Abstract
Prior research consistently reports differences in mental health outcomes among adolescents between intact and non-intact families, highlighting the need to address these disparities. This study aims to investigate the moderating effect of advisers (counselors, teachers, or friends) on the mental health of adolescents from non-intact families. We conducted a cross-sectional study using data from the 2017 Korea Youth Risk Behavior Web-Based Survey, a large, representative nationwide sample of adolescents. We included 61,572 middle and high school students living with at least one parent, categorizing them into five groups: biological parents, single parent (only father or mother), stepfather-biological mother, and biological father-stepmother. We assessed mental health outcomes (poor self-rated health status, self-rated unhappiness, depressive mood, suicidal consideration, suicidal planning, and suicidal attempt) using self-reported measures and evaluated the presence of advisers providing emotional support. Multivariate-adjusted logistic regression analyses were performed to examine associations between family structure and mental health outcomes, and to assess the moderating effect of advisers. Compared to adolescents living with both biological parents, those from non-intact families exhibited significantly higher odds of poor mental health outcomes. While adviser presence was associated with lower odds of adverse outcomes across most family structures, formal tests of interaction were not statistically significant. Our findings suggest that family structure is associated with adolescent mental health, and that adviser presence is generally linked to more favorable outcomes. Although formal interaction tests did not demonstrate statistically significant moderation, the consistent patterns observed across groups highlight the potential value of adviser support. These findings should be interpreted with caution, yet they underscore the importance of promoting access to trusted advisers as a practical strategy to support adolescents, particularly those from non-intact families.
Keywords: Family structure, Mental health, Adolescents, Advisers, Korea
Subject terms: Epidemiology, Psychology, Health care
Introduction
Mental health in adolescents is a clinically and epidemiologically important outcome that can affect their well-being throughout life1–4. Therefore, it is essential to identify and manage the risk factors associated with mental health in adolescents. One of these risk factors could be family structure, which plays an important role in the physical, social, and mental abilities of individuals5. In East Asia, particularly in Korea, the traditional family structure is undergoing significant changes due to industrialization and urbanization6. This has led to the emergence of various family structures, including non-intact families such as single-parent and stepfamilies, with approximately one in ten adolescents living in non-intact families7.
Historically, divorce, cohabitation, and single parenthood have been much less common in East Asian nations than in Western ones. However, cultural pressures to maintain a traditional family structure—with two married parents and a male breadwinner—still remain ingrained in Korean society. In this context, youth from single-parent households without economic power may experience financial crises, and conflicts arising from the parental separation process or the development of relationships with new step-parents can affect their mental health8. In some cases, co-residing grandparents help preserve intergenerational cohesion and may buffer adolescents from the psychological stress of family disruption9,10. Social and cultural stigmas may also impact children, particularly in East Asian cultures, where there is often an emphasis on interdependence, respect for elders, and the importance of family harmony11. Changes in these traditional structures could potentially disrupt these cultural norms and values, leading to increased stress and mental health issues among adolescents.
While previous studies have established that non-intact family structures are associated with poorer mental health outcomes in adolescents12, relatively few have investigated the moderating effects of social or emotional support systems. Drawing on Attachment Theory (Bowlby, 1988), emotionally supportive advisers—such as peers, teachers, or extended family members—may promote resilience by fostering a sense of security and belonging in adolescents experiencing family instability13. Similarly, Bronfenbrenner’s Ecological Systems Theory (1979) emphasizes the role of mesosystemic influences, suggesting that advisers function as bridges between adolescents’ immediate family environments and broader social contexts, such as schools and peer networks14. Empirical evidence supports these theoretical perspectives: a cross-sectional study of 2,074 UK schoolchildren aged 8–15 years demonstrated that family adult support, school adult support, and peer support were each independently associated with higher levels of mental wellbeing, with a graded cumulative protective effect observed as the number of support sources increased15. Notably, high peer support alone provided a protective effect comparable to the combined impact of high family and school adult support, highlighting the critical role of emotionally supportive relationships in both peer and school contexts as key mesosystemic buffers16. Despite these insights, empirical research on such moderating pathways remains limited in East Asian populations. Given the evolving family dynamics in South Korea and the increasing prevalence of non-intact families, this study aimed to investigate the association between family structure and adolescent mental health outcomes. Specifically, it sought to determine: (1) whether adolescents from non-intact families experience higher risks of depression, stress, and suicidality; (2) whether the presence of emotional advisers moderates these associations; and (3) which types of advisers provide the strongest protective effects.
To address this evidence gap, this study investigated the association of family structure with mental health in adolescents, using data from the 2017 Korean Youth Risk Behavior Web-based Survey, which is a large, representative, nationwide sample of adolescents. We compared the mental health outcomes of adolescents from two-parent biological families, stepfamilies, and single-parent families. We hope that the findings of this study will help to develop future intervention strategies and policies that can improve the mental health of adolescents according to their family structure.
Methods
Study population
The study population was derived from the Korea Youth Risk Behavior Web-Based Survey (KYRBS) database from 2017, provided by the Korea Centers for Disease Control and Prevention (KCDC). Since 2005, the KCDC has conducted annual online surveys to construct healthcare indicators for health promotion and to identify health behaviors and mental status among Korean adolescents. The KYRBS is a cross-sectional database containing sociodemographic factors, psychological factors, health behaviors, dietary habits, and factors that affect health inequality among middle and high school Korean students.
The 2017 KYRBS dataset included 62,276 middle and high school students. We excluded 659 adolescents who lived with neither biological nor stepparents and an additional 45 participants due to missing information required to classify family structure. The final study population comprised 61,572 adolescents (55,962 living with two biological parents and 5,610 with single or stepparents) (Fig. 1).
Fig. 1.
Study population flow.
Data collection
Independent variable
Family structure was the dependent variable in this study. Participants responded to the question, “Please check all current family members (including families not currently living together)” using the following responses: father, stepfather, mother, stepmother, grandfather, grandmother, older siblings, and younger siblings. We then categorized them into five groups according to parental type: biological parents, stepfather-biological mothers, biological father–stepmothers, single parents (only father), and single parents (only mother).
Dependent variable
The primary outcomes were six self-reported mental health indicators: poor self-rated health, unhappiness, depressive mood, suicidal ideation, suicidal planning, and suicide attempt. Four outcomes were originally binary in the KYRBS dataset. The remaining two (self-rated health and happiness), measured on 5-point Likert scales, were dichotomized based on prior studies17–19 to facilitate logistic regression. This approach is consistent with established practices in survey-based research.
Covariates
The covariates were age, sex, subjective family economic status (upper, middle, and lower), paternal education level (middle school graduate or below, high school graduate, college graduate or higher, and do not know), maternal education level (middle school graduate or below, high school graduate, college graduate or higher, and do not know), residential area (rural, metropolitan, and mid-sized city), sibling presence (yes or no), and adviser presence (yes or no).
