Associations of family relationships and negative life events with depressive symptoms among Chinese adolescents: A cross-sectional study

RESEARCH ARTICLE Associations of family relationships and negative life events with depressive symptoms among Chinese adolescents: A cross-sectional study Zheng Ren1, Ge Zhou2, Qi Wang2, Wenjing Xiong2, Juan Ma1, Minfu He1, Yue Shen1,3, Xinwen Fan1, Xia Guo1, Ping Gong2, Meitian Liu2, Xiaodi Yang2, Hongjian Liu2, Xiumin Zhang ID1* a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 Department of Social Medicine and Health Management, School of Public Health, Jilin University, Changchun, China, 2 Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China, 3 China Population Communication Center, Beijing, China * , Abstract OPEN ACCESS Citation: Ren Z, Zhou G, Wang Q, Xiong W, Ma J, He M, et al. (2019) Associations of family relationships and negative life events with depressive symptoms among Chinese adolescents: A cross-sectional study. PLoS ONE 14 (7): e0219939. https://doi.org/10.1371/journal. pone.0219939 Editor: Kenji Hashimoto, Chiba Daigaku, JAPAN Received: May 1, 2019 Accepted: July 3, 2019 Published: July 18, 2019 Copyright: © 2019 Ren et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the manuscript and its Supporting Information files. Funding: This study was supported by grants from Health and Family Planning Commission of Jilin Province, China (Grant Numbers: 2017G018, 2018G009); funding acquisition: Xiumin Zhang. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Objectives The main objective of this study was to explore the associations of family relationships and negative life events with depressive symptoms among Chinese adolescents. Methods A cross-sectional study of 3081 middle school students was conducted in Ganzhou City, Jiangxi Province, China. Students were asked to complete questionnaires regarding family relationships, negative life events, and depressive symptoms. A mediation analysis was carried out using a multiple regression analysis and the PROCESS macro method. Results Of all participants, 19.9% reported experiencing depressive symptoms. The prevalence of depressive symptoms was 13.0% and 29.2% in participants with good and poor parental relationships, and the prevalence of depressive symptoms was 11.4% and 30.9% in participants with closed and alienated parental-child relationships, respectively. Parental relationships, parental-child relationships, and negative life events were positively correlated with depressive symptoms. The effect of parental relationships on depressive symptoms was fully mediated by negative life events (Effect = 0.052, 95% CI = [0.023, 0.082]), while the effect of parent-child relationships on adolescent depressive symptoms was partially mediated by negative life events (Effect = 0.075, 95% CI = [0.048, 0.104]). PLOS ONE | https://doi.org/10.1371/journal.pone.0219939 July 18, 2019 1 / 16 Associations of family relationships and negative life events with depressive symptoms among adolescents Competing interests: The authors have declared that no competing interests exist. Conclusions Our results showed a high prevalence of depressive symptoms in Chinese adolescents. Poor family relationships may have the potential to increase the risk of depressive symptoms, and they could affect depressive symptoms through negative life events. Introduction Adolescence is a critical life transition period marked by substantial physical, behavioral, cognitive, and emotional changes, and it is a period during which adolescents are under considerable social pressure, especially in China [1, 2]. Depression is very common among adolescents worldwide, with a depressive disorder prevalence of approximately 6% [3] and a significant global disease burden [4]. In China, a meta-analysis reported that the pooled point prevalence of major depressive disorders in children and adolescents was 1.3% [5]. Depressive symptoms, though not an adequate standard for the clinical diagnosis of depressive disorders, seem to be quite stable throughout adolescence, and individuals who experience depressive symptoms earlier in adolescence are more likely to continue reporting depressive symptoms later in life [6, 7]. A recent systematic analysis showed that 24.3% of adolescents in secondary schools in mainland China suffered from depressive symptoms [8]. Depressive symptoms can bring about many negative consequences, such as poor academic performance [9, 10], poor interpersonal relationships [11], and antisocial behaviors [12]. Moreover, depression can result in suicide [13]. Understanding the risk factors of depressive symptoms is a vital first step in developing effective preventive strategies and measures. Studies on depressive symptoms in adolescents have reported various characteristics or associated factors, including sex [14, 15], grade [16], health status [17], personality vulnerabilities (e.g. low self-esteem) [18, 19], and school environment (such as student-student and student-teacher relationships, classroom management practices) [20, 21]. The transition to adolescence is indicated not only by the development of a reproductively mature body but also by a plethora of challenges in almost every domain of life. Various studies have reported that during this transition into adult life, some young people experience stressful events that, depending on their type and intensity, may lead to psychological problems of an externalizing (aggressiveness and antisocial behavior) and/or internalizing nature (depression and anxiety) [22, 23]. It has been found that the presence of negative life events is a reliable risk factor for the development of depressive symptoms [24, 25]. Adolescence is also characterized by substantial room for change in attachment relationships. Adolescents face important interpersonal challenges, including the renegotiation of relationships with parents and increased involvement with peers and friends [26]. Family is the most stable source of support throughout adolescence. A growing body of evidence highlights the important role of families in the prevention of internalizing problems in children and adolescents [27–29], of which depressive symptoms are the most frequently reported to be associated with family relationships among adolescents. Factors impacting depressive symptoms include parental warmth [30], support from parents [31] or inter-parental conflict, parental divorce [32, 33], and poor parent-child relationships quality [34, 35]. In fact, the relationship between family cohesion and depressive symptoms has been found in longitudinal work as well, such that decreased perceived family cohesion predicted increased depressive symptoms 1 (...truncated)