), and prolonged hospitalization (>7 days). Key secondary endpoints were radiologically confirmed pneumonia and pneumothorax within 7 days and before discharge. Sex-stratified multivariable Cox models were used to estimate adjusted hazard ratios (HRs), adjusting for age, body mass index, left ventricular ejection fraction category, Global Initiative for Chronic Obstructive Lung Disease category, hypertension, and smoking history. Results:Perioperative rehabilitation was not associated with a significant reduction in the primary composite outcome in either sex. Among female patients, it was associated with lower risks of PPCs (adjusted HR 0.55, 95% CI 0.36-0.83; P = 0.005) and pneumonia (adjusted HR 0.48, 95% CI 0.33-0.70; P < 0.001), with a lower risk of pneumothorax also observed (adjusted HR 0.40, 95% CI 0.17-0.99; P = 0.047). No significant associations were observed in male patients. A significant sex-by-treatment interaction was identified for pneumonia (P for interaction = 0.041). Conclusion:Perioperative rehabilitation was associated with improved short-term pulmonary outcomes in female patients, particularly for pneumonia, whereas no significant benefit was observed in males. These findings suggest a potential sex-specific response, which requires confirmation in future multicenter studies.

Social isolation and loneliness are increasingly recognized as key social determinants of mental health. This study aimed to investigate their roles in the onset and progression of depression and anxiety. In this cohort study, we included 445,678 participants free of depression or anxiety at baseline. Social isolation and loneliness were assessed using validated questionnaires, and mental health outcomes were ascertained through hospital records. Multistate Markov models estimated associations of social isolation and loneliness with transitions from baseline to incident depression or anxiety and subsequently to comorbidity. Exploratory mediation analyses examined the role of peripheral immune biomarkers, and exploratory partial correlation analyses investigated associations with brain structural volumes. Participants had a mean (SD) age of 56.6 (8.1) years, and 208,845 (46.9%) were male. Both social isolation and loneliness were linked to higher risks of depression, anxiety, and progression to comorbidity, with loneliness showing consistently stronger associations. Loneliness more than doubled the risk of first-onset depression (HR, 2.10; 95% CI, 1.99-2.23). Mediation analyses indicated that C-reactive protein, white blood cell count, neutrophils, and platelets partially explained a small proportion of these associations. Exploratory correlation analyses identified modest associations between social isolation, loneliness, and brain structures. These findings suggest that social isolation and loneliness contribute not only to the onset of depression and anxiety but also to their progression toward comorbidity. Interventions targeting subjective loneliness and objective social isolation may help reduce the burden. Peripheral immune biomarkers and brain structural alterations may warrant future investigation as potential biological correlates of these associations.

OBJECTIVES:Depressive symptoms are common in adolescents and can be divided into cognitive-affective and somatic dimensions. Sleep disturbance has been consistently associated with depressive symptoms. However, few studies have examined whether its associations differ across symptom dimensions or whether body mass index moderates these links. This study aimed to investigate the longitudinal associations between sleep disturbance and subsequent depressive symptom dimensions and to explore the moderating effect of body mass index. METHODS:A total of 9726 adolescents who completed standardized questionnaires and physical examinations at both baseline and follow-up were included. Sleep disturbance, body mass index, and covariates were assessed at baseline. Depressive symptoms were measured at baseline and follow-up using the 9-item Patient Health Questionnaire (PHQ-9) and categorized into cognitive-affective and somatic domains. Mixed linear regression models, interaction analyses, and subgroup analyses were used to examine the associations. RESULTS:After adjusting for covariates and baseline depressive symptoms, adolescents with sleep disturbance had significantly higher scores for overall (β = 1.51; 95% CI, 1.28-1.75), cognitive-affective (β = 0.53; 95% CI, 0.42-0.64), and somatic (β = 0.99; 95% CI, 0.85-1.13) depressive symptoms, compared with those without sleep disturbance. A modest positive interaction between sleep disturbance and body mass index was observed for somatic symptoms (β = 0.01; 95% CI, 0.001-0.01), but not for cognitive-affective or overall depressive symptoms. Stratified analyses showed a slightly higher β-estimate among adolescents with obesity than those without (β = 1.06; 95% CI, 0.57-1.56). CONCLUSIONS:These findings highlight the relevance of sleep disturbance and body mass index in relation to dimension-specific depressive symptoms among adolescents.

