Observational Study Open Access
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 26, 2024; 12(21): 4642-4651
Published online Jul 26, 2024. doi: 10.12998/wjcc.v12.i21.4642
Comparative study on emotional behavior and parental job stress of only-child and non-only-child preschool children
Zhi-Wei Fu, Kai-Li Wang, Ning-Yu Du, Yue-Jing Li, Jing-Jing Duan, Sheng-Xia Zhao, Department of Children's Health, Shijiazhuang Maternity and Child Healthcare Hospital, Shijiazhuang 050000, Hebei Province, China
ORCID number: Sheng-Xia Zhao (0009-0008-4497-484X).
Author contributions: Zhao SX was the guarantor and designed the study; Fu ZW, Wang KL, Du NY participated in the acquisition, analysis, and interpretation of the data, and drafted the initial manuscript; Li YJ, Duan JJ revised the article critically for important intellectual content.
Supported by Shijiazhuang City Science and Technology Research and Development Self Raised Plan, No. 221460383.
Institutional review board statement: The study was reviewed and approved by the Shijiazhuang City Maternal and Child Health Care Hospital.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sheng-Xia Zhao, MBBS, Associate Chief Nurse, Department of Children's Health, Shijiazhuang Maternity and Child Healthcare Hospital, No. 396 Youyi Street, Qiaoxi District, Shijiazhuang 050000, Hebei Province, China. 18032925759@163.com
Received: April 22, 2024
Revised: May 24, 2024
Accepted: June 7, 2024
Published online: July 26, 2024
Processing time: 68 Days and 20.1 Hours

Abstract
BACKGROUND

Studies have revealed that Children's psychological, behavioral, and emotional problems are easily influenced by the family environment. In recent years, the family structure in China has undergone significant changes, with more families having two or three children.

AIM

To explore the relationship between emotional behavior and parental job stress in only preschool and non-only preschool children.

METHODS

Children aged 3-6 in kindergartens in four main urban areas of Shijiazhuang were selected by stratified sampling for a questionnaire and divided into only and non-only child groups. Their emotional behaviors and parental pressure were compared. Only and non-only children were paired in a 1:1 ratio by class and age (difference less than or equal to 6 months), and the matched data were compared. The relationship between children's emotional behavior and parents' job stress before and after matching was analyzed.

RESULTS

Before matching, the mother's occupation, children's personality characteristics, and children's rearing patterns differed between the groups (P < 0.05). After matching 550 pairs, differences in the children's parenting styles remained. There were significant differences in children's gender and parents' attitudes toward children between the two groups. The Strengths and Difficulties Questionnaire (SDQ) scores of children in the only child group and the Parenting Stress Index-Short Form (PSI-SF) scores of parents were significantly lower than those in the non-only child group (P < 0.05). Pearson’s correlation analysis showed that after matching, there was a positive correlation between children's parenting style and parents' attitudes toward their children (r = 0.096, P < 0.01), and the PSI-SF score was positively correlated with children's gender, parents' attitudes toward their children, and SDQ scores (r = 0.077, 0.193, 0.172, 0.222).

CONCLUSION

Preschool children's emotional behavior and parental pressure were significantly higher in multi-child families. Parental pressure in differently structured families was associated with many factors, and preschool children's emotional behavior was positively correlated with parental pressure.

Key Words: Only child, Family structure, Children's emotional behavior, Parental stress, Tendency score

Core Tip: Children's psychological, behavioral, and emotional problems are easily influenced by the family environment. However, most studies have not clearly indicated whether there is a strong influence mechanism between children's behavioral and emotional problems and parents' educational methods. In recent years, with the emergence of second and third children, the family structure of only children in the past few decades has been changed. In this study, we extracted relevant data from 1314 families to further understand the relationship between emotional behavior of children from only child or non only child families and parental work pressure, providing scientific basis for optimizing children's education and family relationships.



