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Purpose: The purpose of this study was to examine the mediating effect of self-perception on the relationship between body image and depressive symptoms in middle school adolescents. Methods: This study performed a pathway analysis with a sample of 284 adolescents recruited from three middle schools. Self-reported questionnaires consisted of items regarding body image, self-perception, and depressive symptoms. Results: Body image, self-perception, and depressive symptoms showed a significant correlation. Self-perception was directly affected by body image and depressive symptoms were not affected by body image. The mediating effect of self-perception on body image’s impact on depressive symptoms was confirmed. Self-perception had a significant indirect effect on depressive symptoms, which means that self-perception has a full mediating effect on body image’s impact on depressive symptoms. Conclusion: The effect of body image on depressive symptoms was fully mediated by self-perception in early adolescents. It suggests that self-perception needs to be considered when providing nursing interventions for adolescents.