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Family Resilience and Adolescent Mental Health during COVID-19: A Moderated Mediation Model

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Background: The COVID-19 pandemic has impacted and is still impacting people's lives, including physical and mental health. Family plays an important role in adolescent mental health due to the long staying at home. Aims: This paper aimed to investigate the impact of family resilience on adolescent mental health during the COVID-19 pandemic, and the mediation role of pandemic stress perception and the moderation role of meta-mood. Methods: A total of 2691 Chinese adolescents were recruited using convenient sampling. Their mental health, family resilience, pandemic stress perception and meta-mood were surveyed. Multivariate statistics were used to analyze the data. Results: Our results showed that (1) about 36.7% adolescents in our sample have some mental health problems; (2) family resilience can positively predict adolescent mental health, whereas pandemic stress perception can negatively predict mental health; (3) pandemic stress perception mediates the relationship between family resilience and adolescent mental health; (4) meta-mood moderates the relationship between family resilience and pandemic perception, i.e., the first half of the mediation role. Conclusions: Our results indicate that one can either improve family resilience or improve adolescents' meta-mood to relieve adolescents' mental health problems.
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Citation: Zhuo, R.; Yu, Y.; Shi, X.
Family Resilience and Adolescent
Mental Health during COVID-19: A
Moderated Mediation Model. Int. J.
Environ. Res. Public Health 2022,19,
4801. https://doi.org/10.3390/
ijerph19084801
Academic Editor: Cheng-Fang Yen
Received: 21 March 2022
Accepted: 13 April 2022
Published: 15 April 2022
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International Journal of
Environmental Research
and Public Health
Article
Family Resilience and Adolescent Mental Health during
COVID-19: A Moderated Mediation Model
Ran Zhuo 1, Yanhua Yu 2,3 ,* and Xiaoxue Shi 1
1Department of Applied Psychology, School of Humanities, Jilin Agricultural University,
Changchun 130118, China; zhuoran@jlau.edu.cn (R.Z.); shixiaoxuejlnydx@outlook.com (X.S.)
2Faculty of Education, Northeast Normal University, Changchun 130024, China
3Center for Faculty Development, Jilin Agricultural University, Changchun 130118, China
*Correspondence: yuyh677@nenu.edu.cn
Abstract:
Background: The COVID-19 pandemic has impacted and is still impacting people’s lives,
including physical and mental health. Family plays an important role in adolescent mental health due
to the long staying at home. Aims: This paper aimed to investigate the impact of family resilience on
adolescent mental health during the COVID-19 pandemic, and the mediation role of pandemic stress
perception and the moderation role of meta-mood. Methods: A total of 2691 Chinese adolescents
were recruited using convenient sampling. Their mental health, family resilience, pandemic stress
perception and meta-mood were surveyed. Multivariate statistics were used to analyze the data.
Results: Our results showed that (1) about 36.7% adolescents in our sample have some mental health
problems; (2) family resilience can positively predict adolescent mental health, whereas pandemic
stress perception can negatively predict mental health; (3) pandemic stress perception mediates the
relationship between family resilience and adolescent mental health; (4) meta-mood moderates the
relationship between family resilience and pandemic perception, i.e., the first half of the mediation
role. Conclusions: Our results indicate that one can either improve family resilience or improve
adolescents’ meta-mood to relieve adolescents’ mental health problems.
Keywords:
adolescent mental health; family resilience; pandemic stress perception; meta-mood;
COVID-19 pandemic
1. Introduction
COVID-19, originating in December 2019, has spread all over the world and is still af-
fecting people’s daily lives. On 31 January 2020, the World Health Organization designated
COVID-19 Pandemic as an “International Public Health Emergency” (World Health Orga-
nization, Novel Coronavirus (2019-nCoV) Situation report-1. https://www.who.int/docs/
default-source/coronaviruse/situation-reports/20200121-sitrep-1-2019-ncov.pdf?sfvrsn=
20a99c10_ accessed on 6 June 2021). The COVID-19 pandemic has not only threatened
people’s physical health, but also had impacts on people’s mental health [
1
,
2
]. Ref. [
3
] has
shown that most people have experienced different degrees of stress, anxiety and depres-
sion during the pandemic, and these feelings persist for a period of time. Adolescence is
an important period in individual’s development, during which adolescents are sensitive
to appearance, academic performance, interpersonal relationship and many other aspects,
and have increasingly perceived pressures [
4
]. When the pandemic started, it was Chinese
New Year when all Chinese students were on winter vacation. Learning was switched
to online in the following semester, which was never happened before. Similar actions
were taken all over the world during lockdowns. This was undoubtedly an unprecedented
challenge for adolescents and their families. A long time staying at home made family
an important factor for adolescents’ mental health. Therefore, studying the relationship
between family resilience and adolescent mental health during COVID-19 has important
implications for both adolescents and their families.
Int. J. Environ. Res. Public Health 2022,19, 4801. https://doi.org/10.3390/ijerph19084801 https://www.mdpi.com/journal/ijerph
Int. J. Environ. Res. Public Health 2022,19, 4801 2 of 16
1.1. Adolescents’ Stress Perception and Metal Health during COVID-19
Due to the COVID-19 pandemic, adolescents’ daily life and learning patterns have
changed significantly. On the one hand, they have to face the risk of being infected
at any time, and some people may suffer from separation from their family members
or even death of their loved ones. Under these external stressors, they are more likely
to receive great psychological pressure, causing serious mental health problems [
5
]. A
study in China has shown that adolescents were at high risk for mental health during
the pandemic [
6
]. Similarly, [
7
] reported that 85.7% of adolescents showed changes in
emotional states, such as irritability, restlessness, tension during the COVID-19 outbreak,
and the incidence of depressive symptoms ranged from 22.6–43.7%. Ref. [
8
] indicated that
58% of Lithuanian adolescents were of good mental health after the second lockdown,
whereas 19% of adolescents had depression risk. On the other, adolescents who are high
school students have to adapt to the changes in their learning styles, online courses and
assessments, as well as the entrance examinations for higher schools in July (postponed
for one month due to the pandemic). Studies also demonstrated that adolescents’ mental
health such as anxiety, learning pressure, maladjustment and emotional state generally
rose under governments’ pandemic prevention and control policies. If these stress and
anxious emotions were not effectively alleviated, mental health problems would occur [
9
].
In addition, family conflicts increased due to the increasing time and the limited living
spaces that adolescents shared with their parents following the policy of ‘staying at home
and not going out’ during the pandemic. Ref. [
10
] showed that parents reported about
22.2% more conflicts with their children, and 28.3% of parents reported being stressed
about relationship challenges with their partners due to the pandemic. Therefore, the stress
that adolescents feel during the pandemic may come from pandemic risk, study pressure
and family relationship, which all have impacts on their mental health.
