Introduction
Substantial evidence shows that children and adolescents of parents with depression have an elevated risk of internalizing symptoms (e.g., depression and anxiety) [
1‐
3]. Previous studies also found that children of parents with depression histories show maladaptive ways of self-regulating sadness [
4], more conduct problems [
5], and frequent experiences of bullying by peers [
6]. There are several potential mechanisms to explain the associations between parental depression and offspring’s depression and anxiety. One of the most important factors is genetics, which has been well documented in previous studies [
7,
8]. Additionally, prenatal exposures and experiences, parenting, exposure of offspring to childhood adversities, and children’s vulnerabilities are all reported to be related to the intergenerational transmission of depression [
9]. Parents’ attitudes and behaviors in day-to-day interactions with their offspring, that is, their parenting style, play a critical and essential role in children’s neuropsychological development [
10]. However, depressed parents are more likely to exhibit both withdrawn and intrusive behaviors than parents who have not experienced depression, and these behaviors are related to greater symptoms of internalizing psychopathology in young people [
11‐
16]. To explore associations between parenting style and children’s depression/anxiety among depressed parents is of great significance for improving family environment and preventing the risk of offspring’s depression and anxiety.
In classic studies focusing on parenting styles, Baumrind [
17,
18] defined a tripartite model based on the interaction between affection, communication, and control, yielding three parenting styles: authoritative, authoritarian, and permissive. Maccoby and Martin [
19] revised Baumrind’s conceptual framework and defined four parenting styles: authoritative (high warmth and high strictness), authoritarian (low warmth and high strictness), indulgent (high warmth and low strictness), and neglectful (low warmth and low strictness); this framework distinguishes between the variation in warmth among low strictness categories. Schaefer utilized factor analysis and identified three factors based on children’s reports about their parents’ behaviors, which were interpreted as acceptance vs. rejection, psychological autonomy vs. psychological control, and firm control vs. lax control [
20]. Parker proposed a two-domain structure of perceived parenting styles using care and overprotection [
21], which was then developed into a multifactor structure under different cultural contexts. Additional parenting styles, such as “unlabeled” [
22], “controlling-indulgent” [
23], “neglectful/punishing” [
24], “easygoing,” and “tiger” [
25] were also reported in previous studies. However, there are some theoretical and empirical weakness that need to be improved.
On the one hand, the number of parenting subtypes has been predetermined by using arbitrary cut-off scores on dimensions to create parenting style groups (e.g., 1 standard deviation above or below the means on the relevant dimensions), leading some potential parenting subtypes to be omitted [
26]. Although the previously used variable-centered approaches (i.e., factor analysis and principal component analysis) are helpful in understanding the relative contribution of a specific characteristic to an outcome, a person-centered approach (i.e., latent profile analysis [LPA]) can provide a more nuanced understanding of a phenomenon by including multiple parenting dimensions and identifying unique profiles within a large heterogeneous population. Furthermore, the optimal number of groups is determined by an overall consideration of theoretical conceptualization, model fit indices, and validity evidence, which are more valid and reliable [
27]. Several studies have investigated naturally occurring parenting styles using person-centered approaches in western samples [
22‐
24] and a Chinese-American sample [
25]. Zhang and colleagues [
26] used LPA to identify four parenting style subtypes among early adolescents in healthy families in China: authoritative, authoritarian, average-level undifferentiated, and high-level undifferentiated. However, no study has used LPA to explore parenting styles in families with depressed parents. A review found that parents with depression were less sensitive to their children’s needs and had maladaptive parenting behavior, which are negatively correlated with children’s depression and other psychological difficulties [
14]. However, they have not explored whether parenting styles are heterogeneous in families with depressed parents or whether such heterogeneity will lead to different outcomes for children.
On the other hand, parenting styles differ across different cultures, and the best parenting methods identified in studies conducted in western countries are not suitable for families in China. According to Baumrind’s parenting styles, in America, authoritative parents who are highly demanding and responsive are considered remarkably successful in protecting their offspring from behavioral problems [
28]. However, benefits of authoritarian parenting have been found in Chinese-American [
29] and African-American families [
30] in cross-cultural studies. Additionally, recent studies have identified benefits related to indulgent parenting, that is, parental warmth without strictness [
31,
32]. Larger cultural differences may exist in east Asian countries than in western countries. In the context of Confucianism, children in east Asian countries tend to consider strictness as normal parenting behavior and consider obeying their parents and not fighting with them as an external display of respect. Therefore, children in China may have different perceptions of the same parenting styles and different neuropsychological development compared with children raised in western cultures.
