Parent-child communication and self-esteem mediate the relationship between interparental conflict and children's depressive symptoms

Adolescent-Reported Interparental Conflict and Related Emotional-Behavioral Difficulties: The Mediating Role of Psychological Inflexibility

BACKGROUND/OBJECTIVES

Interparental conflict, with its multiple dimensions, represents a risk factor for youth mental health, triggering a series of cascading processes. Despite recent evidence highlighting that psychological inflexibility is a risk factor for adolescents' psychopathology after stressful events, a limited number of studies have investigated its role in family conflicts. This study aims to investigate whether psychological inflexibility mediates the impact of conflict characteristics (intensity, frequency, and resolution) and threat appraisal of interparental conflict on the psychological difficulties of adolescent offspring.

METHODS

A sample of 195 adolescents aged between 15 and 19 years old completed the Children's Perception of Interparental Conflict Scale, the Strengths and Difficulties Questionnaire, and the Avoidance and Fusion Questionnaire for Youth on Google Forms.

RESULTS

The findings revealed that adolescents living in a family environment characterized by high levels of perceived interparental conflicts exhibit a wide spectrum of psychological difficulties, either emotional or behavioral, partially mediated by their psychological inflexibility. However, when conflict between parents is interpreted as threatening, adolescents' inflexibility appears to mediate the relationship between conflict and psychological difficulties.

CONCLUSIONS

While future studies are needed to better understand this association, psychological flexibility might represent a relevant treatment target in adolescents exposed to interparental conflict.

The links between parenting, self-esteem, and depressive symptoms: a meta-analysis

INTRODUCTION

Framed by attachment and cognitive theories, the current meta-analysis tested the direct and indirect links among parenting dimensions (parental support, authoritative control, psychological control, and behavioral control), self-esteem, and depressive symptoms for children and adolescents.

METHODS

Based on 53 studies, and 74 independent samples, the present study used One-Stage Meta-analytic Structural Equation Modeling (OSMASEM) to investigate these links, including testing a mediation effect by self-esteem between parental support-, authoritative control-, psychological control-, behavioral control-, and depressive symptoms. It also tested for potential moderation effects by several variables.

RESULTS

The evidence indicated that parental support (β = .29), authoritative control (β = .23), and behavioral control (β = .07) are positive correlates of self-esteem, while psychological control (β = -.26) is a negative one. It also found that self-esteem was negatively associated with depressive symptoms (β range: -.49 to -.53). Furthermore, parental support (β = -0.14), authoritative control (β = -0.10), and behavioral control (β = -0.05) are negative correlates of depressive symptoms, while psychological control is a positive correlate (β = .11). OSMASEM also provided evidence that parental support, authoritative control, psychological control, and behavioral control are indirectly associated with depressive symptoms, via self-esteem.

CONCLUSION

Parenting dimensions are associated with depressive symptoms both directly and indirectly. That is, self-esteem partially mediates the relationships between parental support, authoritative control, psychological control, and behavioral control with depressive symptoms. Furthermore, OSMASEM moderator tests provided evidence of several significant moderators, including age, sex, parenting measurement, and self-esteem measurement.

"If he doesn't buy in, it's a waste of time": Perspectives from diverse parents and adolescents on engaging children in ADHD treatment

Engaging children and adolescents in ADHD care is critical for future independent disease management. However, there is a lack of evidence guiding health professionals and parents on how best to engage their children and adolescents in ADHD care. We recruited 41 diverse parents of children and adolescents with ADHD and 11 adolescents with ADHD from an urban, safety-net hospital to participate in in-depth, semi-structured qualitative interviews and then analyzed this data using thematic analysis. Children's level of illness insight about ADHD and self-esteem emerged as two major contributors to engagement of children and adolescents in ADHD care, and their intersection created four styles of engagement: proactive (high insight, high self-esteem), anxious (high insight, low self-esteem), apathetic (low insight, high self-esteem), and resistant (low insight, low self-esteem). This framework can help health professionals engage children and adolescents in care for ADHD and guide development of interventions to improve engagement in care.

A systematic review of the association between parent-child communication and adolescent mental health

Background

This systematic review addresses how adolescent-rated parent-child communication (PCC) quality is related to adolescent mental health.