Statistical analysis
Logistic regression analyses were performed to obtain the odds ratio with a 95% confidence interval for family structure and adolescents’ mental health after adjusting for age, sex, subjective family economic status, paternal education level, maternal education level, residential area, sibling presence, and adviser presence. The biological parent group was used as a reference. Stratified analyses were conducted to identify potential subgroups that showed a significant association between family structure differences and adolescents’ mental health, including adviser presence and type. Adviser support was assessed using a self-reported item: “Who do you usually talk to when you have concerns or difficult situations?” Responses were dichotomized to indicate adviser presence (yes vs. no). In addition, adviser type was categorized into family members, friends, and school staff/others. All data mining and statistical analyses were performed with STATA 13.0 (StataCorp LP, College Station, TX, USA). Statistical significance was defined as a two-sided p-value of < 0.05.
Ethics approval and consent to participate
This study was conducted in accordance with the Declaration of Helsinki. All experimental protocols were approved by the Institutional Review Board of Seoul National University Hospital (IRB number: E-2303-123-1414). The need to obtain informed consent was waived by the Institutional Review Board of Seoul National University Hospital, as the KYRBS data provided to researchers are anonymized by the Korea Disease Control and Prevention Agency (KDCA) to prevent participant identification.
Results
The descriptive characteristics of the study participants are presented in Table 1. A total of 61,572 adolescents were included in the final analysis. Those living with both biological parents were more likely to reside in urban areas, have parents with higher educational attainment, and report higher levels of subjective family economic status than those in non-intact families. In contrast, adolescents from step-parent or single-parent households were more frequently found in rural regions and reported lower subjective family economic status.
Table 1.
Descriptive characteristics of study participants by family structures.
| Family structures | |||||
|---|---|---|---|---|---|
| Biological parents | Single parent (father only) | Single parent (mother only) | Stepfather – biological mother | Biological father – stepmother | |
| Population, N(%) | 55,962 (90.89) | 1341 (2.18) | 1715 (2.79) | 583 (0.95) | 1971 (3.20) |
| Grade, n(%) | |||||
| Middle school | 27,605 (49.33) | 629 (46.91) | 750 (43.73) | 273 (46.83) | 1295 (65.70) |
| High school | 28,357 (50.67) | 712 (53.09) | 965 (56.27) | 310 (53.17) | 676 (34.30) |
| Sex, n(%) | |||||
| Male | 28,016 (50.06) | 770 (57.42) | 806 (47.00) | 279 (47.86) | 1302 (66.06) |
| Female | 27,946 (49.94) | 571 (42.58) | 909 (53.00) | 304 (52.14) | 669 (33.94) |
| Paternal education level, n(%) | |||||
| Middle school graduate or below | 1013 (1.81) | 79 (5.89) | 10 (1.72) | 84 (4.26) | |
| High school graduate | 14,811 (26.47) | 487 (36.32) | 107 (18.35) | 503 (25.52) | |
| College graduate or higher | 30,261 (54.07) | 389 (29.01) | 119 (20.41) | 766 (38.86) | |
| Don’t’ know | 9877 (17.65) | 386 (28.78) | 347 (59.52) | 618 (31.35) | |
| Maternal education level, n(%) | |||||
| Middle school graduate or below | 833 (1.49) | 81 (4.72) | 33 (5.66) | 62 (3.15) | |
| High school graduate | 18,117 (32.37) | 673 (39.24) | 221 (37.91) | 416 (21.11) | |
| College graduate or higher | 27,594 (49.31) | 552 (32.19) | 201 (34.48) | 658 (33.38) | |
| Don’t’ know | 9418 (16.83) | 409 (23.85) | 128 (21.96) | 835 (42.36) | |
| Subjective family economic status, n(%) | |||||
| Upper | 23,066 (41.22) | 323 (24.09) | 254 (14.81) | 157 (26.93) | 767 (38.91) |
| Middle | 25,905 (46.29) | 597 (44.52) | 726 (42.33) | 281 (48.20) | 866 (43.94) |
| Lower | 6991 (12.49) | 421 (31.39) | 735 (42.86) | 145 (24.87) | 338 (17.15) |
| Residential area, n(%) | |||||
| Rural | 4138 (7.39) | 179 (13.35) | 172 (10.03) | 66 (11.32) | 202 (10.25) |
| Metropolitan | 25,113 (44.88) | 518 (38.63) | 730 (42.57) | 224 (38.42) | 751 (38.10) |
| Mid-sized city | 26,711 (47.73) | 644 (48.02) | 813 (47.41) | 293 (50.26) | 1018 (51.65) |
| Sibling presence, n(%) | |||||
| Yes | 49,422 (88.31) | 815 (60.78) | 1202 (70.09) | 463 (79.42) | 1725 (87.52) |
| No | 6540 (11.69) | 526 (39.22) | 513 (29.91) | 120 (20.58) | 246 (12.48) |
Table 2 shows the results of the logistic regression analysis indicating the effects of family structure on adolescents’ mental health. Compared to adolescents living with both biological parents, those from non-intact families—including single-parent and step-parent households—tended to show elevated odds of adverse mental health outcomes. Specifically, adolescents in the stepfather–biological mother group exhibited significantly higher odds across most outcomes, including poor self-rated health, unhappiness, depressive mood, suicidal ideation, and suicide attempts. Adolescents in the single-mother and single-father groups were more likely to report poor self-rated health and suicidal behaviors, with some variations by outcome. Additionally, those in the biological father–stepmother group were more likely to experience depressive mood, suicidal ideation, and suicidal planning.
Table 2.
The effects of family structure on adolescents’ mental health.
| Biological parents | Single parent (only father without grandparents) |
Family structures | |||||
|---|---|---|---|---|---|---|---|
| Single parent (only father with grandparents) |
Single parent (only mother without grandparents) | Single parent (only mother with grandparents) |
Stepfather – biological mother | Biological father – stepmother | |||
| Mental health | |||||||
|
Poor self-rated health status, n aOR (95% CI) |
3412 1.00 (ref.) |
66 1.42 (0.70–2.88) |
57 1.02 (0.52–2.02) |
104 1.09 (0.61–1.96) |
56 1.01 (0.54–1.84) |
81 2.13 (1.46–3.12) |
99 0.83 (0.64–1.08) |
|
Self-rated unhappiness, n aOR (95% CI) |
4156 1.00 (ref.) |
70 0.53 (0.32–0.89) |
71 0.47 (0.28–0.77) |
116 0.84 (0.48–1.48) |
75 1.03 (0.59–1.80) |
73 1.43 (0.98–2.07) |
176 1.00 (0.81–1.23) |
|
Depressive mood, n aOR (95% CI) |
13,713 1.00 (ref.) |
199 1.09 (0.75–1.59) |
206 0.99 (0.70–1.40) |
322 0.81 (0.54–1.23) |
186 0.82 (0.54–1.24) |
204 1.43 (1.09–1.87) |
526 1.29 (1.13–1.46) |
|
Suicide consideration, n aOR (95% CI) |
6570 1.00 (ref.) |
106 0.84 (0.52–1.35) |
108 0.75 (0.48–1.16) |
154 0.89 (0.52–1.52) |
101 1.01 (0.58–1.75) |
106 1.43 (1.03–1.98) |
275 1.18 (1.01–1.39) |
|
Suicide planning, n aOR (95% CI) |
2081 1.00 (ref.) |
48 1.23 (0.58–2.65) |
27 0.65 (0.29–1.43) |
53 1.33 (0.59–2.98) |
36 1.31 (0.57–3.01) |
38 1.63 (1.02–2.60) |
104 1.29 (0.98–1.69) |
|
Suicide attempt, n aOR (95% CI) |
1328 1.00 (ref.) |
36 1.38 (0.55–3.44) |
21 0.85 (0.33–2.19) |
39 1.76 (0.72–4.30) |
23 1.25 (0.49–3.21) |
31 2.30 (1.38–3.84) |
73 1.27 (0.93–1.74) |
Poor self-rated health status: self-rated health status of “unhealthy” or “very unhealthy”.
