This study echoed some previous studies’ results but also discovered some novel ones that are closely connected with COVID-19. To answer the research questions, we will first focus on whether location make a difference. Then, we will discuss other predictive factors presented in this research.
Does location matter?
Wuhan is a city that attracted the attention of the Chinese people and the rest of the world during COVID-19. As of April 24, 2020, statistics have shown that there were 3,869 deaths, over 50,333 COVID-19 diagnoses, and a mortality rate of 7.69% in Wuhan, which is much higher than the rest of China (mortality rate of 0.8%) (Qu, Cheng, Duan, Tian, & Hakonarson, 2020). A previous study found that adolescents' depressive symptoms in Wuhan were significantly higher than in other cities in Hubei Province, which indicated that the severity of infection is likely impacting the depressive symptoms (Xie et al., 2020). However, our study found that there is no statistically significant difference in adolescents' depression in Wuhan, but there is a statistically significant difference in anxiety, compared to other urban areas in China. This means that Wuhan’s adolescents appeared to be more anxious than those in other urban areas, but their depression level seems to be similar when compared regionally. This result is supported by Jiao and his research team (2020); they found that that even though the rate of negative emotions was likely to be higher in children living in highly epidemic areas, the difference between areas did not reach a significant level. However, the more in-depth analysis in our study indicated that, even though there is no significant direct effect and difference, by investigating the influence of the parental rearing style, regional factors have certain indirect effects on adolescents' depression and anxiety.
In our study, we found that Wuhan adolescents' parents were less warm and supportive, more protective, and showed more emotional rejection toward their children compared to other urban areas. This might be related to parents' higher distress during the COVID-19 period in Wuhan. A previous study found that parenting stress mediates between a child’s temperament and parenting style (Nam & Chun, 2014); another study that investigated children with developmental disabilities found that, for parents who are under higher stress, it is very difficult for them to implement authoritative parenting approaches, an approach that combines warmth, sensitivity, and limits setting (Woofson & Grant, 2006). Therefore, it is understandable that during times of stress and uncertainty, parenting styles may change accordingly. In the context of COVID-19, parents are faced with greater financial pressure, which might lead to bad temper and an overreliance on less effective parenting approaches. As a result, the relationship between parents and children may be strained by the outbreak. Correspondingly, the psychological problems of parents during the epidemic might also lead to the decline of parents' emotional warmth and support to their children and a stronger emotional response to children's misbehavior, which will eventually lead to the escalation of conflicts between children and their parents (Prime, Wade, & Browne, 2020), and which would subsequently have a negative impact on adolescents' mental health. These parental rearing factors, therefore, indirectly and positively impact adolescents' depression and anxiety symptoms compared to other urban areas. This finding echoes previous findings (Wang, 2000; Yang, Wang, & Wang, 2010), in which the warmth and support that parents showed to their children were found to usually protect their children from feeling depressed or anxious; but for parents who were harsh and relied excessively on punishment with their children, the anxiety and depression on the latter would increase correspondingly.
Other important Risk factors for adolescents' mental health condition during the COVID-19
Results from this study also showed some risk factors. First of all, higher grades (high school compared to middle school in this case), and female gender, are two risk factors for adolescents. This finding is supported by the research of Zhou and his team (2020), in which these two factors were also found to be risk factors for depressive and anxiety symptoms during the COVID-19 pandemic. In addition, there were similar findings in several previous studies. For instance, Branje, Hale III, Frijns and Meeus (2010) stated that older adolescents reported more depressive symptoms; moreover, their study connected adolescents' depressive symptoms with their relationship with parents and found that depressive adolescents appear to have lower quality relationship with their parents. It might also be the case that the isolation brought on by the pandemic has a differential effect on older children because their independence is more compromised (i.e., younger kids are developmentally more naturally dependent upon their parents).
Another interesting risk factor is the only child status. Even though a previous study indicated that, under the one-child policy, children with siblings in China have higher anxiety and depression than those who are only children (Yang, Ollendick, Dong, Xia,& Lin, 1995), during the COVID-19 period, it appears that having siblings became a protective factor, possibly due to their reduced sense of isolation. Our research showed that adolescents who are the only child at home are more likely to perceive their parents as overprotective toward them during the pandemic. This therefore relates to more depressive and anxious symptoms. This is understandable due to the challenges that COVID-19 brought to the family system. To name a few of the challenges, parents' relationships to their children were impacted in this time period, and adolescents were isolated from their peers and other supportive adults. Thus, preservation of the sibling relationship appears to have become a protective factor for adolescents' mental health (Prime, Wade, & Browne, 2020), where adolescents can feel less lonely and they can be more supportive of each other.
Finally, a family member’s compromised health condition is a risk factor that should not be ignored. There is convincing evidence that adversity in family social context negatively influences children's adjustment (Repetti, Taylor, & Seeman, 2002). Our study supported this finding and provided evidence that, when there is a family member who was infected with COVID-19, it not surprisingly positively predicted adolescents' anxiety or depressive symptoms. Even though the effect size is small, the impact on adolescents’ mental health condition should not be ignored. Similar results were found by Cao and his team (2020); when they examined a group of college students, they discovered that, for those students who had relatives infected with COVID-19, there was an increase in their anxiety levels.
Limitations and implications
This study also has some limitations that are important to note. First, we chose Beijing and Hangzhou as two main eastern cities to represent other urban areas in China, not including rural areas. This might have created a biased sample that cannot adequately represent the entire Chinese adolescent population. Second, for the purpose of shortening the survey questionnaire, we selected 10 items from the S-EMBU. Although we have examined the construct validity of this shortened version, it is less rigorous compared to using the full scale and collecting information about mother and father's parenting style separately. Third, we are uncertain if the parenting style difference between Wuhan and other urban areas (Beijing and Hangzhou in this case) is related to the severity of this pandemic. Therefore, we recommend conducting a study after COVID-19 to examine the parenting style differences among different regions in China. In addition, we found that studying online only has a direct effect on adolescents’ mental health condition, but not an indirect effect through parenting on the outcomes. This result might be related to the lack of information collected regarding students’ online study conditions. We did not differentiate between whether students were taking online courses due to home quarantine policy implemented during COVID-19, or because they were having online class as a part of their regular routine and they happen to continue this form of study during the pandemic. Also, when we collected data in late February and early March, online learning had just started and not all students were involved in this type of learning, therefore, its impact on parenting style may have not emerged yet. Thus, we recommend that researchers further investigate online study and its impact on parents’ rearing style and adolescents’ mental health, since online learning might become an increasingly important way of receiving knowledge in the future. Lastly, how adolescents perceive their parents’ rearing style might be related to adolescents’ own level of stress, which was not measured in this study. Researchers can investigate this variable in the future and examine whether adolescents’ stress predicts their perception of their parents’ behavior.
Based on the results of this study, there are several implications for mental health professionals, parents, and teachers. First, parents, especially for parents in the Wuhan area, it is important to be aware of their parental rearing style and how children perceive their style of parenting. When facing certain stressors, parents might change their reaction toward their children; when children perceive their parents to be more harsh, overprotective, or show more emotional rejection toward them, their mental health condition might be compromised. This means that parents should explore ways to take care of themselves emotionally, find more coping resources during this challenging time period, and try to show more emotional warmth towards their children. Second, clinicians can provide intervention for parents and clarify whether the change of parenting style can change adolescents' anxiety and depression level. Furthermore, stakeholders should pay particular attention to adolescents who are female, in higher grades, who are the only child in the family, and whose family members got infected during the pandemic. These factors are all risk factors that were found in this study, and might put these adolescents at higher risk than others.