Abstract
PURPOSE: This longitudinal qualitative study aimed to explore the dynamic symptom management journeys of adolescents with depression, integrate Symptom Management Theory (SMT) with journey mapping, and identify stage-specific characteristics, emotional experiences, and unmet needs across the illness trajectory to inform targeted interventions. METHODS: A longitudinal qualitative design with reflexive thematic analysis (RTA) was adopted. Twelve adolescents with depression (aged 12-18 years) were recruited from a tertiary psychiatric hospital in Zhejiang Province, China. Data were collected through semi-structured interviews at three time points: baseline, 1-month, and 3-month follow-ups, supplemented by observation notes and self-management diaries. Journey mapping was used to visualize dynamic interactions across four phases (symptom recognition, help-seeking, treatment engagement, and daily management), with longitudinal integration of data to track temporal changes. RESULTS: The symptom management journey was non-linear, characterized by distinct emotional and behavioral patterns across phases: numbness and self-loathing during symptom recognition (eg, self-harm as emotional outlet, somatization like headaches); fear and shame in help-seeking (eg, passive medical-seeking due to family coercion, reliance on online support); oscillating hope and skepticism during treatment (eg, selective adherence to preferred therapies like hypnotherapy over Modified Electroconvulsive Therapy) and fluctuating recovery confidence in daily management (eg, re-engaging with interests such as painting or running, forming peer support networks). Key barriers included familial misunderstanding, academic stigma, and inadequate relapse prevention tools, while facilitators involved personalized coping strategies and incremental family adaptation. CONCLUSION: This study captures the dynamic, contextually embedded nature of symptom management in adolescent depression through longitudinal journey mapping, revealing critical tensions between individual agency and multi-level contextual influences (family, school, healthcare). The findings contribute in-depth qualitative insights into stage-specific needs, supporting the development of patient-centered, phase-adapted interventions.