Associations of Parenting Style and Resilience With Depression and Anxiety Symptoms in Chinese Middle School Students

Abstract

Background
Parenting style and resilience are independently associated with symptoms of depression and anxiety. However, no study has tested the interaction effects between the patterns of parenting style and resilience on mental health in adolescent populations. Therefore, this study aimed to explore the interaction effects between the patterns of parenting style and resilience on depression/anxiety symptoms among middle school students in China.

Methods
A sample of 2,179 Chinese middle school students were included in this study. Latent profile analysis (LPA) was used to examine parenting style patterns. Multivariable logistic regression was used to analyze the associations of different parenting patterns and resilience with depression/anxiety symptoms, as well as the interaction effect.

Results
Latent profile analysis results showed that the most suitable model included three-profile solution, which were labeled as positive parenting, negative parenting, and moderate parenting. Subsequent analyses indicated that students across profiles exhibited significant differences in their depression/anxiety symptoms. Specifically, compared to moderate parenting, negative parenting was positively associated with depression/anxiety symptoms, while positive parenting was negatively associated with these symptoms. Moreover, low levels of resilience were positively associated with depression/anxiety symptoms compared to a high level of resilience. Although the interaction effect was not significant, there were differences in the associations between different parenting patterns and symptoms of depression and anxiety when stratifying resilience.

Conclusion
The present study identified three-profile solution of parenting styles among Chinese middle school students using LPA as a person-centered approach. Future interventions targeting depression/anxiety symptoms in adolescents may consider the potential influence of patterns of parenting styles, or improved resilience, to achieve better intervention outcomes.

Full text

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ORIGINAL RESEARCH
published: 01 July 2022
doi: 10.3389/fpsyg.2022.897339
Edited by:
Sara Giovagnoli,
University of Bologna, Italy
Reviewed by:
Manuela Cazzaro,
Università degli studi di Milano
Bicocca, Italy
Zhihua Li,
Hunan University of Science
and Technology, China
Michael Eid,
Freie Universität Berlin, Germany
*Correspondence:
Jun Wang
wangjun@ahmu.edu.cn
Hongbo Zhang
zhhongbo62@163.com
Specialty section:
This article was submitted to
Quantitative Psychology
and Measurement,
a section of the journal
Frontiers in Psychology
Received: 30 March 2022
Accepted: 14 June 2022
Published: 01 July 2022
Citation:
Qiu Z, Guo Y, Wang J and
Zhang H (2022) Associations
of Parenting Style and Resilience With
Depression and Anxiety Symptoms
in Chinese Middle School Students.
Front. Psychol. 13:897339.
doi: 10.3389/fpsyg.2022.897339
Associations of Parenting Style and
Resilience With Depression and
Anxiety Symptoms in Chinese Middle
School Students
Zhihai Qiu1, Ying Guo2, Jun Wang3,4*and Hongbo Zhang3*
1The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China, 2Psychological Center
of Hefei No.1 High Senser School, Hefei, China, 3Department of Maternal, Child and Adolescent Health, School of Public
Health, Anhui Medical University, Hefei, China, 4MOE Key Laboratory of Population Health Across Life Cycle, Anhui
Provincial Key Laboratory of Population Health and Aristogenics, Hefei, China
Background: Parenting style and resilience are independently associated with
symptoms of depression and anxiety. However, no study has tested the interaction
effects between the patterns of parenting style and resilience on mental health in
adolescent populations. Therefore, this study aimed to explore the interaction effects
between the patterns of parenting style and resilience on depression/anxiety symptoms
among middle school students in China.
Methods: A sample of 2,179 Chinese middle school students were included in this
study. Latent profile analysis (LPA) was used to examine parenting style patterns.
Multivariable logistic regression was used to analyze the associations of different
parenting patterns and resilience with depression/anxiety symptoms, as well as the
interaction effect.
Results: Latent profile analysis results showed that the most suitable model included
three-profile solution, which were labeled as positive parenting, negative parenting,
and moderate parenting. Subsequent analyses indicated that students across profiles
exhibited significant differences in their depression/anxiety symptoms. Specifically,
compared to moderate parenting, negative parenting was positively associated with
depression/anxiety symptoms, while positive parenting was negatively associated
with these symptoms. Moreover, low levels of resilience were positively associated
with depression/anxiety symptoms compared to a high level of resilience. Although
the interaction effect was not significant, there were differences in the associations
between different parenting patterns and symptoms of depression and anxiety when
stratifying resilience.
Conclusion: The present study identified three-profile solution of parenting styles
among Chinese middle school students using LPA as a person-centered approach.
Future interventions targeting depression/anxiety symptoms in adolescents may
consider the potential influence of patterns of parenting styles, or improved resilience,
to achieve better intervention outcomes.
Keywords: parenting style, resilience, depression symptoms, anxiety symptoms, latent profile analysis (LPA)
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INTRODUCTION
Depression and anxiety are the most common
psychopathological symptoms in adolescents. Depression
symptoms manifest as persistent sadness, loss of interest,
fear of the future, and potential suicidality (Naab et al., 2015;
Wartberg et al., 2018). Anxiety is an emotion characterized
by feelings of tension, worried thoughts, and physical changes
such as increased blood pressure (Organization, 2013). While
adolescents are in the transition period from childhood to
adulthood, simultaneously experiencing great changes in
social roles and living environment means they are more
prone to depression, anxiety, and other adverse emotions.
The global prevalence of clinically elevated depressive/anxiety
symptoms among adolescents was approximately 25.2 and
20.5%, respectively. Furthermore, a survey completed by Chinese
high school students from 21 provinces and autonomous regions
revealed that the prevalence of depressive and anxiety symptoms
was 43.7 and 37.4% among students (Zhou et al., 2020).
