Abstract
-
Purpose
This study aimed to examine whether perceived parental alienation mediates the relationship between parental and adolescent depressive symptoms, and, if so, whether parents’ subjective health moderates this indirect effect.
-
Methods
This cross-sectional study utilized secondary data from the 2021 wave of the Panel Study on Korean Children, enrolling 541 parent–child dyads. Parental depression was measured using the Kessler Psychological Distress Scale-6, a self-rated health item, the Korean version of the Center for Epidemiological Studies Depression Scale for Children, and a 6-item perceived alienation scale. Descriptive statistics, Pearson correlations, and variance inflation factor checks were conducted, followed by mediation and moderated mediation analyses using PROCESS Models 4 and 7 with 10,000 bootstraps in IBM SPSS ver. 27.0.
-
Results
Parental depression did not directly predict adolescent depression (B=.02, t=.87) but was significantly related to perceived alienation (B=.16, p<.001), which in turn predicted higher adolescent depression (B=.20, p<.001). The indirect effect of alienation was also significant (B=.039; 95% confidence interval, 0.005–0.066). Subjective health moderated the depression–alienation link (interaction B=.19, p<.001), with stronger indirect effects observed among parents with better health.
-
Conclusion
Parental depression symptoms indirectly increase adolescent depression through perceived alienation, particularly when parents viewed their health positively. These results suggest that interventions targeting parental mental health and fostering open-family communication may help reduce adolescent depression.
-
Key words: Adolescent; Depression; Health status; Mental health; Parent-child relations
INTRODUCTION
Middle school represents a transitional stage characterized by rapid physical and mental changes, during which adolescents are prone to emotional instability [
1]. According to the 2022 Mental Health Survey (Children and Adolescents), the prevalence of mental disorders among Korean adolescents (aged 12–17 years) is 9.5%, which is nearly twice as high as that among children (aged 6–11 years, 4.7%) [
2], thus underscoring the gravity of adolescent mental health problems. Furthermore, adolescent depression is caused by complex interactions between both personal (self-esteem, aggression, perfectionism, self-control, etc.) and environmental factors [
1,
3]. Family level influences include parenting attitudes, family conflict/economic stress, and parent–child relationship quality [
3,
4]; school-level influences include relationships with teachers, academic stress, and academic adaptation [
1]; and social/contextual influences include peer relationships and the online/digital environment [
5,
6]. Therefore, to more precisely understand the onset and escalation of adolescent depression, research that comprehensively examines these multilevel factors is essential [
3].
Consequently, research is needed to comprehensively examine the pathways by which parental depression leads to depression in children, with particular attention paid to emotional mediators within the family system, such as relational alienation [
6,
7]. The physical and psychological health of parents are critical factors that both directly and indirectly influence child-rearing environment [
4,
8]. The extent to which parents perceive their own health as “good” can shape the quality of emotional exchanges within the family, thereby altering the level of bonding or alienation between parents and their children [
8,
9]. Recent international research has demonstrated that parental emotional support can alleviate both psychological and somatic symptoms in adolescents by enhancing self-efficacy and that this pathway is moderated by socioeconomic status [
10]. Moreover, perceived parental conflict during online learning has been shown to intensify the comorbidity network of anxiety and depression among Chinese adolescents [
5]. However, limited research has investigated whether parental subjective health (PSH)—beyond emotional support itself—moderates the “parental depression → parent–child relationship” pathway. As such, it is necessary to analyze moderating variables to better understand how parental health awareness influences emotional interactions within the family and, in turn, adolescent depression [
11,
12].