Methods

We performed a systematic literature search in Medline and APA PsycInfo, including peer-reviewed quantitative studies examining associations between adolescent-rated dyadic PCC quality and general as well as specific measures of adolescent mental health. Qualitative and case studies were excluded, as were studies reporting only parent-rated communication quality or instruments assessing other constructs than dyadic PCC. We screened 5314 articles, of which 37 were included in the review. We assessed study quality with the Mixed Methods Appraisal Tool.

Results

We synthesized the findings in a table and narratively, reporting the main outcomes organized according to mental health constructs. The included studies were mainly cross-sectional. The results showed that adolescent-rated PCC quality is negatively associated with mental health constructs, demonstrating small to large effects across different mental health constructs and populations. The associations were found for general mental health and specific domains, including depression, anxiety, psychosis, suicidal ideation, post-traumatic stress symptoms, and addictive internet use/gaming.

Conclusions

The findings demonstrate that PCC is a relevant variable to consider in assessing adolescent mental health and preventive efforts. Limitations include the exclusive focus on adolescent-reported PCC questionnaires since parent- and observer-rated instruments may lead to different results. Also, PCC is related to other constructs, such as dyadic relationships, that were not included in this review. We conclude that PCC is a relevant variable to consider in mental health research. Our findings suggest that PCC may be considered in mental health practice, both in terms of assessing its quality and potentially by tailoring interventions to enhance PCC. These may represent a mean to promote adolescent mental health.

Peer effects of depression between left-behind and non-left-behind children: quasi-experimental evidence from rural China

PURPOSE

The aim of the study is to investigate the interactive influence of depression on left-behind (LB) and non-left-behind (NLB) children from the perspective of peer effects. The roles of teachers, parents, and friends are also explored.

METHODS

Data on 1817 children, 1817 parents, and 55 teachers were obtained from a field survey in December 2021. All students in the sample were randomly assigned to classrooms. A peer effect model and OLS methods were used to estimate the peer influence of depression. Robustness tests were conducted by randomly removing schools from the sample.

RESULTS

Depression was contagious among different groups of rural children, and the peer effect of the NLB children's depression played a dominant role. Both LB and NLB children were more affected by their NLB classmates' depression. LB children were not significantly affected by depression in other LB children. This conclusion remains robust after robustness testing. In addition, heterogeneity analysis showed that outgoing and cheerful teachers, effective parent-child communication and high-quality friendship all alleviated peer influence on depression.

CONCLUSIONS

LB children have more severe depression than NLB children, but LB children are more affected by depression in their NLB peers. Policymakers should train teachers to engage in positive communication with students to improve mental health in children. In addition, this article recommends that children move and live with their parents when family conditions permit.

Oppositional Defiant Disorder Symptoms and Multi-level Family Factors in Chinese Migrant Children: A Network Perspective

Based on the network theory of mental disorders, this study used network analysis to examine the network of ODD symptoms and multilevel family factors and identify the most crucial family factors influencing ODD symptoms in children. A total of 718 Chinese migrant children aged 7-14 years participated in this study. This study measured ODD symptoms, family system-level variables (3 factors), family dyadic-level variables (6 factors), and family individual-level variables (6 factors) with factors selected based on the multilevel family factors theory of ODD symptoms. The results indicated that (1) "annoy" was the center symptom of ODD, (2) "annoy" and "vindictive" was the main bridge connecting the multilevel family factors, and (3) family cohesion at the family system level, parent-child conflict at the family dyadic level, and parental depression at the family individual level were critical central and bridging influencing factors. The findings of this study highlight the critical role of "annoy" and "vindictive" symptoms in the activation of ODD symptom networks in children and provide a basis for future improvements in diagnostic criteria. These potential core and bridge factors might become key intervention targets for childhood ODD.

A Systematic Review of Parent-Child Communication Measures: Instruments and Their Psychometric Properties

Parent-child communication represents an important variable in clinical child and family psychology due to its association with a variety of psychosocial outcomes. To give an overview of instruments designed to measure the quality of parent-child communication from the child's (8-21 years) perspective and to assess the psychometric quality of these instruments, we performed a systematic literature search in Medline and PsycInfo (last: February 25, 2022). Peer-reviewed journal articles published in English with a child-rated instrument measuring the quality of parent-child communication were included. Initial screening for eligibility and inclusion, subsequent data extraction, and quality assessment were conducted by couples of review team members. Based on the screening of 5115 articles, 106 studies reported in 126 papers were included. We identified 12 parent-child communication instruments across the studies. The Parent-Adolescent Communication Scale (PACS) was used in 75% of the studies. On average, the evidence for psychometric quality of the instruments was low. Few instruments were used in clinical and at-risk samples. Several instruments are available to rate parent-child communication from the child's perspective. However, their psychometric evidence is limited and the theoretical foundation is largely undocumented. This review has limitations with regard to selection criteria and language bias.Registration PROSPERO: CRD42021255264.