Parenting style refers to the attitude, goals, and emotional
atmosphere that parents use to raise and educate their children,
which remain relatively stable in different situations (Darling
and Steinberg, 1993). Parental warmth and strictness have
been identified as the two main independent dimensions of
parenting style. From these, four parenting styles were identified:
authoritative (marked by high warmth and high strictness),
authoritarian (marked by low warmth and high strictness),
indulgent (marked by high warmth and low strictness), and
neglectful (marked by low warmth and low strictness) parenting
(Martinez et al., 2020). A systematic literature review showed
that (Gorostiaga et al., 2019) parental warmth, behavioral control,
and autonomy granting were inversely correlated with depressive
symptoms in adolescents, while parental psychological control
and severe control were positively related to depression/anxiety
symptoms. Romero-Acosta et al. (2021) found that compared
with those who experienced authoritative parenting, students
who experienced neglectful parenting styles generally had lower
symptoms of anxiety. Prior studies on parenting style have
mainly used variable-centered methods, which makes it difficult
to examine how the various factors that constitute parenting style
combine within individuals and affect children. In this regard,
it is necessary to examine parenting style by using latent profile
analysis (LPA) with a person-centered approach. A person-
centerd approach can provide more insight than a variable-
centerd approach into the parenting style of specific populations
with heterogeneous characteristics (Lee and Han, 2021).
In addition to the influence of parenting style on depressive
and anxiety symptoms in adolescents, resilience has also been
suggested as influential. For instance, previous research has
confirmed that higher levels of resilience are related to lower
levels of depressive symptoms in children and adolescents
(Wingo et al., 2010;Wu et al., 2017;Lee et al., 2021). Furthermore,
a three-wave cross-lagged design indicated (Lau, 2022) an
unstable reciprocal correlation between resilience and depression
over time and a stable reciprocal correlation between resilience
and anxiety symptoms.
According to the existing mental resilience model (Mandleco
and Peery, 2000), the factors affecting mental resilience can be
divided into internal factors and external factors. Internal factors
are biological factors (e.g., genetic) and psychological factors
(e.g., optimism and self-esteem), while external factors refer to
factors inside and outside the family (e.g., family functions and
social support). Among them, parenting style is an important
external factor. And adolescent mental health can be affected
by parenting style (Milevsky et al., 2007). Research on resilience
and parenting style has shown that authoritative parenting has a
significantly positive impact on resilience (Kritzas and Grobler,
2005;Zakeri et al., 2010). Therefore, based on previous surveys,
the following three hypotheses were proposed: (1) exploring
different patterns of parenting style by LPA; (2) parenting style
and resilience are independently correlated with anxiety and
depressive symptoms in Chinese adolescents; and (3) there are
interaction effects of parenting style and resilience on depressive
and anxiety symptoms.
MATERIALS AND METHODS
Participants
This was a cross-sectional study, and a cluster sampling design
was used to select the sample population from Hefei City, Anhui
Province during the period of September to October 2021. A total
of 2,936 senior high school students were recruited for this study
and 2,879 valid questionnaires were received (57 questionnaires
with missing values >15% were deleted). The efficacy rate was
98.06%. Of them, the mean age was 16.7 ±1.8 years, 63.4% were
boys (1,319) and 36.6% were girls (760).
This study was approved by the Ethics Committee of Anhui
Medical University. Informed consent was obtained from all
students, parents, and teachers before the survey.
Measures
Sociodemographic Data
Sociodemographic data were collected using an anonymous
questionnaire, which included gender, only child status,
registered residence, self-reported academic performance (poor,
medium, or good), and parents’ education level.
Parenting Styles
The Egma Minnen av Bardndosnauppforstran (EMBU) standard
edition, which was co-edited by Perris et al. (1980) of the
Psychiatry Department at Umea University in Sweden, was
used to evaluate parenting attitudes and behaviors. The Chinese
version of the EMBU, which was first introduced in 1993 (Li
et al., 2012). Paternal and maternal parenting styles comprise
58 and 57 items, respectively. It includes six subscales: parental
emotional warmth, parental rejection and denial, parental severe
punishment, parental excessive interference, parental favoring
subjects, and paternal over-protection. In this study, only child
accounted for 44.3% (921), so the subscale of parental favoring
subjects were excluded. Furthermore, except for paternal over-
protection, the other four sub-scales all include two dimensions
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Qiu et al. Depression and Anxiety Symptoms
of father and mother, respectively. In summary, there are nine
dimensions. Each item was adopted a 4-point Likert scale ranged
from 1 (never) to 4 (most of time), and entries were added
according to different dimensions. In this study, the Cronbach’s α
coefficients for paternal and maternal parenting styles were 0.813
and 0.807, respectively.
Depression Symptoms
The Center for Epidemiological Studies Depression Scale (CES-
D) is a widely used depressive symptom screening tool worldwide
(Radloff, 1977). Compared with other depression scales, this scale
focuses more on an individual’s emotional experiences and less on
the somatic symptoms of depression. The scale has a total of 20
items, and each item is rated on a 4-point Likert scale ranging
from 0 (rarely or none), 1 (some or a little), 2 (occasional or
moderate), and 3 (most or all of the time), of which four items on
positive affect were reverse-scored. Adolescents with depressive
symptoms were classified based on whether their total score was
≥20 (Huang et al., 2021;Sun et al., 2021). The overall Cronbach’s
alpha coefficient for the scale was 0.910.
