Dysfunctional attitudes, social support, negative life events, and depressive symptoms in Chinese adolescents: A moderated mediation model

Abstract

BACKGROUND

Depression is a prevalent psychological issue in adolescents that is significantly related to negative life events (NLEs) and dysfunctional attitudes. High levels of social support can significantly buffer NLEs’ effect on depression. Currently, there is limited research on how social support moderates the relationship between NLEs, dysfunctional attitudes, and depression in adolescents in China. It is imperative to investigate this moderating effect to mitigate dysfunctional attitudes in adolescent undergoing depressive mood, ultimately enhancing their overall mental health.

AIM

To investigate the relationship and underlying mechanisms between specific dysfunctional attitudes, social support, and depression among Chinese adolescents.

METHODS

This is a cross-sectional study which selected five middle schools in Shandong Province for investigation in March 2022. Participants included 795 adolescents (49.87% male, mage = 15.15, SD = 1.84, age range = 11-18 years old). All participants completed the Dysfunctional Attitude Scale, Adolescent Life Event Scale, Beck Depression Inventory, and Social Support Rating Scale. A moderated mediation model was conducted to examine the relationship between specific dysfunctional attitudes, social support, and depression.

RESULTS

Results indicated that NLEs affected depression through the mediating role of specific dysfunctional attitudes (autonomy attitudes β = 0.21; perfectionism β = 0.25). Moreover, social support was found to moderate the mediating effect between NLEs, specific dysfunctional attitudes, and depressive symptoms (autonomy attitudes b₂ = -0.08; perfectionism b₂ = -0.09).

CONCLUSION

Dysfunctional attitudes mediated and social support moderated the relationship between NLEs and depression. Social support can buffer depression symptoms among adolescents with autonomy attitudes and perfectionism.

Key Words: Depression; Dysfunctional attitudes; Social support; Adolescents; Moderated mediation model

Core Tip: Depression is a prevalent psychological issue in adolescents that is significantly related to negative life events (NLEs) and dysfunctional attitudes. Enhancing social support can significantly buffer NLEs’ effect on depression. In this study, 795 adolescents were surveyed to examine the mediating role of specific dysfunctional attitudes. It also examined how social support moderated the relationship between NLEs and depression. This study helps develop a theoretical framework for psychological interventions for adolescents with depression. Autonomy and perfectionism are two components of dysfunctional attitudes found to play a role in depression. Social support can protect against depressive symptoms.

INTRODUCTION

Over the past decade, there has been a rapid increase in the prevalence of depression among adolescents[1], with serious negative consequences for social-psychology function[2-7]. And early adolescent depression symptoms may raise the risk of major depressive disorder (MDD) in late adolescence, making interventions more challenging[8,9]. According to the cognitive theory of Beck et al[10], depressive symptoms result from the interaction between negative life events (NLEs) and cognitive vulnerability, which includes negative schema, dysfunctional attitudes, and negative automatic thoughts[10-12].

Dysfunctional attitudes and depression

Dysfunctional attitudes refer to rigid and inappropriate rules (negative views of oneself, the world, and the future) that guide one’s life, such as “My value as a person depends upon what others think of me”[11,13]. Important changes take place during adolescence that may increase young people’s dysfunctional attitudes[14]. Previous studies have indicated that dysfunctional attitudes predict depression symptoms[15-17]. Ju et al[18] found a strong association between dysfunctional attitudes and depression symptoms, and dysfunctional attitudes mediated the impact of childhood trauma on depression symptoms. Critically, dysfunctional attitudes are considered to be strongly associated with the onset of depression and have been recognized as mediators between external stimuli and depressive symptoms[19-21].

Moreover, modifying dysfunctional attitudes is a key focus of cognitive-behavioral therapy (CBT). However, clinical research has shown that CBT for dysfunctional attitudes may not consistently yield significant results[21]. While some studies have reported a reduction in dysfunctional attitudes and an improvement in depression symptoms after interventions for dysfunctional attitudes[22-24], others have found that CBT does not consistently lead to significant changes in dysfunctional attitudes[25]. For example, perfectionism is associated with prolonged depressive symptoms, as well as negative social interactions, avoidance coping[26]. Therefore, it may be essential to explore specialized and tailored mental health interventions, particularly when working with healthy adolescents, using a CBT framework.