INTRODUCTION

With the rapid global development in recent years, growing attention has been paid to children's psychological behavior and emotions in China and abroad[1,2]. Studies have found that some children develop internalized problems, such as depression and negative anxiety and externalizing problems, such as aggressive behavior and violence against family and animals, due to emotional excitement[3,4]. During the early stages of growth and development, children's psychological, behavioral, and emotional states are sensitive and easily influenced by family environment, among which parents' educational methods are the most critical[5]. Research has shown that children's behavioral and emotional problems primarily come from their parents' compulsory behavior, which leads not only to hostility in children but also to psychological depression and anxiety[6]. Whereas, parents' active participation, support, and encouragement can positively influence their children's aggressive behavior[7,8]. However, most studies do not clearly agree on this topic and fall short of examining whether there is a strong influence mechanism between children’s behavioral and emotional problems and their parents’ educational methods.

To cope with the parental social problems, China formulated the family planning policy in the 1980s, implementing the one-child policy. However, recent changes to the only child family structure that had existed for decades with the introduction of second and third children have begun changing the family structure in China. To ensure that children's mental health is more highly regarded by parents and society across different family types, research has been conducted in varying aspects to observe the relationship between the mental health of only children and that of non-only children and families. Thus, this study aimed to further understand the relationship between the emotional behavior of children from only-child and non-only-child families and their parents' job stress. To do so, the relevant data of 1314 families was sampled, seeking a deep understanding of the influencing mechanisms of different family structures on children's psychological development and parental experience and providing an empirical basis for optimizing children's education and family relations.

MATERIALS AND METHODS
Selection of research objects

Through stratified random sampling, 1314 kindergartners, aged 3-6 years, in four main urban areas of the city of Shijiazhuang, Hebei province (China) were randomly selected for a questionnaire survey. The sample comprised 686 males and 628 females, with average ages of (4.22 ± 1.15) years. The inclusion criteria were: (1) Preschool children aged 3-6 years and their parents from kindergartens in Shijiazhuang; and (2) the parents signing an informed consent form. The exclusion criteria were: (1) Parents with mental illness (i.e., schizophrenia, mania, depression, and other psychotic disorders); (2) children with serious physical ailments; (3) children with neurodevelopmental disorders such as ASD and mental retardation; (4) children with special education needs; and (5) parents who were not willing to participate.

Research method

A cross-sectional study was conducted to elucidate the emotional and behavioral problems of preschool children and their parents' parental pressure. First, the kindergarten’s healthcare staff and doctors were systematically trained, and then parents were asked to complete the survey questionnaires. Before the investigation, doctors explained the significance of this study to the parents in detail to ensure their understanding, which is conducive to gaining their cooperation and improving the quality of questionnaire responses. Finally, based on the questionnaire results, the subjects were divided into two groups: only-child and non-only-child.

Survey tools

Investigation of the basic situation of preschool children and their parents: A self-administered questionnaire was used to collect data on basic personal information and family environment. Specific factors, including the children's age, sex, and parity, and the parents’ age, occupation, and educational background were collected. Crucially, the questionnaire also evaluated the family atmosphere, the attitude of the parents and older adults toward children, and the relationship between the husband and wife.

Investigation of preschool children's emotional behavior: The preschool children’s emotional behavior was evaluated using the Strengths and Difficulties Questionnaire (SDQ) developed by American psychologist Robert Goodman[9], which has high reliability and validity and is widely used. It includes 25 items across five subscales: emotional symptoms, conduct problems, hyperactivity-inattention, peer communication problems, and prosocial behaviors. The score of each item ranges from 0 to 2, and the evaluation criteria are not meeting 0, meeting 1, and meeting 2. Items 7, 11, 14, 21, and 25 are reverse-scored. The scoring criteria are as follows: 0–15 = normal; 16–19 = marginal, and 20–40 = abnormal. Parents evaluated their recent behavior and emotional state based on their usual observations of their children. If the total difficulty score exceeds the normal range or if any of the five key factors are abnormal, the child may encounter emotional and behavioral problems.