Self-rated unhappiness: self-rated happiness status of “unhappy” or “very unhappy”.
Depressive mood: depressive mood or hopeless to stop daily life over 2 weeks for the last 12 months.
Suicidal consideration: serious suicidal thoughts for the last 12 months.
Suicidal planning: plan of suicide for the last 12 months.
Suicidal attempt: attempt of suicide for the last 12 months.
aOR: adjusted for age, sex, paternal and maternal education levels, adviser presence, sibling presence, residential area, and subjective family economic status.
Table 3 shows the associations between family structure and mental health stratified by adviser presence. Overall, adolescents with access to advisers had lower adjusted odds of poor mental health compared to those without advisers, across most family types. However, formal interaction terms between adviser presence and family structure were not statistically significant, suggesting that the protective effect of advisers was not meaningfully different across family types. Notably, among adolescents living with single parents, those who also co-resided with grandparents tended to exhibit slightly lower odds of poor mental health outcomes compared to those without grandparental presence.
Table 3.
The association between family structure and adolescents’ mental health in the presence of advisers.
| Biological parents | Single parent (only father without grandparents) |
Family structures | |||||
|---|---|---|---|---|---|---|---|
| Single parent (only father with grandparents) |
Single parent (only mother without grandparents) | Single parent (only mother with grandparents) |
Stepfather – biological mother | Biological father – stepmother | |||
| Mental health | |||||||
| Poor self-rated health status | |||||||
| Without adviser | |||||||
| Subtotal (N) | 10,886 | 166 | 205 | 249 | 126 | 125 | 470 |
| Number of cases (n) | 928 (8.52%) | 20 (12.05%) | 21 (10.24%) | 37 (14.86%) | 15 (11.90%) | 19 (15.20%) | 26 (5.53%) |
| aOR (95% CI) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) |
| With adviser | |||||||
| Subtotal (N) | 45,076 | 463 | 507 | 843 | 497 | 458 | 1,501 |
| Number of cases (n) | 2484 (5.51%) | 46 (9.94%) | 36 (7.10%) | 67 (7.95%) | 41 (8.25%) | 62 (13.54%) | 73 (4.86%) |
| aOR (95% CI) | 0.56 (0.52–0.62) | 0.82 (0.43–1.57) | 0.53 (0.29–0.98) | 0.48 (0.29–0.80) | 0.68 (0.33–1.38) | 0.89 (0.45–1.76) | 0.77 (0.44–1.37) |
| Self-rated unhappiness | |||||||
| Without adviser | |||||||
| Subtotal (N) | 10,886 | 166 | 205 | 249 | 126 | 125 | 470 |
| Number of cases (n) | 1515 (13.92%) | 23 (13.86%) | 31 (15.12%) | 39 (15.66%) | 32 (25.40%) | 21 (16.80%) | 64 (13.62%) |
| aOR (95% CI) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) |
| With adviser | |||||||
| Subtotal (N) | 45,076 | 463 | 507 | 843 | 497 | 458 | 1501 |
| Number of cases (n) | 2641 (5.86%) | 47 (10.15%) | 40 (7.89%) | 77 (9.13%) | 43 (8.65%) | 52 (11.35%) | 112 (7.46%) |
| aOR (95% CI) | 0.36 (0.33–0.39) | 0.65 (0.38–1.11) | 0.39 (0.22–0.71) | 0.63 (0.38–1.05) | 0.28 (0.15–0.50) | 0.44 (0.24–0.82) | 0.49 (0.34–0.72) |
| Depressive mood | |||||||
| Without adviser | |||||||
| Subtotal (N) | 10,886 | 166 | 205 | 249 | 126 | 125 | 470 |
| Number of cases (n) | 2861 (26.28%) | 46 (27.71%) | 60 (29.27%) | 65 (26.10%) | 50 (39.68%) | 40 (32.00%) | 132 (28.09%) |
| aOR (95% CI) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) |
| With adviser | |||||||
| Subtotal (N) | 45,076 | 463 | 507 | 843 | 497 | 458 | 1501 |
| Number of cases (n) | 10,852 (24.07%) | 153 (33.05%) | 146 (28.80%) | 257 (30.49%) | 136 (27.36%) | 164 (35.81%) | 394 (26.25%) |
| aOR (95% CI) | 0.78 (0.74–0.82) | 1.11 (0.70–1.74) | 0.83 (0.54–1.26) | 1.26 (0.89–1.79) | 0.48 (0.31–0.75) | 1.11 (0.68–1.81) | 0.87 (0.66–1.14) |
| Suicide consideration | |||||||
| Without adviser | |||||||
| Subtotal (N) | 10,886 | 166 | 205 | 249 | 126 | 125 | 470 |
| Number of cases (n) | 1844 (16.94%) | 23 (13.86%) | 37 (18.05%) | 39 (15.66%) | 36 (28.57%) | 22 (17.60%) | 85 (18.09%) |
| aOR (95% CI) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) |
| With adviser | |||||||
| Subtotal (N) | 45,076 | 463 | 507 | 843 | 497 | 458 | 1501 |
| Number of cases (n) | 4726 (10.48%) | 83 (17.93%) | 71 (14.00%) | 115 (13.64%) | 65 (13.08%) | 84 (18.34%) | 190 (12.66%) |
| aOR (95% CI) | 0.51 (0.48–0.55) | 0.96 (0.54–1.72) | 0.57 (0.34–0.96) | 0.90 (0.57–1.42) | 0.35 (0.20–0.60) | 0.89 (0.46–1.72) | 0.62 (0.45–0.86) |
| Suicide planning | |||||||
| Without adviser | |||||||
| Subtotal (N) | 10,886 | 166 | 205 | 249 | 126 | 125 | 470 |
| Number of cases (n) | 681 (6.26%) | 5 (3.01%) | 11 (5.37%) | 14 (5.62%) | 16 (12.70%) | 6 (4.80%) | 34 (7.23%) |
| aOR (95% CI) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) |
| With adviser | |||||||
| Subtotal (N) | 45,076 | 463 | 507 | 843 | 497 | 458 | 1501 |
| Number of cases (n) | 1400 (3.11%) | 43 (9.29%) | 16 (3.16%) | 39 (4.63%) | 20 (4.02%) | 32 (6.99%) | 70 (4.66%) |
| aOR (95% CI) | 0.45 (0.41–0.51) | 2.17 (0.73–6.45) | 0.41 (0.15–1.11) | 1.15 (0.54–2.47) | 0.36 (0.16–0.81) | 1.11 (0.46–2.68) | 0.54 (0.32–0.89) |
| Suicide attempt | |||||||
| Without adviser | |||||||
| Subtotal (N) | 10,886 | 166 | 205 | 249 | 126 | 125 | 470 |
| Number of cases (n) | 422 (3.88%) | 3 (1.81%) | 5 (2.44%) | 11 (4.42%) | 10 (7.94%) | 6 (4.80%) | 22 (4.68%) |
| aOR (95% CI) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) |
| With adviser | |||||||
| Subtotal (N) | 45,076 | 463 | 507 | 843 | 497 | 458 | 1501 |
| Number of cases (n) | 906 (2.01%) | 33 (7.12%) | 16 (3.16%) | 28 (3.32%) | 13 (2.62%) | 25 (5.46%) | 51 (3.40%) |
| aOR (95% CI) | 0.47 (0.41–0.54) | 2.91 (0.85–9.93) | 0.64 (0.18–2.26) | 1.05 (0.46–2.41) | 0.16 (0.05–0.48) | 0.93 (0.36–2.43) | 0.63 (0.34–1.17) |
Poor self-rated health status: self-rated health status of “unhealthy” or “very unhealthy”.