Additionally, it is important to consider the influence of the sociocultural context, as there may be variations in adolescents’ dysfunctional attitudes across different cultural contexts[27,28]. Merely relying on findings from studies conducted in foreign settings may not be fully applicable to mental health teachers, psychotherapists, and psychiatrists seeking to understand the cognitive characteristics of adolescents in China. Therefore, our research is specifically focused on examining dysfunctional attitudes associated with depression symptoms in Chinese healthy adolescents, as well as the specific role dysfunctional attitudes play in the relationship between life events and depressive symptoms.

Social support and depression

Social support is a strong protective factor against depressive symptoms. Sufficient social support can help individuals cope with stress and develop the ability to cope. In turn, this increased ability contributes to reduce psychological stress and the risk of physical illnesses[29]. Evidence showed that support from family and friends has consistently been associated with positive mental health outcomes, including lower rates of major depression, fewer symptoms of post-traumatic stress disorder, lower levels of psychological distress and higher levels of positive affect on adolescents[30].

Thus, a person with dysfunctional attitudes will develop depression symptoms after stressful events, while social support can help individuals prevent depression. However, the relationship between dysfunctional attitudes and social support has received little attention. Social support provides individuals with the feeling of being valued, which may help to increase self-esteem and counter the negative self-perceptions, and feelings of worthlessness that come with depressive symptoms[29,30]. Social isolation is a risk factor for increased negativity and depressive cognition[31]. It is helpful to explore the role of social support for dysfunctional attitudes that will further expand our understanding of the relationship between dysfunctional attitudes and depressive symptoms. It also contributes to our understanding of the importance of social support in adolescent development. Given the shortage of professional pediatricians, psychotherapists, and counselors focused on adolescent mental health issues in China[32], social support becomes a valuable intervention point in non-specialist settings. It can offer timely assistance to adolescents experiencing subclinical depressive moods and reduce the risk of developing MDD[30]. Based on this premise, the current study aims to explore whether social support for adolescents could moderate the impact of dysfunctional attitudes on the relationship between life events and depressive mood.

Current study

Our hypotheses are as follows: Firstly, NLEs will be negatively associated with depression symptoms. Secondly, specific dysfunctional attitudes will mediate the association between NLEs and depression symptoms. Thirdly, social support can moderate the association between NLEs and dysfunctional attitudes. More specifically, dysfunctional attitudes will pose a greater risk for adolescents with low social support compared to those with high social support.

MATERIALS AND METHODS

Patient and public involvement

This cross-sectional study involved a total of 795 students (49.87% male) from five middle schools in Shandong Province. The participants’ mean age was 15.15 years, with a standard deviation of 1.84. The age range of the participants was 11 to 18 years. On average, the participants had 9.46 years of education, with a standard deviation of 1.69. All participants were of Chinese cultural background and were local residents in China.

Measures

Adolescents Life Events Scale: All students completed the 27-item Adolescent version of the Life Events Scale, based on events that occurred in the past 12 months (e.g., “I saw something bad happen”). The items were rated on a 5-point Likert scale, ranging from 1 (no impact) to 5 (severe impact). The scale consisted of six sub-dimensions: Interpersonal relationships, academic stress, punishment, loss, health adjustment, and other. Higher scores on the scale indicated a greater impact of NLEs on the students. The Adolescents Life Events Scale (ACLES) demonstrated good test-retest reliability and validity in previous research[33]. In this study, Cronbach’s alpha for the ACLES was 0.86.

Beck Depression InventorySecond Edition: Depressive symptoms were assessed using the 21-item Beck Depression Inventory-Second Edition (BDIII)[10]. The items were rated on a 4-point Likert scale (ranging from 0 to 3) based on experiences over the past 2 weeks. The responses were summed to create a total BDI-II score, with higher scores indicating higher levels of depressive symptoms. The BDI-II has shown good reliability and convergent validity in previous research[10]. In this study, Cronbach’s alpha for the BDI-II was 0.70.

Dysfunctional Attitudes Scale: The Dysfunctional Attitudes Scale (DAS)[34] consists of two parallel forms (Forms A and B) that assess the belief in 40 statements frequently endorsed by depressed individuals. Statements such as “I am nothing if a person I love does not love me” are rated on a 7-point Likert scale to indicate the degree of belief. The DAS has demonstrated high test-retest reliability[34] and high internal consistency, particularly with undergraduate samples[35]. In this study, DAS Form A α = 0.82, and DAS Form B α = 0.75.

