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

作者：Jinlong He, Yunling Zhong, Yuqin Song, Jing Luo, Jing Luo, Cen Lin, Yuhang Wu, Lu Pan, Yu Cen, Jiayu Zhao, Shiya Gou, Yao Wang, Lei Tang, Lei Tang, Jiaming Luo, Jiaming Luo · 发表于：BMC Public Health · 年份：2025 · DOI：10.1186/s12889-025-23383-y · 被引用次数：15 · 研究领域：Child and Adolescent Psychosocial and Emotional Development、Family Dynamics and Relationships、Child Abuse and Trauma

BACKGROUND: 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. METHODS: 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. RESULTS: 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 adju...