Parental stress survey: The Parenting Stress Index-Short Form (PSI-SF)[10] was used to investigate parenting pressure among the participating children's parents. The scale comprises 36 items and three subscales. A five-point Likert scoring method was used; the higher the score, the greater the pressure on the parents. A score greater than 90 indicates high parenting pressure. The PSI-SF has been applied in many domestic studies and has high reliability and validity.

Propensity score matching

The potential confounding factors of the two groups of children were balanced using the tendentiousness score method, and only children and non-only children were paired at a 1:1 ratio according to the same class and age (the difference was less than or equal to six months). After successful matching, the related data of the two groups were analyzed.

Statistical analysis

The statistical software SPSS version 26.0 was used to analyze the data. Counting data were represented by examples (%), and a χ2 test was used for comparison between groups. The measurement data were expressed as s, and the comparison between groups was a group t-test. Children’s emotional behavior and parents’ job stress scores before and after matching were continuous variables, and a Pearson’s correlation analysis was used to analyze the correlation between them. Statistical significance was set at P < 0.05.

RESULTS
Comparing two groups of related data before matching

Before matching, only the mother's occupation, children's personality characteristics, and children's rearing patterns were significantly different between the two groups (P < 0.05), while the other general data were not significantly different (P > 0.05). Table 1 shows the general data findings.

Table 1 Comparison of two groups of general data before matching, n (%).
General information
Only child group (n = 691)
Non-only group (n = 623)
χ2/t
P value
Age (mean ± SD, years)4.23 ± 1.124.22 ± 1.110.1620.871
Child sexMan207 (29.96)179 (28.73)0.2370.627
Woman484 (70.04)444 (71.27)
Parity1 time273 (39.51)234 (37.56)0.6980.706
2 time401 (58.03)376 (60.35)
More than 316 (2.32)13 (2.09)
Mother age (mean ± SD, years)36.95 ± 5.1737.11 ± 5.020.5680.570
Father's age (mean ± SD, years)35.86 ± 4.6136.21 ± 4.451.3970.163
Motherhood occupationCivil servants; teacher115 (16.64)118 (18.94)12.7900.025
Technology; finance; financial worker110 (15.91)76 (12.20)
Freelancer; individual operator91 (13.17)115 (18.46)
Workers; employees of industrial and commercial enterprises111 (16.06)107 (17.17)
Unemployed person34 (4.92)30 (4.82)
Other230 (33.29)177 (28.41)
Father's occupationCivil servants; teacher141 (20.41)141 (22.63)5.7870.328
Technology; finance; financial worker94 (13.60)63 (10.11)
Freelancer; individual operator143 (20.69)145 (23.27)