Early-life interparental relationship quality and late-life depressive symptoms: A mediation analysis

BACKGROUND

A growing body of literature has demonstrated that poor relationships between parents are associated with offspring's elevated depressive symptoms among children and adolescents. However, researchers have paid scant attention to whether marital discord during offspring's childhood casts a long shadow on their late-life depressive symptoms. This study examines the association between early exposure to a poor interparental relationship and offspring's late-life depressive symptoms among Chinese and identifies underlying mechanisms.

METHODS

We employed path models to analyze data from the China Health and Retirement Longitudinal Study (CHARLS). The analytic sample consisted of 4107 respondents aged 60 and older in 2015. Depressive symptoms were assessed with a 10-item Center for Epidemiologic Studies Depression Scale (CES-D).

RESULTS

Individuals who had experienced poor interparental relationships in childhood showed higher levels of and faster increases in depressive symptoms in late adulthood. The mediators were offspring's experiences of physical abuse by their parents in childhood and their poor relationships with spouses and children in adulthood.

LIMITATIONS

Limitations include recall bias on childhood conditions, absence of personality traits, and limited measures of parenting practices.

CONCLUSIONS

Early-life interparental relationships exert a long-term effect on offspring's mental health. Individuals who suffered from poor interparental relationships during childhood might be at relatively high risk of developing depressive symptoms in late adulthood. Possible measures to relieve these depressive symptoms include protecting offspring from physical abuse in childhood and improving their relationships with their spouses and children later in life.

The Association between Coparenting Behavior and Internalizing/Externalizing Problems of Children and Adolescents: A Meta-Analysis

This study aimed to determine the association between coparenting behavior and children's externalizing and internalizing problems and possible factors that may moderate their associations. A meta-analysis of 93 studies involving 41,207 participants found that coparenting behavior was slightly and significantly related to externalizing problems, r = -0.17, 95% CI [-0.194, -0.15], and internalizing problems, r = -0.16, 95% CI [-0.18, -0.14]. In addition, coparenting integrity, cooperation, conflict, competitiveness, and triangulation were significantly related to externalizing and internalizing problems. Moderation analyses revealed the following findings: (a) data reporter moderated the association between coparenting and internalizing problems, with children-report coparenting showing a significantly stronger relation with internalizing symptom than father-report coparenting; (b) developmental stage was found to moderate the association between coparenting behavior and externalizing problems, with stronger association found in childhood than in toddlerhood; (c) female percentage, individualism-collectivism culture, research methods, and publication year were not found to moderate the association between coparenting behavior and externalizing or internalizing problems. These findings help summarize the previous studies and provide an empirical basis for the relation between coparenting and child externalizing/internalizing problems, and benefits targeted interventions towards coparenting behaviors.

Life events and parent style for mental health in children: a cross-sectional study

BACKGROUND

Life events and parenting styles might play an important role in children's mental health.

AIMS

This study aims to explore how life events and parenting styles influence children's mental health based on a Chinese sample.

METHODS

A total of 3535 participants had at least one mental disorder (positive group), while a total of 3561 participants had no mental disorders (negative group). The Child Behavior Checklist (CBCL), Adolescent Self-Rating Life Events Check List (ASLEC) and Egna Minnen Beträffande Uppfostran (EMBU) were used for screening these two groups.

RESULTS

CBCL total scores differed significantly by sex in the Positive group according to the Mann-Whitney tests (Z = -5.40, p < 0.001). Multiple regression analyses showed that the dimensions of punishment (p = 0.014) and other (p = 0.048) in the ASLEC scale can significantly predict CBCL total scores in the Positive group. Sex, age and overprotection from the father were risk factors (p < 0.001) according to binary logistic regression.

CONCLUSIONS

Life events and parenting styles may have impacts on mental health. Fathers play a very important role in children's growth. Punitive education and fathers' overprotection might be risk factors for children's mental health.

