Abstract
Background
Children’s prosocial development may be influenced by maternal depressive symptoms (MDS), but how overreactive parenting relates to both factors remains unclear. This study examined the associations among overreactive parenting, MDS, and child prosocial behaviors from mother-child dyads in western China.
Methods
We analyzed cross-sectional data from 16,258 mother-child dyads when children were aged 3–6 years. Data were collected between February 28 and March 5, 2025. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to measure MDS. Children’s prosocial behavior was assessed through the Strengths and Difficulties Questionnaire (SDQ). Overreactive parenting was evaluated using the Parenting Scale. Associations between MDS, overreactive parenting, and child prosocial behavior were analyzed using linear and logistic regression. Indirect effects analysis was conducted to examine whether a significant proportion of the association between MDS and child prosocial behavior was shared with overreactive parenting.
Results
Among 16,258 mother-child dyads, 47.8% (n = 7,766) of children had prosocial behavior scores below 6, indicating potential prosocial behavior problems. Mothers with elevated depressive symptoms (CES-D score ≥ 16) had significantly higher levels of overreactive parenting (β = 0.52, 95% CI: 0.48–0.57, P < 0.0001) and were more likely to have children with prosocial behavior problems (OR = 1.72, 95% CI: 1.58–1.88, P < 0.0001) compared to mothers without significant depressive symptoms. Furthermore, each one-unit increase in overreactive parenting score was associated with higher odds of child prosocial behavior problems (OR = 1.51, 95% CI: 1.46–1.55, P < 0.0001). Indirect effects analysis revealed that overreactive parenting accounted for 35.9% of the association between MDS and child prosocial behavior.
Conclusions
MDS are associated with reduced prosocial behavior in preschool children from western China, and overreactive parenting links MDS and child prosocial behaviors.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12889-026-26410-8.
Keywords: maternal depressive symptoms, prosocial behaviors, overreactive parenting, CES-D, SDQ
Introduction
Prosocial behavior, defined as “voluntary behavior intended to benefit others,” is recognized as a crucial marker of healthy social development in children [1]. Recent systematic reviews confirm that prosocial capacities, including attachment-based helping behaviors, emerge early and predict long-term developmental outcomes [1]. Research has demonstrated that prosocial behavior begins to emerge in toddlerhood and continues to develop throughout the preschool period (ages 3–6 years), with increasing complexity and frequency [2, 3]. The preschool period represents a critical developmental window for prosocial capacities, as children transition from simple helping behaviors to more complex forms including sharing, comforting, and cooperative actions [3]. Individual differences in prosocial trajectories during this period predict long-term social-emotional outcomes, including peer relationship quality and psychological well-being in later childhood and adolescence [4, 5]. Importantly, longitudinal evidence demonstrates that prosocial and aggressive behaviors show distinct developmental pathways from early childhood through adolescence, with early prosocial behavior serving as a protective factor against later behavioral problems [3, 5]. Globally, approximately 13.4% of children experience psychiatric disorders [6], highlighting the public health significance of understanding factors that promote positive child development. Given that early prosocial development influences children’s current learning, quality of life, and potentially has long-term implications for psychological health and social functioning [5, 7], identifying modifiable risk factors that affect prosocial behavior during the preschool years is of critical importance.
Research consistently demonstrates associations between maternal depressive symptoms (MDS) and offspring’s prosocial developmental outcomes [8–10]. Children of mothers with elevated depressive symptoms exhibit more severe peer relationship problems and lower levels of prosocial behavior [11]. Longitudinal evidence indicates that maternal depression trajectories during early childhood predict offspring’s socioemotional competences into middle childhood [9], and recent research demonstrates that depressive symptoms are linked to both prosocial and antisocial behavior patterns in youth [10]. Moreover, research with preschool-aged children specifically demonstrates that MDS predict reduced helping, sharing, and comforting behaviors, though this association may be moderated by child attachment security [12]. However, the mechanisms through which MDS influences children’s prosocial development require further investigation.
Parenting behaviors represent a factor linked to both maternal mental health and child outcomes [13]. Among various parenting dimensions linked to child prosocial behavior – including warmth, responsiveness, and autonomy support [14] – overreactive parenting represents a particularly important yet understudied factor. Overreactive parenting, characterized by excessively intense, harsh, or inappropriate responses to children’s behaviors, reflects dysregulated emotional responses during parent-child interactions [15]. This construct has been operationalized in prior research as including verbal hostility, physical intensity, and irritability during parent-child interactions, particularly in response to child misbehavior [15]. Unlike other parenting dimensions, overreactivity may directly model poor emotion regulation for children – a key mechanism underlying prosocial behavior development [14]. Extensive meta-analytic evidence demonstrates that maternal depression is consistently associated with more negative and less positive parenting behaviors, including increased hostility and reduced responsiveness [14]. This association is particularly pronounced for overreactive disciplinary practices. Longitudinal evidence from adoption studies confirms that parental depression predicts early childhood externalizing problems through the pathway of overreactive parenting, with this association moderated by social support [16]. While these studies have focused primarily on externalizing behaviors, the mechanisms may similarly apply to prosocial development, as both require effective emotion regulation capacities.