In large-scale social crises, such as the coronavirus disease 2019 (COVID-19) pandemic, interactions among family members may be restricted or distorted, thereby exacerbating adolescents’ emotional and behavioral problems [
4,
13]. Changes in family communication during disasters can also negatively affect adolescent mental health [
5,
13]. Parental psychological stress and health perceptions can alter the emotional climate at home, thereby increasing adolescents’ emotional vulnerability [
4,
8]. Adolescents who experience alienation in their parental relationships report higher levels of loneliness and depression, whereas close relationships enhance emotional stability and resilience [
6,
14]. During the pandemic, increased family stress and reduced parent–child communication were found to be associated with poorer adolescent mental health [
13,
15]. Meta-analytic evidence has indicated that the quality of parental educational involvement, home-based support, school-based engagement, and academic socialization all show a protective association with adolescent depressive symptoms [
16]. Since middle school involves profound physical and psychological changes, developmentally tailored interventions are required to prevent the onset of depression [
1,
3]. Poor parental health perception can undermine the parent–child relationship, increase perceived relational alienation, and ultimately heighten adolescents’ depressive symptoms [
4,
6]. Consequently, it is necessary to investigate the indirect effects of parental mental health on adolescent depression, focusing on the mediating role of perceived parent–child alienation [
11].
METHODS
Ethical statements: The Panel Study on Korean Children (PSKC) was conducted by the Korea Institute of Child Care and Education (KICCE) with approval from the Institutional Review Board (IRB) of KICCE (approval number: KICCEIRB-2021-05). For the present study, which performed secondary analyses of PSKC Wave 14 data, ethical approval was obtained from the Institutional Review Board of Presbyterian Medical Center, Jeonju, Korea (IRB no., PMC 2025-06-001-001).
1. Study Design
This cross-sectional secondary analysis of the nationally representative PSKC Wave 14 (2021) tested a moderated mediation from parental depression to adolescent depression via adolescent-perceived relationship alienation, moderated by PSH. Reporting followed the Strengthening the Reporting of Observational Studies in Epidemiology statement [
17].
This study was a secondary data analysis using data from the PSKC, which has been conducted by the KICCE since 2008. The PSKC is a nationally representative longitudinal study designed to track the growth and development of children in Korea and to collect national-level data on developmental characteristics, parenting environments, and parental needs across various stages of childhood. We used PSKC Wave 14 (fieldwork: June–November 2021).
The original sample consisted of households with newborns born between April and July 2008. The sampling frame included medical institutions across South Korea that recorded more than 500 deliveries per year as of 2006. A stratified multistage sampling method was used to select the sample, resulting in a final panel of 2,150 children. For the current study, we analyzed data from Wave 14 (2021), when the cohort reached their first year of middle school (Grade 7 in Korea). At that time, 1,328 children remained in the panel. Among them, 541 participants (283 boys and 258 girls) were included in the final analysis based on complete responses from both the parent and the adolescent, with no missing data on the key study variables (listwise deletion). PSKC cross-sectional sampling weights were applied in all analyses.
3. Variables and Measurements
1) Adolescent depression
Adolescent depression was assessed using the 11-item Korean short form of the Center for Epidemiological Studies Depression Scale for Children (CES-DC). The original 20-item CES-DC was developed by Faulstich et al. [
18] in 1986 for children and adolescents, based on the adult Center for Epidemiologic Studies Depression Scale (CES-D) developed by Radloff [
19]. The Korean version was translated and culturally adapted by Hoe et al. [
20], who shortened the scale to 11 items for use with Korean children and adolescents. Example items include “I didn’t sleep well” and “I felt sad.” Each item was rated on a 4-point Likert scale ranging from 0 (rarely or none of the time) to 3 (most of the time), with higher scores indicating more severe depressive symptoms. The Korean short form has demonstrated strong concurrent validity with the original CES-DC and high internal consistency reliability (Cronbach’s α=.85) in prior research [
20]. In the present study, Cronbach’s α was .83.
2) Parental depression
Parental depression was measured using the Kessler Psychological Distress Scale-6 (K6) [
21], a short form of the K10 developed for the National Health Interview Survey in the United States. The K6 consists of six items, and in this study, both fathers and mothers responded to the same six items separately, resulting in a total of 12 items. Example items include “During the past 30 days, how often did you feel hopeless?” and “During the past 30 days, how often did you feel nervous?” Each item was rated on a 5-point Likert scale from 1 (none of the time) to 5 (all the time), with higher scores indicating greater levels of depressive symptoms. In the current study, Cronbach’s α was .90.
