BRS-Assessed Resilience, Symptom Burden, and Functional Burden in Adolescents With Depressive, Anxiety, or Somatic Symptom-Related Disorders: A Single-Center Real-World Cross-Sectional Study.

Abstract

Background: Adolescents with depressive, anxiety, and somatic symptom-related disorders often present with overlapping symptom domains and functional difficulties, but cross-sectional associations of Brief Resilience Scale (BRS) score with multidimensional symptom and functional burden in routine outpatient care remain insufficiently characterized.

Methods: This single-center, real-world, cross-sectional study retrospectively analyzed routinely collected data from adolescents aged 12-18 years attending a psychological/psychiatric outpatient clinic between January 2024 and December 2025. Eligible patients had clinician-recorded depressive, anxiety, or somatic symptom-related disorders and completed the BRS, PHQ-9, GAD-7, and PHQ-15. Associations of BRS score with symptom outcomes and predefined pragmatic functional-burden indicators were assessed using multivariable linear, logistic, and negative binomial regression models; restricted cubic spline analyses were exploratory.

Results: Among 522 screened adolescents, 447 were included. Across increasing BRS-score quartiles, mean PHQ-9 scores ranged from 17.1 ± 5.8 to 9.9 ± 5.2, GAD-7 scores from 13.4 ± 5.1 to 7.2 ± 4.5, and PHQ-15 scores from 12.2 ± 5.0 to 6.9 ± 4.3. The predefined marked functional impairment indicator ranged from 71.4% in Q1 to 30.6% in Q4 (P for trend <0.001). After adjustment, each 1-SD higher BRS score was associated with lower PHQ-9 score (β, -2.42; 95% CI, -3.02 to -1.82), GAD-7 score (β, -1.84; 95% CI, -2.38 to -1.30), PHQ-15 score (β, -1.50; 95% CI, -2.05 to -0.95), and functional impairment count (incidence rate ratio, 0.72; 95% CI, 0.64 to 0.82). Higher BRS score was also associated with lower odds of PHQ-9 score ≥10 (OR, 0.49; 95% CI, 0.36 to 0.66), GAD-7 score ≥10 (OR, 0.57; 95% CI, 0.43 to 0.75), PHQ-15 score ≥10 (OR, 0.61; 95% CI, 0.45 to 0.82), and marked functional impairment (OR, 0.53; 95% CI, 0.40 to 0.71). Exploratory spline analyses showed graded inverse associations but were not interpreted as identifying clinical thresholds.

Conclusion: Higher BRS score was concurrently associated with lower depressive, anxiety, and somatic symptom burden and fewer pragmatic indicators of functional burden in adolescent psychiatric outpatients. These cross-sectional findings do not establish causality, prognostic utility, or treatment-guiding value; longitudinal studies are needed to clarify temporal relationships and clinical utility.