Social Support Rating Scale: The Social Support Rating Scale was employed to assess the degree of social support received by the students. It comprises a total of 10 items, organized into 3 dimensions: Subjective support, objective support, and support utilization. Higher scores on the scale indicate higher levels of perceived social support. The internal consistency coefficient of the scale in this study was 0.92.

Procedures

Data collection occurred in March 2022, with ethical approval obtained for the study. All students voluntarily provided signed informed consent before participating. The participants completed surveys on social-demographics, life events, depression symptoms, and dysfunctional attitudes. Each survey took approximately 20-30 minutes to complete and was collected by research assistants. The effective questionnaires accounted for 98.88% of the overall questionnaires.

Statistical analysis

Statistical analyses were performed using SPSS version 24.0. Descriptive statistics were computed for all variables. Next, correlation analyses were conducted to assess the associations between life events, dysfunctional attitudes, social support, and depressive symptoms.

To test the moderated mediation model separately for adolescent males and females, we employed Hayes’ (2018) PROCESS. Specifically, we used Model 7 in Process to examine direct and indirect effects. The bootstrap method, based on 5000 samples, was utilized to obtain bias-corrected and accelerated 95% confidence intervals (CIs) for the moderated mediation model. The mediating effect is considered moderated if the confidence interval does not include zero.

RESULTS

Characteristics of descriptive statistics

Correlation analysis revealed that age and years of education were not significantly associated with NLE scores and depression scores (P > 0.05).

Table 1 presents the means, standard deviations, and correlation coefficients of the variables included in the study. Significant positive correlations were observed between the total scores of NLEs, DAS scores, and depression scores in secondary school students (P < 0.01). Furthermore, significant negative correlations were found between total social support scores and depression scores (P < 0.01), as well as between social support scores and scores of NLEs and DAS (P < 0.01). However, it was found that the “cognitive philosophy” dimension of the DAS did not correlate with the ACLES or the SRSS. Consequently, “cognitive philosophy” was not included in the moderating and mediating analyses.

Table 1 Descriptive characteristic and correlation.

	mean ± SD	Depression symptoms	Total score of dysfunctional attitudes	Social support	Negative life events
Depression symptoms	8.63 ± 9.90
Total score of dysfunctional attitudes	124.02 ± 34.21	0.38a
Social supports	24.93 ± 9.60	-0.34a	-0.31a
Negative life events	7.79 ± 8.02	0.33a	0.33a	-0.31a
Autonomy	15.51 ± 6.70	0.36a	0.78a	-0.30a	0.29a
Cognitive philosophy	19.72 ± 6.58	0.03	0.07a	-0.03	-0.01
Vulnerability	14.32 ± 4.91	0.32a	0.76a	-0.34a	0.27a
Attraction and repulsion	14.12 ± 5.66	0.31a	0.83a	-0.32a	0.27a
Perfectionism	14.69 ± 6.48	0.40a	0.83a	-0.34a	0.29a
Compulsory	17.07 ± 4.55	0.26a	0.67a	-0.24a	0.27a
Need for approval	16.09 ± 4.86	0.31a	0.78a	-0.26a	0.26a
Dependency	15.63 ± 5.04	0.30a	0.80a	-0.24a	0.25a
Subjective support	19.55 ± 5.45	-0.31a	-0.36a	0.93a	-0.34a
Objective support	24.23 ± 6.08	-0.31a	-0.34a	0.92a	-0.34a
Support utilization	22.80 ± 7.06	-0.33a	-0.33a	0.94a	-0.33a
Relationship	1.27 ± 1.12	0.41a	0.34a	-0.38a	0.87a
Stress of study	1.20 ± 1.08	0.40a	0.29a	-0.34a	0.88a
Being punished	0.79 ± 1.06	0.22a	0.25a	-0.28a	0.85a
Loss	0.79 ± 1.16	0.14a	0.20a	-0.20a	0.76a
Adaption	0.73 ± 0.95	0.29a	0.28a	-0.34a	0.90a
Else	0.88 ± 1.01	0.33a	0.34a	-0.35a	0.86a

^aP < 0.01.

Analyses of mediating and moderating

According to the mediation and moderating effect test steps proposed by Wen et al[36,37], the study examined the mediating and moderating effects of dysfunctional attitudes and social support between NLEs and depressive symptoms. Covariates such as gender and age were controlled in the analyses.

