The impact of only-child status on adolescent mental health: a multi-center cross-sectional study using propensity score matching in Western China

• Published in: BMC public health Vol. 25; no. 1; pp. 2140 - 13
• Main Authors: He, Jinlong, Zhong, Yunling, Song, Yuqin, Luo, Jing, Lin, Cen, Wu, Yuhang, Pan, Lu, Cen, Yu, Zhao, Jiayu, Gou, Shiya, Wang, Nianjie, Wang, Yao, Tang, Lei, Luo, Jiaming
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 07.06.2025; BioMed Central; BMC
• Subjects: Adolescent; Adolescents; Analysis; Anxiety; Care and treatment; Child; Child & adolescent mental health; Child abuse & neglect; Child Abuse - psychology; Child Abuse - statistics & numerical data; Children; China - epidemiology; Confounding (Statistics); Consent; Cross-Sectional Studies; Depressive disorder; Diagnosis; Educational attainment; Emotions; Families & family life; Female; Health aspects; Humans; Hypotheses; Male; Matching; Mental depression; Mental disorders; Mental health; Mental Health - statistics & numerical data; Multivariate analysis; Only child; Only Child - psychology; Only Child - statistics & numerical data; Parent educational background; Population; Propensity Score; Psychological aspects; Psychological factors; Questionnaires; Sample size; Schools; Sleep; Sociodemographics; Stress (Psychology); Students; Well being; China; Only child; Propensity score; Adolescents; Mental health; Depressive disorder
• ISSN: 1471-2458; 1471-2458
• DOI: 10.1186/s12889-025-23383-y

Prior research on the mental well-being of adolescents has shown conflicting findings regarding the impact of only-child status. This study uses Propensity Score Matching (PSM) to control for confounding variables and investigate the impact of only-child status on the psychological health of adolescents. A multi-center cluster sampling approach included 7,359 students from 33 middle schools in Western China. The Depression, Anxiety, and Stress Scale-21 (DASS-21), the Childhood Psychological Abuse and Neglect Scale (CPANS), the Pittsburgh Sleep Quality Index (PSQI), the Chinese iteration of the Barratt Impulsiveness Scale (BIS-11), and the Chinese version of the Positive and Negative Affect Scale for Children (PANAS-C) were utilized to assess the adolescents' emotions, sleep, psychological abuse, and neglect. PSM was employed to address confounding variables. Univariate analysis used t-tests, chi-square tests, and Wilcoxon rank-sum tests, while multivariate analysis used GLM to compare DASS-21, PSQI, and PANAS-C scores. After PSM, 980 only-child and 980 non-only-child adolescents were included. Only-child adolescents showed significantly lower levels of depression, stress, emotional neglect, and negative affect. Further scrutiny of the mean ranks of these dimensions indicated that the only-child group yielded lower scores. In the GLM analysis, after adjusting for neglect, no significant associations were observed (all p > 0.05). However, post adjustments for psychological abuse, the only-child group also recorded lower scores in depression, stress, and negative affect. This study reveals that the only-child adolescents possibly showing better psychological well-being overall in western China. This study's findings suggest that, during adolescent development, families and society should pay greater attention to the mental health of non-only children.