3) Parental relationship alienation (child-perceived)
Parental relationship alienation, as perceived by adolescents, was assessed using a modified version of the parent subscale of the Inventory of Parent and Peer Attachment (IPPA) [
22]. The IPPA was adapted and validated for Korean children by Yoo et al. [
23] and further revised by the PSKC research team to suit the 12th wave of the panel study. The scale includes six items: three for the father and three for the mother. Each item was rated on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree), with higher scores indicating greater perceived alienation in the parent–child relationship. Example items include “My father often doesn’t notice when I’m upset” and “My mother doesn’t understand the difficulties I’m experiencing these days.” Cronbach’s α for this scale in the present study was .72.
4) Parental subjective health status
PSH status was assessed using two single-item questions, one for the father and one for the mother. Each parent rated their own health on a 5-point Likert scale ranging from 1 (very poor) to 5 (very good), with higher scores indicating better perceived health. A sample item is, “How would you rate your current health status?” The use of a single-item self-rated health measure has been shown to have good reliability and predictive validity for various health outcomes in Korean adult populations [
8,
9]. For analysis, we created a family-level parental health index by averaging the two ratings (higher scores indicate better perceived health).
All analyses were performed with IBM SPSS ver. 27.0 (IBM Corp.). Mediation and moderated-mediation models were estimated within a conditional-process framework and implemented with the PROCESS macro for SPSS (mediation: Model 4; first-stage moderated mediation: Model 7). This study tested a cross-sectional moderated-mediation model in which parental relationship alienation (M), as perceived by adolescents, mediates the association between parental depression (X) and adolescent depression (Y), while PSH (W) moderates the X→M path. All models controlled for adolescent age, gender, household income, and parental education.
These analytic steps are as follows: (1) We inspected distributional properties (means, standard deviations [SDs], skewness, kurtosis) and multicollinearity (variance inflation factors [VIFs]) to evaluate model assumptions. (2) Pearson correlations were computed among X, M, and Y. (3) A simple mediation model (X→M→Y) was estimated to test the indirect effect via M (paths
a and
b; direct effect
c′ adjusted). (4) A first-stage moderated-mediation model was then estimated in which W moderates the X→M path; conditional indirect effects a(W)×ba(W)×ba(W)×b were derived across the observed range of W. Johnson–Neyman probing was used to identify the region(s) of significance for the conditional effect of X on M and to visualize the J–N threshold [
24].
For inference on indirect and conditional indirect effects, we used bias-corrected bootstrap 95% confidence intervals (CIs) with 10,000 resamples; effects were considered statistically significant when the 95% CI excluded zero. All tests were two-tailed with α=.05. The Johnson–Neyman technique is a procedure that, in the context of linear interactions (conditional effects), directly computes and visualizes the region(s) of significance, the range of moderator values for which the 95% CI of the simple slope excludes zero, and the corresponding threshold(s), thereby addressing the limitations of the pick-a-point approach that tests only the mean and ±1 SD [
11,
24].
RESULTS
1. Descriptive Statistics and Correlations of Parental Depression, Parental Relationship Alienation, and Adolescent Depression
Descriptive statistics and correlation coefficients for the major study variables parental depression, parental relationship alienation, and adolescent depression are presented in
Table 1. The mean score for parental depression was 1.91 (SD=0.63), for parental relationship alienation 2.41 (SD=0.74), and for adolescent depression 1.49 (SD=0.41). Skewness ranged from 0.25 to 1.64 and kurtosis from 0.13 to 4.05, confirming the normality of the data distribution (criteria: skewness <2, kurtosis <7) [
25,
26]. Additionally, VIF values for all variables were below 10, indicating no issues with multicollinearity.
Pearson correlation analysis revealed a significant positive correlation between parental depression and parental relationship alienation (r=.163, p<.05), and between parental relationship alienation and adolescent depression (r=.201, p<.001).