The first step involved testing a moderating model that included social support, depressive symptoms, and NLEs. In the second step, a mediated model with moderation was developed to investigate whether the mediating effect of NLEs through dysfunctional attitudes was moderated by social support. In the third step, confidence intervals were computed for a1b2, a3b1, and a3b2 using the bias-corrected percentile Bootstrap method. Finally, the distinct role of various dysfunctional attitudes in the association between NLEs and depressive symptoms was examined individually, with different dimensions of dysfunctional attitudes considered as mediating variables.

The results revealed that the direct effect of NLEs on depressive symptoms was significant (c1 = 0.21, t = 6.66, P < 0.01). Moreover, the interaction term of NLEs and social support on depressive symptoms was also significant (c3 = -0.10, t = -3.85, P < 0.01). This indicates that the impact of NLEs on depressive symptoms in secondary school students is significantly moderated by social support (Figure 1A).

Figure 1 Simple slope diagram of the moderating effect, and mediated effects model of autonomy or perfectionism with moderation. A: The impact of negative life events on depression varied via dysfunctional attitudes based on different level of social support. Statistic performed by a moderated mediation model; B: The impact of negative life events on depression varied via autonomy based on different level of social support. Statistic performed by a moderated mediation model; C: The impact of negative life events on depression varied via perfectionism based on different level of social support. Statistic performed by a moderated mediation model; Sup: Support.

The effect of NLEs on dysfunctional attitudes was significant (a1 = 0.18, t = 6.86, P < 0.01). However, the effect of the interaction term between NLEs and social support on dysfunctional attitudes was not significant (a3 = 0.01, t = -2.04, P = 0.60). Additionally, the effect of dysfunctional attitudes on depressive symptoms was significant (b1 = 0.25, t = 6.33, P < 0.01), but the effect of the interaction term between dysfunctional attitudes and social support on depressive symptoms was not significant (b2 = -0.02, t = 0.57, P = 0.39).

All 95%CIs for these coefficient products encompass 0 [a1b2 (-0.022 to 0.015), a3b1 (-0.019 to 0.024), and a3b2 (-0.007 to 0.002)]. It can be inferred that the mediating impact of NLEs on depression through dysfunctional attitudes remains unaffected by social support. However, it is worth noting that the overall social support score only moderates the direct influence of NLEs on depressive symptoms. Mediation model concerning specific dysfunctional attitudes.

Table 2 presents the results of the first step of the hierarchical test, which remain consistent and need not be reiterated. The findings reveal significant mediating effects for various dysfunctional attitudes, including autonomy attitude, vulnerability, attraction and rejection, perfection, coercion, approval seeking, and dependence, in the relationship between NLEs and depressive symptoms. Furthermore, the mediating effects of autonomy attitude and perfectionism in the association between NLEs and depressive symptoms were found to be moderated by social support. Social support was observed to moderate the latter part of the pathway in the NLE-autonomy attitude/perfectionism-depressed mood process (refer to Figure 1B and C). Simple slope plots illustrate that the predictive effect of dysfunctional attitudes on depressed mood tends to diminish when social support is high.

Table 2 Model metrics of specific dysfunctional attitudes.

Variables	No.	β	t	95%CI
Dysfunctional attitudes Wi(1-8)
Negative life events X	1	0.27	7.80	0.20 to 0.34
	2	-0.01	-0.29	-0.08 to 0.06
	3	0.20	5.18	0.13 to 0.28
	4	0.21	5.64	0.14 to 0.28
	5	0.28	8.07	0.21 to 0.35
	6	0.22	5.48	0.14 to 0.30
	7	0.22	5.26	0.14 to 0.30
	8	0.18	4.30	0.10 to 0.27
Social support U × X	1	-0.01	-0.48	-0.07 to 0.05
	2	-0.07	-2.20	-0.14 to -0.01
	3	0.04	0.97	-0.04 to 0.12
	4	-0.03	-0.76	-0.12 to 0.05
	5	0.003	0.09	-0.06 to 0.06
	6	0.01	0.16	-0.08 to 0.09
	7	0.01	0.29	-0.08 to 0.10
	8	0.03	0.67	-0.06 to 0.10
Depression symptoms Y
Autonomy attitudes W1		0.21	6.18	0.15 to 0.28
U × W1		-0.09	-3.19	-0.15 to -0.04
Cognitive philosophy W2		0.03	0.81	-0.04 to 0.09
U × W2		0.01	0.43	-0.05 to 0.07
Vulnerability W3		0.17	4.29	0.09 to 0.25
U × W3		-0.03	-0.92	-0.10 to 0.04
Attraction and rejection W4		0.18	4.56	0.10 to 0.26
U × W4		-0.03	-0.79	-0.09 to 0.04
Perfectionism W5		0.25	7.31	0.18 to 0.32
U × W5		-0.08	-2.79	-0.14 to -0.02
Mandatory W6		0.14	3.50	0.06 to 0.21
U × W6		-0.05	-1.30	-0.12 to 0.03
Need for approval W7		0.77	4.42	0.10 to 0.24
U × W7		-0.02	-0.51	-0.09 to 0.06
Dependency W8		0.15	4.11	0.08 to 0.22
U × W8		-0.02	-0.62	-0.10 to 0.05