Self-rated unhappiness: self-rated happiness status of “unhappy” or “very unhappy”.
Depressive mood: depressive mood or hopeless to stop daily life over 2 weeks for the last 12 months.
Suicidal consideration: serious suicidal thoughts for the last 12 months.
Suicidal planning: plan of suicide for the last 12 months.
Suicidal attempt: attempt of suicide for the last 12 months.
aOR: adjusted for age, sex, paternal and maternal education levels, sibling presence, residential area, and subjective family economic status.
No significant interaction was observed between family structure and adviser presence (all p > 0.20).
Table 4 displays the associations between family structure and mental health outcomes by adviser type. Emotional support from family members and friends was generally associated with reduced odds of adverse mental health outcomes. In contrast, advisers such as teachers or others did not show a consistent protective effect across outcomes.
Table 4.
The association between family structure and adolescents’ mental health in the presence of advisers and their types.
| Family structures | |||||
|---|---|---|---|---|---|
| Biological parents | Single parent (father only) |
Single parent (mother only) | Stepfather – biological mother | Biological father – stepmother | |
| Mental health | |||||
| Poor self-rated health status | |||||
| Without adviser | |||||
| Subtotal (N) | 10,886 | 371 | 375 | 125 | 470 |
| Number of cases (n) | 928 (8.52%) | 41 (11.05%) | 52 (13.87%) | 19 (15.20%) | 26 (5.53%) |
| aOR (95% CI) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) |
| With adviser - family | |||||
| Subtotal (N) | 22,689 | 394 | 617 | 198 | 744 |
| Number of cases (n) | 1109 (4.89%) | 25 (6.35%) | 36 (5.83%) | 19 (9.60%) | 31 (4.17%) |
| aOR (95% CI) | 0.52 (0.47–0.57) | 0.54 (0.30–0.99) | 0.32 (0.19–0.53) | 0.81 (0.36–1.80) | 0.68 (0.36–1.29) |
| With adviser - friends | |||||
| Subtotal (N) | 19,834 | 444 | 614 | 225 | 598 |
| Number of cases (n) | 1136 (5.73%) | 44 (9.91%) | 62 (10.10%) | 33 (14.67%) | 28 (4.68%) |
| aOR (95% CI) | 0.55 (0.50–0.61) | 0.70 (0.42–1.20) | 0.76 (0.48–1.20) | 0.76 (0.36–1.58) | 0.67 (0.33–1.38) |
| With adviser – teacher or etc. | |||||
| Subtotal (N) | 2553 | 132 | 109 | 35 | 159 |
| Number of cases (n) | 239 (9.36%) | 13 (9.85%) | 10 (9.17%) | 10 (28.57%) | 14 (8.81%) |
| aOR (95% CI) | 1.06 (0.89–1.25) | 0.98 (0.46–2.11) | 0.85 (0.37–1.96) | 2.27 (0.79–6.51) | 1.69 (0.78–3.65) |
| Self-rated unhappiness | |||||
| Without adviser | |||||
| Subtotal (N) | 10,886 | 371 | 375 | 125 | 470 |
| Number of cases (n) | 1,515 (13.92%) | 54 (14.56%) | 71 (18.93%) | 21 (16.80%) | 64 (13.62%) |
| aOR (95% CI) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) |
| With adviser - family | |||||
| Subtotal (N) | 22,689 | 394 | 617 | 198 | 744 |
| Number of cases (n) | 966 (4.26%) | 26 (6.60%) | 36 (5.83%) | 17 (8.59%) | 38 (5.11%) |
| aOR (95% CI) | 0.27 (0.24–0.30) | 0.34 (0.20–0.59) | 0.28 (0.17–0.47) | 0.42 (0.19–0.94) | 0.31 (0.19–0.51) |
| With adviser - friends | |||||
| Subtotal (N) | 19,834 | 444 | 614 | 225 | 598 |
| Number of cases (n) | 1387 (6.99%) | 47 (10.59%) | 74 (12.05%) | 27 (12.00%) | 55 (9.20%) |
| aOR (95% CI) | 0.41 (0.38–0.46) | 0.61 (0.37–0.98) | 0.68 (0.44–1.05) | 0.39 (0.18–0.83) | 0.63 (0.39–1.01) |
| With adviser – teacher or etc. | |||||
| Subtotal (N) | 2553 | 132 | 109 | 35 | 159 |
| Number of cases (n) | 288 (11.28%) | 14 (10.61%) | 10 (9.17%) | 8 (22.86%) | 19 (11.95%) |
| aOR (95% CI) | 0.75 (0.64–0.87) | 0.60 (0.28–1.28) | 0.51 (0.23–1.12) | 0.87 (0.35–2.17) | 0.78 (0.42–1.44) |
| Depressive mood | |||||
| Without adviser | |||||
| Subtotal (N) | 10,886 | 371 | 375 | 125 | 470 |
| Number of cases (n) | 2861 (26.28%) | 106 (28.57%) | 115 (30.67%) | 40 (32.00%) | 132 (28.09%) |
| aOR (95% CI) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) |
| With adviser - family | |||||
| Subtotal (N) | 22,689 | 394 | 617 | 198 | 744 |
| Number of cases (n) | 4408 (19.43%) | 107 (27.16%) | 158 (25.61%) | 61 (30.81%) | 155 (20.83%) |
| aOR (95% CI) | 0.60 (0.57–0.64) | 0.83 (0.57–1.21) | 0.79 (0.57–1.09) | 0.92 (0.54–1.59) | 0.66 (0.48–0.90) |
| With adviser - friends | |||||
| Subtotal (N) | 19,834 | 444 | 614 | 225 | 598 |
| Number of cases (n) | 5640 (28.44%) | 154 (34.68%) | 204 (33.22%) | 90 (40.00%) | 194 (32.44%) |
| aOR (95% CI) | 0.94 (0.89–1.00.89.00) | 1.02 (0.72–1.46) | 1.04 (0.76–1.42) | 1.27 (0.73–2.21) | 1.11 (0.80–1.54) |
| With adviser – teacher or etc. | |||||
| Subtotal (N) | 2553 | 132 | 109 | 35 | 159 |
| Number of cases (n) | 804 (31.49%) | 38 (28.79%) | 31 (28.44%) | 13 (37.14%) | 45 (28.30%) |