2. Mediating Effect of Parental Relationship Alienation in the Relationship between Parental Depression and Adolescent Depression
The results of the mediation analysis are presented in
Table 2. Parental depression had a statistically significant effect on parental relationship alienation (B=.16,
p<.01), and parental relationship alienation significantly predicted adolescent depression (B=.20,
p<.001). However, the direct effect of parental depression on adolescent depression was not statistically significant (B=.02,
p=.87).
The indirect effect of parental depression on adolescent depression via parental relationship alienation was statistically significant (B=.039, Boot standard error [SE]=.015; 95% CI, .005–.066). Since the CI did not include zero, the mediating effect was supported. These results suggest that parental depression does not directly influence adolescent depression but rather exerts an indirect effect through adolescents perceived alienation in parent-child relationships.
3. Moderating Effect of Parental Subjective Health on the Association between Parental Depression and Parental Alienation
Table 3 presents the results of the moderate mediation analysis. Parental depression significantly predicted parental relationship alienation (β=.16,
p<.01), and PSH status significantly moderated this relationship (interaction term: β=.192,
p<.01). The inclusion of the interaction term (parental depression×subjective health status) led to a statistically significant increase in the explained variance (ΔR²=.024,
p<.01), confirming that the association between parental depression and parental relationship alienation differed depending on the level of perceived parental health.
Given the significant moderating effect of PSH status, this study further estimated the conditional indirect effects of parental depression on adolescent depression via parental relationship alienation across different levels of parental health. To do this, Model 7 of the PROCESS macro was used with 10,000 bootstrapped resamples and a 95% CI. The Johnson–Neyman technique was applied to determine the regions of significance for the conditional indirect effect.
Figure 1 presents the Johnson–Neyman plot illustrating the moderating effect of PSH on the indirect pathway from parental depression to adolescent depression via relationship alienation [
27]. The red vertical line marks the threshold (z=–0.094), which separates the region of nonsignificance (left) from the region of significance (right). The conditional indirect effect was significant only at moderate to high levels of subjective health: it was nonsignificant at −1 SD (Boot B=0.05, Boot SE=0.07,
p=.415) but significant at the mean (Boot B=0.16, Boot SE=0.06,
p=.006) and at +1 SD (Boot B=0.27, Boot SE=0.08,
p=.001) (
Table 4). Taken together, these results indicate that higher PSH strengthens the a-path (parental depression → relationship alienation), thereby increasing the conditional indirect effect on adolescent depression; the b-path (relationship alienation → adolescent depression) is not moderated.
DISCUSSION
This study demonstrated that parental depression did not directly predict adolescent depression but exerted an indirect effect through adolescents’ perceptions of relational alienation in the parent–child relationship. Furthermore, this indirect effect was moderated by PSH, such that the pathway was stronger when parents rated their health more positively. These findings are consistent with conditional process modeling frameworks [
11,
24] and underscore the relevance of family systems theory in explaining adolescent psychological adjustment [
22].
These findings further suggest that parental emotional distress may lead to increased alienation in the parent-child relationship, which in turn may negatively impact adolescents’ emotional well-being [
1,
4]. However, no significant correlations were found between parental and adolescent depressive symptoms. The present study found that parental depression does not directly influence adolescent depression but exerts an indirect effect through adolescents’ perceived alienation in the parent–child relationship [
11,
24]. This aligns with previous findings indicating that excessive psychological control or negative parenting behaviors contribute to shame or self-silencing in children, which in turn exacerbate depressive symptoms [
7,
14]. Furthermore, alienation in the parent–child relationship may lead to maladaptive peer interactions, thereby reinforcing a negative feedback loop of emotional distress in adolescents [
6,
28]. This finding further indicates that adolescent depressive symptoms are more strongly influenced by relational dynamics, specifically by perceived alienation from parents, than by parental depressive symptoms alone. These results align with those of prior studies on adolescent depression and parent–child relationships [
1,
4], indicating that the psychological impact of parental depression may be mediated by the quality of the emotional bond between parents and their children.