Previous studies have suggested an association between certain allergic diseases and school bullying among children. However, there is still a lack of population-based evidence concerning any allergic disease, especially among East Asian populations. This observational study aimed to examine the association between childhood allergic diseases and school bullying. A school-based cross-sectional study was conducted among 3114 students from primary and secondary schools in Longhua district, Shenzhen, China. Data on physician-diagnosed allergic disease and school bullying among children were collected via self-administered structured questionnaires. Multivariable logistic regression models were used to estimate odds ratios (ORs) and 95

Objective Depressive symptoms, problematic internet use (PIU), and suicidal behaviors are common, severe, and interrelated mental health challenges among adolescents, while social support has been reported as a protective factor. However, few studies have examined their symptom-level interactions or identified which symptoms are most directly linked to suicidal behaviors. This study aimed to construct a symptom-level network of depressive symptoms, PIU, and social support, and to identify key symptoms associated with suicidal behaviors in Chinese adolescents. Methods Data were drawn from 85,386 Chinese adolescents (mean age 14.95 years) who completed assessments of depressive symptoms, PIU, social support, and suicidal behaviors (i.e., suicidal ideation and suicide attempts). The ggmModSelect algorithm was used to establish the network structure and identify central and bridge symptoms, and flow networks were used to identify symptoms most directly associated with suicidal behaviors. Results The prevalence of suicidal ideation and suicide attempts was 17.9% and 5.3%, respectively. Social support was negatively associated with depressive symptoms and PIU. In the network, “depressive affect” and “withdrawal and social problems” were the most central symptoms, while “reality substitute” and “time management and performance” emerged as key bridge symptoms. “Depressive affect” and “interpersonal problems” were most strongly linked to suicidal ideation and suicide attempts, and “objective support” showed direct negative associations. Conclusions The identified central and bridge symptoms can be prioritized to disrupt the network underlying suicidal behaviors. Targeting these symptoms, together with enhancing social support, may effectively prevent adolescent suicidal behaviors and reduce co-occurring psychological problems.

BACKGROUND:The longitudinal associations between multidimensional sleep traits, distinct types of screen time, and emotional and behavioral problems (EBPs) in adolescents remain inadequately understood, with traditional analytical methods struggling to capture their directional, symptom-level dynamics. METHODS:This longitudinal study included 4,800 Chinese adolescents (57.2% female; mean [SD] age, 15.84 [0.57] years) who completed baseline and 6-month follow-up surveys. Sleep traits, screen use, and EBPs were assessed using validated scales. A cross-lagged panel network (CLPN) model was employed to map directional predictive pathways, with centrality analyses (out-expected influence [OEI], in-expected influence [IEI], and bridge expected influence [BEI]) identifying core and bridge symptoms. Gender-specific subgroup networks were also estimated and compared. RESULTS:EBPs demonstrated high temporal stability and dense internal connectivity, with "hyperactivity" (HA) and "emotional symptoms" (ES) serving as central nodes. Prosocial behaviors (PB) negatively predicted subsequent HA. Bridge pathways indicated that daytime dysfunction (DDF) and sleep disturbance (SDT) predicted subsequent ES and HA. Bidirectional associations were observed between HA and playing video games. Centrality analyses showed that ES, HA, DDF, and SDT were influential nodes with high OEIs and BEIs. Gender-specific networks were highly correlated (Pearson's r = 0.733). CONCLUSIONS:ES and HA were central in the short-term longitudinal network linking sleep traits, screen use, and EBPs. Sleep-related problems, particularly DDF and SDT, emerged as key bridging symptoms connecting sleep and EBPs and may precede maladaptive screen use. These findings highlight potential targets for strategies for early identification and intervention to disrupt self-reinforcing cycles of adolescent EBPs.

Introduction Acute decompensated heart failure (ADHF) is associated with high mortality rates and significant decline in physical function following hospitalisation. Although exercise-based cardiac rehabilitation is recognised as a key component of comprehensive heart failure management, clinical evidence supporting its application in patients with ADHF remains limited. The trial aims to evaluate the efficacy and safety of an early initiated comprehensive rehabilitation in patients with ADHF.Methods and analysis This is a prospective, multicentre, randomised, open-label, parallel-group clinical trial. A total of 140 patients hospitalised with ADHF will be enrolled and randomised in a 1:1 ratio to receive either comprehensive rehabilitation intervention or attention control. The intervention group will receive a supervised, 6-week structured comprehensive rehabilitation programme consisting of progressive balance, endurance, strength and inspiratory muscle training. Rehabilitation therapy commences after admission and continues into the outpatient period with a total of 18 sessions. The control group will receive standard usual care supplemented by fortnightly non-rehabilitation-related contact from study personnel to control for attention. Coprimary outcomes are changes in the Kansas City Cardiomyopathy Questionnaire Overall Summary Score and in maximum inspiratory pressure expressed as a percentage of predicted value (PImax%pred) at 6 weeks postrandomisation. Secondary outcomes include changes in the Short Physical Performance Battery score, frailty phenotype, pulmonary function tests and 6-month all-cause rehospitalisation.Ethics and dissemination The Early Comprehensive Rehabilitation in patients with ADHF (EACH-ADHF) trial was granted by the Medical Research Ethics Committee of Guangdong Provincial People’s Hospital (KY-Q-2022-487). Findings will be disseminated to patients, clinicians and commissioning groups through peer-reviewed publication.Trial registration number NCT06161987.