| aOR (95% CI) | 1.21 (1.09–1.34) | 0.82 (0.49–1.37) | 1.25 (0.73–2.14) | 1.40 (0.57–3.45) | 1.06 (0.68–1.67) |
| Suicide consideration | |||||
| Without adviser | |||||
| Subtotal (N) | 10,886 | 371 | 375 | 125 | 470 |
| Number of cases (n) | 1844 (16.94%) | 60 (16.17%) | 75 (20.00%) | 22 (17.60%) | 85 (18.09%) |
| aOR (95% CI) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) |
| With adviser - family | |||||
| Subtotal (N) | 22,689 | 394 | 617 | 198 | 744 |
| Number of cases (n) | 1787 (7.88%) | 61 (15.48%) | 65 (10.53%) | 33 (16.67%) | 74 (9.95%) |
| aOR (95% CI) | 0.38 (0.35–0.41) | 0.75 (0.47–1.20) | 0.49 (0.31–0.76) | 0.84 (0.39–1.81) | 0.50 (0.34–0.73) |
| With adviser - friends | |||||
| Subtotal (N) | 19,834 | 444 | 614 | 225 | 598 |
| Number of cases (n) | 2476 (12.48%) | 70 (15.77%) | 98 (15.96%) | 41 (18.22%) | 91 (15.22%) |
| aOR (95% CI) | 0.60 (0.56–0.65) | 0.67 (0.43–1.06) | 0.76 (0.51–1.14) | 0.79 (0.39–1.61) | 0.73 (0.49–1.08) |
| With adviser – teacher or etc. | |||||
| Subtotal (N) | 2553 | 132 | 109 | 35 | 159 |
| Number of cases (n) | 463 (18.14%) | 23 (17.42%) | 17 (15.60%) | 10 (28.57%) | 25 (15.72%) |
| aOR (95% CI) | 1.05 (0.93–1.19) | 0.88 (0.49–1.59) | 0.85 (0.43–1.69) | 1.99 (0.83–4.74) | 0.77 (0.45–1.34) |
| Suicide planning | |||||
| Without adviser | |||||
| Subtotal (N) | 10,886 | 371 | 375 | 125 | 470 |
| Number of cases (n) | 681 (6.26%) | 16 (4.31%) | 30 (8.00%) | 6 (4.80%) | 34 (7.23%) |
| aOR (95% CI) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) |
| With adviser - family | |||||
| Subtotal (N) | 22,689 | 394 | 617 | 198 | 744 |
| Number of cases (n) | 566 (2.49%) | 29 (7.36%) | 27 (4.38%) | 12 (6.06%) | 33 (4.44%) |
| aOR (95% CI) | 0.36 (0.32–0.42) | 1.18 (0.56–2.48) | 0.63 (0.32–1.26) | 0.98 (0.33–2.92) | 0.46 (0.25–0.85) |
| With adviser - friends | |||||
| Subtotal (N) | 19,834 | 444 | 614 | 225 | 598 |
| Number of cases (n) | 665 (3.35%) | 22 (4.95%) | 26 (4.23%) | 15 (6.67%) | 25 (4.18%) |
| aOR (95% CI) | 0.49 (0.43–0.55) | 0.99 (0.43–2.26) | 0.84 (0.42–1.66) | 1.00 (0.41–2.42) | 0.53 (0.27–1.03) |
| With adviser – teacher or etc. | |||||
| Subtotal (N) | 2553 | 132 | 109 | 35 | 159 |
| Number of cases (n) | 169 (6.52%) | 8 (6.06%) | 6 (5.50%) | 5 (14.29%) | 12 (7.55%) |
| aOR (95% CI) | 0.99 (0.82–1.18) | 0.80 (0.30–2.09) | 0.74 (0.26–2.09) | 3.55 (1.22–10.36) | 0.88 (0.39–2.03) |
| Suicide attempt | |||||
| Without adviser | |||||
| Subtotal (N) | 10,886 | 371 | 375 | 125 | 470 |
| Number of cases (n) | 422 (3.88%) | 8 (2.16%) | 21 (5.60%) | 6 (4.80%) | 22 (4.68%) |
| aOR (95% CI) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) | 1.00 (ref.) |
| With adviser - family | |||||
| Subtotal (N) | 22,689 | 394 | 617 | 198 | 744 |
| Number of cases (n) | 348 (1.53%) | 20 (5.08%) | 18 (2.92%) | 13 (6.57%) | 23 (3.09%) |
| aOR (95% CI) | 0.36 (0.31–0.43) | 1.34 (0.54–3.33) | 0.50 (0.22–1.14) | 1.37 (0.45–4.19) | 0.61 (0.30–1.24) |
| With adviser - friends | |||||
| Subtotal (N) | 19,834 | 444 | 614 | 225 | 598 |
| Number of cases (n) | 461 (2.32%) | 21 (4.73%) | 18 (2.93%) | 10 (4.44%) | 21 (3.51%) |
| aOR (95% CI) | 0.53 (0.45–0.62) | 1.62 (0.60–4.40) | 0.69 (0.31–1.54) | 0.66 (0.23–1.91) | 0.62 (0.28–1.38) |
| With adviser – teacher or etc. | |||||
| Subtotal (N) | 2553 | 132 | 109 | 35 | 159 |
| Number of cases (n) | 97 (3.80%) | 8 (6.06%) | 5 (4.59%) | 2 (5.71%) | 7 (4.40%) |
| aOR (95% CI) | 0.96 (0.76–1.21) | 1.42 (0.45–4.47) | 0.49 (0.17–1.36) | 0.34 (0.07–1.82) | 0.678 (0.25–1.87) |
Poor self-rated health status: self-rated health status of “unhealthy” or “very unhealthy”.
Self-rated unhappiness: self-rated happiness status of “unhappy” or “very unhappy”.
Depressive mood: depressive mood or hopeless to stop daily life over 2 weeks for the last 12 months.
Suicidal consideration: serious suicidal thoughts for the last 12 months.
Suicidal planning: plan of suicide for the last 12 months.
Suicidal attempt: attempt of suicide for the last 12 months.
aOR: adjusted for age, sex, paternal and maternal education levels, sibling presence, residential area, and subjective family economic status.
Discussion
This study analyzed the association between family structure and adolescents’ mental health by adjusting for socioeconomic factors using a large national database. We found that adolescents who experienced a change in family structure had poorer mental health than those who lived with two biological parents. The poorest mental health outcomes were observed among individuals living with stepfathers and biological mothers. However, the presence of advisers, especially family members and friends, appeared to attenuate the association between family structure and poor mental health.
