Parental education level and adolescent depression: A multi-country meta-analysis

The impact of family structure on depressive symptoms in secondary school students: The mediating role of emotional neglect

PURPOSE

A growing body of research has identified the influence of family factors on depression. This study aimed to investigate the effects of different family structures on adolescent depressive symptoms and to investigate the mediating role of adverse childhood experiences between family structure and adolescent depressive symptoms.

METHODS

Stratified whole cluster sampling was used. Junior and senior high school students were randomly selected from three schools in one district each in urban and rural areas. Depressive symptoms and traumatic events were investigated through the Patient Health Questionnaire-9 (PHQ-9) questionnaire and the Adverse Childhood Experiences International Questionnaire (ACE-IQ). Adolescent family structure types were classified using latent category analysis (LCA), and mediation models were used to explore the mediating effects of adverse childhood experiences (ACEs) between family structure and depressive symptoms.

RESULTS

After LCA analysis, three family structure types were delineated: Nuclear Family, Paternal Grandparents Family (single father + paternal grandparents as primary caregivers), and Paternal Grandparents Family (single mother + maternal grandparents as primary caregivers). Detection rate of depressive symptoms in non-nuclear families was 27.2 %; adolescent depressive symptoms were higher in Paternal Grandparents Family compared to Nuclear Family (OR = 0.823, 95 % CI:0.037,1.610, p < 0.05); the difference in adolescent depressive symptoms in Maternal Grandparents Family was not significant (OR = -0.504, 95 % CI: -1.570,0.561). The mediating effect of emotional neglect was only present in the association between Paternal Grandparents Family and depressive symptoms in secondary school students [β(95 %CI) = 0.490 (0.153,0.845)], with a mediating effect proportion of 58.40 %.

CONCLUSION

Depressive symptoms are more prominent among secondary school students in non-nuclear families, especially Paternal Grandparents Family. Emotional neglect, which may be triggered by the absence of the mother's role, increases the risk of depressive symptoms among secondary school students.

The association between screen time trajectories and the comorbidity of depression and anxiety

Depression and anxiety are often comorbid among adolescents. Adolescent screen time changes over time. This study investigates the association between screen time trajectories and the comorbidity of depression and anxiety from a longitudinal perspective. The data were collected from an ongoing prospective puberty cohort which was established in 2014 from Chongqing, China. 838 participants (52.03 % female; wave 1 mean age = 8.62, SD = 1.15) were followed up from 2014 to 2020. Questions about screen time were administered every six months. Trajectories of screen time were identified using latent class growth analysis. Children's Depression Inventory (CDI) and Screen for Child Anxiety Related Disorders (SCARED) were used to measure depression and anxiety. Latent profile analysis was used to identify the subtypes of comorbidity of depression and anxiety. Logistic regression was used to explore the association between screen time trajectory and the comorbidity of depression and anxiety. Three distinct trajectories of screen time were identified: Group Low (68.26 %) had consistently low screen time, Group High (26.37 %) had high screen time and Group Increasing (5.37 %) was characterized by an increasing screen time. Four subtypes of the comorbidity of depression and anxiety were fitted ("High comorbidity", "Low comorbidity", "Low depression symptoms" and "No symptoms"). Group Increasing and Group High were associated with "Low comorbidity" and "Low depression symptoms". Group Increasing was more likely to be the "high comorbidity" both boys and girls. However, Group High was associated with "high comorbidity" only in girls. The results of this study may inform future research and provide possible intervention targets.

Longitudinal associations between family conflict, intergenerational transmission, and adolescents' depressive symptoms: evidence from China Family Panel studies (2016-2020)

BACKGROUND

Adolescent depression is increasing globally, and family conflict may contribute to its transmission across generations. However, longitudinal evidence on these dynamics remains sparse. This study examines the longitudinal associations between family conflict and adolescents' and parents' depressive symptoms from three waves of data.

METHODS

Data from the 2016-2020 China Family Panel Studies (CFPS) were analyzed, including 1,772 adolescents (Mean age = 12.4, SD = 1.68 in 2016) and their parents. Family conflict was measured using three questions from adolescents, while depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale (CESD). Multiplelinear regression, latent growth models (LGM), and cross-lagged panel models (CLPM) were employed to examine longitudinal associations between family conflict and depressive symptoms.

