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Nature Human Behaviour

Loneliness and desire for thinness as pathways to girls' higher internalizing problems in the Tokyo Teen Cohort

In the Tokyo Teen Cohort, 3,171 adolescents (46.9% girls) assessed at ages 12, 14 and 16 showed higher internalizing problems among girls at age 16 — depressive symptoms 15.9% versus 8.2% and suicidal ideation 29.8% versus 18.1% — and, after coproduction with young people identified loneliness and desire for thinness as candidate pathways, mediational g-formula estimates attributed 34.7% of the total effect of female sex on depressive symptoms and 46.3% of that on suicidal ideation to pathways through these factors at age 14, suggesting that social intermediates may contribute to the higher prevalence among girls in this cohort.