Anxiety Symptoms
The Self-rating Anxiety Scale (SAS) is a 20-item retrospective
self-report questionnaire designed to detect symptoms related
to anxiety in the general population (Zung, 1971). Responses to
each question range from 1 (no or little time at all) to 4 (most
or all of the time), equating to a total scale raw score of 20–
80, then conversed to a index score with a potential range of
25–100. The index score is “derived by dividing the sum of the
values (raw scores) obtained on the 20 items by the maximum
possible score of 80, converted to a decimal and multiplied by
100” (Zung, 1971). The higher the standard score, the more
severe the symptom. Subsequently, 50 points were set as the cut-
off standard for anxiety symptoms (Zung, 1971;Huang et al.,
2021). In this study, Cronbach’s αcoefficient was 0.799.
Resilience
Resilience was measured using the Self-rating Resilience Scale
for Middle School Students (SRSMSS) compiled by Hu et al.
(2011). A total of 26 items were used, including six dimensions:
problem solving, cooperation and communication, self-efficacy,
goals and aspirations, self-awareness, and empathy. According
to the situation experienced by participants over the previous
two weeks, each option was scored on a scale of 1–5,
indicating “never,” “occasionally,” “sometimes,” “often,” and
“always”. Students in this study were categorized as having low
or high resilience, with P75 as the cutoff point. The SRSMSS has
high reliability and validity (Lü et al., 2013), and Cronbach’s α
coefficient was 0.931 in the present study.
Statistical Analysis
SPSS 23.0 was used for data processing and analysis, and
the inspection level was α= 0.05. First, we used χ2tests to
compare the associations between sociodemographic variables
and anxiety and depression symptoms. Second, in order to
identify parenting styles of different clustering patterns, Mplus
version 7.4 was utilized for LPA. Indicators for the primary
analysis included nine dimensions from the EMBU. The number
of latent classes was determined based on the commonly used
fit statistics of Akaike’s Information Criterion (AIC), Bayesian
Information Criterion (BIC), and sample-size adjusted BIC
(a-BIC); lower numbers indicated better model fit, as well
as the bootstrapped likelihood ratio test (BLRT), which is a
significance test for model improvement with the addition
of each potential class. Generally, a relative entropy >0.7
indicates that the model is in the acceptable range, and the
proportion of each classification group should be >5% of the
total population. Third, multivariable logistic regression was
used to analyze the associations of parenting style and resilience
with depressive and anxiety symptoms, controlling for gender,
only child status, registered residence, self-reported academic
performance, and parents’ education level. In examining the
association of resilience with depressive and anxiety symptoms,
we also used the thresholds of resilience score ≥P67 and ≥P90
for sensitivity analysis. Binary logistic regression was used to
analyze the relationship between the interaction of parenting style
and resilience with depressive and anxiety symptoms. Finally,
a stratified analysis of the relationship between parenting style
and anxiety as it relates to depression symptoms was conducted
according to the level of resilience.
RESULTS
Characteristics of Participants
As shown in Table 1, of 2,079 participants, 63.4% were boys and
the rates of depression/anxiety symptoms were 26.0% (541) and
13.4% (279), respectively. Depression/anxiety symptoms were
more common in girls and in rural areas (P<0.001). Rates
were highest among students with poor self-reported academic
performance (P<0.001). No statistically significant differences
in depression/anxiety symptoms were found in students who
were an “only child” or in fathers’ educational level (P>0.05).
Latent Profile Analysis of Parenting
Styles
Models with one to five profiles were tested in the LPA. The
three-profile solution was regarded as the most suitable based on
the indices (Table 2), which showed the high entropy (0.896),
p-values of LMR and BLRT test were significant. In addition,
the average posterior class membership probability scores were
acceptable among the groups (0.929–0.966; Supplementary
Table 1). Due to the lower AIC, BIC, and aBIC for the four-profile
solution, we also compared and analyzed it (Supplementary
Figure 1). The results showed that there were not much
distinction between profiles solution. Moreover, the proportion
of a profile group was 4.0% (<5%) of the total population,
it did not meet the selection requirements of the model.
Meanwhile, further stratified analysis showed that the sample
size of some groups was too small to obtain effective results.
Therefore, based on the above reasons and the principle of model
simplicity, we chose the three-profile solution for the suitable of
in the present study.
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TABLE 1 | Characteristics of participants by depression/anxiety symptoms.
Variable Total (N= 2079) Depression symptoms n(%) Anxiety symptoms n(%)
No Yes χ2No Yes χ2
Gender 5.33* 17.16**
Male 1319 (63.4) 998 (75.7) 321 (24.3) 1173 (88.9) 146 (11.1)
Female 760 (36.6) 540 (71.1) 220 (28.9) 627 (82.5) 133 (17.5)
Only child 0.55 0.11
Yes 921 (44.3) 674 (73.2) 247 (26.8) 800 (86.9) 121 (13.1)
No 1158 (55.7) 864 (74.6) 294 (25.4) 1000 (86.4) 158 (13.6)
Registered
residence
13.77** 11.06**
Rural 825 (39.7) 574 (69.6) 251 (30.4) 689 (83.5) 136 (16.5)
Urban 1254 (60.3) 964 (76.9) 290 (23.1) 1111 (88.6) 143 (11.4)
Self-reported academic performance 12.88* 11.55*
Good 228 (11.0) 163 (71.5) 65 (28.5) 191 (83.8) 37 (16.2)
Medium 1731 (83.3) 1302 (75.2) 429 (24.8) 1516 (87.6) 215 (12.4)
Poor 120 (5.8) 73 (60.8) 47 (39.2) 93 (77.5) 27 (22.5)
Father’s education level 3.11 4.13
Primary or
below
85 (4.1) 60 (70.6) 25 (29.4) 70 (82.4) 15 (17.6)
Junior middle
school
599 (28.8) 431 (72.0) 168 (28.0) 512 (85.5) 87 (14.5)
Senior middle
school
515 (24.8) 381 (74.0) 134 (26.0) 442 (85.8) 73 (14.2)
College or
above
880 (42.3) 666 (75.7) 214 (24.3) 776 (88.2) 104 (11.8)
Mother’s education level 10.44* 3.32
Primary or
below
188 (9.0) 145 (77.1) 43 (22.9) 165 (87.8) 23 (12.2)
Junior middle
school
655 (31.5) 455 (69.5) 200 (30.5) 554 (84.6) 101 (15.4)
Senior middle
school
524 (25.2) 401 (76.5) 123 (23.5) 459 (87.6) 65 (12.4)
College or
above
712 (34.2) 537 (75.4) 175 (24.6) 622 (87.4) 90 (12.6)
*P <0.05. **P <0.001.