RESULTS

The results revealed that family conflict correlated with adolescents' depressive symptoms (r = 0.580,p < 0.001). Adolescents' depressive symptoms also exacerbated family conflict (β1 = 0.030, p < 0.05; β2 = 0.032, p < 0.01) across three waves, while family conflict had a limited contribution to parents' depressive symptoms. Mothers' depressive symptoms influenced adolescents' depressive symptoms significantly (β = 0.043,p < 0.05), while adolescents' depressive symptoms were transmitted to fathers' depressive symptoms (β = 0.080,p < 0.01) between Wave 2 and Wave 3. Moreover, the mother's education level negatively predicted adolescents' depressive symptoms (β = -0.296,p < 0.05).

CONCLUSIONS

Family conflict plays a critical role in adolescents' depressive symptoms and its intergenerational transmission. The findings underscore the pivotal role of family dynamics in mental health, especially in the development of adolescents' depressive symptoms. Interventions aimed at reducing family conflict may help mitigate depressive symptoms across generations.

Association Between Triglyceride-Glucose Related Index and Endometriosis Varies According to Educational Level

BACKGROUND

The association between the triglyceride-glucose (TyG) level, its obesity-related derivatives, and the occurrence of endometriosis (EMS) remains ambiguous, particularly in individuals with higher levels of education. This study sought to explore the relationship between TyG, its obesity-related derivatives, and EMS across various educational backgrounds.

METHODS

This study utilized a substantial dataset obtained from four cycles of the National Health and Nutrition Examination Survey (NHANES) conducted between 1999 and 2006. To explore the relationship between TyG, its obesity-related derivatives, and EMS, we employed a variety of analytical methods, including multivariable logistic regression models, smooth curve fitting, threshold effect analysis, and subgroup analysis, which were applied to participants with varying educational levels.

RESULTS

Among the 2347 participants, 203 (8.65%) were diagnosed with EMS. In the overall population, only the TyG, TyG-waist-to-height ratio (TyG-WHtR), and TyG-waist circumference (TyG-WC) variables demonstrated a positive association with EMS. However, within the group with high educational attainment, TyG, TyG-WHtR, TyG-WC, and TyG-body mass index (TyG-BMI) all exhibited positive correlations with EMS. These associations remained robust after adjustment for multiple potential confounding variables. The subgroup analysis demonstrated that these associations were consistent across different subgroups (p > 0.05). Furthermore, both linear and nonlinear relationships were observed between TyG and its obesity-related derivatives and EMS, as evidenced by the smooth curve fittings and threshold effect analyses. In contrast, no significant associations were identified in the group with lower levels of education.

CONCLUSIONS

Our study suggests that there is variation in the association between TyG and its obesity-related derivatives and EMS across different educational levels, warranting further investigation. In individuals with higher education, elevated levels of TyG and its obesity-related derivatives were associated with a higher prevalence of EMS. Conversely, this correlation was not observed among those with lower educational levels.

Association between parental education level and intelligence quotient of children referred to the mental healthcare system: a cross-sectional study in Poland

Considering the gap in understanding of the link between parental education and child intelligence quotient (IQ), our study aimed to investigate the association between parental education and the IQ of children referred to the mental healthcare system, explore which parent's education level is more influential, and examine the impact of the child's age and sex on these relationships. This cross-sectional study included 80,303 children aged 3-18 years who were referred to the mental healthcare system between 2018 and 2023. We predefined IQ composite score (Full IQ Scale), as measured by the Stanford Binet 5 Intelligence Scale, Fifth Edition (SB-5) as the primary outcome; the remaining SB-5 composite scores were the secondary outcomes. Linear regression analysis was performed using staircase coding for ordinal predictors with several binary independent variables. A significant correlation was found between parental education levels and IQ of the sampled children, with higher levels of parents' education predicting higher IQ scores, particularly with mother's education explaining 18.23% of the variance in children's overall intelligence. No significant interaction was observed between parental education and child's sex in predicting child IQ. However, a significant interaction was observed with age, showing that IQ decreases with age in children of parents with lower education, while it increases with age in children of parents with higher education. Our study underscores the pivotal influence of parental education on the IQ levels of children referred to mental healthcare services. Maternal education level was a stronger predictor of child IQ, potentially because mothers tend to be the primary caregivers. These findings suggest the need for targeted support programs for caregivers, particularly those with lower education levels, to facilitate the early detection of developmental challenges. Integrated education and healthcare efforts are crucial for equitable mental healthcare access.