Parenting style quality has been reported to be associated with the child’s later mental health [
14,
33]. Depression in high-risk children and adolescents is being researched more often and has been gaining clinical attention over the years, given the three-fold increase in such children’s rate of depression, compared with offspring of parents without depression [
34]. Thus, it would be useful to investigate the relationship between parental bonding and various clinical outcomes among children and adolescents at high-risk for depression. The main purpose of the current study was to explore the children’s perceived parenting subtypes of depressed parents using LPA and to further explore the association between parental subtypes and children’s depression and anxiety.
Discussion
The present study makes an important contribution to the literature on parenting styles. It is the first study to use LPA to examine the potential subtypes of both maternal and paternal parenting styles among children from families with a depressed parent.
The results showed that parenting style is heterogeneous in families with a depressed parent. Four parenting styles were identified: care-autonomy, overprotection-indifference, indifference, and undifferentiated. Children’s perceptions of mothers’ and fathers’ parenting were largely congruent; children with care-autonomy parents were at a lower risk of depression and anxiety, while indifference parenting increased children’s risk of depression, followed by undifferentiated parenting.
A novel contribution of our study was that we used LPA to identify patterns of parenting emerging from the ratings of high-risk children along four dimensions of PBI. This differs from past research regarding families with a depressed parent, which largely relied on comparing parenting styles between families with a depressed parent with families without one. Several previous studies [
1,
14] have examined associations among mothers’ or fathers’ parenting styles and internalizing symptoms among children with depressed parents by differentiating parenting dimensions for either fathers or mothers. To our knowledge, this is the first study to include all parenting dimensions for both fathers and mothers by employing person-centered analyses.
Additionally, we found a high level of agreement across parenting characteristics of mothers and fathers, with all participants living with two parents classified in the same profile. Our results are comparable to those of Fletcher and Sellers [
44], who found that 72% of two-parent families in their large U.S. sample had consistent parenting styles. Such congruence is not surprising given the likelihood of assortative mating, the possibility that parents influence each other’s beliefs and values, and, perhaps, informant effects (e.g., children rating both parents together).
Our results show that depressed parents’ parenting is not as monolithically negative as the literature suggests [
12]. Four different parenting styles existed among Chinese depressed parents. Parents were most frequently classified as showing undifferentiated parenting, which provides moderate support, warmth, and love, along with moderate intrusiveness and restraint. The undifferentiated parenting styles were previously observed in Zhang et al.’s research [
26] wherein healthy families were recruited. However, unlike Zhang et al.’s research, no high-level undifferentiated parenting style was identified in the present study. This indicated a potential poor parenting environment among depressed parents. In comparison with the classic parenting styles from Baumrind [
45], only permissive and authoritarian styles were found. No authoritative parenting style, which was previously reported in healthy parents and generally considered the ideal style, was identified in the present study. Moreover, overprotection-indifference parenting and indifference parenting, which were generally considered undesirable parenting practices, were also identified in the current study. The above findings suggest that the parenting status among depressed parents is worrying. Parental depressive symptoms were correlated with negative family atmosphere and were predictive of children’s inattentive and hyperactive symptoms, depression, and anxiety [
46,
47]. Our findings revealed the significance and urgency of providing parenting interventions to depressed parents.
Similar to previous studies on parenting styles [
48,
49], we found that children under indifference parenting were more likely to be depressed. Compared with children in overprotection-indifference parenting families, those in indifference parenting families were extremely lacking in interactions with their parents. As Chinese children tend to be shy or reserved, indifference from parents has great potential to lead to children being bullied and further risk for depression and anxiety [
50]. However, it is important to note that the sample size of the indifference parenting subtype was small and that the confidence intervals of the effect size were large; therefore, the result needs to be cautiously interpreted.