TABLE 2 | Fitting information was analyzed by latent categories of parenting styles.
Profiles df AIC BIC aBIC Entropy LMR BLRT Profile probability
1 18 115,441.750 115,543.263 – – – – –
2 28 109,155.840 109,313.750 109,224.791 0.926 <0.001 <0.001 74.80/25.20
3 38 107,232.838 107,447.165 107,326.435 0.896 0.041 <0.001 58.87/31.99/9.22
4 48 106,382.317 106,653.019 106,500.519 0.888 0.022 <0.001 30.54/12.17/53.3/3.99
5 58 105,739.617 106,066.716 105,882.445 0.849 0.344 <0.001 41.08/18.33/16.26/20.30/4.04
df, degrees of freedom; AIC, Akaike Information Criteria; BIC, Bayesian Information Criteria; aBIC, Adjusted Bayesian Information Criteria; LMR, Lo-Mendell-Rubin
Likelihood Ratio; BLRT, Bootstrapped Likelihood Ratio Tests.
Figure 1 shows the three parenting profiles. profile 1
showed a high level of parental emotional warmth and was
labeled as “positive parenting” (58.6%). In contrast, profile 2
was characterized by a high probability of severe punishment,
excessive interference, rejection and denial, and overprotection,
thus we labeled it as “negative parenting” (9.2%). Meanwhile,
profile 3 consisted of a moderate probability across nine
dimensions of parenting styles, which was labeled as “moderate
parenting” (32.2%).
Patterns of Parenting Styles and
Resilience With Depression/Anxiety
Symptoms
Table 3 shows the association of the three profiles of parenting
styles and resilience with depression/anxiety symptoms. After
adjusting for sociodemographic characteristics (gender, only
child status, registered residence, self-reported academic
performance, and parents’ education level), compared with
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FIGURE 1 | Plot of 3 latent profiles of parenting styles. P1 = paternal emotional warmth; M1 = maternal emotional warmth; P2 = paternal severe punishment;
M2 = maternal severe punishment; P3 = paternal excessive interference; M3 = maternal excessive interference; P4 = paternal rejection and denial; M4 = maternal
rejection and denial; P5 = paternal over protection.
TABLE 3 | Association of parenting style and resilience with depression/anxiety symptoms in adolescents.
Variable Total (N= 2079) Depression symptoms Anxiety symptoms
n(%) Crude OR (95% CI) Adjusted OR (95% CI)an(%) Crude OR (95% CI) Adjusted OR (95% CI)a
Parenting style
Positive parenting 1,224 (58.9) 194 (15.8) 0.32 (0.25–0.39)** 0.30 (0.24–0.37)** 91 (7.4) 0.34 (0.25–0.45)** 0.32 (0.24–0.43)**
Negative parenting 190 (9.1) 98 (51.6) 1.78 (1.29–2.46)* 1.82 (1.30–2.53)** 60 (31.6) 1.94 (1.35–2.78)** 2.01 (1.38–2.92)**
Moderate parenting 665 (32.0) 249 (37.4) 1.00 1.00 128 (19.2) 1.00 1.00
Resilience
Low 1549 (74.5) 504 (32.5) 6.43 (4.53–9.13)** 6.74 (4.78–9.61)** 245 (15.8) 2.74 (1.88–3.98)** 2.80 (1.92–4.09)**
High 530 (22.5) 37 (7.0) 1.00 1.00 34 (6.4) 1.00 1.00
aAdjusted for gender, only child, registered residence, self-reported academic performance, parents’ education level. *P <0.05. *P <0.001.
the “moderate parenting” pattern, logistics regression analysis
showed that the “negative parenting” pattern was positively
associated with depression symptoms (OR = 1.82, 95%CI:
1.30–2.53) and anxiety symptoms (OR = 2.01, 95%CI: 1.38–2.92).
Conversely, the “positive parenting” pattern was negatively
associated with depression symptoms (OR = 0.30, 95%CI:
0.24–0.37) and anxiety symptoms (OR = 0.32, 95%CI: 0.24–0.43).
With a high level of resilience (≥P75) as the control group, a
low level of resilience was positively associated with depression
(OR = 6.74, 95%CI: 4.73–9.61) and anxiety symptoms (OR = 2.80,
95%CI: 1.92–4.09). Across different gender subgroups, the above
association results were similar (Supplementary Tables 2,3).
Using the thresholds of resilience score ≥P67 and ≥P90 for
separate data analysis, we found that the associations of
different level of resilience and depression/anxiety symptoms
(Supplementary Table 4) were similar to those found with ≥P75
(Table 3).
The patterns of parenting style and resilience were highly
correlated in the present study (Supplementary Table 5).