Workers; employees of industrial and commercial enterprises122 (17.66)106 (17.01)
Unemployed person11 (1.59)13 (2.09)
Other180 (26.05)155 (24.88)
Mother educationJunior high school and below19 (2.75)18 (2.89)5.5900.232
High school or technical secondary school69 (9.99)72 (11.56)
Universities and colleges219 (31.69)164 (26.32)
Undergraduate course312 (45.15)309 (49.60)
Master degree or above72 (10.85)60 (9.63)
Father's educationJunior high school and below19 (2.75)15 (2.41)4.7290.316
High school or technical secondary school75 (10.85)88 (14.13)
Universities and colleges227 (32.85)201 (32.26)
Undergraduate course312 (45.15)279 (44.78)
Master degree or above58 (8.39)40 (6.42)
Family typeNuclear family (parents and children)390 (56.44)340 (49.06)1.8620.602
Single parent10 (1.45)9 (1.30)
Of three generations under one roof281 (40.67)259 (37.37)
Other10 (1.45)15 (2.16)
Main caregiversMother494 (71.49)479 (76.89)5.1410.162
Father47 (6.80)33 (5.30)
Grandparents or grandparents147 (21.27)108 (17.34)
Housemaid3 (0.43)3 (0.48)
Parents' attitude towards children's disciplineHighly consistent173 (25.04)165 (23.81)0.6420.726
Basically the same503 (72.79)442 (63.78)
Basically different15 (2.17)16 (2.31)
The attitude of the elderly and parents towards children's disciplineHighly consistent22 (3.18)18 (2.60)1.4680.480
Basically the same279 (40.38)272 (39.25)
Basically different390 (56.44)333 (48.05)
Proportion of children's expensesOne fifth or less158 (22.87)150 (21.65)5.9820.113
One quarter242 (35.02)202 (29.15)
One third193 (27.93)203 (29.29)
A half98 (14.18)68 (9.81)
Family atmosphereVery harmonious297 (42.98)305 (48.96)8.0630.089
Good294 (42.55)250 (40.13)
Common97 (14.04)66 (10.59)
Bad3 (0.43)1 (0.16)
Very bad0 (0.00)1 (0.16)
Conjugal relationHarmonious594 (85.96)550 (79.37)1.6450.439
Common80 (11.58)60 (8.66)
Other circumstances (such as single parent/separation, etc.)17 (2.46)13 (1.88)
Children's personality characteristicsExtroverted228 (33.00)258 (37.23)11.3660.003
Middle387 (56.03)316 (45.60)
Introverted76 (11.00)49 (7.07)
Child rearing practicesAbsolute authority type621 (89.87)558 (89.57)12.3860.006
Spoiling type36 (5.20)15 (2.40)
Neglect indifference type31 (4.49)48 (7.70)
Absolute authority type3 (0.43)2 (0.32)
Coping styles of children's negative emotionsEncourage expression655 (94.79)597 (86.15)1.0420.594
Neglect19 (2.75)12 (1.73)
Punish17 (2.46)14 (2.02)
Questionnaire filled byFather138 (19.97)134 (19.34)0.4720.492
Mother553 (80.03)489 (70.56)
SDQ score (mean ± SD, score)44.44 ± 4.5244.63 ± 4.340.7750.438
PSI-SF score (mean ± SD, score)
PD total score28.51 ± 10.7828.14 ± 11.190.6100.542
P-CDI total19.41 ± 7.8818.73 ± 7.111.6360.102
DC total22.80 ± 9.8022.14 ± 8.481.2990.194
Aggregate score70.72 ± 24.1869.00 ± 22.531.3300.184
Comparison of related data between the two groups after matching