1.2. Family Resilience and Adolescent Mental Health
Although perceived stresses can have negative effects on mental health [
11
], individu-
als could stay healthy and do well facing the pandemic or adversity, which is inseparable
from the function of resilience [
12
,
13
]. This study discussed resilience in the context of
family and analyzed its influence on adolescent mental health. First, family itself is an
important place where children and adolescents’ socialization processes take place, and
it is also a very important social ecological system that affects the psychological devel-
opment of adolescents [
14
]. Second, ‘home quarantine’ was used by governments as a
coping strategy at the beginning of the pandemic. Family environment where adolescents
live and study, and the relationship between family members would undoubtedly affect
adolescents’ external behaviors and emotions [
15
]. Moreover, many researchers have re-
alized the importance of family resilience for family members to adapt and develop in
adversity [
16
,
17
]. There are two types of definitions for family resilience. First, family
resilience is defined as the ability and strength of a family as a whole to cope with stress
and crisis [
16
,
18
,
19
]). Second, family resilience is seen as the dynamic process in which
families constantly balance pressure, demands and resources to survive and adapt to the
environment [
16
,
17
]. Whatever the definition is, family resilience has three characteristics.
First, family is treated as a whole. Second, there must be some adversity that the family
is involved in. Third, the final adaptation to the adversity is achieved through family
members’ joint efforts [
17
,
20
]. Ref. [
20
] found that families with high resilience are more
in control under stressful situations; ref. [
21
] posited that family resilience can directly
predict adolescents’ depression, loneliness and happiness, which has a compensatory ef-
fect. Most studies on family resilience and mental health primarily focused on left-behind
children, families with diseases or families with economic difficulties, demonstrating that
family resilience can help left-behind children, families with patients and other families
in adversity to actively adapt and achieve good development [
22
]. In addition, protective
factors in family resilience, such as family belief and family support, can help families
move forward in crisis and protect the survival and well-being of the whole family [
23
].
Int. J. Environ. Res. Public Health 2022,19, 4801 3 of 16
Therefore, family resilience may have a significant impact on adolescents’ mental health
during the COVID-19 pandemic.
Meanwhile, high family resilience can reduce the adverse effects of stress through the
perception of pressures [
24
]. According to the family resilience system theory, the three
most important parts of family functioning are family belief systems, organization patterns
and communication processes [
25
]. Family resilience is nurtured by shared beliefs that
help members understand crisis situations, lead positive lives, and provide transcendent
spiritual values and purpose [
23
]. Families can achieve a sense of cohesion by redefining
a crisis as a common challenge that is understandable, manageable and meaningful [
26
].
Normalizing and contextualizing family members’ pain, and viewing stressful events as
natural or understandable can weaken family members’ responses and reduce feelings of
blame, shame, and guilt [
23
]. Identifying and affirming the strength of family in difficulties
help to deal with the feelings of helplessness, failure and despair, so individuals can get
good adaptation and development. Ref. [
27
] summarized the characteristics of children
with high resilience, and pointed out that children with high resilience cannot do well
without the support and encouragement of family members. Although the arrival of the
pandemic could make adolescents feel pressured from various sources, it is possible for
them to treat the pressure and crisis as understandable and meaningful challenges if they
live in families with high intimacy, good communication, strong faith. Their negative per-
ception of pressures may be weakened. Through the above argument, it can be conjectured
that family resilience could not only affect adolescents’ mental health directly, but also
indirectly by reducing their perceived pandemic stress.
1.3. The Role of Meta-Mood
Meta-mood is the ability to notice, distinguish, reflect and control ones’ emotions,
which can help individuals to identify and adjust negative emotions when facing stressful
events and deal with negative events in a positive way [
28
]. It can improve individuals’
anxiety, mental health level and obtain more happiness [
29
]. In addition, meta-mood also
affects self-harmony, social adaptation and psychological resilience [
30
]. The Trait Meta
Mood Scale (TMMS) measures meta-mood from three dimensions: attention to emotions,
emotional clarity and emotion repair [
31
]. It is reported that individuals vary in their
meta-mood [
28
]. Ref. [
32
] showed that meta-mood can predict perceived stress. Moreover,
for those who pay a lot of attention to their emotions and have difficulties in emotion repair,
it is very likely that they perceive more stresses during the pandemic, even if their family
resilience is high [
32
]. On the contrary, if individuals do not consider mood as relevant
to anything and can easily repair their emotions, they may perceive less stress even if
the family resilience is not so high [
32
]. Therefore, it is reasonable to hypothesize that
the meta-mood has moderating effect on the relationship between family resilience and
pandemic stress perception.
1.4. The Present Study
This study will investigate the associations between family resilience, pandemic stress
perception, meta-mood and adolescent mental health under COVID-19 Pandemic. Specifi-
cally, we will explore the mediating role of pandemic stress perception in the relationship
between family resilience and adolescent mental health and the moderating role of meta-
mood on the link between family resilience and pandemic stress perception. Based on the
previous discussion, we proposed the following hypotheses:
Hypothesis 1. Pandemic stress perception has a negative effect on adolescent mental health.
Hypothesis 2. Family resilience has a positive effect on adolescent mental health.
Hypothesis 3.
Pandemic stress perception mediates the impact of family resilience on adolescent
mental health.
Int. J. Environ. Res. Public Health 2022,19, 4801 4 of 16
Hypothesis 4.
Meta-mood moderates the first half of the mediation role that Pandemic stress
perception plays.
Putting the above hypotheses together, we get our conceptual model as depicted in
Figure 1.
Int. J. Environ. Res. Public Health 2022, 19, x FOR PEER REVIEW 4 of 17
Hypothesis 2. Family resilience has a positive effect on adolescent mental health.
Hypothesis 3. Pandemic stress perception mediates the impact of family resilience on adolescent
mental health.
Hypothesis 4. Meta-mood moderates the first half of the mediation role that Pandemic stress per-
ception plays.
Putting the above hypotheses together, we get our conceptual model as depicted in
Figure 1.
Figure 1. Conceptual model.
2. Materials and Methods
2.1. Participants
The participants were recruited from Jilin Province, Yunnan Province and other
provinces in China by convenient sampling via Chinese social media WeChat between 15
October 2020 and 2 December 2020. During that period, most places in China lifted the
lockdown restrictions. A total of 2711 questionnaires were distributed to junior (year 7–
year 9) and senior high school (year 10 to year 12) students. All the questionnaires were
returned with a response rate of 100%. 2691 of them were valid. The demographic infor-
mation of the participants is presented in Table 1 as follows: 1244 male students (46.2%)
and 1447 female students (53.8%); 1,668 junior high school students (62%) and 1023 senior
high school students (38%); The participants were 11–18 years old with an average age of
16.66 ± 1.77. Among the 2691 participants, 58 were infected and recovered, accounting
2.2%.
