Background Preterm birth is associated with long-term neurodevelopmental challenges, yet evidence on psychosocial outcomes in Chinese preschool children, particularly in less developed regions, remains scarce. Methods A cross-sectional study was conducted in a western Chinese city from February 28 to March 5, 2025. Using stratified cluster sampling, 20,913 parent–child dyads were recruited from 189 kindergartens. Preterm birth (< 37 weeks gestation) was parent-reported. For the assessment of psychosocial functioning, the Chinese adaptation of the Strengths and Difficulties Questionnaire (SDQ) was utilized, with its focus on total difficulties, internalizing problems, externalizing problems and prosocial behavior. Multivariable regression models were used, adjusting for child age and gender, child birth weight, number of children, parental age, parental gender, education level, employment status, marital status, annual family income, smoking status, alcohol intake status, and parental depressive symptoms (CES-D score). Subgroup analyses explored effect modification. Results Of 20,913 children (mean age 4.82 ± 0.89 years), 860 (4.1%) were preterm. After full adjustment, preterm birth was significantly associated with increased odds of total difficulties (OR = 1.32, p = 0.0015), but not with internalizing problems (OR = 1.07, p = 0.4153), externalizing problems (OR = 1.02, p = 0.8083), or prosocial behavior (OR = 0.89, p = 0.1009). Conclusions Preterm birth in preschool children from Western China was associated with higher odds of total difficulties, but not with internalizing problems, externalizing problems, or prosocial behavior after full adjustment. Stratified interaction analyses revealed that these associations differed by alcohol intake status (for total difficulties) and parental education level (for prosocial behavior) after FDR correction.
Hongli Sun, Jia Wang, H. Qiang· Frontiers in Pediatrics· 0 citations
Objectives This study aimed to examine whether parental overreactivity is associated with the relationship between child gender and mental health in preschool children, exploring potential pathways that may underlie observed gender-related disparities. Methods A total of 21,366 children aged 3–6 years were recruited through stratified cluster sampling from 189 kindergartens across 13 districts in western China. Child gender (boy/girl) was treated as the exposure variable. Parental overreactivity was assessed using the Arnold–O’Leary Parenting Scale, and child mental health was measured with the Strengths and Difficulties Questionnaire (SDQ), focusing on total difficulties and prosocial behavior. Multivariable logistic and linear regression models were applied, and mediation analysis was conducted to quantify indirect effects. Results Compared with boys, girls exhibited a 12% lower risk of total difficulties (OR = 0.88; 95% CI: 0.82–0.94; P = 0.0003) and a 21% higher likelihood of prosocial behavior (OR = 1.21; 95% CI: 1.14–1.28; P < 0.0001). Each one-point increase in parental overreactivity was associated with an 85% higher risk of total difficulties (OR = 1.85; 95% CI: 1.78–1.92; P < 0.0001) and a 34% reduction in prosocial behavior (OR = 0.66; 95% CI: 0.64–0.68; P < 0.0001). Girls experienced significantly lower levels of parental overreactivity (β = –0.04; 95% CI: –0.06 to –0.01; P = 0.0152). Mediation analysis showed that overreactivity statistically explained 16.22% of the gender effect on total difficulties and 7.49% on prosocial behavior. Subgroup analyses suggested stronger effects among families with lower socioeconomic status. Conclusions Parental overreactivity was identified as a statistically significant indirect factor in the association between child gender and early mental health. Girls showed lower parental overreactivity, which was statistically associated with more favorable psychological profiles. These findings suggest that parental overreactivity may represent a potential intervention target, and highlight the value of gender-sensitive parenting approaches for narrowing early mental health disparities.
Ziyi Wang, Jiahua Liu, Hongli Sun et al.· Frontiers in Psychiatry· 0 citations
Objectives Guided by the Family Economic Stress Model, this study investigated the associations between parental employment status and emotional and behavioral problems among preschoolers in Western China. Methods This cross-sectional study included 21,968 children aged 3–6 years recruited from 189 kindergartens. Parental employment status was categorized into four family-level patterns and further analyzed separately for paternal and maternal employment. Children's outcomes were assessed using the Strengths and Difficulties Questionnaire. Results Father-only employment was associated with higher internalizing problems (aOR = 1.11) but lower externalizing problems (aOR = 0.90); dual non-employment was associated with increased internalizing problems (aOR = 1.31). Paternal unemployment was linked to externalizing problems (aOR = 1.25), while maternal non-employment was associated with internalizing problems (aOR = 1.11–1.27). No significant effect modification was observed after FDR correction. Conclusions Parental employment status is associated with preschoolers' emotional and behavioral problems in a gender-differentiated manner. Paternal unemployment is primarily linked to externalizing problems, whereas maternal non-employment is more strongly associated with internalizing problems.
BACKGROUND
Parental depression is a well-established risk factor for child psychopathology, yet most studies focus on mothers. Whether nonlinear patterns with thresholds exist, especially for fathers, remains unclear. This study examines these associations and identified optimal thresholds comparing mothers and fathers.
METHODS
This cross-sectional study included 21,366 parents (16,258 mothers and 5108 fathers) of children aged 3-6 years in western China. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CESD). Child internalizing and externalizing problems were measured with the Strengths and Difficulties Questionnaire (SDQ). Piecewise logistic regression with grid search identified thresholds, adjusting for demographic and socioeconomic covariates.
RESULTS
Higher CES-D scores were associated with increased odds of child problems (all P < 0.001). The gender by CES-D interaction was significant for externalizing problems (P = 0.019), indicating a stronger association in fathers. For internalizing problems, the optimal threshold was a CES-D score of 17 for both mothers and fathers. For externalizing problems, the threshold was lower in fathers (16) than in mothers (21). Below these thresholds, each one-point increase in CES-D score was associated with 10-16% higher odds of child problems. Above the thresholds, the associations were attenuated. Piecewise models fitted significantly better than linear models (all P < 0.001).
CONCLUSIONS
Fathers' depressive symptoms were associated with child externalizing problems at a lower severity level compared with mothers, suggesting that screening for paternal depression even at subclinical levels may help identify families at elevated risk. The identified thresholds may help generate hypotheses for future longitudinal and clinical validation studies.
Minna Liu, Hongli Sun, Jiahua Liu et al.· Journal of Affective Disorde...· 0 citations
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