title: Community factors influencing child and adolescent depression: A systematic review and meta-analysis.
abstract: OBJECTIVE
  Depression has been identified as a priority disorder among children and adolescents. While numerous reviews have examined the individual and family factors that contribute to child and adolescent depressive symptoms, less is known about community-level risk and protective factors. The aim of this study was to complete a systematic review to identify community risk and protective factors for depression in school-aged children (4-18 years).
  
  
  METHODS
  The review adopted the procedures recommended by the Cochrane Non-Randomised Studies Methods Working Group and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was conducted to identify both observational and intervention study designs in both peer-reviewed and non-peer reviewed publications.
  
  
  RESULTS
  A total of 21 studies met the inclusion criteria. Seventeen of the 18 community association studies and 2 of the 3 intervention studies reported one or more significant effects. Results indicated that community safety and community minority ethnicity and discrimination act as risk factors for depressive symptoms in school-aged children. Community disadvantage failed to achieve significance in meta-analytic results but findings suggest that the role of disadvantage may be influenced by other factors. Community connectedness was also not directly associated with depressive symptoms.
  
  
  CONCLUSIONS
  There is evidence that a number of potentially modifiable community-level risk and protective factors influence child and adolescent depressive symptoms suggesting the importance of continuing research and intervention efforts at the community-level.
authors.affiliation: Deakin University, Burwood, VIC, Australia kstirlin@deakin.edu.au.
authors.forename: Katie
authors.initials: K
authors.lastname: Stirling
authors.affiliation: Deakin University, Burwood, VIC, Australia.
authors.forename: John W
authors.initials: JW
authors.lastname: Toumbourou
authors.affiliation: Deakin University, Burwood, VIC, Australia.
authors.forename: Bosco
authors.initials: B
authors.lastname: Rowland
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003863:Depression / Q000209:etiology*; D006801:Humans; D065840:Protective Factors; D012111:Residence Characteristics; D012307:Risk Factors
keywords: Adolescence; children; community risk and protective factors; depression; depressive symptoms; emotional disorders; intervention studies; meta-analysis; systematic review