Table 1. Demographic information (N = 2691).
Variable Value Number Percentage
Gender Boy 1244 46.2%
Girl 1447 53.8%
Grade
Year 7 765 28.4%
Year 8 534 19.8%
Year 9 369 13.7%
Year 10 69 2.6%
Year 11 81 3.0%
Year 12 873 32.5%
Infection condition Uninfected 2633 97.8%
Infected 58 2.2%
Figure 1. Conceptual model.
2. Materials and Methods
2.1. Participants
The participants were recruited from Jilin Province, Yunnan Province and other
provinces in China by convenient sampling via Chinese social media WeChat between
15 October 2020
and 2 December 2020. During that period, most places in China lifted
the lockdown restrictions. A total of 2711 questionnaires were distributed to junior
(
year 7–year 9
) and senior high school (year 10 to year 12) students. All the questionnaires
were returned with a response rate of 100%. 2691 of them were valid. The demographic
information of the participants is presented in Table 1as follows: 1244 male students (46.2%)
and 1447 female students (53.8%); 1668 junior high school students (62%) and 1023 senior
high school students (38%); The participants were 11–18 years old with an average age of
16.66
±
1.77. Among the 2691 participants, 58 were infected and recovered, accounting 2.2%.
Table 1. Demographic information (N= 2691).
Variable Value Number Percentage
Gender Boy 1244 46.2%
Girl 1447 53.8%
Grade
Year 7 765 28.4%
Year 8 534 19.8%
Year 9 369 13.7%
Year 10 69 2.6%
Year 11 81 3.0%
Year 12 873 32.5%
Infection condition Uninfected 2633 97.8%
Infected 58 2.2%
2.2. Procedures
Participants were recruited by word of mouth on the Chinese social media application
WeChat. Introduction about the research was given at the beginning of the questionnaire
detailing the purpose of the research. In addition, the participants were briefed about
the anonymous and voluntary nature of the participation, and they can withdraw at any
time. The research was approved by the first author’s research review board against the
university’s research ethics guideline.
2.3. Measures
Most measures have been tested in a Chinese context. The adolescent pandemic
stress perception questionnaire was developed by the research team, and its reliability and
validity were rigorously tested.
Int. J. Environ. Res. Public Health 2022,19, 4801 5 of 16
2.3.1. Family Resilience
The family resilience questionnaire in China context was developed by [
33
] to evaluate
the performance of a family as a whole under pressure, consisting of four dimensions:
(1) Perseverance (6 items), reflecting a family’s courage, perseverance and positive efficacy
in adversities. (2) Harmony (6 items), reflecting close and harmonious relationship between
family members, i.e., whether they respect and care for each other. (3) Openness (4 items),
reflecting whether the family has a good social relationship, that is, if it is positive and
optimistic, and constantly seeks to learn and change. (4) Support (4 items), reflecting
the cooperation and mutual help between family members when facing difficulties. The
questionnaire was used on a five-point Likert scale from “1 = completely disagree” to
“5 = completely agree.” The reliability and validity of the questionnaire have been tested
using samples from Chinese contexts [
33
]. The Cronbach
α
coefficient of the overall
questionnaire was 0.94, and the Cronbach
α
coefficients of each dimension were 0.81, 0.87,
0.78, 0.81, respectively, indicating that the questionnaire had a good reliability.
2.3.2. Pandemic Stress Perception Questionnaire
The assessment tool of pandemic stress perception was developed by the research
team. Firstly, narrative interviews about pandemic stress were conducted with 6 adoles-
cents from different places in China, and the authors extracted stressors that adolescents
reported through qualitative analysis. Then, the Pandemic Stress Perception Question-
naire for adolescents was developed based on the SARS stress perception questionnaire
developed by [
34
]. The scale consists of 20 items, including three dimensions: Pandemic
panic (3 items), study pressure (9 items), family pressure (8 items). A 5-point score was
used, ranging from “0 = did not happen”, “1 = not very serious” to “4 = very serious”.
And rigorous psychometric evaluations (including preliminary test, item analysis, item
correlation analysis, exploratory factor analysis, retest, confirmatory factor analysis, reli-
ability and validity analysis, etc.) were conducted, demonstrating a good reliability and
validity. The structural model of the questionnaire reached acceptable level:
χ2
/DF = 24.05,
RMSEA = 0.093, GFI = 0.0.866, CFI = 0.916. Mean score was used with high score mean-
ing high pandemic stress perception by adolescents. The Cronbach
α
coefficient of the
scale was 0.946, and the Cronbach αcoefficients for each dimension were 0.793, 0.942 and
0.944, respectively.
2.3.3. Meta-Mood
The Trait Meta-mood Scale (TMMS) was developed by [
28
] and revised by [
35
] in
Chinese context. The revised TMMS was used in this research, which contains 26 items in
total, including three dimensions, i.e., attention to feelings, emotional clarity and emotion
repair. A five-point Likert scale was used ranging from “1 = Very inconsistent” to “5 = Very
consistent” and the total score was added up for each dimension. The scale has a good
reliability and validity. In this study, the Cronbach αcoefficient of the scale was 0.893.
2.3.4. Adolescent Mental Health
The General Health Questionnaire 12-item (GHQ-12) [
36
] was used. It consists of
12 items, half positive (e.g., “able to concentrate on whatever I do”) and half negative
(e.g., “insomnia due to anxiety”), with a 4-point scale ranging from “1 = never” to “4 = of-
ten”. Reverse score was used for negative items. The total score ranges from 12 to 48,
with a higher score indicating a better mental health, whereas an overall score below 33 is
considered poor mental health [36]. In our sample, the Cronbach αcoefficient is 0.765.
2.4. Data Analysis Methods
All the data were analyzed by SPSS 26 (IBM, New York, NY, USA). First, the data were
screened to check the suitability for statistical analysis. Missing data were checked and
normality check for variables were done. Then, descriptive analysis was conducted for
the variables. And variance analysis was used to test the differences of variables against
Int. J. Environ. Res. Public Health 2022,19, 4801 6 of 16
demographic variables. Next, the main effect was tested by using linear regression. The
mediation effect and moderated mediation effect were tested using the macro “PROCESS”
for SPSS.