Overprotection-indifference parenting, which had higher level of overprotection but the same level of indifference as indifference parenting, was also identified in the current study. There are some differences between the two parenting styles. Overprotective-indifferent parents rarely appreciate or praise their children, while frequently using coercive discipline, have more control and restraint over their children, and rarely consider their children’s thoughts and wishes. Indifferent parents were found to have low levels of control and were largely unresponsive toward their children, consistent with previous studies [
19,
51]. Compared to undifferentiated parenting, the overprotection-indifference parenting style was not found to be associated with depression. In contrast to our findings, some studies found that authoritarian parenting, which was less warm and highly strict, and similar to overprotection-indifference parenting, was significantly related to the presence of depression [
52,
53]. Excessive protection may prevent a child’s psychological needs for autonomy and competence from being met [
54,
55] and affect their overall social development and well-being, resulting in more severe symptomatology. However, in our study, overprotection did not have a negative effect, which is consistent with Liu’s study [
38]. This may be because the overprotection factors on the PBI has demonstrated cross-cultural inconsistencies [
26,
56]. An item such as “Tended to baby me,” classified as reflecting overprotection in one culture, may be interpreted as reflecting care in another [
57]. Overprotection-indifference parenting showed low levels of autonomy. However, autonomy is not as deeply imbedded a construct in eastern cultures as it is in western ones. Lack of autonomy, therefore, may be viewed more neutrally by children in eastern cultures. In addition, Chinese parents were highly attached to their children compared with other cultural populations [
38], leading some children to perceive the overprotection as normal. This could partially explain why overprotection or lack of autonomy was not viewed as a risk factor for children’s depression in our sample.
Compared to undifferentiated individuals, the care-autonomy parenting group had a lower incidence rate of depression and anxiety. Both mothers and fathers who were classified under care-autonomy parenting treated their children as independent individuals, had an accepting attitude toward the child, made few demands for mature behavior, and respected and understood their children, thus providing more empathy, warmth, and support. This style has been recognized as a suitable rearing combination in a previous study [
56]. However, another previous study reported that permissive parenting (high warmth and low strictness, similar to care-autonomy parenting) tends to be related to negative developmental outcomes for children and adolescents [
58]. This inconsistency may be because of the different analytic approaches. Previous variable-centered approaches usually utilized high percentile scores to define whether an individual belongs to one kind of parenting style, which may lead to extreme parenting scores. The permissive parenting style was once divided into indulgent (high warmth and low strictness) and neglectful (low warmth and low strictness) parenting [
19]. However, a person-centered approach was conducted an average levels of parenting style and showed the positive characteristics of care and autonomy. Furthermore, the children in the current study were raised under China’s one-child policy and have been accustomed to enjoying care from the family. Furthermore, it is difficult for them to perceive this care as negative and indulgent.
The findings of this study have implications for depressed parents regarding modeling the ideal parenting style. Indifference parenting styles have harmful effects on children, whereas the care-autonomy parenting style benefits children. Depressed parents can heed this research knowledge, examine their own parenting styles, and possibly change their parenting styles to ensure the best outcomes for their children. To do so, clinicians can inform parents how each parenting style looks and guide parents to offer adequate caring, warmth, loving, and support for their children, while encouraging their independence. Second, these results have implications for family-oriented prevention strategies in that they provide information on which combinations of parenting dimensions are particularly relevant. Counselors and family therapists could also utilize the information detailed in each cluster for foster children from depressed families to help them learn more coping styles or resilient coping skills to reduce the risk of depression and anxiety.
Limitations
This study has some limitations. First, its cross-sectional design limits our ability to infer the temporal and potential causal direction between parenting styles and children’s depression and anxiety, and it could not be ascertained whether parenting styles changed over time. Future longitudinal or cross-lagged designs can be used to provide support for causal mechanisms. Second, our study focused on the children’s reports, which may have introduced some bias. Fletcher [
59] pointed to the extensive literature demonstrating that adolescents can provide accurate and reliable reports of their parents’ parenting practices, and some have claimed that because adolescents act on the basis of their perceptions, studies should focus on adolescents’ ratings. However, the children’s depression/anxiety may also influence the parenting they received and their perceptions of parenting styles. It would be worthwhile to include reports from both parents and children in future research to determine whether similar profiles emerge in their reports and to examine consistency between the reporters. Third, only depressed parents who were visiting clinics were recruited, and depressed parents not receiving treatment were not included; this may have led to selection bias. The small sample size of the present study limits the generalizability of our findings, which needs to be addressed. The small sample size in the “indifference cluster” led to large confidence intervals, and the impact of this cluster on children’s depression need to be cautiously interpreted. In addition, measurement bias and confounder bias were also non-negligible limitations. Finally, it is important to note that the pronatalist policy of China has changed since 2016, the year that the two-children policy was enacted. The children recruited in the current study, from 2018 to 2020, experienced various impacts under the two-children policy. Although the PBI measures children’s average perceptions of parenting style up to the age of 16 years, the potential bias caused by the change of policy cannot be ignored. Specifically, the three-children policy was published this year, and the transformation of the associations between parenting style and children’s risk of mental disorders need to be further studied and traced. Owing to the many limitations, future studies need to follow up participants longitudinally, include parents and children at the same time, increase sample representativeness and sample size, and include as many confounders as possible.
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