CI: Confidence intervals.

DISCUSSION

In this study, we conducted an examination of the relationship and underlying mechanisms between specific dysfunctional attitudes, social support, and depression among healthy Chinese adolescents. Our findings revealed that NLEs significantly and positively predicted depressive symptoms in middle school students through the mediation of specific dysfunctional attitudes. Furthermore, we identified that social support played a moderating role in the relationship between NLEs, specific dysfunctional attitudes, and depressive symptoms. This research is particularly noteworthy as there have been limited studies focusing on specific dysfunctional attitudes among Chinese adolescents. Thus, our current results make a valuable contribution to the existing literature on dysfunctional attitudes and depression symptoms among middle school students in China.

First, in line with cognitive-behavioral theory and previous research[17,38-42], our overall model revealed that NLEs positively predicted depression symptoms through the influence of dysfunctional attitudes in healthy middle school students. This positive relationship indicates that as adolescents experience more NLEs, their dysfunctional attitudes become stronger, leading to more severe depressive symptoms. Consistent with Beck’s hypothesis, dysfunctional attitudes are implicit and relatively stable, potentially impacting emotions after encountering stressful events[13,25]. Our findings validate Beck’s hypothesis in a healthy Chinese adolescent population, suggesting that dysfunctional attitudes are activated in healthy secondary school students following NLEs, thereby increasing the risk of developing depression symptoms.

Second, this study extends prior literature by demonstrating that several specific dysfunctional attitudes (Vulnerability, attraction and rejection, perfectionism, coercion, dependence, autonomy attitudes, and need for approval) mediate the relationships between NLEs and depression symptoms. In accordance with the cognitive vulnerability-stress theory of depression[42,43], dysfunctional attitudes can be activated and reinforced with a high probability after experiencing negative events. Our findings provide further specificity to this model, showing that NLEs can activate multiple dysfunctional attitudes (such as vulnerability, perfectionism, dependence, autonomy attitudes, and need for approval), acting as mediating factors that lead to depression symptoms in adolescents. Similar findings were observed in the studies by Alloy et al[44] and Chioqueta et al[45,46]. After experiencing negative events, adolescents are more prone to negative thinking, pursuing perfection, relying on others, and seeking more support and approval, all of which may contribute to an increased risk of depression. According to some studies[13,46-48], perfectionism refers to harsh self-criticism, stringent self-evaluation, unrealistic standard-setting, intense interpersonal sensitivity, extreme fear of evaluation, and basing self-worth on achievement. Autonomy indicates having more stable self-esteem instead of external evaluation and possessing self-confidence. Need for approval entails pleasing others, craving nurturance, needing admiration, requiring acceptance, and deriving self-worth from others’ approval. Multiple dysfunctional attitudes may be activated in healthy adolescents after experiencing NLEs. This finding underscores the importance of exploring sub-dimensions of dysfunctional attitudes in adolescents.

Interestingly, the results of this study revealed that social support played a moderating role in the relationship between NLEs and depression symptoms, as well as in the mediating effect of dysfunctional attitudes between NLEs and depression symptoms. These findings align with previous research, indicating that social support can help mitigate the impact of NLEs on depressive symptoms in adolescents[39,49]. High levels of social support were associated with reduced likelihood of experiencing depressive symptoms in adolescents[50]. The study’s results suggest that social support, following an NLE, can help counteract the negative reinforcement effects of dysfunctional assumptions and may aid in reducing the risk of depression. Although dysfunctional attitudes tend to be more state-like[51], social support can assist adolescents in overcoming and adapting dysfunctional attitudes, thereby promoting emotional stability. In cases where adolescents lack sufficient social support resources, experiencing NLEs or activating dysfunctional attitudes can increase the risk of depression.