3. Results
3.1. Data Screening
Prior to the formal analysis, data should be screened regarding to their suitability to
statistical analysis. First, missing data was processed. In our sample, all the questionnaires
were filled completely without missing data. Second, the normality of variables was
checked. We calculated the skewness and kurtosis for family resilience (
1.492, 2.309),
Pandemic stress perception (0.719, 0.11), meta-mood (
0.133, 2.533), mental health (0.14,
0.313). We also conducted the both the KS and Shapiro–Wilk normality tests for the
four variables. Family resilience, pandemic stress perception, meta-mood and mental
health were statistically significant (p< 0.001). So, we believe that the variables follow
normal distribution [
37
]. In addition, Harman’s single factor test results showed that there
were 11 factors with trait roots greater than 1. The first factor could explain 25.92% of
the cumulative variation, which was less than recommended threshold of 40%, indicating
that there was no serious common method bias [
38
]. After the data screening, we then
proceeded with the statistical data analysis. In the following analysis, the mean values of
the variables were used.
3.2. Descriptive Analysis
3.2.1. Adolescent Mental Health
According to the General Health Questionnaire 12-item (GHQ-12) assessment standard
(the score range is between 12 and 48, and the higher the score, the better the mental health),
the score below 33 indicates poor mental health. Table 2shows the distributions of health
status across junior and senior high schools and gender. Data showed that the overall
mental health of adolescents during the pandemic was good, with 36.7% of them having
certain mental health problems. In addition, the distribution of mental health in junior
high school students is significantly different from senior high school students, whereas
the distribution of mental health in gender is not statistically significant.
Table 2. Adolescents’ mental health during the pandemic.
Good Mental Health Poor Mental Health χ2p
Junior Number 1139 529
93.34 0.00
Percentage 68.3% 31.7%
Senior Number 564 459
Percentage 55.1% 44.9%
Boy Number 768 476
2.38 0.12
Percentage 61.7% 38.3%
Girl Number 935 512
Percentage 64.6% 35.4%
Total Number 1703 988
Percentage 63.3% 36.7%
3.2.2. Adolescents’ Pandemic Stress Perception
As shown in Figure 2, the means and standard deviations of the three dimensions
were as follows: Pandemic panic (2.18
±
0.96), study pressure (2.46
±
1.08), family pressure
(1.54
±
0.85). ANOVA test showed that the difference among the three dimensions was
statistically significant (p< 0.00). Post hoc analysis showed that study pressure is the
highest and family pressure is the lowest among the three dimensions.
Int. J. Environ. Res. Public Health 2022,19, 4801 7 of 16
Int. J. Environ. Res. Public Health 2022, 19, x FOR PEER REVIEW 7 of 17
Table 2. Adolescents’ mental health during the pandemic.
Good Mental Health Poor Mental Health χ
2
p
Junior Number 1139 529
93.34 0.00
Percentage 68.3% 31.7%
Senior Number 564 459
Percentage 55.1% 44.9%
Boy Number 768 476
2.38 0.12
Percentage 61.7% 38.3%
Girl Number 935 512
Percentage 64.6% 35.4%
Total Number 1703 988
Percentage 63.3% 36.7%
3.2.2. Adolescents’ Pandemic Stress Perception
As shown in Figure 2, the means and standard deviations of the three dimensions
were as follows: Pandemic panic (2.18 ± 0.96), study pressure (2.46 ± 1.08), family pressure
(1.54 ± 0.85). ANOVA test showed that the difference among the three dimensions was
statistically significant (p < 0.00). Post hoc analysis showed that study pressure is the high-
est and family pressure is the lowest among the three dimensions.
Figure 2. Adolescents’ Pandemic stress perception.
3.2.3. Family Resilience
The descriptive analysis of family resilience is presented in Table 3. It can be seen that
the family resilience during the pandemic was relatively good, and the average score of
each subscale was close to 4, indicating that the families of adolescents during the pan-
demic were resilient overall.
Table 3. Family resilience situation.
N Minimum Value Maximum Value M SE
Tena city 2691 1.00 5.00 4.26 0.90
Harmony 2691 1.00 5.00 4.35 0.90
Openness 2691 1.00 5.00 3.90 0.94
Support 2691 1.00 5.00 4.38 0.89
Overall 2691 1.00 5.00 4.23 0.82
Figure 2. Adolescents’ Pandemic stress perception.
3.2.3. Family Resilience
The descriptive analysis of family resilience is presented in Table 3. It can be seen that
the family resilience during the pandemic was relatively good, and the average score of
each subscale was close to 4, indicating that the families of adolescents during the pandemic
were resilient overall.
Table 3. Family resilience situation.
NMinimum Value Maximum Value M SE
Tenacity 2691 1.00 5.00 4.26 0.90
Harmony 2691 1.00 5.00 4.35 0.90
Openness 2691 1.00 5.00 3.90 0.94
Support 2691 1.00 5.00 4.38 0.89
Overall 2691 1.00 5.00 4.23 0.82
3.2.4. Adolescents’ Meta-Mood
The meta-mood scores are summarized in Table 4. It can be seen that the meta-mood
scores of adolescents during the pandemic period are at a middle and upper level. Accord-
ing to the score of each dimension, adolescents had slightly higher scores in emotional
repair than in emotional clarity and in emotional attention.
Table 4. Adolescents’ meta-mood.
NMinimum Value Maximum Value M SE
Emotion attention 2691 1.90 5.00 3.49 0.54
Emotion recognition 2691 1.70 5.00 3.48 0.58
Emotion recovery 2691 1.00 5.00 3.90 0.76
Overall score 2691 1.92 5.00 3.58 0.52
3.3. Analysis of Differences in Adolescents’ Mental Health
ANOVA was used to analyze if there is significant difference of adolescents’ mental
health in gender, grade, whether they were in graduating classes during the pandemic
period. The results are shown in Table 5. It can be seen that there was no significant gender
difference in adolescents’ mental health. The mental health of senior high school students
was worse than that of junior high school students, and the mental health of graduating
students was worse than that of non-graduating students. Overall, the mental health level
of year 7 was the highest and year 10 was the lowest.
Int. J. Environ. Res. Public Health 2022,19, 4801 8 of 16
Table 5. ANOVA analysis of mental health.
N M SD t/F p
Gender Boy 1244 2.89 0.43 0.006 0.995
Girl 1447 2.89 0.45
School level Junior high 1668 2.80 0.44 8.73 *** 0.000
Senior high 1023 2.95 0.43
Graduating
(non-graduating)
Non-graduating 1449 2.93 0.43 4.53 *** 0.000
Graduating 1242 2.86 0.45
Grade
Year 7 765 2.99 0.18
37.49 *** 0.000
Year 8 534 2.92 0.43
Year 9 369 2.90 0.47
Year 10 69 2.55 0.28
Year 11 81 2.67 0.37
Year 12 873 2.83 0.43
*** p< 0.001.
3.4. Analysis of Differences in Adolescents’ Stress Perception
It can be seen from Table 6that there was no significant gender difference in adoles-
cents’ stress perception. The stress perception of senior high school students was worse
than that of junior high school students, and the stress perception of graduating students
was worse than that of non-graduating students. On the whole, the stress perception of
year 10 is highest and year 7 is lowest.