Mobile phone addiction and negative emotions: an empirical study among adolescents in Jiangxi Province

Background

The relationship between mobile phone addiction and negative affect among adolescents is characterized by intricate interconnections. These factors have an impact on the emotional and psychological well-being of young people. While previous studies have provided preliminary insights into this relationship, further in-depth exploration and research is required to fully understand the complex mechanisms behind these relationships and to identify any group differences.

Methods

This study collected questionnaire data from 493 adolescents aged 17-22 years old in Jiangxi Province. The data were analyzed using Pearson correlation analysis, restricted cubic spline (RCS), and structural equation modelling (SEM) with the aim of exploring the mechanisms and differences in the effects of mobile phone addiction on negative emotions of different youth groups.

Results

The findings of the study indicated notable discrepancies in mobile phone addiction by gender and place of residence. Secondly, mobile phone addiction among adolescents positively drives negative emotions. The findings revealed that negative emotions triggered by mobile phone addiction were significantly higher among rural adolescents than urban adolescents; male adolescents exhibited higher levels than female adolescents in the same place of residence. Additionally, family factors, physical exercise and psychological resilience can directly or indirectly inhibit mobile phone addiction among adolescents. Finally, adolescents' psychological resilience can significantly alleviate the negative emotions associated with mobile phone addiction. Physical exercise and family factors can reduce the negative emotional impact of mobile phone addiction by increasing psychological resilience.

Conclusions

This study employs the relationship between mobile phone addiction and negative emotions in adolescents, reveals the complex mechanisms and group differences behind these relationships, and provides a fresh perspective for understanding the impact of mobile phone addiction on adolescents' mental health, as well as a scientific basis for the development of effective interventions.

Shift-and-Persist Strategies and Psychological Well-Being: Where Adolescents Stand on Social Ladder Matters

OBJECTIVES

Shift-and-persist coping strategies have been demonstrated to be beneficial for physical health of individuals in low socioeconomic status (SES); however, their impacts on psychological well-being remain less clear. This study aimed to examine: (1) whether the protective effects of shift-and-persist with respect to psychological well-being (i.e., depressive symptoms and subjective well-being) only exist among adolescents with lower (vs. higher) subjective SES, and (2) what drives the potential benefits, shifting strategy or persisting strategy, or both of them?

METHODS

This study recruited 686 middle school students (54.5% male; Mage = 12.57 years, SD = 0.65) from Guangdong Province, China, in January 2019, and they completed measures of subjective SES (i.e., perceived family social status), shift-and-persist strategies, depressive symptoms, subjective well-being, and demographic information.

RESULTS

Adolescents who engaged in more shift-and-persist strategies reported fewer depressive symptoms and higher levels of subjective well-being, with stronger effects among those lower (vs. higher) in subjective SES. When further exploring what drove these effects, results showed that persisting strategy was associated with fewer depressive symptoms and higher levels of subjective well-being, with more pronounced effects for adolescents with lower (vs. higher) subjective SES. The shifting strategy was associated with fewer depressive symptoms only among those with lower subjective SES, while associated with higher levels of subjective well-being regardless of subjective SES levels.

CONCLUSIONS

Findings support the applicability of the shift-and-persist model to both positive and negative indicators of psychological well-being and enrich the theory by providing preliminary evidence for the domain-specific roles of shifting strategy in buffering the negative psychological effects of low-SES contexts.

Factors Associated With Mental Health Literacy, Depression, and Anxiety Amongst Indonesian Adolescents

AIMS

This study aims to identify factors associated with mental health literacy (mental health knowledge and attitudes towards mental health and help-seeking behaviours), depression and anxiety amongst adolescents, and test the hypothesised model by examining the interrelationships between these outcomes.

DESIGN

Cross-sectional descriptive quantitative research.

METHODS

Using convenient sampling, 615 adolescents from four public schools completed online questionnaires measuring mental health literacy, depression, and anxiety. The data were analysed using Pearson correlation, multiple linear regression, and structural equation modelling (SEM).