Social support during adolescence primarily comes from parental support, teacher support, and peer support[52-54]. Parental support gradually decreases, while teacher support and peer support increase during this developmental period[54]. Moreover, parental support and peer support may vary depending on factors such as gender, age, and socio-cultural influences. For instance, studies have shown significant differences between maternal support (focused on emotional support) and paternal support (focused on material support), although both types of support are effective for adolescents[55,56]. In terms of peer support, adolescents with predominantly same-sex peers perceive more social support and experience fewer depressive symptoms, while those with mostly opposite-sex peers report less social support and exhibit higher levels of depression[57]. Additionally, cultural differences in parenting styles may influence the type and extent of support available to adolescents. Chinese parents, for example, are often more protective, and adolescents in China may be more dependent on parental support. They tend to maintain closer relationships with others and seek social support more actively, potentially making the effect of social support on depression more pronounced in this context compared to different cultures[58]. As a result, parental support and peer support in Chinese and different cultures may differ[58]. Consequently, different types of social support may have distinct buffering effects between NLEs, dysfunctional attitudes, and depressive symptoms, necessitating further investigation in future studies. Nevertheless, the findings of this study suggest potentially beneficial directions for intervention. Future interventions should consider the sources of social support for adolescents and cultural factors, such as incorporating peer-support techniques in school mental health classes and developing parenting classes aimed at enhancing family support.

The second half of the process, mediated by autonomy attitudes and perfectionism, is moderated by social support, as observed in previous study. After an NLE, among the activated dysfunctional attitudes, autonomy attitudes and perfectionism are influenced by social support, leading to a reduction in depressive mood. These findings suggest that timely provision of social support can alleviate depression arising from external attributions and deliberate pursuit of perfection among secondary school students. This result is consistent with previous studies, highlighting the impact of social support on the thinking patterns of secondary school students[39,49]. Less research has been conducted in China on specific dysfunctional attitudes in young, healthy adults, making the results of this study a valuable addition to the existing research and enhancing our understanding of dysfunctional attitudes in Chinese healthy teenagers.

In summary, this study establishes a moderated mediation model that provides deeper insights into the mechanisms by which NLEs influence depressed mood. It elucidates how NLEs specifically impact depressed mood through dysfunctional attitudes and how this process is influenced by social support. Social support acts as a protective factor with a buffering effect on the development of depressed mood. In terms of managing students’ mental health, schools should focus on providing appropriate social support for secondary school students, which can come from teachers, peers, and parents. Emphasis should be placed on enhancing home-school communication to better understand students’ daily experiences and mental health status, thereby providing timely support to help them cope with the effects of negative events. Moreover, guiding students to support each other should also be emphasized. Additionally, schools should actively engage in mental health education to improve students’ utilization of social support and help them prevent or reduce depression. Teachers should learn and understand the common cognitive biases among secondary school students, conducting timely mental health programs to guide students in adjusting their cognitive biases, enhancing cognitive flexibility, and reducing the likelihood of depression triggered by repetitive negative thoughts after NLEs.

However, the present study has some limitations. First, being a cross-sectional study, causal inferences are not possible, and the findings mainly aid in understanding how the various components interact. Second, recall bias may be increased in adolescents with depressive symptoms, so future assessments of adolescent social support should consider a combination of objective assessments to account for this bias. Lastly, while we primarily focused on the function of dysfunctional attitudes and their unique features based on Beck’s theory, it is important to consider that additional cognitive vulnerability variables, as per the Hopelessness Theory and Response Style Theory of depression, may have varying effects on how depression manifests in adolescents[44]. Thus, future studies should explore different cognitive vulnerability factors together to enhance the understanding of depression among adolescents.

CONCLUSION

The current study successfully demonstrated a moderated mediation model, wherein NLEs and dysfunctional attitudes among middle school students significantly and positively predicted the development of depressive symptoms. Additionally, social support was found to moderate the relationship between NLEs and depressive symptoms, as well as the mediating effect of dysfunctional attitudes between NLEs and depressive symptoms. Notably, various dysfunctional attitudes exhibited significant associations with and served as significant predictors of depressive symptoms among secondary school students. Specifically, the second half of the mediated process involving autonomy and perfectionism was found to be moderated by social support.

ACKNOWLEDGEMENTS

We thank Wen-Yan Zhang, Dong Zhang, Chun-Feng Hu for assistance with the data collection.