Table 6. ANOVA analysis of stress perception.
N M SD t/F p
Gender Boy 1244 2.07 0.83 0.56 0.57
Girl 1447 2.05 0.79
School level Junior high 1668 1.84 0.74 0.11 *** 0.000
Senior high 1023 2.59 0.98
Graduating
(non-graduating)
Non-graduating 1449 2.21 0.78 9.28 *** 0.000
Graduating 1242 1.93 0.81
Grade
Year 7 765 1.82 0.75
75.11 *** 0.000
Year 8 534 1.89 0.76
Year 9 369 1.82 0.71
Year 10 69 2.99 0.94
Year 11 81 2.27 0.92
Year 12 873 2.38 0.75
*** p< 0.001.
3.5. Correlation Analysis
Correlation analysis was conducted to study the correlations between variables which
are presented in Table 7. It indicates that there was significant positive correlation be-
tween family resilience and adolescents’ mental health, meaning that the higher the family
resilience is, the better the adolescent mental health. There was a significant negative
correlation between pandemic stress perception and mental health. It suggests that the
more stress adolescents felt, the lower their mental health level. In addition, meta-mood
was positively related to family resilience and mental health, and negatively related to
stress perception.
Int. J. Environ. Res. Public Health 2022,19, 4801 9 of 16
Table 7. Correlation analysis among variables (N= 2691).
M SD 1 2 3 4
Family resilience 4.22 0.82 1
Pandemic stress perception 2.06 0.81 0.19 ** 1
Meta-mood 3.50 0.520 0.58 ** 0.28 ** 1
Adolescent mental health 2.89 0.44 0.41 ** 0.41 ** 0.61 ** 1
** p< 0.01.
3.6. Main Effects
Linear regression was used with family resilience and pandemic stress perception as
independent variables and adolescent mental health as dependent variables. Considering
grade was significant in the ANOVA analysis, we put it into the model as a control variable.
The regression results are shown in Table 8. It can be seen that family resilience had a
significant positive effect on adolescents’ mental health (
β
= 0.185 p< 0.001), and Pandemic
stress perception has a significant negative effect on adolescents’ mental health (
β
=
0.187
p< 0.001). Therefore, hypothesis 1 and hypothesis 2 are supported. Family resilience and
Pandemic stress perception have significant effect on adolescent mental health.
Table 8. Regression analysis (N= 2691).
Value R2B (SE) βp
Constant
0.29
2.52(0.04) 0.00
Year 8 0.04(0.02) 0.04 ** 0.02
Year 9 0.07(0.02) 0.05 ** 0.003
Year 10 0.06(0.04) 0.02 0.201
Year 11 0.12(0.04) 0.04 ** 0.006
Year 12 0.01(0.01) 0.01 0.535
Family resilience 0.18(0.00) 0.34 *** 0.000
Pandemic stress perception 0.18(0.01) 0.34 *** 0.000
** p< 0.01, *** p< 0.001.
3.7. Mediation Effect
We used model 4 of SPSS macro PROCESS to test the mediating effect of pandemic
stress perception on family resilience and adolescent mental health [
39
]. The results showed
that family resilience can significantly predict adolescents’ pandemic stress perception
(a=
0.136, SE = 0.018, p< 0.001). Family resilience can significantly predict adolescent
mental health (c= 0.185, SE = 0.009, p< 0.001. Pandemic stress perception can significantly
predict adolescent mental health, (b=
0.187, SE = 0.01, p< 0.001). The model output is
presented in Figure 3, which shows that the relationship between family resilience and
adolescent metal health is mediated by pandemic stress perception.
The standardized indirect effect on this model is (
0.136)
×
(
0.186) = 0.025. We
used bootstrapping procedure to test the significance of this indirect effect with 5000 boot-
strapped samples and computed the 95% CI (confidence interval) by determining the
indirect effects at the 2.5th and 97.5th percentiles as illustrated in Table 9.
It showed that pandemic stress perception had a significant mediating effect be-
tween family resilience and adolescents’ mental health, ab = 0.025 Boot SE = 0.004, 95%
confidence interval [0.017, 0.034]. The proportion of mediating effect to total effect was
ab/(ab +c) = 11.8%
. Therefore, the Hypothesis 3 was supported. Pandemic stress percep-
tion mediates the relationship between family resilience and mental health.
Int. J. Environ. Res. Public Health 2022,19, 4801 10 of 16
Int. J. Environ. Res. Public Health 2022, 19, x FOR PEER REVIEW 10 of 17
3.7. Mediation Effect
We used model 4 of SPSS macro PROCESS to test the mediating effect of pandemic
stress perception on family resilience and adolescent mental health [39]. The results
showed that family resilience can significantly predict adolescents’ pandemic stress per-
ception (a = 0.136, SE = 0.018, p < 0.001). Family resilience can significantly predict ado-
lescent mental health (c = 0.185, SE = 0.009, p < 0.001. Pandemic stress perception can sig-
nificantly predict adolescent mental health, (b = 0.187, SE = 0.01, p < 0.001). The model
output is presented in Figure 3, which shows that the relationship between family resili-
ence and adolescent metal health is mediated by pandemic stress perception.
Figure 3. Standardized regression coefficients for the relationship between family resilience and
adolescent mental health mediated by pandemic stress perception. *** p < 0.001.
The standardized indirect effect on this model is (0.136) × (0.186) = 0.025. We used
bootstrapping procedure to test the significance of this indirect effect with 5000 boot-
strapped samples and computed the 95% CI (confidence interval) by determining the in-
direct effects at the 2.5th and 97.5th percentiles as illustrated in Table 9.
Table 9. Effects in the mediation model.
Effect SE p 95% CIs
Lower CI Upper CI
Total effect 0.211 0.01 0.000 0.192 0.229
Direct effect 0.185 0.01 0.000 0.167 0.203
Indirect effect 0.025 0.004 0.017 0.034
Standardized indirect effect 0.047 0.008 0.032 0.062
Note: The bootstrap sample size is 5000.
It showed that pandemic stress perception had a significant mediating effect between
family resilience and adolescents’ mental health, ab = 0.025 Boot SE = 0.004, 95% confidence
interval [0.017, 0.034]. The proportion of mediating effect to total effect was ab/(ab + c) =
11.8%. Therefore, the Hypothesis 3 was supported. Pandemic stress perception mediates
the relationship between family resilience and mental health.