IMPACT

It is a large sample (3535) study of Chinese children and adolescents It provides evidence that life events and parenting styles have impacts on mental health and that fathers play a very important role in children's growth. It is conducive to the development of interventions for the mental health of children and adolescents.

The Relationship Between Parent-Adolescent Communication and Depressive Symptoms: The Roles of School Life Experience, Learning Difficulties and Confidence in the Future

Purpose

Adolescent depression has become a public health issue in China. Family environment and school life play important roles in shaping adolescent mental health. Our study aimed to examine the effect of parent-adolescent communication, school-life experiences, learning difficulties, and confidence in the future on depressive symptoms. We also examined the mediating effects of school-life experiences, learning difficulties, and confidence in the future on the relationship between parent-adolescent communication and depressive symptoms.

Methods

Data on depressive symptoms, parent-adolescent communication, and mediating variables were obtained from the China Education Panel Survey (CEPS), including baseline data (2013–2014) and follow-up data (2014–2015). Mixed-effect models were used to evaluate the effects of parent-adolescent communication, school-life experiences, learning difficulties, and confidence in the future on depressive symptoms, and path analyses were performed to determine the mediating roles of school-life experiences, learning difficulties, and confidence in the future on the relationship between parent-adolescent communication and adolescent depressive symptoms.

Results

More father-adolescent communication, better school-life experiences, and higher confidence in the future were protective factors for depressive symptoms among all boys and girls, and learning difficulties were a risk factor for depressive symptoms among all boys and girls. School-life experiences, learning difficulties, and confidence in the future had statistically significant mediating effects on the relationship between parent-adolescent communication and depressive symptoms.

Conclusion

More father-adolescent communication, higher confidence in the future, better school-life experiences, and fewer academic difficulties were associated with lower levels of depressive symptoms. Both mother-adolescent communication and father-adolescent communication affected depressive symptoms through their effects on school-life experience, learning difficulties, and confidence in the future. This finding highlighted the importance of parent-adolescent communication and its impact on depression.

Happiness in University Students: Personal, Familial, and Social Factors: A Cross-Sectional Questionnaire Survey

Happiness is the foundation of a better life and a goal that people pursue; however, happiness levels among university students are low. The purpose of this study is to explore the main factors influencing student happiness. A nationwide cross-sectional study was conducted in China in 2020. Data on student happiness was collected using the Oxford Happiness Questionnaire, and students' personal, familial, and social information were obtained using another questionnaire. Logistic regression analysis was employed to examine the association between student happiness and these factors in terms of odds ratio (OR) and 95% confidence interval (CI). A total of 2186 valid questionnaires were obtained. Firstly, student happiness was found to be associated with personal factors. The results found that happiness was significantly associated with state of health, the adjusted OR (95% CI) = 3.41 (2.01-5.79) for healthy students compared to unhealthy students, and that happiness decreased with the student's age (OR = 0.79 and 95% CI = 0.63-0.98). Secondly, the research suggested that happiness was associated with familial factors. Both frequent contact with family and a harmonious relationship with parents significantly enhanced happiness with ORs (95% CIs) 1.42 (1.17-1.71) and 2.32 (1.83-2.95), respectively. Thirdly, student happiness was associated with several social factors. Students who performed well academically, who went to sleep early, and who were in a loving relationship were found to be happier than those with poor academic performance, went to sleep late, and who were single, for which the ORs (95% CIs) were, respectively, 1.87 (1.51-2.32), 1.50 (1.24-1.81), and 1.32 (1.09-1.60). The survey identified several key personal, familial, and social factors influencing university student happiness, which can provide an effective measure to improve their happiness.

Interparental Conflict and Early Adulthood Depression: Maternal Care and Psychological Needs Satisfaction as Mediators

Previous research has identified exposure to interparental conflict (IPC) in childhood as a risk factor for young adults' depression. However, there is still a lack of understanding of the underlying mediating mechanisms of this association. Driven by the spillover hypothesis, the present study investigated whether maternal antipathy and neglect, and in turn unmet psychological needs, mediated the relation between IPC and early adulthood depression in a sample of 347 undergraduate students (M = 23.27 years; SD = 0.86; 57.05% women) in China. The participants completed self-report measures of IPC, maternal care, satisfaction of basic psychological needs, and depression. Structural equation modeling revealed that: (a) IPC was positively associated with early adulthood depression; (b) this association was sequentially mediated by inadequate maternal care (i.e., antipathy and neglect) and by unsatisfied psychological needs. These findings suggest that efforts to prevent depression should focus on reducing not only IPC, but also inadequate maternal care and unmet psychological needs.