One of the key findings of this study is that PSH moderated the association between parental depression and parent–child relational alienation [
11,
24]. These findings further suggest that the association between parental depression and parental relationship alienation differs depending on parents’ perceived health status. Parental health awareness may shape the degree of emotional connectedness with children, as suggested in prior work on parental mental health and the parent–child relationship [
4]. Specifically, when parents perceived their health more positively, the adverse impact of depression on their emotional relationships with their children became more pronounced (see the J-N threshold), which is consistent with contextual moderation in family processes [
3,
22]. This suggests that parents who outwardly feel “unhealthy” may be less likely to express or acknowledge their internal emotional difficulties, which could inadvertently deepen emotional disconnection and conflict within the parent–child relationship [
4,
29]. However, when parents perceived their health status as low, the effect of depression on their children’s sense of alienation was not statistically significant. This may indicate that emotional exchanges within the family were already restricted due to parents’ health difficulties, potentially limiting the variability in parent–child relational quality [
4], which is consistent with the conditional-process interpretation [
11,
24]. This finding indicates that the indirect pathway from parental to adolescent depression may vary depending on PSH [
11,
24].
Prior research has shown that parental stress and depression tend to affect the entire family system [
6,
30], and that PSH may either buffer or exacerbate this influence [
10,
16]. When parents experience high levels of depression, they are less likely to provide emotional support to their children, potentially leading to psychological disconnection and relational alienation [
10,
16]. This, in turn, may increase adolescents’ internalized shame and self-silencing, eventually worsening depressive symptoms [
14]. Moreover, previous studies have demonstrated that parental overcontrol or inconsistent parenting is linked to difficulties in peer relationships, while reduced autonomy is associated with increased depressive symptoms [
6,
7]. Consistent with the family systems theory, this study confirms that the absence of emotional connectedness between parents and children indirectly exacerbates adolescents’ depressive symptoms through perceived alienation rather than via direct transmission of depressive symptoms [
14,
22].
During large-scale social crises such as the COVID-19 pandemic, increased parental psychological stress has been shown to worsen children’s sleep, behavior, and emotional well-being [
13,
31]. In this context, the present study suggests that PSH may further influence the degree of emotional disconnection within the family [
8,
9]. Adolescence is a period marked by intense emotional and physical development, and both the quality of the parent–child relationship and the emotional climate within the household significantly affect adolescents’ vulnerability to depression [
1,
3].
Overall, these results suggest that adolescent depression is not solely explained by individual factors but is a complex process involving emotional interactions with parents and PSH [
8,
12]. Prior studies have shown that alienation from parents increases adolescents’ emotional distress, and that such effects can be mediated or moderated by psychological or contextual factors [
6,
7]. Our analyses indicate that PSH moderates the association between parental depression and parent–child relationship alienation, in line with conditional process analysis and standard interaction-probing procedures (e.g., Johnson–Neyman) [
11,
24]. Given that PSH is validated as a health indicator in Korean populations [
8,
12], family-centered interventions that address parents’ psychological and physical well-being while strengthening emotional bonds within the family are warranted [
4,
10]. In addition, school-based mental health education and counseling for middle school students should be implemented, and coordinated systems linking schools with family counseling and home-based health supports are recommended [
2,
13].
This study has some limitations. First, its cross-sectional design precludes causal inference and limits conclusions regarding temporal ordering [
11,
24]. Second, the perspectives of diverse family members (e.g., grandparents and single parents) were not sufficiently incorporated, which may constrain the ecological validity of the results [
30]. Third, socioeconomic and cultural contexts were not explicitly modeled, potentially limiting generalizability across subgroups [
32]. Future research should employ longitudinal, qualitative, or mixed-methods designs to trace changes in parent–child emotional dynamics and clarify temporal ordering [
29,
33]. It is also important to design and test family centered intervention models tailored to diverse structures (e.g., single-parent, grandparent-led, and multicultural families) to ensure cultural and contextual relevance [
6]. To better probe the link between parental and adolescent depression, studies should prioritize long-term longitudinal designs and analytic strategies appropriate for conditional processes (e.g., moderated mediation/J–N probing) [
11,
24]. A family centered integrative agenda may ultimately inform prevention and intervention by addressing parents’ psychological and physical health along with adolescents’ emotional well-being [
34].