3.8. Moderated Mediation Effect
We used model 7 of SPSS macro program PROCESS to test the moderating effect of
meta-mood on the link between family resilience and pandemic stress perception. The
results are presented in Table 10. Bootstrap analysis results showed that the indirect effect
of the mediation test did not contain 0 (LLCI = 0.02 ULCI = 0.05), indicating that the me-
diation effect of the pandemic stress perception was significant, and the size of the medi-
ation effect was 0.04. In addition, the direct effect of the independent variable family re-
silience on the mental health of adolescents was significant, and the interval (LLCI = 0.16,
ULCI = 0.20) did not include 0. This suggests that pandemic stress perception plays a par-
tially mediating role in the relationship between family resilience and adolescents’ mental
health.
Figure 3.
Standardized regression coefficients for the relationship between family resilience and
adolescent mental health mediated by pandemic stress perception. *** p< 0.001.
Table 9. Effects in the mediation model.
Effect SE p95% CIs
Lower CI Upper CI
Total effect 0.211 0.01 0.000 0.192 0.229
Direct effect 0.185 0.01 0.000 0.167 0.203
Indirect effect
0.025 0.004 0.017 0.034
Standardized
indirect effect
0.047 0.008 0.032 0.062
Note: The bootstrap sample size is 5000.
3.8. Moderated Mediation Effect
We used model 7 of SPSS macro program PROCESS to test the moderating effect of
meta-mood on the link between family resilience and pandemic stress perception. The
results are presented in Table 10. Bootstrap analysis results showed that the indirect effect of
the mediation test did not contain 0 (LLCI = 0.02 ULCI = 0.05), indicating that the mediation
effect of the pandemic stress perception was significant, and the size of the mediation effect
was 0.04. In addition, the direct effect of the independent variable family resilience on the
mental health of adolescents was significant, and the interval (LLCI = 0.16, ULCI = 0.20) did
not include 0. This suggests that pandemic stress perception plays a partially mediating
role in the relationship between family resilience and adolescents’ mental health.
Table 10. The moderated mediation effect model.
Regression Equation Fitting
Index Regression Coefficient
Result
Variable
Predictive
Variable R2Fβ95%CI t
Pandemic
Stress
perception
Year 8
0.18 78.19
0.053 [0.02, 0.13] 1.27
Year 9 0.04 [0.13, 0.04] 0.92
Year 10 0.98 *** [0.79, 1.16] 10.44
Year 11 0.29 *** [0.12, 0.46] 3.36
Year 12 0.48 *** [0.41, 0.55] 13.18
Family resilience 0.09 *** [0.14, 0.04] 3.43
Meta mood 0.28 *** [0.35, 0.21] 8.12
Family resilience
×Meta-mood 0.18 *** [0.25, 0.11] 4.98
Adolescent
mental
health
Year 8
0.29 157.91
0.04 *** [0.08, 0.00] 2.29
Year 9 0.07 *** [0.11, 0.02] 3.00
Year 10 0.06 [0.15, 0.03] 1.27
Year 11 0.12 *** [0.20, 0.03] 2.72
Year 12 0.01 [0.049, 0.02] 0.62
Family resilience 0.18 *** [0.16, 0.20] 20.45
Pandemic Stress
perceived 0.18 *** [0.20, 0.16] 19.52
Note: N= 2691. Bootstrap sample size: 5000. *** p< 0.001.
Int. J. Environ. Res. Public Health 2022,19, 4801 11 of 16
At the same time, the first half of the mediating effect of pandemic stress perception
between family resilience and adolescent mental health was moderated by meta-mood. In
order to clearly reveal the interaction effect of family resilience and meta-mood, simple
slope analysis was estimated using the “pick a point” method [
40
]. We calculated the
regression coefficients of family resilience on pandemic stress perception when the meta-
mood was high (mean + 1 SD) and low (mean
1 SD). For descriptive purposes, we plotted
the predicted pandemic stress perception against family resilience separately for low and
high levels of meta-mood (See Figure 4). Results showed that when meta-mood was low,
family resilience could not significantly predict epidemic stress perception (Bsimple = 0.002,
SE = 0.02, p > 0.05); when meta-mood was high, the family resilience significantly predicted
epidemic stress perception (Bsimple =
0.19, SE = 0.04, p< 0.001). Therefore, the interaction
supports the reinforcement hypothesis of “protection factor-protection factor model”.
Int. J. Environ. Res. Public Health 2022, 19, x FOR PEER REVIEW 11 of 17
Table 10. The moderated mediation effect model.
Regression Equation Fitting Index Regression Coefficient
Result Varia-
ble Predictive Variable R² F β 95%CI t
Pandemic
Stress per-
ception
Year 8
0.18 78.19
0.053 [0.02, 0.13] 1.27
Year 9 0.04 [0.13, 0.04] 0.92
Year 10 0.98 *** [0.79, 1.16] 10.44
Year 11 0.29 *** [0.12, 0.46] 3.36
Year 12 0.48 *** [0.41, 0.55] 13.18
Family resilience 0.09 *** [0.14, 0.04] 3.43
Meta mood 0.28 *** [0.35, 0.21] 8.12
Family resilience × Meta-
mood 0.18 *** [0.25, 0.11] 4.98
Adolescent
mental
health
Year 8
0.29 157.91
0.04 *** [0.08, 0.00] 2.29
Year 9 0.07 *** [0.11, 0.02] 3.00
Year 10 0.06 [0.15, 0.03] 1.27
Year 11 0.12 *** [0.20, 0.03] 2.72
Year 12 0.01 [0.049, 0.02] 0.62
Family resilience 0.18 *** [0.16, 0.20] 20.45
Pandemic Stress per-
ceived 0.18 *** [0.20, 0.16] 19.52
Note: N = 2691. Bootstrap sample size: 5000. *** p < 0.001.
At the same time, the first half of the mediating effect of pandemic stress perception
between family resilience and adolescent mental health was moderated by meta-mood. In
order to clearly reveal the interaction effect of family resilience and meta-mood, simple
slope analysis was estimated using the “pick a point” method [40]. We calculated the re-
gression coefficients of family resilience on pandemic stress perception when the meta-
mood was high (mean + 1 SD) and low (mean 1 SD). For descriptive purposes, we plotted
the predicted pandemic stress perception against family resilience separately for low and
high levels of meta-mood (See Figure 4). Results showed that when meta-mood was low,
family resilience could not significantly predict epidemic stress perception (Bsimple =
0.002, SE = 0.02, p > 0.05); when meta-mood was high, the family resilience significantly
predicted epidemic stress perception (Bsimple = 0.19, SE = 0.04, p < 0.001). Therefore, the
interaction supports the reinforcement hypothesis of “protection factor-protection factor
model”.
