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 di ffer- ences. Methods: Survey data on depressive symptoms, I-P relationship, and indicators of P-C relationships were col- lected 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 e ffects: beta=-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 re- duce depression among Chinese adolescents.