Despite these associations, current understanding remains limited. Research has predominantly focused on school-aged populations [11, 12] rather than preschoolers, when prosocial capacities undergo rapid development. Furthermore, investigations have been conducted primarily in Western contexts [17], raising questions about generalizability to Chinese populations where parenting norms may differ [18]. We propose that overreactive parenting may be associated with both MDS and preschool children’s prosocial behavior, potentially accounting for a portion of their association. MDS are characterized by emotion dysregulation, irritability, and cognitive biases including negative attributions toward child behavior [19]. These symptoms are associated with impaired capacity for emotion regulation during parent-child interactions, which may increase the likelihood of overreactive disciplinary responses [15]. Overreactive parenting may be associated with reduced prosocial development. Theoretically, multiple mechanisms may explain this association. Harsh parenting models poor emotion regulation and fails to teach children appropriate emotional responses to others’ distress – a key foundation for prosocial responding [2]. Additionally, overreactive discipline creates a coercive family environment that prioritizes compliance over internalization of prosocial values. Such parenting practices may also interfere with the development of empathy and perspective-taking by inducing fear and self-focused concern rather than other-oriented concern [14].
Therefore, the cross-sectional study sought to examine associations between MDS and preschool children’s prosocial behavior in a Chinese sample, and to investigate the proportion of this association that can be accounted for by overreactive parenting.
Methods
Study design and sample
This secondary analysis utilized cross-sectional data from a large-scale epidemiological survey in Shaanxi Province, China, which employed a stratified cluster sampling strategy. Applying this method, 189 public kindergartens were randomly selected from government-registered lists across all 13 districts/counties, with enrollment targets for each district proportional to its preschool-aged population to ensure demographic representativeness. The original study examined the association between MDS and child prosocial behavior, with 17,115 mother-child dyads (children aged 3–6 years) included in the analysis. Building upon this foundation, the current study developed novel hypotheses to investigate indirect associations between MDS and child behavioral problems via parenting practices.
Data were collected through maternal-reported questionnaires including the CES-D, SDQ prosocial subscale, and overreactive parenting subscale. Maternal report was chosen as the primary data source because: (1) mothers are typically the primary caregivers in Chinese families and have extensive daily observations of their children’s prosocial behavior across diverse contexts; (2) the study aimed to examine the maternal perspective on child behavior as it relates to maternal mental health and parenting practices, maintaining consistency in the informant across all constructs; and (3) this approach aligns with the original epidemiological survey design.
Missing data were limited exclusively to covariates (maternal age: n = 340; child age: n = 525), with complete data available for all primary study variables. After excluding missing covariate data, the final analytical sample comprised 16,258 mother-child dyads.
Measurements
Prosocial behavior
Children’s prosocial behavior was assessed using the Strengths and Difficulties Questionnaire (SDQ) [20–22]. The SDQ is a widely used behavioral screening questionnaire comprising 25 items across five subscales. The prosocial behavior subscale consists of 5 items assessing helping, sharing, and caring behaviors toward others. Items are scored using a 3-point Likert scale (0–2). The prosocial behavior subscale generated scores ranging from 0 to 10, with greater scores indicating higher levels of prosocial behavior. Based on validated Chinese normative cut-off values, children with a prosocial behavior score below 6 were categorized as at-risk, suggesting potential prosocial behavior problems [20, 23]. The prosocial behavior subscale demonstrated good internal consistency in this sample (Cronbach’s α = 0.833), which is consistent with previous validation studies in Chinese populations [23].
Maternal depressive symptoms
MDS were measured using the Center for Epidemiologic Studies Depression Scale (CES-D) [24–26]. This instrument contains 20 questions measuring how often depressive symptoms occurred within the preceding seven days. Responses utilize a 4-point rating system, with values from 0 (rarely/never) to 3 (frequently/always). Elevated scores correspond to greater depressive symptom severity. Total scores range from 0 to 60, with higher scores indicating greater depressive symptoms. A cutoff score of 16 or higher was used to identify elevated depressive symptoms, as recommended in previous validation studies [27, 28]. The scale demonstrated good internal consistency in this sample (Cronbach’s α = 0.849).