However, there were no interaction effects between parenting
style and resilience on depression/anxiety symptoms in the
total sample (Supplementary Table 6). Table 4 shows the
stratified data analysis by resilience group level. A significant
association of depression symptoms (C1: OR = 0.34, 95%CI:
0.27–0.43; C2: OR = 1.79, 95%CI: 1.25–2.58) and anxiety
symptoms (C1: OR = 0.36, 95%CI: 0.26–0.50; C2: OR = 1.96,
95%CI: 1.32–2.92) with the patterns of parenting styles
was seen in adolescents with low levels of resilience. At a
high level of resilience, the “positive parenting” pattern was
negatively associated with depressive symptoms (OR = 0.39,
95%CI: 0.18–0.83) and anxiety symptoms (OR = 0.28,
95%CI: 0.13–0.62), and there was no significant association
of “negative parenting” patterns with depressive symptoms and
anxiety symptoms.
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TABLE 4 | Association of parenting style with depression/anxiety symptoms by different level of resilience.
Parenting style Depression symptoms Anxiety symptoms
n(%) Crude OR (95% CI) Adjusted OR (95% CI)an(%) Crude OR (95% CI) Adjusted OR (95% CI)a
Low
Positive parenting 175 (21.0) 0.36 (0.28–0.45)** 0.34 (0.27–0.43)** 75 (9.0) 0.38 (0.27–0.51)** 0.36 (0.26–0.50)**
Negative parenting 93 (57.1) 1.78 (1.25–2.53)* 1.79 (1.25–2.58)* 55 (33.7) 1.94 (1.32–2.84)* 1.96 (1.32–2.92)*
Moderate parenting 236 (42.8) 1.00 1.00 115 (20.8) 1.00 1.00
High
Positive parenting 19 (4.9) 0.39 (0.19–0.83)* 0.39 (0.18–0.83)* 16 (4.1) 0.33 (0.15–0.71)* 0.28 (0.13–0.62)*
Negative parenting 5 (18.5) 1.75 (0.57–5.41) 1.75 (0.53–5.72) 5 (18.5) 1.75 (0.57–5.41) 1.99 (0.60–6.61)
Moderate parenting 13 (11.5) 1.00 1.00 13 (11.5) 1.00 1.00
aAdjusted for gender, only child, registered residence, self-reported academic performance, parents’ education level. *P <0.05. **P <0.001.
DISCUSSION
This study examined the effects of parenting style patterns and
resilience on depression/anxiety symptoms among adolescents.
Results revealed that diverse profilees of parenting styles
with different resilience levels have various relationships with
depression/anxiety. However, we found no interaction between
parenting style, resilience, depression, and anxiety symptoms
among adolescents.
In the current study, we found that the prevalence of
depression/anxiety symptoms among adolescents was 26.0 and
13.4%, respectively, which was lower than that reported by Zhou
et al. (2020) (43.7 and 37.4%, respectively). Severval studies
indicated that the prevalence of depressive/anxiety symptoms
among adolescents in China may be higher than in other
countries (Denda et al., 2006;Liu and Lu, 2012;Polanczyk et al.,
2015;Murshid, 2017). It may be explained by the following
reasons. First, Chinese teenagers are burdened with homework,
high academic pressure and little physical activity, which may
increase the risk of depressive/anxiety symptoms (Tepper et al.,
2008). Second, the difference in prevalence of depression/anxiety
symptoms may be associated with the different scales, evaluation
criteria, and the different ages of the study populations (Wang
et al., 2016;Rao et al., 2019). Third, the level of economic
development in different regions, interpersonal relationships,
and specific cultural factors in different regions could have
contributed to the difference in results (Tang et al., 2019;Wang
S. et al., 2019;Wang Y. Y. et al., 2019).
In the real world, parenting styles are not limited to a single
form, and each parenting style is an integrated combination of
behaviors. Thus, in this study, LPA was used to classify parenting
styles into three profiles: “positive parenting” (58.6%), “negative
parenting” (9.2%) and “moderate parenting” (32.2%). Similarly,
a Chinese study conducted by Wu et al. (2016) labeled parenting
styles as “positive parenting,” “negative parenting,” and “mixed
parenting”. These results differed from the comprehensive
model of parenting styles used in other studies. For example,
Ayón et al. (2015) investigated different parenting styles and
labeled four profiles as “family parenting,” “child-centered
parenting,” “moderate parenting,” and “disciplinarian parenting.”
The reason for the difference in results may be that these
studies were conducted in different cultural contexts and used
different parenting style questionnaires. In summary, parenting
styles may not be limited to one form, which suggests that
different cultural backgrounds and different questionnaires
for the comprehensive model of parenting styles can be
further explored.
This study revealed that, compared with the “moderate
parenting” profile, the “positive parenting” and the “negative
parenting” profiles were both related to depression/anxiety
symptoms among adolescents, while positive parenting was
a protective factor for depression/anxiety. Wang et al. (2021)
identified four parenting styles through LPA as: the “care-
autonomy” profile, “overprotection indifference” profile,
“indifference” profile, and “undifferentiated parenting” profile.
These results suggested that the risk of depression/anxiety
symptoms among adolescents was lower in the “care-
autonomy” profile, while the risk of depression was higher in
the “indifference parenting” profile than in the “undifferentiated
parenting” profile. A cross-sectional study (Eun et al., 2018)
showed that different types of parenting styles were associated
with depression/anxiety symptoms among adolescents, while
“high maternal control” style was related to greater odds of
depression/anxiety.