Previous studies have also used similar methods to explore the association of family structure with various aspects of adolescent health, such as health behavior, physical activity, internet addiction, weight, well-being, academic achievement, and mental and behavioral health20,21. However, most of these studies focused on specific types of family structures, such as single-parent families22–24 or step-families25, and did not compare the effects of different family structures on adolescent health outcomes. Moreover, some of these studies did not adjust for socioeconomic factors, which may confound the relationship between family structure and adolescent health. In our study, adolescents from stepfamilies or single parents with lower socioeconomic status also had poorer mental health than those from families with a higher socioeconomic status. It is consistent with previous studies that have reported negative effects of family structure change on adolescent mental health20,21. The study also found that living with stepfathers and biological mothers was associated with the lowest level of mental health among adolescents, which is a novel finding that has not been reported by previous studies. This finding suggests that there may be specific factors that affect the mental health of adolescents in this type of family structure, such as parental conflict, attachment insecurity, or role ambiguity. A further finding of the study is that the availability of advisers, particularly from one’s own family or social network, moderated the relationship between family structure change and adolescent mental health, attenuating the adverse effect of the former on the latter. This finding is in line with previous studies that have emphasized the role of social support and coping resources in protecting adolescent mental health26,27. Stratified analyses revealed that adolescents co-residing with grandparents—particularly in single-parent households—exhibited significantly reduced odds of internalizing and externalizing symptoms compared to those without grandparental presence. This pattern supports the role of grandparents as supplemental caregivers who alleviate parental burden and provide emotional and practical support during periods of family instability28. For instance, Zhao et al. (2025) demonstrated in a meta-analysis that positive grandparenting styles were moderately associated with reduced depression (r = − 0.33) and anxiety (r = − 0.12) among children and adolescents, whereas negative styles were positively associated with internalizing symptoms (r = 0.25)9. Similarly, a Chinese study of school-aged youth found that living in a three-generation household was associated with small but significant increases in emotional stability, agreeableness, and conscientiousness (ΔSD = 0.045–0.063; p < 0.05) compared with two-parent households29. Consistent with these findings, our results indicate that grandparents may serve as mesosystemic buffers—a concept rooted in Bronfenbrenner’s Ecological Systems Theory—by strengthening linkages between family’s microsystems and broader social contexts such as schools and community networks30. This form of supplementary caregiving enhances household stability, promotes adaptive behavioral modeling, and expands adolescent support systems, thereby reducing stress and fostering resilience14.
Our study found that adolescents who had stepfathers and biological mothers had poorer mental health compared to those who only had single mothers. In contrast to the common assumption that remarriage improves the economic and emotional well-being of children, having a better socioeconomic status did not moderate the association between family structure and mental health among adolescents31. This finding is consistent with a previous study that showed that children of stepparents faced comparable challenges as children of single or divorced parents. Remarriage is often motivated by economic reasons, but it also introduces new challenges and stressors for children, such as adjusting to new roles and relationships, coping with parental conflict and loyalty issues, and dealing with changes in family boundaries and routines25. Compared to children living with married biological parents, children in stepfamilies are more likely to experience negative mental or physical outcomes7,32. Youth in stepfather families have been found to have lower levels of emotional well-being than those in single-mother families, especially if they had gone through a prior divorce. Epidemiologic data from a study on adolescents experiencing bankruptcy, separation, and bereavement showed that these stressors were associated with increased levels of psychological distress, quantified by a mean stress score increase of 15% in comparison to a control group of peers who had not experienced such circumstances33. An extensive study of a large British sample found that children with stepfathers tend to face more developmental and behavioral problems than children with biological fathers or single mothers34. However, a longitudinal study of Canadian families found that the quality of the father-child relationship was a more important influence on child development than family structure35. Adolescent-mother relationships can be influenced by the presence of stepfathers in the household, with the closeness potentially affected when stepfathers, whether cohabiting or married, enter the picture, with pre-existing maternal bonds playing a role in shaping these dynamics36.
Since a change in family structure can be a risk factor with a negative effect on children’s mental health, this study aimed to identify practical modifiable factors to reduce such risks. Counseling is a well-known factor that could have a positive physical and mental impact on children37,38. Participants were stratified into two groups: with and without an adviser. The results showed that having an adviser significantly moderated the association between family structure and poor mental health among adolescents compared to the absence of an adviser. Among adolescents with both biological parents, having an adviser had an attenuated effect on all poor mental health factors. In the single-parent group, being in a stepfamily also moderated the effect of poor mental health factors. These findings are expected to help reduce the risk of poor mental health among adolescents within all family structures if advisers can support them. These results suggest that not only the family structure (relationship), but also the quality of the parent-adolescent relationship can have a significant impact on the mental health of adolescents39. In general, children who receive emotional support from their parents are known to be able to relieve stress40. This support continues to be beneficial during adolescence41. In a previous study, children with unstable relationships with their mothers were more likely to have a higher probability of mental or behavioral problems than those with stable relationships with their mothers42. Therefore, not only the status of the relationship but also the quality of the relationship should be considered to understand the influence of family on adolescents’ mental health. Although we hypothesized that adviser presence might moderate the association between family structure and mental health outcomes—particularly by offering protective effects among adolescents in non-intact families—formal interaction analyses revealed no statistically significant moderation effects. This suggests that while advisers were generally associated with better mental health outcomes, the magnitude of this association did not vary meaningfully across different family structures. These findings imply that the benefit of having a trusted adviser may be broadly applicable across family types, rather than disproportionately protective in specific subgroups. Nevertheless, the lack of significant interaction should be interpreted with caution, given potential limitations in statistical power for detecting moderation and the dichotomous nature of the adviser variable.
Furthermore, we analyzed the association between family structure and adolescents’ mental health in the presence of advisers to determine which type of adviser was more important to adolescents’ mental health. The results showed that having family advisers, such as parents, siblings, and friends, moderated the effect of poor mental health among adolescents. The presence of adviser in the family suggests strong solidarity and emotional support. Particularly, adolescents reported less unhappiness for all family members when they had a family adviser. This result in single-parent families may be because single parents have healthy emotional connections with their adolescents. The reason for this result in adoptive families may be that family members adjusted well to the new family. Previous studies have shown that children’s internalization and externalization problems decrease when the parent-child relationship of adoptive families is strong43. Furthermore, the quality of friendship is an important factor in the development and adaptation of mental health44,45. According to a previous study, adolescents have positive experiences, such as happiness and increased social connections, when they feel that they receive more support from friends and parents46. In addition, our findings indicated that adolescents from father-only households without advisers showed a tendency toward elevated risks of suicidal behaviors, including suicide attempts (aOR: 1.38, 95% CI: 0.55–3.44), as well as higher levels of internalizing symptoms such as depressive mood, although these associations did not reach statistical significance. These patterns may reflect the compounded effects of limited emotional communication, reduced parental supervision, and sociocultural pressures on fathers as sole caregivers47. Conversely, the presence of an adviser—especially in father-only households with grandparents—was associated with reduced odds of poor self-rated health (aOR: 0.53, 95% CI: 0.29–0.98) and unhappiness (aOR: 0.39, 95% CI: 0.22–0.71), suggesting that external emotional support may buffer the psychological impact of disrupted family environments16.