Figure 4. The moderating effect of meta-mood on the relationship between family resilience and
pandemic stress perception.
Figure 4.
The moderating effect of meta-mood on the relationship between family resilience and
pandemic stress perception.
In sum, the mediation process of family resilience impacting adolescents’ mental
health through pandemic stress perception was moderated by meta-mood. For adolescents
with high meta-mood, the indirect effects of family resilience on adolescents’ mental health
through pandemic stress perception was 0.035 which was significant, with BootSE = 0.008,
and 95% confidence interval [0.02, 0.05]; for adolescents with low meta-mood, the indirect
effect was
0.00 which was not significant, with BootSE = 0.004 and 95% confidence interval
[0.01, 0.00]. Therefore, Hypothesis 4 was supported.
4. Discussion
4.1. Adolescent Mental Health and Pandemic Stress Perception during the Pandemic
Our results showed that, although the overall adolescent mental health was good, a
proportion (36.7%) of the samples got a low score, which means that the pandemic indeed
had some impacts on adolescents’ lives. The main pressures were from study pressure
and pandemic panic. This was because adolescents are in a key period of developing
their outlooks on world, life and values, during which they have strong reliance on their
parents and have weak adaptation capabilities. They cannot have a full picture of things
and their self-judgement and adjustment capability are not strong enough to cope with
the unprecedented events. When facing threats of the pandemic, their emotions and
behaviors could be easily affected. This is in line with which showed that different degrees
of emotional problems would emerge if adolescents stayed in a closed space for a long time.
When adolescents have different opinions with their family members, conflicts could be
easily occurred. Senior high school students had higher pressure than junior high school
students and graduating students had higher pressure than non-graduating students in
Int. J. Environ. Res. Public Health 2022,19, 4801 12 of 16
study pressure, pandemic panic and family pressure. This may be because higher-grade
adolescents can use social media more frequently and can get more pandemic related
information, which may increase their information anxiety [
41
]. Higher-grade students
have more difficult assignments and study challenges which may increase their study
pressure. In addition, most adolescents could not adapt to the online learning, resulting
in low learning efficiency. This is particularly true for adolescents in graduating year and
senior high school students with greater learning difficulties. However, the pressure level
of senior high school students did not decrease with the increase in grade, the pressure
level of freshmen in senior high school is the highest. This may be because the resilience
and emotional adjustment of year 9 was worse than year 10 and year 11, so they felt more
academic frustration when pandemic disrupted their preparation for entry examination for
a higher school and home study cannot achieve the expected effects. Therefore, they were
facing both pressures of pandemic and examination.
The proportion of unhealthy adolescents (36.7%) is different from existing research
from Canada which identified that 67–70% of adolescents had mental health problems [
1
].
This could be caused by the different measurements used and the differences of the pan-
demic prevention policies between the two countries. From the variance analysis, we can
see that mental health had no significant differences on gender, whereas it had significant
differences on grades; in particular, senior high school students had worse mental health
than junior high school students and graduating students had worse mental health than
non-graduating students. This result was consistent with the case of adolescents’ pressures,
which indicated that senior students were more prone to mental health problems.
In sum, besides the direct physical threats, the impact of COVID-19 pandemic on
mental health cannot be ignored due to the various pressures including but not limited to
the uncertainties of the pandemic, constantly delayed re-opening of schools, maladaptation
to online learning, conflicts with family members. The results suggested that families and
schools should understand adolescents’ emotions and stresses, help them to relieve the
negative perception of pressures, increase their capability of decrease pressure perception
to reduce the impact of the COVID-19 pandemic.
4.2. The Impact of Family Resilience and Pandemic Stress Perception on Mental Health
Our results have shown that family resilience can positively predict adolescent mental
health and pandemic stress perception can negatively predict adolescent mental health.
This is consistent with the literature [
24
]. Facing the threats to adolescents’ mental health
brought by the panic and pressures from the pandemic, families would schedule their
resources to make adjustment. However, not all families can come out of the pressures easily,
and family resilience plays an important role in this process. This could be explained from
the following aspects. First, the belief system of family resilience can make adolescents see
the pandemic positively, and see the disadvantages as temporary, changeable, so they can
deal with the negative impacts by the pandemic positively, adapt to the new environment,
enabling them to progress towards a better and positive direction [
22
]. Another research
showed that positive people can solve their current problem in a better way, reducing
pressures and overcoming the difficulties, which is an important factor predicting their
positive development [42]. Second, family organizing system and communication system
can make family members get along well with each other, making them feel happy and
comfortable. Adolescents can actively seek help and get more support from family, which
make them show stronger psychological resilience when facing risks [
43
]. Meanwhile,
literature has shown that more stresses could lead to mental health problems such as
depression [
44
]. This is the same during the pandemic. Although the stressors are different,
the perceived stress during the pandemic can significantly impact adolescents’ mental
health as shown in our result.
Int. J. Environ. Res. Public Health 2022,19, 4801 13 of 16
4.3. The Mediation Role of Pandemic Stress Perception
Research has shown that stressful life event is a risk factor to adolescents’ mental
health [
5
,
45
]. Our research supported the existing research and showed that family re-
silience cannot only impact adolescents’ mental health directly, but also through reducing
adolescents’ perceived stresses indirectly.
Specifically, our research found that family resilience had negative prediction on
adolescents’ pandemic stress perception. The resiliency model of family stress indicates
that members in a family under pressure (big risk event, or daily hassles etc.) can unite
together through holding various social psychological resources to cope with risks so that
family functions well, which in turn makes family members to adjust and adapt from
the imbalanced status caused by the risk to a balanced status. Adolescents from families
with better family resilience could feel less panic of the pandemic (e.g., worse off of the
pandemic), less study pressure (e.g., disruption of the preparation for examination), less
family pressure (e.g., increased conflicts between members) [46]. On the one hand, family
resilience can help adolescents see the uncertainties and damages positively and reduce
their negative emotions. On the other hand, family conflicts, which are usually high when
members are staying in a closed space for a long time, are less in families with better
resilience [
10
,
47
]. This could be due to their higher intimacy and better communications,
which help adolescents control their emotions and feel less pressures from family, but
rather more support and sense of belonging from family. A study on family resilience and
development of high school students after a trauma from Sichuan Wenchuan earthquake
disaster area showed that students from better family resilience can see the disaster of the
earthquake in a positive way, and can feel positive power from their family so as to find
positive ways to cope with the disaster [48].