Psycho-social factors associated with high depressive symptomatology in female adolescents and gender difference in adolescent depression: an epidemiological survey in China's Hubei Province

BACKGROUND

Exploring etiological clues to adolescent depression, especially in female adolescents, might be helpful to improve the social environment of female adolescents. The aim at this study is to explore psycho-social factors of female adolescents with high depressive symptomatology and gender differences in depressive symptoms among Chinese adolescents.

METHOD

We examined 4100 adolescents from Wuhan city and Jianli county via a cross-sectional study. Depressive symptomatology was screened through the Chinese version of Center for Epidemiology Studies Depression Scale. Multivariate logistic regression was performed to explore the factors related to high depressive symptomatology in female and male adolescents, respectively.

RESULTS

The prevalence of high depressive symptomatology in female and male were 38.9 and 30.2% respectively. The psycho-social factors of high depressive symptomatology in female adolescents were age (Adjusted odds ratio [aOR] = 1.201, 95% confidence interval [CI], 1.076 ~ 1.341), single parent family (aOR = 2.004, 95%CI, 1.448 ~ 2.772) and fathers' education level (compared to primary school and below, [Junior middle school, aOR = 0.641, 95%CI, 0.439 ~ 0.934; Senior middle school, aOR = 0.603, 95%CI, 0.410 ~ 0.888; College degree and above, aOR = 0.639, 95%CI, 0.437 ~ 0.936]).

CONCLUSION

Fathers' education level was associated with high depressive symptomatology in female adolescents. Female adolescents whose father with primary school education or below deserves more attention. Further epidemiologic researches need to be conducted to explore the different risk factors between female and male adolescents in China.

Tutor of Resilience: A Model for Psychosocial Care Following Experiences of Adversity

This article describes a model for training service providers to provide interventions that build resilience among individuals who have experienced adversity. The Tutor of Resilience model emphasizes two distinct dimensions to training: (1) transforming service providers' perceptions of intervention beneficiaries by highlighting their strengths and capacity for healing; and (2) flexibly building contextually and culturally specific interventions through a five-phase model of program development and implementation. Tutor of Resilience has been employed successfully with child and youth populations under stress in humanitarian settings where mental health and psychosocial support professionals are required to design and deliver interventions that enhance resilience among vulnerable children.

Depressive symptoms prevalence, associated family factors, and gender differences: A national cohort study of middle school students in China

BACKGROUND

This study examined prevalence and change in depressive symptoms in Chinese adolescents, and roles of inter-parental (I-P) relationship and parent-child (P-C) relationships in its etiology and gender differences.

METHODS

Survey data on depressive symptoms, I-P relationship, and indicators of P-C relationships were collected in China Education Panel Survey (2013-2015) from a nationally representative sample of adolescents (n=9,869) at 7^th (at baseline), 8^th and 9^th (follow-up) grades.

RESULTS

Prevalence of depressive symptoms was 17.9% in 7^th graders and higher at 25.7% for 9^th graders, more remarkably in girls. Better I-P relationship could reduce the risk of depressive symptoms among all (OR=0.53, 95%CI: 0.48, 0.58), girls (OR=0.61, 95%CI: 0.54, 0.69), and boys (OR=0.54, 95%CI: 0.49, 0.61). Greater mother-child (M-C) and father-child (F-C) closeness were protective of depressive symptoms in all and girls (ORs=0.94 to 0.96, p<0.01). More P-C interactions was associated with reduced risk of depressive symptoms among all (OR=0.91, 95%CI: 0.89, 0.93), boys (OR=0.91, 95%CI: 0.89, 0.94), and girls (OR=0.93, 95%CI: 0.91, 0.96). Better I-P relationship increased M-C closeness, F-C closeness, and P-C interactions, which in turn reduced depressive symptoms risk (indirect effects: β=-0.03, 95% CI: -0.04, -0.03).

LIMITATIONS

The brief depressive inventory was only able to capture higher depressive symptoms, not clinical depression.

CONCLUSIONS

Depressive symptoms are prevalent in Chinese adolescents with increases from early to middle adolescence. I-P and P-C relationships reduce depressive symptoms risk. P-C relationships mediated associations between I-P relationship and depressive symptoms. Future interventions may target these family factors to reduce depression among Chinese adolescents.

