Clarifying Subthreshold Depression in Adolescents: A Concept Analysis for Mental Health Nursing

Adolescent subthreshold depression (SD) is an increasingly recognized clinical condition marked by significant emotional distress and functional impairment that falls below the diagnostic threshold for major depressive disorder. However, inconsistent terminology and boundary ambiguities continue to hinder effective early assessment in mental health nursing. Utilizing Walker and Avant's framework, this concept analysis aims to clarify the defining attributes, antecedents, consequences, and empirical indicators of adolescent SD based on a systematic search of major Chinese and international databases. The analysis identified five core attributes: core depressive symptoms, subthreshold features, symptom persistence, subjective distress, and developmental functional impairment. Arising from an interplay of internal vulnerabilities and developmental stressors, SD leads to behavioral maladaptation and long-term developmental challenges. Standardized screening tools like the PHQ-9 facilitate early detection but may underrepresent adolescent-specific symptoms. Clarifying this concept provides a robust theoretical foundation for mental health nurses to optimize early risk surveillance and deliver age-appropriate preventive interventions, shifting the clinical perspective from viewing SD as a transient fluctuation to recognizing it as a critical, high-risk clinical entity.