RESULTS

Individual factors (e.g., gender, physical health and past traumatic experiences), family factors (e.g., parental criticism and family support) and school/community factors (e.g., academic pressure and safety) were associated with mental health outcomes. SEM revealed an association between higher mental health knowledge and better attitudes towards mental health and help-seeking behaviours but did not show a significant association with depression and anxiety.

CONCLUSIONS

Findings emphasise the need for holistic and culturally safe approaches to address adolescent mental health in Indonesia.

IMPLICATIONS

Future research should focus on developing and evaluating tailored mental health interventions in Indonesia that address individual, family, school, and community factors. These interventions should target the interrelated aspects of mental health literacy, depression, and anxiety identified in this study. Key areas for intervention include enhancing self-esteem, promoting help-seeking behaviours, supporting spirituality, managing long-term conditions, improving sleep hygiene, encouraging physical activity, teaching stress management techniques, fostering diversity, managing trauma, and combating discrimination. A comprehensive approach to adolescent mental well-being should integrate parental involvement, peer support systems, community engagement initiatives, and mental health literacy education.

IMPACT

This research informs future interventions such as school-based programs, family-oriented campaigns, and community initiatives to support adolescent mental health, potentially influencing policy decisions, and resource allocation in mental health services.

REPORTING METHOD

STROBE guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No direct patient or public contribution.

Association between stressful life events and depression, anxiety, and quality of life among urban adolescents and young adults in Latin America

Background

Latin American youth have a high prevalence of mental health disorders and face major socioeconomic and public safety problems. This study assesses the association between stressful life events (SLEs) and depression, anxiety, and quality of life among adolescents and young adults from deprived neighbourhoods of Latin America.

Methods

The sample consisted of 2,402 participants, between adolescents (15-16 years) and young adults (20-24 years), from Bogotá (Colombia), Buenos Aires (Argentina), and Lima (Peru), assessed in 2021-2022 and recruited in education and community settings and social media. We evaluated the most frequent recent and distant SLEs (occurred in the previous year and more than a year ago, respectively), the relationship between SLEs and severity of depression (PHQ-8), anxiety (GAD-7), and quality of life (MANSA), and we tested for differences by gender and age group.

Results

The most common recent and distant SLEs were related to public safety issues and financial distress. Accidents and school suspensions were more frequent among men, and sexual harassment and bullying among women. Every additional reported recent SLE increased the odds of mild, moderate, and severe depression (18, 17, and 25%, respectively) and anxiety (10, 17, and 21%, respectively) symptoms. Similar trends were found with distant SLEs and depression (8, 9, and 11% for mild, moderate, and severe symptoms, respectively) and anxiety (9, 11, and 12%, respectively). Furthermore, a higher number of recent and distant SLEs were associated with lower quality of life (β = -0.05, p < 0.001, 95% CI [-0.06, -0.04] and β = -0.04, p < 0.001, 95% CI [-0.05, -0.03], respectively). The relationship between mental distress and quality of life of recent SLEs seems stronger than the one from distant SLEs, and recent SLEs may have a higher impact on adolescents' mental health compared with young adults.

Conclusion

Both recent and distant SLEs are related to mental distress and quality of life. Policies and programmes should aim to enhance public and health safety, as well as improve individual, family, and community protective factors that could mitigate the effect of SLEs on Latin American youth.

Socio-demographic factors and mental health trajectories in Australian children and primary carers: Implications for policy and intervention using latent class analysis

Children's mental health status (MHS) is frequently influenced by their primary carers (PCs), underscoring the significance of monitoring disparities longitudinally. This research investigated the association between socio-demographic clusters and mental health trajectories among children and their PCs over time. Data from waves 6-9c2 of the Longitudinal Study of Australian Children (LSAC) were analyzed using Latent Class Analysis (LCA) to identify four socio-demographic classes among children aged 10-11 years at wave 6. Multinomial logistic regression and predictive marginal analysis explored associations between classes and mental health outcomes. PCs in Class 4 (disadvantaged and separated families with indigenous children) exhibited higher odds of borderline and abnormal MHS compared to Class 1 (prosperous and stable working families) across all waves. However, while MHS of PCs' impacted children consistently, the association with socio-demographic classes was significant only in wave 6. Class 4 children had elevated risks of mental illness compared to Class 1, while Class 3, characterized by educated working mothers, had lower risks. Reducing mental health risks entails addressing socio-economic disparities, supporting stable family structures, and offering tailored interventions like counseling and co-parenting support. Longitudinal monitoring and culturally sensitive approaches are crucial for promoting mental well-being across diverse groups.

