Exploring why adolescents of disadvantaged family socio-economic status were more depressed than others: Serial mediations via personal psychological resources, loneliness, and school refusal functions.

Background: Disadvantageous family socio-economic status (DFSES) is a potential source of disparity in adolescent mental health. This study investigated the association between DFSES and probable depression and its mediation mechanisms via personal psychological resources (hope and resilience), loneliness, and school refusal functions.

Methods: A school-based anonymous survey was conducted among 8285 middle school students in China from February to March 2022; the response/eligible rate was 98.6 %/88.4 % (n = 8169/7321). The DFSES index counted the number of five unfavorable conditions (not living with both parents, either the father's or the mother's education level was primary school or below, self-reported poor/very poor household financial situation, and single-parent family). Probable depression was defined as the 9-item Patient Health Questionnaire score ≥ 10.

Results: The prevalence of probable depression was 18.9 %. The proportions endorsing nil/1/2/≥3 DFSES conditions were 49.4 %/30.4 %/15.1 %/5.1 %. Adjusting for age and sex, DFSES was positively associated with probable depression. Such an association was fully mediated by three 2-step indirect paths (via personal psychological resources of hope and resilience, loneliness, and school refusal functions, respectively) and two 3-step serial mediation (via personal psychological resources then school refusal functions, and via loneliness and then school refusal); the mediation effect size ranged from 8.8 % to 23.5 %.

Conclusions: DFSES was a significant factor of adolescent depression. Modifications of the personal psychological resources of hope and resilience, loneliness, and school refusal functions might mitigate such potentially harmful effects of DFSES. Future longitudinal and intervention studies are warranted to verify the findings and reduce adolescent depression.