AccScience Publishing / HPR / Online First / DOI: 10.36922/HPR0474
Submit to HPR
Cite this article
7
Download
221
Views
Journal Browser
Volume | Year
Issue
Search
Forthcoming Issue
Current Issue
View All
News and Announcements
View All
RESEARCH ARTICLE

Family function and adolescent depression: Serial mediation by resilience and positive coping

Yuwei Xia1† ,  Bin Zhang1† ,  Peiying Li1 ,  Tianhong Zhou2* ,  Ling Sun1* ,  Fuqiang Mao3*
Show Less
1 Department of Child and Adolescent Psychology, Tianjin Anding Hospital, Tianjin Medical University, Tianjin, China
2 Department of Clinical Psychology, Tianjin Women and Children’s Healthcare Center, Tianjin, China
3 Department of Psychiatry and Psychology, Tianjin Medical University, Tianjin, China
†These authors contributed equally to this work.
HPR, 0474 https://doi.org/10.36922/HPR0474
Received: 5 January 2026 | Revised: 12 July 2026 | Accepted: 13 July 2026 | Published online: 27 July 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
Download PDF
XML
Cite
Abstract

Background: The high prevalence of depression among adolescents has become a significant public health concern, with relapse rates remaining high even after treatment. While family function is consistently linked to depression, the cross-sectional statistical associations linking family-level contextual factors to individual clinical outcomes remain incompletely characterized.

Objective: We aimed to examine the cross-sectional associations of resilience and positive coping within the relationship between family function and depressive symptoms among adolescents with depressive disorder.

Methods: A total of 200 adolescents with depressive disorder were recruited from Tianjin Anding Hospital. After screening, 145 valid questionnaires were included for final analysis. Trained investigators administered four widely used standardized scales to measure family function, individual resilience, coping style, and depression. The bootstrap approach was utilized to conduct mediation analysis.

Results: The mean BDI-II score was 36.02 (SD = 14.02). Family function was negatively associated with the severity of depression (β = −0.570, p < 0.001). Meanwhile, it also exhibited statistical correlational linkage with depression via the serial associational chain of resilience and positive coping (β = −0.701, p < 0.001).

Conclusion: Resilience and positive coping were significant statistical mediators in the cross-sectional association between family function and depression.