Importantly, the protective effects of advisers varied depending on the type of adviser and the specific mental health outcome. Family advisers appeared particularly effective in reducing internalizing symptoms such as unhappiness and depressive mood, likely due to their emotional closeness and long-term relational stability48. Peer advisers were associated with improved self-rated health and reduced feelings of isolation, suggesting their role in enhancing social connectedness49. In contrast, teachers and other formal advisers did not show consistent protective effects, possibly due to limited emotional intimacy or inconsistent availability50. These outcome-specific differences underscore the importance of considering both the type of adviser and the nature of the mental health domain when designing support interventions51. These findings highlight the differentiated roles of family structure and external support systems in shaping adolescent mental health outcomes, and indicate that providing intensive support from family or friendships may be a beneficial strategy to improve mental health in adolescents52,53.
This study has several limitations. First, the KYRBS dataset does not capture certain potentially important variables, such as parental characteristics, that may influence both family structure and adolescent mental health54. The absence of these factors could have introduced residual confounding or omitted variable bias, thereby reducing the precision of our estimates. Although we adjusted for key covariates (e.g., age, sex, socioeconomic status, and parental education), the possibility of unmeasured confounders cannot be entirely excluded. Second, the KYBRS lacks data on policy-relevant topics (such as parental employment) that may affect family structure and well-being. Third, all mental health outcomes were self-reported and measured using single-item indicators. While four outcomes were originally binary in the KYRBS, self-rated health and happiness were dichotomized based on prior studies to improve interpretability. However, single-item and binary measures may limit sensitivity and validity. Future research should consider using validated multi-item scales or alternative modeling approaches. Additionally, the dataset did not allow assessment of different types of counseling support. It would have been advantageous to incorporate elements such as adolescents’ future planning or current emotional regulation, but these were not included due to data constraints. The concept of ‘loved ones’, which is frequently addressed in palliative care and end-of-life research, was not incorporated into the present study due to data constraints. However, it could be employed in future comprehensive investigations examining the mediating role of intimate relationships in mitigating mental health issues in adolescents. Finally, a previous study showed that parents’ well-being is also important in contributing to their children’s well-being54, but the KYBRS data do not include parents’ physical or mental health information; therefore, we could not consider the role of parents’ well-being in our analysis. Marriage, divorce, and remarriage are important factors that affect children’s mental health; therefore, future studies should take these factors into account.
Conclusions
The results of our study suggest that family structure is associated with adolescents’ mental health problems. Adviser presence, particularly support from family members or friends, was generally linked to better outcomes; however, formal interaction analyses did not demonstrate statistically significant moderation effects. These findings indicate that while adviser support is broadly beneficial, its protective role does not differ meaningfully across family structures. Nonetheless, fostering supportive relationships remains important, and proactive measures are essential to prevent severe outcomes such as suicide, especially among adolescents in vulnerable family contexts.
Author contributions
S.M.K., S.K.L., K.H.K., and S.M.P. contributed to the study conception and design. Material preparation and data collection were performed by S.M.K., and analysis was performed by S.M.K and S.K.L. The draft of the manuscript was written by S.M.K. and S.K.L. All authors interpreted the data, provided feedback, and reviewed the manuscript.
Funding
The Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (RS-2023-00244084).
Data availability
The raw KYRBS dataset can be obtained from the website of the Korea Disease Control and Prevention Agency (KDCA) (https://www.kdca.go.kr/yhs/) with the user’s consent.
Declarations
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Sung Min Kim and Su Kyoung Lee contributed equally to this work.
Contributor Information
Kyae Hyung Kim, Email: kh.kim@snu.ac.kr.
Sang Min Park, Email: smpark.snuh@gmail.com.
References
- 1.Barrett, A. E. & Turner, R. J. Family structure and mental health: the mediating effects of socioeconomic status, family process, and social stress. J. Health Soc. Behav.46 (2), 156–169 (2005). [DOI] [PubMed] [Google Scholar]
- 2.Bernardi, F., Boertien, D. & Geven, K. Childhood family structure and the accumulation of wealth across the life course. J. Marriage Family. 81 (1), 230–247 (2019). [Google Scholar]
- 3.Chun, S. Y. et al. Long-term effects of parental divorce timing on depression: A population-based longitudinal study. Int. J. Soc. Psychiatry. 62 (7), 645–650 (2016). [DOI] [PubMed] [Google Scholar]
- 4.Mackay, R. The impact of family structure and family change on child outcomes: A personal reading of the research literature. Social Policy J. New. Z.24 (4), 111–133 (2005). [Google Scholar]
- 5.Bramlett, M. D. Blumberg, family structure and children’s physical and mental health. Health Aff.26 (2), 549–558 (2007). [DOI] [PubMed] [Google Scholar]
- 6.Choi, H. Industrialization, urbanization and family change in Korea. Akademika, 30 (1), (1987).
- 7.Park, H. & Lee, K. S. The association of family structure with health behavior, mental health, and perceived academic achievement among adolescents: a 2018 Korean nationally representative survey. BMC public. Health. 20, 1–10 (2020). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Agnafors, S. et al. Mental health in young mothers, single mothers and their children. BMC Psychiatry. 19 (1), 112 (2019). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Zhao, L. et al. Associations of grandparenting dimensions/styles with mental health in children and adolescents: a systematic review and meta-analysis. Behav. Sci. (Basel), 15(2), 180 (2025). [DOI] [PMC free article] [PubMed]
- 10.Tracy, E. M. et al. Grandmothers Raising grandchildren: managing, balancing and maintaining family relationships. J. Women Aging. 34 (6), 757–772 (2022). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Dufur, M. J. & Woo, H. Associations between gendered family structures and adolescent stress, loneliness, and sadness in South Korea. Int. J. Environ. Res. Public. Health, 20(4). 3656 (2023). [DOI] [PMC free article] [PubMed]
- 12.Le Goff, J. M., Ryser, V. A. & Bernardi, L. Subjective Well-Being, Family Dynamics and Vulnerability. 17–29. (2023).
- 13.Spruit, A. et al. The relation between attachment and depression in children and adolescents: a multilevel meta-analysis. Clin. Child Fam. Psychol. Rev.23 (1), 54–69 (2020). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Antony, E. Framing Childhood Resilience Through Bronfenbrenner’s Ecological Systems Theory: A Discussion Paper. 9. (2022).
- 15.Rose, T. et al. Socio-ecological domains and adolescent mental health: an application of the dual-factor model. J. Res. Adolesc.35 (2), e70029 (2025). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Butler, N. et al. The contributing role of family, school, and peer supportive relationships in protecting the mental wellbeing of children and adolescents. School Ment Health. 14 (3), 776–788 (2022). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Kim, J. H. Association between self-rated health status and the presence of current depression in Korean adults over 19 years old: based on 2018 Korean National health and nutrition examination survey. Korean J. Family Pract.11 (6), 444–448 (2021). [Google Scholar]
- 18.Kim, E. J. et al. Predictive factors of adolescents’ happiness: a random forest analysis of the 2023 Korea youth risk behavior survey. Child. Health Nurs. Res.31 (2), 85 (2025). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Jo, H. S. et al. Analysis of socio-demographics, self-rated health, social capital, and happiness in a medium-sized healthy city, Republic of Korea. J. Lifestyle Med.5 (2), 68 (2015). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Park, H. & Lee, K. S. The association of family structure with health behavior, mental health, and perceived academic achievement among adolescents: a 2018 Korean nationally representative survey. BMC public. Health. 20 (1), 1–10 (2020). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Wang, J. L. The difference between single and married mothers in the 12-month prevalence of major depressive syndrome, associated factors and mental health service utilization. Soc. Psychiatry Psychiatr. Epidemiol.39, 26–32 (2004). [DOI] [PubMed] [Google Scholar]
- 22.Schor, E. L. Family pediatrics: report of the task force on the family. Pediatrics111 (6 Pt 2), 1541–1571 (2003). [PubMed] [Google Scholar]
- 23.Fomby & Kravitz-Wirtz, N. Family systems and parents’ financial support for education in early adulthood. Demography56 (5), 1875–1897 (2019). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.McLanahan, S. & Sandefur, G. D. Growing Up with a Single Parent: What hurts, What Helps (Harvard University Press, 2009).