In total, 550 pairs were successfully matched. There was no significant difference in the occupation of the mother and the character of the child between the two groups after matching (P > 0.05). However, differences remained in child-rearing practices. M, significant differences existed in the sex of the children between the two groups and in parental rearing attitudes toward children. Additionally, the SDQ scores of children and the PSI-SF scores of parents in the only-child group were significantly lower than those in the non-only-child group (both P < 0.05; Table 2).

Table 2 Comparison of two groups of general data after matching, n (%).
General information
Only child group (n = 550)
Non-only child group (n = 550)
χ2/t
P value
Age (mean ± SD, years)4.28 ± 1.114.23 ± 1.110.7470.455
Child genderMan169 (30.73)158 (28.73)27.4870.000
Woman381 (69.27)392 (71.27)
Type number1 time224 (40.73)207 (37.64)1.6520.438
2 times312 (56.73)332 (60.36)
3 times and above14 (2.55)11 (2.00)
Mother's age (mean ± SD, years)36.87 ± 5.0937.08 ± 5.030.6880.492
Father's age (mean ± SD, years)35.82 ± 4.6836.26 ± 4.501.4810.139
Mother's occupationCivil servants, teachers98 (17.82)98 (17.82)6.7530.240
Science and technology, finance, finance workers86 (15.64)72 (13.09)
Freelance, self-employed78 (14.18)96 (17.45)
Workers, industrial and commercial enterprise employees87 (15.82)100 (18.18)
Unemployed20 (3.64)27 (4.91)
Other181 (32.91)157 (28.55)
Father's occupationCivil servants, teachers118 (21.45)116 (21.09)4.8380.436
Science and technology, finance, finance workers72 (13.09)57 (10.36)
Freelance, self-employed114 (20.73)124 (22.55)
Workers, industrial and commercial enterprise employees98 (17.82)101 (18.36)
Unemployed6 (1.09)13 (2.36)
Other142 (25.82)139 (25.27)
Mother's educationJunior secondary and below15 (2.73)18 (3.27)8.3460.080
High school or technical secondary school46 (8.36)62 (11.27)
Universities and colleges177 (32.18)143 (26.00)
Undergraduate course252 (45.82)277 (50.36)
Master degree or above60 (10.91)50 (9.09)
Father's educationJunior secondary and below16 (2.91)14 (2.55)4.8500.303
High school or technical secondary school53 (9.64)75 (13.64)
Universities and colleges176 (32.00)175 (31.82)
Undergraduate course264 (48.00)252 (45.82)
Master degree or above41 (7.45)34 (3.18)
Family typeNuclear family (parents and children)314 (57.09)297 (54.00)2.1130.549
Single parent5 (0.91)8 (1.45)
Of three generations under one roof222 (40.36)232 (42.18)
Other9 (1.64)13 (2.36)
Primary caregiverMother389 (70.73)416 (75.64)4.7961.187
Dad38 (6.91)31 (5.64)
Grandparents122 (22.18)100 (18.18)
Housemaid1 (0.18)3 (0.55)
Parental control over childrenHighly consistent161 (29.27)126 (22.31)8.9790.011
Basically the same383 (69.64)409 (74.36)
Basically different6 (1.09)15 (2.73)
Parenting attitudes among seniors and parentsHighly consistent7 (1.27)17 (3.09)3.0660.216
Basically the same202 (36.73)256 (46.55)
Basically different241 (43.82)277 (50.36)
Proportion of children's expensesOne fifth or less131 (23.09)126 (22.91)1.9860.575
One quarter190 (34.55)186 (33.82)
One third160 (29.09)179 (32.55)
A half69 (12.55)59 (10.73)
Family atmosphereVery harmonious268 (48.73)250 (45.45)2.9210.571
Good229 (41.64)234 (42.55)
Common52 (9.45)64 (11.64)
Bad1 (0.18)1 (0.18)
Very bad0 (0.00)1 (0.18)
RelationshipHarmonious496 (90.18)483 (87.82)1.8460.397
Common44 (8.00)57 (10.36)
Other circumstances (e.g. single parent/separation etc.)10 (1.82)10 (1.82)
Children's personality characteristicsExtroverted191 (34.73)221 (40.18)3.6290.163
Middle303 (55.09)281 (51.09)
Introverted56 (10.18)48 (8.73)
Child rearing practicesDemocratic authority type512 (93.09)489 (88.91)15.4790.001
Absolute authority type21 (3.82)15 (2.73)
Spoiling type17 (3.09)44 (8.00)
Neglect indifference type0 (0.00)2 (0.36)
Coping styles of children's negative emotionsEncourage expression527 (98.82)525 (95.45)0.1580.954
Neglect11 (2.00)11 (2.00)
Punish12 (2.18)14 (2.55)
Scale filled byFather103 (18.73)122 (22.18)2.0170.156
Mother447 (81.27)428 (77.82)
SDQ score (mean ± SD, score)44.09 ± 3.9444.78 ± 4.382.7470.006
PSI-SF score (mean ± SD, score)
PD total score25.19 ± 8.6930.05 ± 10.490.1310.896
P-CDI total16.49 ± 4.1819.49 ± 7.238.0430.000
DC total19.63 ± 6.4323.28 ± 8.378.1100.000
Aggregate score61.31 ± 14.9672.82 ± 21.2110.4000.000
After matching difference index correlation analysis

Pearson’s correlation analysis showed that before matching, there was no significant correlation among the mother's occupation, child's character, and child's rearing style (both P > 0.05), as shown in Table 3. After matching, a positive correlation was found between the child's rearing style and parents' attitude toward child discipline (r = 0.096, P < 0.01). Moreover, the PSI-SF score showed a significant positive correlation with the child's sex, parents' attitude toward child discipline, and SDQ score (r = 0.077, 0.193, 0.172, 0.222, P < 0.05), as shown in Table 4. A correlation analysis between the children’s SDQ scores and the parents’ PSI-SF scores is shown in Figure 1.