Overreactive parenting
Overreactive parenting was assessed through the overreactivity subscale of the Parenting Scale [16, 29]. The Parenting Scale comprises 30 self-report items that assess dysfunctional parenting practices in discipline situations. The overreactivity subscale of the Parenting Scale consists of 10 items. Each item is rated on a 7-point scale ranging from 1 to 7. The overreactivity subscale measures mothers’ tendency to respond to children’s misbehavior with anger, irritability, and harsh discipline. Subscale scores are calculated by averaging the 10 items, yielding scores ranging from 1 to 7, with higher scores indicating more overreactive parenting. In this sample, the subscale showed acceptable internal consistency (Cronbach’s α = 0.796).
Covariates
Demographic and socioeconomic characteristics were collected during initial recruitment. Maternal age and child age were recorded as continuous variables in years. Child gender was categorized as boy or girl. Household composition was dichotomized as one child versus two or more children. Annual household income was stratified into three categories: < ¥100,000 and ≥ ¥100,000 to < ¥300,000, ≥ ¥300,000 [20]. Maternal marital status was classified as married versus unmarried (including never married, separated, divorced, or widowed). Maternal education was categorized into four levels: ≤ Junior high school, High school diploma and junior college, Undergraduate degree, and ≥ Master’s degree [20].
Statistical analysis
Statistical analyses were conducted using EmpowerStats (X&Y Solutions, Inc., Boston, MA; www.empowerstats.com) and R software (version 4.2.2). A P value of < 0.05 was considered statistically significant. To ensure the validity of regression analyses, we assessed multicollinearity among the independent variable (MDS) and covariates using variance inflation factors (VIF). VIF values were calculated for each variable, and all variables exhibited VIF values below 5 (range: 1.0–1.1), indicating no substantial multicollinearity issues that would compromise the stability of the regression estimates (see Supplementary Tables S1 and S2).
Continuous data were presented as mean ± standard deviation, whereas categorical data were shown as counts and percentages (n, %). Between-group comparisons of continuous variables were conducted following assessment of normality and variance homogeneity. Student’s t-test was performed when parametric conditions were fulfilled; the Mann-Whitney U test was used otherwise. We compared categorical data using chi-square analysis, applying Fisher’s exact test when expected cell frequencies were less than 5. For descriptive and exploratory purposes, overreactive parenting scores were also categorized into tertiles (low, middle, high) based on sample distribution, as no established clinical cutoffs exist for this scale. The primary analyses used continuous scores to preserve statistical power.
We conducted logistic regression models to explore the relationships between MDS and prosocial behavior problems in children, as well as between overreactive parenting and prosocial behavior problems in children, with findings expressed as odds ratios with 95% confidence intervals (95% CI). We performed linear regression modeling to examine the association between MDS and overreactive parenting, with results presented as regression coefficients (β) and 95% CI. Subgroup and interaction analyses were conducted to detect potential differences in specific population subgroups.
We examined indirect effects using the “mediation” package [30, 31] in R 4.2.2 to determine whether overreactive parenting accounted for a significant proportion of the association between MDS and children’s prosocial behavior. Following established methodological conventions [32–34], we use the term “indirect effect” to describe the statistical process through which the predictor-outcome association is shared with a third variable. However, we emphasize that our cross-sectional design does not permit causal or temporal inferences [35]. The indirect effect was estimated using bootstrap resampling (1,000 iterations) with bias-corrected 95% confidence intervals. This bootstrap approach has been demonstrated to provide superior statistical power compared to traditional methods such as the Sobel test or the causal steps approach [36]. Statistical significance was determined when the confidence interval excluded zero.
Missing data were present for some covariates in our sample of 17,115 mother-child dyads, including maternal age (n = 340, 1.98%) and child age (n = 525, 3.07%). To handle these missing values and assess the robustness of our findings, we created dummy variables to indicate missing covariate values for continuous variables with missingness exceeding 1% [37], and sensitivity analyses were performed by comparing results with and without the missing indicator approach.
Results
Participants characteristics
Analysis of 16,258 mother-child dyads revealed significant differences in multiple demographic characteristics between the above cut-off (without prosocial behavior problems, N = 8,492) and below cut-off groups (with prosocial behavior problems, N = 7,766) (Table 1). The above cut-off group had older mothers, older children, and significantly lower maternal CES-D scores and overreactive parenting scores. The below cut-off group had a higher proportion of boys (53.82% vs. 49.00%) and lower maternal education and household income levels. Regarding overreactive parenting distribution, the above cut-off group had a significantly higher proportion in the low tertile (40.25% vs. 23.64%), while the below cut-off group had a significantly higher proportion in the high tertile (43.15% vs. 26.98%).
Table 1.