CONCLUSION
This study confirmed that parental depression indirectly increases adolescents’ depressive symptoms through perceived parent–child relational alienation. The magnitude of this indirect effect varied according to parents’ subjective health perception, indicating that health awareness shapes the quality of emotional interactions within families. These findings indicate that adolescent depression should be addressed within the family context, emphasizing both parental mental health and emotional connectedness. Family centered interventions that promote parental well-being and strengthen parent–child relationships are recommended as key strategies for preventing adolescent depression.
ARTICLE INFORMATION
Figure 1.Johnson-Neyman Plot [
27]: The indirect effect of parental depression on adolescent depression through alienation moderated by subjective health. LLCI, lower level of confidence interval; ULCI, upper level of confidence interval.
Table 1.Correlation and descriptive statistics of research variables
|
Variable |
r (p) |
M±SD |
Skewness |
Kurtosis |
VIF |
|
1 |
2 |
3 |
|
1. Parental depression |
1 |
|
|
1.91±0.63 |
0.71 |
0.30 |
1.01 |
|
2. Parental relationship alienation |
.11 (.010) |
1 |
|
2.41±0.74 |
0.25 |
–0.13 |
1.17 |
|
3. Adolescent depression |
.08 (.063) |
.37 (<.001) |
1 |
1.49±0.41 |
1.64 |
4.05 |
1.16 |
Table 2.Mediating effect of parental relationship alienation on the relationship between parental depression and adolescent depression
|
Variable |
B |
SE |
Boot SE |
t |
p
|
95% CI |
95% Boot CI |
|
Parental relationship alienation |
|
|
|
|
|
|
|
|
Constant |
2.44 |
0.03 |
|
71.45 |
<.001 |
2.38 to 2.51 |
|
|
Parental depression |
0.16 |
0.06 |
|
2.76 |
.006 |
0.06 to 0.28 |
|
|
Adolescent depression |
|
|
|
|
|
|
|
|
Constant |
1.00 |
0.06 |
|
17.83 |
<.001 |
0.89 to 1.11 |
|
|
Parental depression |
0.02 |
0.03 |
|
0.87 |
.385 |
–0.03 to 0.08 |
|
|
Parental relationship alienation |
0.20 |
0.02 |
|
9.00 |
<.001 |
0.16 to 0.24 |
|
|
Indirect effect |
|
|
|
|
|
|
|
|
Parental depression → parental relationship alienation → adolescent depression |
0.04 |
|
0.02 |
|
|
|
0.01 to 0.07 |
Table 3.Examining the moderating effects of subjective health status on the relationship between parental depression and parental relationship alienation
|
Moderating variable |
Variable |
B |
SE |
R2
|
t |
F |
p
|
95% CI |
|
Subjective health status |
Constant |
2.44 |
0.03 |
|
71.45 |
|
<.001 |
2.38–2.51 |
|
Parental depression |
0.16 |
0.06 |
|
2.76 |
|
.006 |
0.05–0.28 |
|
Subjective health status×parental depression |
0.19 |
0.07 |
|
2.60 |
|
.010 |
0.05–0.23 |
|
R2 change of interaction item |
|
|
.024 |
|
4.46 |
.004 |
|
Table 4.Conditional indirect effects of parental depression on adolescent depression at different levels of parental subjective health
|
Level of moderator (subjective health status) |
Boot B |
Boot SE |
p
|
95% Boot CI |
|
–1SD (–0.57) |
0.05 |
0.07 |
.415 |
–.08 to .18 |
|
Mean (0) |
0.16 |
0.06 |
.006 |
.05 to .28 |
|
+1SD (+0.57) |
0.27 |
0.08 |
.001 |
.12 to .43 |
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