Keywords
Adolescents
Depression
Family function
Resilience
Positive coping
Funding
This study was supported by the Tianjin Key Medical Discipline Construction Project (Grant No. TJYXZDXK-3-015B), the Tianjin Health Research Project (Grant No. TJWJ2023MS038), and the Tianjin Education Commission Research Project (Grant No. 2023KJ044).
Conflict of interest
The authors declare that they have no conflicts of interest.
References
  1. Li X, Wang J. Abnormal neural activities in adults and youths with major depressive disorder during emotional processing: a meta-analysis. Brain Imaging Behav. 2020;15(2):1134-1154. doi: 10.1007/s11682-020-00299-2
  2. Thapar A, Eyre O, Patel V, Brent D. Depression in young people. Lancet. 2022;400(10352):617-631. doi: 10.1016/s0140-6736(22)01012-1
  3. Stallwood E, Monsour A, Rodrigues C, et al. Systematic Review: The Measurement Properties of the Children's Depression Rating Scale-Revised in Adolescents With Major Depressive Disorder. J Am Acad Child Adolesc Psychiatry. 2021;60(1):119-133. doi: 10.1016/j.jaac.2020.10.009
  4. Hua LL, Lee J, Rahmandar MH, Sigel EJ. Suicide and Suicide Risk in Adolescents. Pediatrics. 2023;153(1):e2023064800. doi: 10.1542/peds.2023-064800
  5. Chang JC, Lin HT, Wang YC, Gau SS. Chapter 1 - Treatment-resistant depression in children and adolescents. In: Li C-T, Cheng C-M, eds. Progress in Brain Research. Amsterdam, Netherlands: Elsevier; 2023:1-24. doi: 10.1016/bs.pbr.2023.03.004
  6. Curry JF, Meyer AE. Evidence-Based Psychosocial Treatments of Depression in Adolescents. In: Steele RG, Roberts MC, eds. Handbook of Evidence-Based Therapies for Children and Adolescents: Bridging Science and Practice. Cham, Switzerland: Springer International Publishing; 2020:121-136. doi: 10.1007/978-3-030-44226-2_9
  7. Long Y, Cao H, Yan C, et al. Altered resting-state dynamic functional brain networks in major depressive disorder: Findings from the REST-meta-MDD consortium. Neuroimage Clin. 2020;26:102163. doi: 10.1016/j.nicl.2020.102163
  8. Hetrick SE, McKenzie JE, Bailey AP, et al. New generation antidepressants for depression in children and adolescents: a network meta-analysis. Cochrane Database Syst Rev. 2021;5(5):CD013674. doi: 10.1002/14651858.CD013674.pub2
  9. Fang Z, Chen J, Meng H, Lu X, Liu B. The Impact of Childhood Trauma and Family Functioning on Self-Injurious Behavior in Adolescents with Mood Disorders. Neural Inj Funct Reconstr. 2023;18(3):136-139. [In Chinese] doi: 10.16780/j.cnki.sjssgncj.20220763
  10. Xie QW, Fan XL, Sun Y, Xuan Y, Lu J, Zhou X. The impact of neighborhood environment on adolescent anxiety and depression: A moderated mediation model involving screen time and family function. J Affect Disord. 2025;389:119751. doi: 10.1016/j.jad.2025.119751
  11. Zhao S, Chen P, Jin L, Yu C, Zhang H, Lin D. Unlocking emotional well-being: Evaluation of a stress mindset intervention with a metacognitive approach. Emotion. 2025;25(5):1169-1184. doi: 10.1037/emo0001474
  12. Ungar M, Theron L. Resilience and mental health: how multisystemic processes contribute to positive outcomes. Lancet Psychiatry. 2020;7(5):441-448. doi: 10.1016/s2215-0366(19)30434-1
  13. Guo S, Kaminga AC, Xiong J. Depression and Coping Styles of College Students in China During COVID-19 Pandemic: A Systemic Review and Meta-Analysis. Front Public Health. 2021;9:613321. doi: 10.3389/fpubh.2021.613321
  14. Mesman E, Vreeker A, Hillegers M. Resilience and mental health in children and adolescents: an update of the recent literature and future directions. Curr Opin Psychiatry. 2021;34(6):586-592. doi: 10.1097/yco.0000000000000741
  15. Llistosella M, Castellvi P, Limonero JT, Pérez-Ventana Ortiz C, Baeza-Velasco C, Gutiérrez-Rosado T. Development of the Individual and Environmental Resilience Model among children, adolescents and young adults using the empirical evidence: An integrative systematic review. Health Soc Care Community. 2022;30(6):e3277-e3299. doi: 10.1111/hsc.13899