Approaching Temporal Dynamics in the Dimension-Level Associations Between Career Adaptability/Ambivalence and Internalizing Symptoms Among Chinese Adolescents Throughout Their High Middle School Years

Despite the well-established associations between adolescents' internalizing symptoms and career development, it still remains unclear whether adolescents' internalizing symptoms are precursors or consequences of their career adaptability/ambivalence. Subtler nuance inherent within such association also await to be revealed, because internalizing symptoms and career development have been primarily treated as broad constructs, despite the multifaceted nature of both. To narrow such gaps, this study examined the potentially dynamic associations among career adaptability, career ambivalence, and internalizing symptoms using three-wave longitudinal data. The study collected data from 3196 Chinese adolescents (52.72% girls, mean age = 15.56 years, SD = 0.58) at Wave 1, with 2820 (attrition rate = 11.76%) participating in Wave 2 and 2568 (attrition rate = 8.93%) in Wave 3. The measurement invariance suggested that there were no significant differences across both waves and genders. This study approached associations at both broader construct levels and subtler dimension levels. Results of cross-lagged path models at broader construct levels demonstrated a unidirectional association between internalizing symptoms and career adaptability. Results of models at subtler dimension levels indicated a series of transactional links over time between career adaptability dimensions/ambivalence and depressive symptoms in particular. Career adaptability dimensions and career ambivalence predicted later anxiety symptoms rather than the reverse. Group model comparisons showed no difference across waves and genders. These findings shed light on the dynamic nature of the associations during adolescence between career adaptability/ambivalence and internalizing symptoms, particularly at subtler dimensional levels, which should be considered in relevant clinical and educational practices.

Emphasizing symbolic capital: its superior influence on the association between family socioeconomic status and adolescent subjective well-being uncovered by a large-scale multivariate network analysis

Background

Family socioeconomic status (FSES) serves as a significant determinant for subjective well-being. However, extant research has provided conflicting evidence on the correlation between FSES and adolescent students' subjective well-being (SSWB).

Methods

Data were collected from 12,058 adolescent students (16 years of age) by the Programme for International Student Assessment (PISA) 2018. Multivariate canonical correlation and Mantel test were utilized to investigate the specific connection between FSES and SSWB. Furthermore, a Gaussian EBICglasso graph-theoretical model was used to capture the topological properties of the FSES-SSWB network and reveal the interplay among multifarious components of FSES and SSWB.

Results

FSES was positively correlated with SSWB. In the FSES-SSWB network, parental educational attainment and occupation status demonstrated the highest centrality values, thereby contributing significantly to the relationship between FSES and SSWB. However, family wealth, along with educational and cultural resources, displayed lower centrality values, signifying their weaker roles in this relationship.

Conclusion

Our findings suggest that symbolic capital, rather than family affluence, exerts a dominant influence on adolescent SSWB. In other words, SSWB may not be detrimentally influenced by a deficiency in monetary resources. However, it is more susceptible to being unfavorably impacted by inferior parental educational attainment and occupational standing.

COVID-19 Pandemic Quarantines and Mental Health Among Adolescents in Norway

Importance

Adolescence is a critical developmental phase when mental health disorders, such as anxiety and depression, often emerge. Stringent public health measures and quarantine mandates during the COVID-19 pandemic could threaten adolescent mental health.

Objective

To investigate the associations of public health measures and quarantine experiences with mental distress among Norwegian adolescents and to explore if certain vulnerability factors moderate these associations.

Design, Setting, and Participants

This longitudinal cohort study used repeated measures to capture variations in mental distress explained by the stringency of public health measures and quarantine experiences. Data from the Norwegian Mother, Father, and Child cohort study were linked to national health registries and a national stringency index from April 1, 2020, to February 17, 2021. Participant included 7787 Norwegian adolescents aged 16 to 18 years. Data were analyzed from October 2022 to October 2023.