Figure 1
Figure 1 Correlation analysis between Strengths and Difficulties Questionnaire scores of children and Parenting Stress Index-Short Form scores of parents. SDQ: Strengths and Difficulties Questionnaire; PSI-SF: Parenting Stress Index-Short Form.
Table 3 correlation analysis between difference indexes before matching.
Index
Mother's occupation
Children's character traits
Correlation
P value
Correlation
P value
Mother's occupation----
Children's character traits-0.0100.713--
Child rearing pattern0.0160.5620.0400.146
Table 4 correlation analysis between difference indexes after matching.
Index
Child gender
Parents' attitude towards their children
Child rearing pattern
SDQ score
Child gender----
Parents' attitude towards their children0.004---
Child rearing pattern0.0430.0962--
SDQ score-0.010-0.0480.041-
PSI-SF score0.07710.19310.17210.2221
DISCUSSION

In contemporary society, changes in the family structure and the concept of reproduction have attracted attention to the conditions and behaviors of only and non-only children. In China, the long-term implementation of the one-child policy has had a profound impact on family structure and fertility. One-child families occupy an important position in Chinese society, typically enjoying more resources and attention, but may also face the pressure of a lack of siblings’ company and competition. In contrast, families of non-only children include siblings, and the interaction and competition among them may have different effects on emotional behavior[11,12]. Therefore, studying the emotional behavior of only and non-only-child preschoolers helps understanding the influence of family structure on children’s psychological development. Parental pressure is also an issue of concern. With social and economic development and the accelerated pace of life, an increasing number of parents are facing the difficulties of balancing work and family[13]. Therefore, a comparative study was conducted of parental pressure among parents of only- and non-only-child preschoolers to understand the psychological state and quality of life of parents in different family structures.

This study explored the internal relationship between children's emotional behavior and parental pressure in one-child and multi-child families. Due to the many factors that affect children's emotional behavior and parental pressure, a propensity scoring method was used to balance and avoid the interference of potential confounding factors in the two groups for a more accurate assessment. The results showed that before matching there were no significant differences between the two groups for other indicators, besides those observed for the mother's occupation, child's character, and child's rearing style. The study found that children's age and education level affected their emotional behavior and parents' parental pressure to a certain extent[14]. Therefore, this study balanced these traditional influencing factors.

Using disposition scoring, 550 family pairs were successfully matched. Afterward, there were still differences in the children's rearing styles, and the SDQ scores and parents’ PSI-SF scores for children in the only-child group were significantly lower than those of children in the non-only-child group. This indicates that the number of children in families can affect children's emotional behaviors and parents' parental pressure to some extent. This conclusion is consistent with that of a previous study by Gómez-Ortiz et al[15]. This is primarily because in a one-child family parents place more expectations and focus more attention on that child such that these children bear considerable family expectations and pressure[16]. Moreover, the lack of sibling interaction negatively impacts the social skills of only children, making them feel lonely and insecure, thus affecting their emotional state[17]. For non-only-child families, in the case of limited family resources, parents must allocate resources equitably to multiple children, which also increases the care burden and pressure on parents[18]. Additionally, in non-only-child families, there is competition and comparison among the children in many aspects, which affects children's emotional state. Moreover, parents must spend more time and energy mediating conflicts among siblings, which further aggravates the pressure on parents. The Pearson correlation analysis showed no significant correlation between the general data of the two groups before matching, while there was a significant positive correlation between parents' PSI-SF scores and children's sex and parents' attitudes toward children's discipline after matching, as well as a significant positive correlation between parents' PSI-SF scores and children's SDQ scores. These findings indicate that children's emotional behavior has a significant impact on parents' job stress. This is because when parents are under pressure, the negative emotions they exhibit, such as anxiety and depression, are transmitted to their children, thus affecting the children’s emotional state and behavioral performance[19]. When parental pressure is greater, the emotional management and upbringing performance changes, and this change directly affects the child, and subsequently their emotional behavior[20]. In contrast, when children are in a negative emotional state, they also make parents worry and experience anxiety, further increasing parental pressure.