An ecological investigation of resilience among rural-urban migrant adolescents of low socioeconomic status families in China

The present study aims to explore the mechanism of resilience among rural-urban migrant adolescents of low socioeconomic status (SES) families in China with the ecological system perspective. Selecting 946 rural-urban migrant adolescents from the China Education Panel Survey, we used latent class analyses to distinguish different levels of resilience among migrant adolescents from low-SES families, and logistic regressions to identify factors associated with resilience and to examine the cumulative risk and protection models. The findings show that parental expectation, teacher support and organised neighbourhood are salient resilience-promoting factors; and resilience happens only if protective factors accumulate enough at multiple systems to compensate the negative effect of cumulative community risk. The study describes the importance of a protective environment in the domains of family, school and neighbourhood on the resilience of this group, and suggest intervention programmes should extend the paradigm from child-centred approach to environment-focused approach to potentiate the positive development of this population.

Personality, Behavior Characteristics, and Life Quality Impact of Children with Dyslexia

Dyslexia is one of the most common neurobehavioral disorders. Children with dyslexia usually suffer from negative, behavior personality problems, and impacted life quality. We aimed to identify family environment factors for dyslexia, and to evaluate the personality, behavior characteristics and life quality of children with dyslexia. A total of 60 children diagnosed with dyslexia and 180 normal children that were aged 7-12 who speak Chinese were recruited from four primary schools in Shantou City, China. Self-designed questionnaire, children's edition of the Eysenck Personality Questionnaire (EPQ), Conners' Parent Rating Scale (CPRS), and Quality of Life scale for children and adolescents (QLSCA) were employed for investigation. Multiple logistic regressions show that antenatal training (OR = 0.36), higher household income, higher parents' educational levels, and parents engaging in white-collar jobs were negatively associated with dyslexia; while, family members also suffering from dyslexia (OR = 12.17), lower frequency of communication between parents and children, and worse parent-child relationship were positively associated with dyslexia. Children with dyslexia scored higher in psychoticism and neuroticism (p = 0.040, 0.008), but lower in extroversion and dissimulation than normal children (p = 0.025, 0.007) in the EPQ test. They tended to be more introversion (68.3% vs. 43.0%), psychoticism (25.0% vs. 13.3%), and neuroticism (46.7% vs. 18.8%) than the controls. In addition, children with dyslexia had higher scores in conduct problem, learning problem, hyperactivity, and Conners' index of hyperactivity (CIH) in CPRS test; and, lower scores of psychosocial function, physical and mental health, and satisfaction of living quality in QLSCA test (all p < 0.05). Several family environment and parenting factors were associated with children's dyslexia significantly. Children with dyslexia had the personality of psychoticism, neuroticism, introversion, and more behavioral problems. Dyslexia significantly impacted the children's quality of life. Our findings provide multiple perspectives for early intervention of dyslexia in children, particularly in family factors and the parenting environment.

Psychosocial risk factors associated with depressive symptoms among adolescents in secondary schools in mainland china: A systematic review and meta-analysis

BACKGROUND

The objective of the study is to systematically estimate the effect size of psychosocial risk factors for depressive symptoms among adolescents in secondary schools in mainland China.

METHOD

A literature search was conducted in both English and Chinese databases. This meta-analysis used a random-effects model to estimate the effect size.

RESULTS

Fifteen psychosocial risk factors were identified in a total of 164 articles. The results revealed the absolute value of effect size ranging from 0.16 to 0.43. Among them, poor parent-child communication (r = 0.43), negative life events (r = 0.40), academic pressure (r = 0.40), abuse (r = 0.33), poor family functioning (r = 0.33), bullying (r = 0.32), and poor family cohesion (r = 0.32) were associated with depression with a medium to large effect. Moderator analysis shows that grade, study quality, mean age, and gender were significant moderators of at least one factor for depression.

LIMITATIONS

Limitations included the heterogeneity which is largely unexplained, and the inability to investigate the interactions of different factors and to determine the direction of causal relationships between psychosocial factors and depression in the present meta-analysis.

CONCLUSIONS

This study suggests that family-related factors and school-related factors may be significantly associated with depressive symptoms in Chinese secondary school students. Further research is needed to develop effective strategies to modify these factors in depression prevention programmes.