Simultaneously, this study found that resilience was related to
depression/anxiety symptoms among adolescents. The resilience
protection model suggested that resilience had a buffer effect on
the negative effects of adversity on adolescents, and the higher the
resilience score was, the lower the risk of negative consequences
(Brookmeyer et al., 2005). It indicated that resilience may
be a factor influencing depression/anxiety symptoms among
adolescents. Skrove et al. (2013) demonstrated this, and also
showed that resilience is a protective factor against adolescent
depression/anxiety symptoms. A cohort study examined the
impact of resilience on depression symptoms among left-
behind children in China, and found that baseline resilience
was related to follow-up depressive symptoms among children
(Wu et al., 2017). These results were consistent with those of
the current study.
At present, there are few studies on the relationship between
parenting style, resilience, and depression/anxiety symptoms
among adolescents. Similar studies have explored the correlation
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Qiu et al. Depression and Anxiety Symptoms
mediating effect of negative life events, resilience, and depressive
symptoms in Chinese adolescents, and found that resilience was
negatively associated with depression symptoms; among these,
resilience partially mediated the impact of negative life events
on depressive symptoms in Chinese adolescents (Liu et al.,
2019). Anyan et al. (Anyan and Hjemdal, 2016) investigated
the effect of stress on the relationship between resilience and
anxiety/depression symptoms among adolescents. They found
that resilience was inversely related to anxiety and depression
symptoms, with resilience playing a partial mediating role
between stress and anxiety/depression symptoms. In this study,
we found no association between parenting style, resilience,
depression, and anxiety symptoms among adolescents. The above
studies indirectly suggest that different types of parenting styles
may affect adolescent depression/anxiety symptoms through
resilience, but given the limited research results, it remains to
be seen whether the relevant theoretical hypotheses are valid and
can be verified.
STRENGTH AND LIMITATIONS
This study used more advanced statistical analysis (LPA)
to identify the different patterns of parenting styles, and
subsequently evaluate the relationship between patterns of
parenting styles, resilience, and depression/anxiety symptoms
among middle school students. The research ideas are novel
and provide a reference for the promotion of adolescent mental
health. However, this study has some limitations. First, this was a
cross-sectional study; thus, we were unable to establish a causal
relationship between variables, and cohort studies should be
conducted to further explore these relationships. Second, the
research object was limited to senior high school students in Hefei
City. The sample size of the survey was small and extrapolation
of the conclusions was limited. Future research with a larger
cohort may wish to explore stability and transition patterns across
parenting styles. Finally, our study questionnaire was completed
subjectively by participants; thus, there may have been some
recall bias. Therefore, combined with the EMBU child and parent
versions (Mathieu et al., 2020), this study aimed to understand
how depression/anxiety symptoms may be affected differently
across these two reporting types.
CONCLUSION
This study identified three profiles of parenting style practiced
on Chinese adolescents using a LPA approach. Simultaneously,
we investigated the influence of different parenting patterns and
resilience on depression/anxiety symptoms among adolescents
and their interaction effects. Future studies on exporting the risk
and protective factors of depression/anxiety symptoms should
consider the potential influence of different patterns of parenting
styles and levels of resilience.
DATA AVAILABILITY STATEMENT
The raw data supporting the conclusions of this article will be
made available by the authors, without undue reservation.
ETHICS STATEMENT
The studies involving human participants were reviewed and
approved by Ethics Committee of Anhui Medical University.
Written informed consent to participate in this study was
provided by the participants or their legal guardian/next of kin.
AUTHOR CONTRIBUTIONS
ZQ reviewed the topic related literature and drafted the first
version of manuscript. ZQ and YG performed the study design,
coordination, and data collection and worked on data analysis.
JW involved in interpretation of the data and revision of the
manuscript. HZ performed the study design and carried out study
supervision and revision of the manuscript. All authors checked
interpreted results and approved the final version.
FUNDING
Funding for the project was provided by Humanities and
Social Science research project of Anhui Universities in 2018
(SK2018A0159). The funders had no role in study design,
data collection and analysis, decision to publish, or preparation
of the manuscript.
ACKNOWLEDGMENTS
We would like to thank the action teams, staff, and students
involved in the senior school survey for their assistance in
gathering information.
SUPPLEMENTARY MATERIAL
The Supplementary Material for this article can be found
online at: https://www.frontiersin.org/articles/10.3389/fpsyg.
2022.897339/full#supplementary-material
REFERENCES
Anyan, F., and Hjemdal, O. (2016). Adolescent stress and symptoms of anxiety
and depression: resilience explains and differentiates the relationships. J. Affect.
Disord. 203, 213–220. doi: 10.1016/j.jad.2016.05.031
Ayón, C., Williams, L. R., Marsiglia, F. F., Ayers, S., and Kiehne, E. (2015). A Latent
Profile Analysis of Latino Parenting: the Infusion of Cultural Values on Family
Conflict. Fam. Soc. 96, 203–210. doi: 10.1606/1044-3894.2015.96.25
Brookmeyer, K. A., Henrich, C. C., and Schwab-Stone, M. (2005). Adolescents
who witness community violence: can parent support and prosocial cognitions
Frontiers in Psychology | www.frontiersin.org 7July 2022 | Volume 13 | Article 897339

fpsyg-13-897339 June 27, 2022 Time: 16:37 # 8
Qiu et al. Depression and Anxiety Symptoms
protect them from committing violence?. Child Dev. 76, 917–929. doi: 10.1111/
j.1467-8624.2005.00886.x
Darling, N., and Steinberg, L. (1993). Parenting style as context: an
integrative model. Psychol. Bull. 113, 487–496. doi: 10.1037/0033-2909.11
3.3.487
Denda, K., Kako, Y., Kitagawa, N., and Koyama, T. (2006). Assessment of
depressive symptoms in Japanese school children and adolescents using the
Birleson depression self-rating scale. Int. J. Psychiatry Med. 36, 231–241. doi:
10.2190/3YCX-H0MT-49DK-C61Q
Eun, J. D., Paksarian, D., He, J. P., and Merikangas, K. R. (2018). Parenting style
and mental disorders in a nationally representative sample of US adolescents.