CONCLUSION

In summary, compared with only-child families, the emotional behavior of preschool children from non-only-child families is more evident and the parental occupational stress is significantly greater. The parental occupational stress of families with different structures is related to many factors, and the emotional behavior of preschool children is positively correlated with parental occupational stress. However, the children included in this study were very young (3-5 years old), and their understanding of emotions might have been biased. Therefore, the age range of research participants could be increased in a future study to improve the accuracy and reliability of the research results.

ACKNOWLEDGEMENTS

We thank all the medical staff, parents, and children who agreed to participate in this study.

Footnotes

Provenance and peer review: Unsolicited article; Externally peer reviewed.

Peer-review model: Single blind

Specialty type: Health care sciences and services

Country of origin: China

Peer-review report’s classification

Scientific Quality: Grade C

Novelty: Grade C

Creativity or Innovation: Grade B

Scientific Significance: Grade B

P-Reviewer: Mends-Brew E, Ghana S-Editor: Gong ZM L-Editor: A P-Editor: Cai YX

References
1.  Paulich KN, Ross JM, Lessem JM, Hewitt JK. Screen time and early adolescent mental health, academic, and social outcomes in 9- and 10- year old children: Utilizing the Adolescent Brain Cognitive Development ℠ (ABCD) Study. PLoS One. 2021;16:e0256591.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 11]  [Cited by in F6Publishing: 22]  [Article Influence: 7.3]  [Reference Citation Analysis (0)]
2.  Beck A, LeBlanc JC, Morissette K, Hamel C, Skidmore B, Colquhoun H, Lang E, Moore A, Riva JJ, Thombs BD, Patten S, Bragg H, Colman I, Goldfield GS, Nicholls SG, Pajer K, Potter BK, Meeder R, Vasa P, Hutton B, Shea BJ, Graham E, Little J, Moher D, Stevens A. Screening for depression in children and adolescents: a protocol for a systematic review update. Syst Rev. 2021;10:24.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 11]  [Cited by in F6Publishing: 7]  [Article Influence: 2.3]  [Reference Citation Analysis (0)]
3.  Sekmen M, Grijalva CG, Zhu Y, Williams DJ, Feinstein JA, Stassun JC, Johnson JA, Tanguturi YC, Gay JC, Antoon JW. Characteristics Associated With Serious Self-Harm Events in Children and Adolescents. Pediatrics. 2023;151.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 2]  [Reference Citation Analysis (0)]
4.  Hari S, Ruch DA, Bridge JA, Brink FW. The evaluation of emotional maltreatment's effect on family dynamics and suicidal behaviors. Child Abuse Negl. 2023;144:106351.  [PubMed]  [DOI]  [Cited in This Article: ]  [Reference Citation Analysis (0)]
5.  Coles DC, Cage J. Mothers and Their Children: An Exploration of the Relationship Between Maternal Mental Health and Child Well-Being. Matern Child Health J. 2022;26:1015-1021.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in F6Publishing: 6]  [Reference Citation Analysis (0)]
6.  Fields A, Harmon C, Lee Z, Louie JY, Tottenham N. Parent's anxiety links household stress and young children's behavioral dysregulation. Dev Psychobiol. 2021;63:16-30.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 1]  [Cited by in F6Publishing: 9]  [Article Influence: 2.3]  [Reference Citation Analysis (0)]
7.  Ravi S, Havewala M, Kircanski K, Brotman MA, Schneider L, Degnan K, Almas A, Fox N, Pine DS, Leibenluft E, Filippi C. Parenting and childhood irritability: Negative emotion socialization and parental control moderate the development of irritability. Dev Psychopathol. 2023;35:1444-1453.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 7]  [Cited by in F6Publishing: 4]  [Article Influence: 4.0]  [Reference Citation Analysis (0)]