- 25.Ganong, L., Coleman, M. Effects of stepfamily living on children. In: Stepfamily Relationships: Development, Dynamics, and Interventions. 175–189 (Springer, 2016)
- 26.Peng, B. et al. Parenting style and adolescent mental health: the chain mediating effects of self-esteem and psychological inflexibility. Front. Psychol.12, 738170 (2021). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Booysen, F., Botha, F. & Wouters, E. Conceptual causal models of socioeconomic status, family structure, family functioning and their role in public health. BMC public. Health. 21 (1), 191 (2021). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 28.Daliana, N. & Antoniou, A. S. The mental health of single-parent families in relation to psychological, societal and financial parameters. (2018).
- 29.Tang, B. et al. The impact of family residence structure on adolescents’ non-cognitive abilities: evidence from China. Front. Psychol.15, 1367308 (2024). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 30.Sekaran, V. et al. Role of micro- and mesosystems in shaping an adolescent. J. Nepal. Pediatr. Soc.37, 178 (2018). [Google Scholar]
- 31.Trahan, M. H., Morley, R. H. & Shafer, K. Father-adolescent relationship closeness: A path analysis of family factor associates with father-adolescent engagement and relationship quality. Child Adolesc. Soc. Work J.38, 265–282 (2021). [Google Scholar]
- 32.Scrimin, S. et al. Effects of socioeconomic status, parental stress, and family support on children’s physical and emotional health during the COVID-19 pandemic. J. Child Fam. stud.31 (8), 2215–2228 (2022). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 33.Núñez-Regueiro, F. et al. Measuring stressors among children and adolescents: a scoping review 1956–2020. Adolesc. Res. Rev.7 (1), 141–160 (2022). [Google Scholar]
- 34.Jenkins, J. et al. Mutual influence of marital conflict and children’s behavior problems: shared and nonshared family risks. Child Dev.76 (1), 24–39 (2005). [DOI] [PubMed] [Google Scholar]
- 35.Pougnet, E. et al. Fathers’ influence on children’s cognitive and behavioural functioning: A longitudinal study of Canadian families. Can. J. Behav. Sci.43 (3), 173 (2011). [Google Scholar]
- 36.King, V. Stepfamily formation: implications for adolescent ties to mothers, nonresident fathers, and stepfathers. J. Marriage Family. 71 (4), 954–968 (2009). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 37.Bergman, H. et al. Client feedback in psychological therapy for children and adolescents with mental health problems. Cochrane Database Syst. Rev. 8, Cd011729 (2018). [DOI] [PMC free article] [PubMed]
- 38.Chu, B. C. & Kendall, P. C. Positive association of child involvement and treatment outcome within a manual-based cognitive-behavioral treatment for children with anxiety. J. Consult. Clin. Psychol.72 (5), 821 (2004). [DOI] [PubMed] [Google Scholar]
- 39.Hannighofer, J. et al. Impact of relationship status and quality (family type) on the mental health of mothers and their children: A 10-year longitudinal study. Front. Psychiatry. 8, 266 (2017). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 40.Desjardins, T. L. & Leadbeater, B. J. Relational victimization and depressive symptoms in adolescence: moderating effects of mother, father, and peer emotional support. J. Youth Adolesc.40, 531–544 (2011). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 41.Robinson, N. S. Evaluating the nature of perceived support and its relation to perceived self-worth in adolescents. J. Res. Adolescence. 5 (2), 253–280 (1995). [Google Scholar]
- 42.Perry, N. B. et al. The relation between maternal emotional support and child physiological regulation across the preschool years. Dev. Psychobiol.55 (4), 382–394 (2013). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 43.Jensen, T. M. et al. Stepfamily relationship quality and children’s internalizing and externalizing problems. Fam. Process. 57 (2), 477–495 (2018). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 44.Youniss, J. & Haynie, D. L. Friendship in adolescence. J. Dev. Behav. Pediatr.13 (1), 59–66 (1992). [PubMed] [Google Scholar]
- 45.Burk, W. J. & Laursen, B. Adolescent perceptions of friendship and their associations with individual adjustment. Int. J. Behav. Dev.29 (2), 156–164 (2005). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 46.Schacter, H. L. & Margolin, G. The interplay of friends and parents in adolescents’ daily lives: towards a dynamic view of social support. Soc. Dev.28 (3), 708–724 (2019). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 47.Hu, J. & Zhou, T. Parent- and adolescent-driven effects in emotion-related communication and longitudinal relationships with depressive symptoms in adolescents. J. Youth Adolesc.54 (2), 310–325 (2025). [DOI] [PubMed] [Google Scholar]
- 48.Mastrotheodoros, S. et al. Family functioning and adolescent internalizing and externalizing problems: disentangling between-, and within-family associations. J. Youth Adolesc.49 (4), 804–817 (2020). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 49.Wickrama, T., Merten, M. J. & Terrell, A. Adolescent social connectedness and young adult achievement: the linking and moderating role of self-esteem trajectories. J. Child Fam. stud.34 (4), 974–989 (2025). [Google Scholar]
- 50.De Neve, D. et al. Emotion regulation in the classroom: a network approach to model relations among emotion regulation difficulties, engagement to learn, and relationships with peers and teachers. J. Youth Adolesc.52 (2), 273–286 (2023). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 51.Neill, R. D. et al. Understanding adolescent mental health and well-being: a qualitative study of school stakeholders’ perspectives to inform intervention development. SN Social Sci.2 (8), 161 (2022). [Google Scholar]
- 52.van Harmelen, A. L. et al. Friendships and family support reduce subsequent depressive symptoms in at-risk adolescents. PloS One. 11 (5), e0153715 (2016). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 53.Butler, N. et al. The contributing role of family, school, and peer supportive relationships in protecting the mental wellbeing of children and adolescents. School Mental Health. 14 (3), 776–788 (2022). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 54.Weng, X. et al. Linking parent-adolescent congruence in perceived parental emotional support to adolescent developmental outcomes: the more, the better? J. Youth Adolesc.54 (3), 649–664 (2025). [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The raw KYRBS dataset can be obtained from the website of the Korea Disease Control and Prevention Agency (KDCA) (https://www.kdca.go.kr/yhs/) with the user’s consent.