Associations between parenting styles, problematic smartphone use, and depression severity in adolescents with...

Adolescent depression represents a significant public health issue in China. Parenting styles and problematic smartphone use (PSU) are closely associated with adolescent depression. Consistent with the I-PACE model, depression is considered a distal vulnerability factor for PSU; however, among adolescents already diagnosed with depressive disorder, whether PSU is associated with increased symptom severity remains unclear, and the potential indirect role of parenting styles warrants further investigation.

A cross-sectional study was conducted among adolescent patients diagnosed with depressive disorder. From December 2023 to October 2024, 451 participants were recruited from a tertiary psychiatric hospital in Nanjing, with data from 403 participants included in the final analysis. Parenting styles were assessed using the short Chinese version of the Egna Minnen av Barndoms Uppfostran (S-EMBU-C), problematic smartphone use was measured with the Mobile Phone Addiction Index (MPAI), and depression severity was evaluated using the 17-item Hamilton Depression Rating Scale (HAMD-17). Data were analyzed using LASSO regression and structural equation modeling.

LASSO regression retained maternal emotional warmth, maternal rejection, paternal rejection, and all four dimensions of problematic smartphone use as significant correlates of depression severity. Maternal emotional warmth was negatively associated with depression, whereas parental rejection and problematic smartphone use dimensions showed positive associations. In structural equation models, problematic smartphone use statistically accounted for part of the associations between maternal rejection and depression (indirect effect β = 0.144, 95% CI [0.070, 0.232]), between paternal rejection and depression (indirect effect β = 0.090, 95% CI [0.020, 0.165]), and between maternal emotional warmth and depression (indirect effect β = -0.099, 95% CI [-0.166, -0.040]).

In this clinical sample of adolescents with depressive disorder, PSU was associated with higher depression severity, suggesting that PSU may have an exacerbating role in adolescents already in a depressed state. Parenting styles were indirectly associated with depression severity through their associations with PSU. These findings underscore the potential value of addressing both family environment and maladaptive digital behavior in the assessment and intervention of adolescent depression. Given the cross-sectional design, the temporal direction of these associations cannot be determined, and longitudinal validation is required.