4.4. The Moderation Role of Meta-Mood
Our result showed that meta-mood can moderate the impact of family resilience on
pandemic stress perception. The moderation role supported the reinforcement hypothesis
in the “protection factor- protection factor model” [
49
]. This means that meta-mood can
increase the protection of family resilience on pandemic stress perception, supporting
the stress buffer model, i.e., meta-mood as a protection factor for individuals coping
with pressures could buffer or reduce its bad affects [
50
]. Literature has investigated
the interaction model between meta-mood and negative life events (such as pandemic
pressure) [
51
] which showed that negative life events’ negative prediction on happiness
and mental health depended on individual’s meta-mood level.
On the one hand, staying home during the pandemic increased adolescents’ usage of
social media, which increased the possibility of information anxiety. Adolescents’ negative
cognition on pandemic information is one of the important sources of anxiety. Meta-
mood is the ability of an individual recognizing and controlling his/her emotion [
52
].
Meta-mood can help adolescents’ get more positive mental capital (confidence, hope,
positive, resilience), enabling them to actively deal with and resolve the impact of a negative
event [
29
,
53
]. Furthermore, adolescents with higher meta-mood usually pay less attention
to their emotions, know their emotion status clearly and are able to repair their bad
emotion [
52
]. This will strengthen their relationship with family members. Therefore, when
they face pressure events, they can feel positive power from family and get more social
supports [
54
]. Therefore, compared with adolescents with lower meta-mood, those with
higher meta-mood can more easily have positive cognition on the pandemic and see the
pandemic as a temporary and surmountable challenge. Family intimacy, cohesiveness
and adaptability would be higher. When facing pressures and conflicts, family members
can actively communicate, understand each other, support each other to find a solution.
This cannot only make adolescents have more resources to cope with difficulties, but also
promote family’s recovery capabilities from disaster.
Int. J. Environ. Res. Public Health 2022,19, 4801 14 of 16
4.5. Implications and Suggestions
Our results have important implications to the prevention and avoidance of adoles-
cents’ mental health problems during the pandemic. First, adolescents’ mental health is
impacted by their stresses in their ecosystem. With the increase in perceived stresses, their
mental health gets worse. Therefore, it is necessary to consider adolescents’ stresses from
family, school and society systematically and comprehensively to conduct intervention on
their crisis in time. Second, our results showed that family resilience and meta-mood are
internal mechanisms for adolescents’ mental health, which suggests parents should create
a good family environment, using democratic parenting and increase positive emotional
accompany. Meanwhile, parents should care about adolescents’ emotion control capability,
making them realize that they are the master of their emotions. Schools should strengthen
the training of applying emotion adjustment policies in pressured contexts (for example,
mindfulness training, behavioral therapy) and reduce their negative emotional experience.
5. Conclusions
Using a sample from Chinese adolescents, this paper investigated the relationship
between family resilience and adolescent mental health. We found that (1) there was
a proportion of adolescents who had mental health problems, but the overall situation
was good; (2) after controlling grades, we found that pandemic stress perception can
significantly negatively predict adolescents’ mental health, whereas family resilience can
positively predict mental health. (3) Adolescents’ stress perception mediates the impact
of family resilience on adolescents’ mental health. (4) The impact of family resilience on
pandemic stress perception was moderated by meta-mood.
This research is not without limitations. First, we used self-reported measurements
to evaluate adolescents’ mental health, which may not be able to measure the true degree
of mental health such as anxiety or depression. Therefore, mental health experts should
be invited to evaluate adolescents’ mental health. Second, adolescents’ stresses during
the pandemic and mental health are changing processes during the development of the
pandemic. Therefore, longitudinal research methods should be used to trace adolescents’
stresses and mental health at different time points during the pandemic to explore the
relationship between the variables. Third, our samples were drawn using convenient
sampling method, which may not be representative. Therefore, other sampling methods
should be used to select various samples.
Author Contributions:
Conceptualization, R.Z.; methodology, R.Z. and Y.Y.; formal analysis, Y.Y.
and X.S.; resources, R.Z.; data curation, R.Z., Y.Y. and X.S.; writing—original draft preparation, X.S.;
writing—review and editing, R.Z.; visualization, Y.Y.; supervision, R.Z.; project administration, R.Z.;
funding acquisition, R.Z. All authors have read and agreed to the published version of the manuscript.
Funding:
This study was supported by the National Planning Office of Philosophy and Social Science,
China (Grant No. 18CRK004).
Institutional Review Board Statement:
The study was conducted according to the guidelines of the
Declaration of Helsinki, and approved by the research review board of Jilin Agricultural University
with reference number: JLAU-SH-2020-0003.
Informed Consent Statement:
Informed consent was obtained from all subjects involved in the study.
Data Availability Statement: The dataset in this research can be obtained upon request.
Conflicts of Interest:
The authors declare that the research was conducted in the absence of any
commercial or financial relationships that could be construed as a potential conflict of interest.
Int. J. Environ. Res. Public Health 2022,19, 4801 15 of 16
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... And these poor parent-child relationships are risk factors for the development of anxiety and depressive symptoms (73). On the other hand, positive and stable family relationships help to alleviate mental health problems in young people (74). It was found that families with high levels of education were effective in alleviating adolescents' stress and emotional fluctuations during the COVID-19 pandemic, while adolescents from low/moderately educated families experienced more dramatic and negative changes in their emotional health (75). ...
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Background Family resilience and its role in behavioral and mental health problems has not been well documented among U.S. adolescents, especially those with ADHD. Methods Using data from the 2016 and 2017 National Survey of Children's Health (NSCH), we examined associations between family resilience connection index (FRCI) and conduct problems, depression, anxiety, and substance abuse in adolescents with ADHD aged 11-17 (n=4,169). Data were analyzed using multivariate logistic regression and chi-square tests. Results Adolescents with ADHD who had a lower FRCI score were more likely to have conduct problems (OR:1.64, CI:1.13-2.38) and depression (OR: 3.08, CI: 2.12-4.49). There were small differences between adjusted and unadjusted odds after controlling for adverse childhood experience and other covariates. Limitation We could not assert prediction or causation, only associations among variables, due to the cross-sectional design of the 2016-2017 NSCH; however, a major advantage of the NSCH is that it includes a nationally representative sample of children and allows inferences to be made for understanding of the adolescents with ADHD in the U.S. Conclusion Findings suggest that family resilience may serve as a protective factor that leads to decreasing conduct problems, despite experiencing adversity in childhood. Targeting family resilience, in terms of teaching families ways to cope with adversities such as: a child's diagnosis of ADHD; behavioral problems, and/or other adverse experiences in children's environments, has great potential to reduce adolescents’ conduct and mental health problems.