8.  Laurenzi CA, Hunt X, Skeen S, Sundin P, Weiss RE, Kosi V, Rotheram-Borus MJ, Tomlinson M. Associations between caregiver mental health and young children's behaviour in a rural Kenyan sample. Glob Health Action. 2021;14:1861909.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 1]  [Cited by in F6Publishing: 1]  [Article Influence: 0.3]  [Reference Citation Analysis (0)]
9.  Goodman R. The Strengths and Difficulties Questionnaire: a research note. J Child Psychol Psychiatry. 1997;38:581-586.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 8394]  [Cited by in F6Publishing: 7503]  [Article Influence: 277.9]  [Reference Citation Analysis (0)]
10.  Luo J, Wang MC, Gao Y, Zeng H, Yang W, Chen W, Zhao S, Qi S. Refining the Parenting Stress Index-Short Form (PSI-SF) in Chinese Parents. Assessment. 2021;28:551-566.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 19]  [Cited by in F6Publishing: 23]  [Article Influence: 4.6]  [Reference Citation Analysis (0)]
11.  Huang W, Zhou YJ, Zou HY, Yang X, Xu H, Li GH, Wang YN, Li RF, Zeng LY. [Differences in non-suicidal self-injury behaviors between only-child and non-only-child adolescents with mood disorders: a cross-sectional study]. Zhongguo Dang Dai Er Ke Za Zhi. 2022;24:806-811.  [PubMed]  [DOI]  [Cited in This Article: ]  [Reference Citation Analysis (0)]
12.  Rodrigues LP, Lima RF, Silva AF, Clemente FM, Camões M, Nikolaidis PT, Rosemann T, Knechtle B. Physical Fitness and Somatic Characteristics of the Only Child. Front Pediatr. 2020;8:324.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 5]  [Cited by in F6Publishing: 3]  [Article Influence: 0.8]  [Reference Citation Analysis (0)]
13.  Dufur MJ, Woo H. Associations between Gendered Family Structures and Adolescent Stress, Loneliness, and Sadness in South Korea. Int J Environ Res Public Health. 2023;20.  [PubMed]  [DOI]  [Cited in This Article: ]  [Reference Citation Analysis (0)]
14.  Usler E, Foti D, Weber C. Emotional reactivity and regulation in 5- to 8-year-old children: An ERP study of own-age face processing. Int J Psychophysiol. 2020;156:60-68.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 7]  [Cited by in F6Publishing: 7]  [Article Influence: 1.8]  [Reference Citation Analysis (0)]
15.  Gómez-Ortiz O, Sánchez-Sánchez C. Is the Predisposition to Have More Children Beneficial among Parents with Only One Child? Evidence from Spanish Parents. Int J Environ Res Public Health. 2022;19.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 3]  [Cited by in F6Publishing: 6]  [Article Influence: 3.0]  [Reference Citation Analysis (0)]
16.  Lao Y, Lin S. Comparison of educational performance between the only children and children in two-child families. Sci Rep. 2022;12:15355.  [PubMed]  [DOI]  [Cited in This Article: ]  [Reference Citation Analysis (0)]
17.  Gray P, Lancy DF, Bjorklund DF. Decline in Independent Activity as a Cause of Decline in Children's Mental Well-being: Summary of the Evidence. J Pediatr. 2023;260:113352.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 2]  [Cited by in F6Publishing: 3]  [Article Influence: 3.0]  [Reference Citation Analysis (0)]
18.  Herbell K, Breitenstein SM, Melnyk BM, Guo J. Family resilience and flourishment: Well-being among children with mental, emotional, and behavioral disorders. Res Nurs Health. 2020;43:465-477.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 10]  [Cited by in F6Publishing: 10]  [Article Influence: 2.5]  [Reference Citation Analysis (0)]
19.  Blum M, Ribner A. Parents' expressed emotions and children's executive functions. J Exp Child Psychol. 2022;219:105403.  [PubMed]  [DOI]  [Cited in This Article: ]  [Reference Citation Analysis (0)]
20.  Wang Y, Wu X, Chen H. Mothers' depressive symptoms and children's behavioral adjustment: The role of negative parental emotional states. J Fam Psychol. 2023;37:1220-1229.  [PubMed]  [DOI]  [Cited in This Article: ]  [Reference Citation Analysis (0)]