Exposures

Stringency index of public health measures and quarantine experiences including recent quarantine (within the last 2 weeks) and quarantine frequency (cumulative number of quarantine episodes).

Main Outcome and Measures

Mental distress was measured using the Hopkins Symptom Checklist across 6 data collection waves.

Results

In this study, 7787 participants were included in the analysis (4473 female [57%]; mean [SD] age, 17.0 [0.6] years). Stringent public health measures (β = 0.18; SE, 0.02; P < .001), recent quarantine (β = 0.11; SE, 0.02; P < .001), and frequent quarantine (β = 0.08; SE, 0.01; P < .001) were associated with higher levels of mental distress. The associations between public health measures and mental distress were not moderated by sex, age, prepandemic anxiety or depression, or genetic liability for mental health conditions. Frequency of quarantine appeared to be more strongly associated with mental distress among younger adolescents (β = -0.04; SE, 0.01; P = .008), those with parents with lower education (β = -0.04; SE, 0.01; P = .007), and those with lower genetic risk for depression (β = -0.03; SE, 0.01; P = .006).

Conclusions and Relevance

In this study, younger adolescents, those with parents with lower education, or those with low genetic liability for depression appeared more vulnerable when being quarantined several times. These findings emphasize the need for targeted support strategies to better protect adolescent well-being during future crises. Adolescents who experienced increased mental distress during the COVID-19 pandemic may be at risk of continued mental health problems and in need of ongoing support.

Role of parental educational level as psychosocial factor in a sample of inpatients with anorexia nervosa and bulimia nervosa

Introduction

Evidence on parental educational level (PEL) as a risk factor for Eating Disorders (EDs) is mixed, and no study has assessed its role in relation to the compliance and outcomes of treatments in EDs. Further, no study differentiated from the educational level of mothers and fathers, nor considered the possible mediation of perfectionism in fostering EDs.

Methods

A clinical sample of 242 first-ever admitted inpatients with EDs provided information on PEL and completed the following questionnaires: the Eating Disorder Examination Questionnaire (EDE-Q) and the Frost Multidimensional Perfectionism Scale (F-MPS). Clinicians also provided information on the Hamilton Rating Scale for Anxiety (HAM-A) and the Hamilton Rating Scale for Depression (HAM-D) for each participant.

Results

Individuals with high PEL (whether mothers, fathers, or both parents) showed significantly higher scores on depressive symptoms and lower on parental criticism, were younger, had an earlier age of onset, had fewer years of illness, more were students and employed, and fewer had offspring. Individuals with fathers or both parents with high educational levels suffered more from Anorexia Nervosa rather than Bulimia Nervosa, had a longer length of stay during the current hospitalization, had less dietary restraint, and had higher personal standards. Individuals with mothers with high educational levels showed a lower rate of previous substance or alcohol addiction. Personal standards partially mediated the relationship between higher PEL and lower dietary restraint.

Discussion

PEL emerged to be a twofold psychosocial risk factor, being associated with higher depressive symptoms and a longer length of stay, but also with a shorter duration of illness and better scholar and working involvement. Higher PEL was related to higher personal standards but not to global perfectionism. Patterns of eating psychopathology emerged based on the high PEL of mothers or fathers.

The experience of Thai adolescents with depression: A qualitative study

AIM

People who have depression experience a maelstrom of emotion as they attempt to understand what is happening to them. While the experience has been quite extensively documented in adults and older individuals, there is a great deal less information available about adolescent depression experiences and reactions. The purpose of this study was to investigate the experiences of Thai-adolescents suffering from depression.

DESIGN

Interpretative phenomenological analysis.

METHOD

Fourteen adolescents were recruited from a secondary school in Chiangrai province, Thailand. Semi-structured interviews were carried out. Interviews were analysed using interpretative phenomenological analysis.

RESULTS

The following four themes were identified: (1) struggling to make sense of their situation, (2) feeling down and withdrawing, (3) contemplating self-harm and (4) therapy as a last choice. The results point to the continuing significance of promoting psychoeducation for Thai-adolescents with depression as well as parents, school nurses and health providers while eliminating stigma.