  16. Fang D, Lu J, Che Y, et al. School bullying victimization-associated anxiety in Chinese children and adolescents: the mediation of resilience. Child Adolesc Psychiatry Ment Health. 2022;16(1):52. doi: 10.1186/s13034-022-00490-x
  17. Wu Y, Yu W, Wu X, Wan H, Wang Y, Lu G. Psychological resilience and positive coping styles among Chinese undergraduate students: a cross-sectional study. BMC Psychol. 2020;8(1):79. doi: 10.1186/s40359-020-00444-y
  18. Wang R, Liu Q, Zhang W. Coping, social support, and family quality of life for caregivers of individuals with autism: Meta-analytic structural equation modeling. Pers Individ Dif. 2022;186:111351. doi: 10.1016/j.paid.2021.111351
  19. Zhou H, Zhu Z, Feng X, Zhang R. Low mindfulness is related to poor sleep quality from middle adolescents to emerging adults: a process model involving resilience and emotional dysfunction. BMC Psychiatry. 2023;23(1):626. doi: 10.1186/s12888-023-05092-1
  20. Wang Z, Zhuang J, Lai X. Factors Associated with Community Nurses' Ability to Recognize Elder Abuse. Chin Nurs Res. 2023;37(2):200-206. [In Chinese] doi: 10.12102/j.issn.1009-6493.2023.02.003
  21. Good MD, Smilkstein G, Good BJ, Shaffer T, Arons T. The Family APGAR Index: A study of construct validity. J Fam Pract. 1979;8(3):577-582.
  22. Hu Y, Gan Y. Development and Psychometric Validity of the Resilience Scale for Chinese Adolescents. Acta Psychol Sin. 2008;40(8):902-912. doi: 10.3724/SP.J.1041.2008.00902
  23. Xie Y. A preliminary study of the reliability and validity of the Simplified Coping Style Questionnaire. Chin J Clin Psychol. 1998;6(2):114-115. [In Chinese]
  24. Beck AT. An Inventory for Measuring Depression. Arch Gen Psychiatry. 1961;4(6):561-571. doi: 10.1001/archpsyc.1961.01710120031004
  25. Alfitri R, Kuntoro K, Qomaruddin MB, Indawati R, Maulina R. Exploring the impact of family support and its function on high-risk behaviour among adolescents in Malang City, East Java, Indonesia: A cross sectional study. Afr J Reprod Health. 2024;28(10):74-80. doi: 10.29063/ajrh2024/v28i10s.9
  26. Wang MJ, Chang MY, Gu CF, Zhang RX. Psychological adaptation profiles are associated with coping style, social support, and family intimacy in caregivers of children with hematologic malignancies: a cross-sectional study. BMC Nurs. 2025;24(1):90. doi: 10.1186/s12912-025-02873-9
  27. Bian Y, Jin K, Zhang Y. The association between family cohesion and depression: A systematic review and meta-analysis. J Affect Disord. 2024;355:220-230. doi: 10.1016/j.jad.2024.03.138
  28. Wang K, Hu Y, He Q, et al. Network analysis links adolescent depression with childhood, peer, and family risk environment factors. J Affect Disord. 2023;330:165-172. doi: 10.1016/j.jad.2023.02.103
  29. Song Q, Su W, Li N, et al. Family function and emotional behavior problems in Chinese children and adolescents: A moderated mediation model. J Affect Disord. 2023;341:296-303. doi: 10.1016/j.jad.2023.08.138
  30. Gao Y, Wang Y, Wang Z, et al. Family intimacy and adaptability and non-suicidal self-injury: a mediation analysis. BMC Psychiatry. 2024;24(1):210. doi: 10.1186/s12888-024-05642-1
  31. Jung SJ, Jeon YJ, Cho KW, et al. Correlates of psychological resilience and risk: Prospective associations of self-reported and relative resilience with Connor-Davidson resilience scale, heart rate variability, and mental health indices. Brain Behav. 2021;11(5):e02091. doi: 10.1002/brb3.2091
  32. Campione-Barr N, Skinner A, Moeller K, Cui L, Kealy C, Cookston J. The role of family relationships on adolescents' development and adjustment during the COVID-19 pandemic: A systematic review. J Res Adolesc. 2025;35(1):e12969. doi: 10.1111/jora.12969
  33. Kato T. Moderating Effect of Perceived Stress on the Relationship Between Perseverative Coping and Suicide Ideation. Arch Suicide Res. Published online December 3, 2025:1-11. doi: 10.1080/13811118.2025.2597347
Share
Back to top
Health Psychology Research, Print ISSN: 2420-8124, Published by AccScience Publishing
We use cookies on our website to ensure you get the best experience.
Read more about our cookies here
Accept