Background Venous thromboembolism (VTE) is a leading cardiovascular disease with substantial burden, yet the association between cardiorespiratory fitness (CRF) and VTE risk remains inconclusive. Objectives This study is aimed to investigate the association of CRF with incident VTE, and quantify the mediating effects of circulating biomarkers. Methods A total of 63,755 participants from the UK Biobank without prior VTE were included. CRF was estimated using a submaximal cycle ergometer test and classified into low (<20th percentile), moderate (20th-60th percentile), and high (>60th percentile) categories, standardized by sex and 10-year age groups. VTE was ascertained through linkage to national health records. Cox proportional hazards models adjusted for potential confounders were used to estimate hazard ratios (HRs) and 95% CIs. Polygenic risk scores for VTE were categorized into low, middle, and high tertiles. Mediation analyses were performed to assess the contribution of circulating biomarkers. Results During a median follow-up of 12.5 years, 1744 incident VTE cases were documented. Each 1-metabolic equivalents increment in CRF was associated with an 8% lower VTE risk (HR 0.92, 95% CI 0.89-0.95). Compared with low CRF, high CRF was associated with a 27% lower risk (HR 0.73, 95% CI 0.63-0.84). The inverse association was consistently observed across all genetic risk strata. C-reactive protein, alkaline phosphatase, gamma-glutamyl transferase, cystatin C, and creatinine were estimated to account for 21.5% of this association. Conclusion Higher CRF is associated with a lower VTE risk, regardless of genetic susceptibility. Inflammation, hepatobiliary enzymes, and renal function markers may account for a portion of this association.

OBJECTIVES:We examined associations between healthy sleep patterns and incident depression, accounting for genetic susceptibility, identified related plasma proteins and their mediating role, and explored associations with brain structure. METHODS:Among 39,702 depression-free UK Biobank participants, five healthy sleep factors, plasma proteomic profiles, polygenic risk scores (PRS) for depression, brain imaging, and covariates were assessed. Linear and LASSO regression identified sleep-associated proteins and constructed proteomic signatures. Cox proportional hazards models examined associations of sleep patterns and proteomic signatures with incident depression, adjusting for genetic susceptibility. Mediation analysis and brain structure correlations were also assessed. RESULTS:During a median follow-up of 14.5 years, 1,941 participants developed depression. After adjustment for covariates and PRS, higher overall healthy sleep pattern scores showed a dose-dependent reduced risk of depression (HR per 1-score increment = 0.81; 95% CI: 0.77-0.85). We identified 496 proteins linked to healthy sleep patterns and derived a composite signature of 181 proteins. This signature was inversely associated with depression risk across PRS groups, and mediated 15.8% of the sleep-depression association. The proteomic signature correlated with emotion regulation brain regions. CONCLUSIONS:Healthy sleep patterns and their plasma proteomic signature are associated with reduced depression risk, highlighting targets for prevention and mechanistic research.

BACKGROUND:Subthreshold depression is common, but whether lifetime trauma exposure and combined lifestyle are differentially associated with symptom transitions remains unclear. METHODS:We analyzed a prospective community cohort in Shenzhen, China, of adults aged 18-65 years with a Patient Health Questionnaire-9 (PHQ-9) score ≥ 5 and no depressive disorder at baseline. Depressive symptom states (Normal, Mild, and Moderate/Severe) were assessed repeatedly over 36 months. Continuous-time multi-state Markov models estimated transition intensities, probabilities, and hazard ratios (HRs) for lifetime trauma exposure and a five-component combined lifestyle score, adjusting for demographic, socioeconomic, and health-related covariates. RESULTS:Among 2361 participants (mean age, 37.30 years; 61.9% women), recovery transitions were more frequent than worsening transitions. The monthly Mild-to-Normal intensity was 0.131 (95% CI, 0.100-0.171), 2.47 times the Mild-to-Moderate/Severe intensity; Moderate/Severe-to-Mild was highest (0.205; 95% CI, 0.158-0.272). Lifetime trauma exposure was associated with lower Mild-to-Normal (HR, 0.54; 95% CI, 0.42-0.69) and Moderate/Severe-to-Mild rates (HR, 0.52; 95% CI, 0.41-0.65). Unfavorable lifestyle was associated with a lower Mild-to-Normal rate (HR, 0.70; 95% CI, 0.53-0.92) and a higher Mild-to-Moderate/Severe rate (HR, 1.60; 95% CI, 1.13-2.25). Those with both exposures had the lowest Mild-to-Normal rate (HR, 0.39; 95% CI, 0.26-0.59) and a higher Mild-to-Moderate/Severe rate (HR, 1.69; 95% CI, 1.05-2.73). CONCLUSIONS:Lifetime trauma exposure was associated with lower recovery rates, whereas an unfavorable lifestyle was associated with lower recovery and higher worsening rates. These associations may inform trauma-informed assessment and lifestyle support for adults with subthreshold depression.