Soc. Psychiatry Psychiatr. Epidemiol. 53, 11–20. doi: 10.1007/s00127-017-1
435-4
Gorostiaga, A., Aliri, J., Balluerka, N., and Lameirinhas, J. (2019). Parenting styles
and internalizing symptoms in adolescence: a systematic literature review. Int.
J. Environ. Res. Public Health 16:3192. doi: 10.3390/ijerph16173192
Hu, H., Zhang, H., and Wang, J. (2011). Reliability and validity of the self-rating
scale of psychological resilience for secondary school students. Chin. J. Sch.
Health 32, 291–293. doi: 10.16835/j.cnki.1000-9817.2011.03.017
Huang, X., Wang, X., Hu, J., Xue, Y., Wei, Y., Wan, Y., et al. (2021). Inadequate
mental health literacy and insufficient physical activity potentially increase the
risks of anxiety and depressive symptoms in Chinese college students. Front.
Psychiatry 12:753695. doi: 10.3389/fpsyt.2021.753695
Kritzas, N., and Grobler, A. A. (2005). The relationship between perceived
parenting styles and resilience during adolescence. J. Child Adolesc. Ment.
Health 17, 1–12. doi: 10.2989/17280580509486586
Lau, W. K. W. (2022). The role of resilience in depression and anxiety symptoms:
a three-wave cross-lagged study. Stress Health [Epub ahead of print]. doi: 10.
1002/smi.3136
Lee, H., and Han, J. W. (2021). Analysis of Parenting Attitude Types and
Influencing Factors of Korean Parents by Using Latent Transition Analysis. Int.
J. Environ. Res. Public Health 18:7394. doi: 10.3390/ijerph18147394
Lee, T. S., Wu, Y. J., Chao, E., Chang, C. W., Hwang, K. S., and Wu, W. C.
(2021). Resilience as a mediator of interpersonal relationships and depressive
symptoms amongst 10th to 12th grade students. J. Affect. Disord. 278, 107–113.
doi: 10.1016/j.jad.2020.09.033
Li, Z., Wang, L., and Zhang, L. (2012). Exploratory and confirmatory factor analysis
of a short-form of the EMBU among Chinese adolescents. Psychol. Rep. 110,
263–275. doi: 10.2466/02.08.09.21.PR0.110.1.263-275
Liu, W. J., Zhou, L., Wang, X. Q., Yang, B. X., Wang, Y., and Jiang, J. F. (2019).
Mediating role of resilience in relationship between negative life events and
depression among Chinese adolescents. Arch. Psychiatr. Nurs. 33, 116–122.
doi: 10.1016/j.apnu.2019.10.004
Liu, Y., and Lu, Z. (2012). Chinese high school students’ academic stress and
depressive symptoms: gender and school climate as moderators. Stress Health
28, 340–346. doi: 10.1002/smi.2418
Lü, X., Sun, Y., Yang, L., Chen, M., Jiang, Y., Zhang, H., et al. (2013). Reevaluation
of the scale of psychological resilience for middle and primary school students.
Wei Sheng Yan Jiu 42, 257–262.
Mandleco, B. L., and Peery, J. C. (2000). An organizational framework for
conceptualizing resilience in children. J. Child Adolesc. Psychiatr. Nurs. 13,
99–111. doi: 10.1111/j.1744-6171.2000.tb00086.x
Martinez, I., Garcia, F., Veiga, F., Garcia, O. F., Rodrigues, Y., and Serra, E. (2020).
Parenting styles, internalization of values and self-esteem: a cross-cultural study
in Spain. Portugal and Brazil. Int. J. Environ. Res. Public Health 17:2370. doi:
10.3390/ijerph17072370
Mathieu, S. L., Conlon, E. G., Waters, A. M., and Farrell, L. J. (2020). Perceived
parental rearing in paediatric obsessive-compulsive disorder: examining the
factor structure of the EMBU child and parent versions and associations with
OCD symptoms. Child Psychiatry Hum. Dev. 51, 956–968. doi: 10.1007/s10578-
020-00979- 6
Milevsky, A., Schlechter, M., Netter, S., and Keehn, D. (2007). Maternal
and paternal parenting styles in adolescents: associations with self-esteem,
depression and life-satisfaction. J. Child Fam. Stud. 16, 39–47. doi: 10.1007/
s10826-006- 9066-5
Murshid, S. N. (2017). Parents, friends, and depression: a multi-country study of
adolescents in south Asia. Child. Youth Serv. Rev. 79, 160–165.
Naab, S., Hauer, M., Voderholzer, U., and Hautzinger, M. (2015). Depressive
störungen bei jugendlichen: diagnostik und therapie [depressive disorders in
juveniles: diagnosis and therapy. Fortschr. Neurol. Psychiatr. 83, 49–61. doi:
10.1055/s-0034- 1385776
Organization, A. P. (2013). Diagnostic and Statistical Manual of Mental Disorders.
5th ed. Virginia: American Psychiatric Association.
Perris, C., Jacobsson, L., Lindström, H., von Knorring, L., and Perris, H. (1980).
Development of a new inventory assessing memories of parental rearing
behaviour. Acta psychiatr. Scand. 61, 265–274. doi: 10.1111/j.1600-0447.1980.
tb00581.x
Polanczyk, G. V., Salum, G. A., Sugaya, L. S., Caye, A., and Rohde, L. A. (2015).
