How stressful life events are associated with depression: the mediating pathway of security in a clinical adolescent...

Stressful life events are well-established risk factors for adolescent depression; however, the psychological mechanisms underlying this association remain insufficiently understood, particularly regarding which types of stress and which dimensions of security are most closely linked to depression. This study aimed to investigate whether security and its two sub-dimensions statistically mediated the association between stressful life events and depression among clinically diagnosed adolescents, while also examining the relative strength of indirect associations across specific stress types.

A cross-sectional study was conducted with 284 adolescents (70.1% female; mean age = 15.82 ± 1.86 years) diagnosed with major depressive disorder according to the DSM-5 criteria at a tertiary psychiatric hospital in Western China. Participants completed the Adolescent Self-Rating Life Events Checklist (ASLEC), Self-Rating Depression Scale (SDS), and Security Questionnaire (SQ) questionnaires. Simple mediation, parallel mediation, and dimension-specific analyses were performed using the PROCESS macro (Model 4) with 5,000 bootstrap resamples, controlling for gender and parental marital status.

stressful life events were significantly positively correlated with depression (r = 0.491, p < 0.001) and negatively correlated with security (r = -0.464, p < 0.001). Simple mediation analysis revealed that security demonstrated a significant indirect association through security (indirect effect = 0.176, 95% CI [0.126, 0.232]), accounting for 53.8% of the total association. Parallel mediation analysis further indicated a dual-pathway model: both Interpersonal Security (indirect effect = 0.083, 95% CI [0.037, 0.133]) and Certainty in Control (indirect effect = 0.093, 95% CI [0.043, 0.152]) functioned as significant statistical mediators of comparable magnitude, with no significant difference between them (Contrast = -0.010, 95% CI [-0.065, 0.042]). Furthermore, dimension-specific analyses revealed that Interpersonal Stress (standardized indirect effect = 0.266) and Academic Stress (standardized indirect effect = 0.231) showed the strongest indirect associations with depression through the security pathway. Exploratory subgroup analyses revealed a gender-crossed pattern: for male adolescents (n = 85), the indirect association was significant only through Interpersonal Security (effect = 0.116, 95% CI [0.048, 0.199]); for female adolescents (n = 199), it was significant only through Certainty in Control (effect = 0.136, 95% CI [0.067, 0.212]).

Security functions as a significant statistical mediator in the association between stressful life events and adolescent depression. The findings are consistent with a "dual-pathway" model wherein stress is concurrently associated with lower levels of both relational security (Interpersonal Security) and personal agency (Certainty in Control). Exploratory analyses suggest that the relative importance of these two pathways may differ by gender. If confirmed by future longitudinal research, clinical interventions may benefit from an integrated approach that addresses both dimensions, with particular attention to interpersonal conflicts and academic pressure as the stressors most strongly associated with depression through security pathways.