Annual research review: a meta-analysis of the worldwide prevalence of mental
disorders in children and adolescents. J. Child Psychol. Psychiatry 56, 345–365.
doi: 10.1111/jcpp.12381
Racine, N., McArthur, B. A., Cooke, J. E., Eirich, R., Zhu, J., and Madigan, S.
(2021). Global Prevalence of depressive and anxiety symptoms in children and
adolescents during COVID-19: a meta-analysis. JAMA Pediatr. 175, 1142–1150.
doi: 10.1001/jamapediatrics.2021.2482
Radloff, L. (1977). The CES-D Scale: a self-report depression measure for research
in the general population. Appl. Psychol. Meas. 1, 385–401. doi: 10.1177/
014662167700100306
Rao, W. W., Xu, D. D., Cao, X. L., Wen, S. Y., Che, W. I., Ng, C. H., et al.
(2019). Prevalence of depressive symptoms in children and adolescents in
China: a meta-analysis of observational studies. Psychiatry Res. 272, 790–796.
doi: 10.1016/j.psychres.2018.12.133
Romero-Acosta, K., Gómez-de-Regil, L., Lowe, G. A., Lipps, G. E., and
Gibson, R. C. (2021). Parenting styles, anxiety and depressive symptoms in
child/adolescent. Int. J. Psychol. Res. 14, 12–32. doi: 10.21500/20112084.4704
Skrove, M., Romundstad, P., and Indredavik, M. S. (2013). Resilience, lifestyle
and symptoms of anxiety and depression in adolescence: the Young-HUNT
study. Soc. Psychiatry Psychiatr. Epidemiol. 48, 407–416. doi: 10.1007/s00127-
012-0561- 2
Sun, W., Mei, J., Wang, Y., Zhao, X., Zhu, Z., Zhang, C., et al. (2021). 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. BMC Psychiatry 21:168. doi: 10.1186/s12888-021-
03165-7
Tang, X., Tang, S., Ren, Z., and Wong, D. F. K. (2019). Prevalence of depressive
symptoms among adolescents in secondary school in mainland China: a
systematic review and meta-analysis. J. Affect. Disord. 245, 498–507. doi: 10.
1016/j.jad.2018.11.043
Tepper, P., Liu, X., Guo, C., Zhai, J., Liu, T., and Li, C. (2008). Depressive symptoms
in Chinese children and adolescents: parent, teacher, and self reports. J. Affect.
Disord. 111, 291–298. doi: 10.1016/j.jad.2008.03.013
Wang, L., Feng, Z., Yang, G., Yang, Y., Wang, K., Dai, Q., et al. (2016).
Depressive symptoms among children and adolescents in western china: an
epidemiological survey of prevalence and correlates. Psychiatry Res. 246, 267–
274. doi: 10.1016/j.psychres.2016.09.050
Wang, S., Sun, Q., Zhai, L., Bai, Y., Wei, W., and Jia, L. (2019). The prevalence
of depression and anxiety symptoms among overweight/obese and non-
overweight/non-obese children/adolescents in China: a systematic review
and Meta-analysis. Int. J. Environ. Res. Public Health 16:340. doi: 10.3390/
ijerph16030340
Wang, Y. Y., Xiao, L., Rao, W. W., Chai, J. X., Zhang, S. F., Ng, C. H., et al. (2019).
The prevalence of depressive symptoms in ’left-behind children’ in China: a
meta-analysis of comparative studies and epidemiological surveys. J. Affect.
Disord. 244, 209–216. doi: 10.1016/j.jad.2018.09.066
Wang, Y., Shi, H., Wang, Y., Zhang, X., Wang, J., Sun, Y., et al. (2021). The
association of different parenting styles among depressed parents and their
offspring’s depression and anxiety: a cross-sectional study. BMC Psychiatry
21:495. doi: 10.1186/s12888-021- 03512-8
Wartberg, L., Kriston, L., and Thomasius, R. (2018). Depressive symptoms in
adolescents. Dtsch. Arztebl. Int. 20, 549–555. doi: 10.3238/arztebl.2018.0549
Wingo, A. P., Wrenn, G., Pelletier, T., Gutman, A. R., Bradley, B., and Ressler,
K. J. (2010). Moderating effects of resilience on depression in individuals with a
history of childhood abuse or trauma exposure. J. Affect. Disord. 126, 411–414.
doi: 10.1016/j.jad.2010.04.009
Frontiers in Psychology | www.frontiersin.org 8July 2022 | Volume 13 | Article 897339

fpsyg-13-897339 June 27, 2022 Time: 16:37 # 9
Qiu et al. Depression and Anxiety Symptoms
Wu, P., Ma, S., Fang, Z., Xu, B., and Liu, H. (2016). The latent classes of
parenting style: an application of latent profile analysis. Stud. Psychol. Behav.
14:523.
Wu, Y. L., Zhao, X., Ding, X. X., Yang, H. Y., Qian, Z. Z., Feng, F., et al.
(2017). A prospective study of psychological resilience and depression among
left-behind children in China. J. Health Psychol. 22, 627–636. doi: 10.1177/
1359105315610811
Zakeri, H., Jowkar, B., and Razmjoee, M. (2010). Parenting styles and resilience.
Procedia Soc. Behav. Sci. 5, 1067–1070.
Zhou, S. J., Zhang, L. G., Wang, L. L., Guo, Z. C., Wang, J. Q., Chen, J. C.,
et al. (2020). Prevalence and socio-demographic correlates of psychological
health problems in Chinese adolescents during the outbreak of COVID-
19. Eur. Child Adolesc. Psychiatry 29, 749–758. doi: 10.1007/s00787-020-0
1541-4
Zung, W. W. (1971). A rating instrument for anxiety disorders. Psychosomatics 12,
371–379. doi: 10.1016/S0033-3182(71)71479- 0
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