Characteristics of the study population (N = 16,258)
| Characteristics | Prosocial behavior problems | P value | |
|---|---|---|---|
| No (N = 8492) | Yes (N = 7766) | ||
| Maternal age (y) | 34.49 ± 4.46 | 34.15 ± 4.38 | < 0.001 |
| Child age (y) | 4.90 ± 0.86 | 4.74 ± 0.91 | < 0.001 |
| Maternal CES-D score | 10.10 ± 6.48 | 12.24 ± 6.60 | < 0.001 |
| Overreactive parenting score | 2.69 ± 1.09 | 3.13 ± 1.00 | < 0.001 |
| Child gender | < 0.001 | ||
| Boy | 4161 (49.00%) | 4180 (53.82%) | |
| Girl | 4331 (51.00%) | 3586 (46.18%) | |
| Maternal education level | < 0.001 | ||
| ≤Junior high school | 2207 (25.99%) | 2334 (30.05%) | |
| High school diploma and junior college | 3777 (44.48%) | 3408 (43.88%) | |
| Undergraduate degree | 2405 (28.32%) | 1913 (24.63%) | |
| ≥Master’s degree | 103 (1.21%) | 111 (1.43%) | |
| Maternal marital status | 0.027 | ||
| Married | 8275 (97.44%) | 7608 (97.97%) | |
| Unmarried | 217 (2.56%) | 158 (2.03%) | |
| Annual household income (¥) | < 0.001 | ||
| <¥100,000 | 6803 (80.11%) | 6536 (84.16%) | |
| ≥¥100,000 <¥300,000 | 1576 (18.56%) | 1178 (15.17%) | |
| ≥¥300,000 | 113 (1.33%) | 52 (0.67%) | |
| Number of children in the household | 0.259 | ||
| 1 | 2380 (28.03%) | 2115 (27.23%) | |
| ≥2 | 6112 (71.97%) | 5651 (72.77%) | |
| Maternal CES-D score | < 0.001 | ||
| <16 | 7435 (87.55%) | 6239 (80.34%) | |
| ≥16 | 1057 (12.45%) | 1527 (19.66%) | |
| Overreactive parenting score tertile | < 0.001 | ||
| Low | 3418 (40.25%) | 1836 (23.64%) | |
| Middle | 2783 (32.77%) | 2579 (33.21%) | |
| High | 2291 (26.98%) | 3351 (43.15%) | |
Data are expressed as mean ± SD or number (percentage). CES-D, Center for Epidemiologic Studies Depression Scale; SDQ, Strengths and Difficulties Questionnaire. Elevated depressive symptoms defined as CES-D ≥ 16. Prosocial behavior problems defined as SDQ prosocial behavior score < 6
¥, yuan renminbi (to convert to US dollar, multiply by 7.30)
Univariate associations between variables and child prosocial behavior problems
Univariate associations between variables and child prosocial behavior problems are presented in Supplementary Table S3. MDS (CES-D ≥ 16: OR = 1.72, 95% CI: 1.58–1.87, P < 0.0001) and overreactive parenting (high tertile: OR = 2.72, 95% CI: 2.52–2.94, P < 0.0001) were strongly associated with increased odds of prosocial difficulties. Girls had 18% lower odds compared to boys (OR = 0.82, 95% CI: 0.77–0.88, P < 0.0001). Higher maternal education (high school/junior college: OR = 0.85, 95% CI: 0.79–0.92; undergraduate degree: OR = 0.75, 95% CI: 0.69–0.82) and higher household income (≥¥100,000<¥300,000: OR = 0.78, 95% CI: 0.72–0.85; ≥¥300,000: OR = 0.48, 95% CI: 0.34–0.67) were associated with lower odds of prosocial behavior problems.
Association between MDS and prosocial behavior problems in children
Table 2 displays the association between MDS and prosocial behavior in children across three progressive adjustment models. Mothers with elevated depressive symptoms (CES-D score ≥ 16) showed consistently higher odds of having children with poor prosocial behavior compared to mothers without significant depressive symptoms across all models. The unadjusted model revealed an odds ratio of 1.72 (95% CI: 1.58–1.87, P < 0.0001), which increased slightly to 1.77 (95% CI: 1.62–1.93, P < 0.0001) after adjusting for basic demographic variables (child age, child gender, maternal age) in Model 2. After further adjustment for maternal educational attainment, marriage status, yearly family income, and number of offspring per household in Model 3, the association remained robust with an odds ratio of 1.72 (95% CI: 1.58–1.88, P < 0.0001).
Table 2.
The association between maternal depressive symptoms and child prosocial behavior problems (N = 16,258)
| OR (95% CI) P value | |||
|---|---|---|---|
| Model 1 | Model 2 | Model 3 | |
| Maternal CES-D Score | 1.05 (1.05, 1.06) < 0.0001 | 1.06 (1.05, 1.06) < 0.0001 | 1.05 (1.05, 1.06) < 0.0001 |
| Maternal CES-D Score | |||
| <16 | Reference | Reference | Reference |
| ≥16 | 1.72 (1.58, 1.87) < 0.0001 | 1.77 (1.62, 1.93) < 0.0001 | 1.72 (1.58, 1.88) < 0.0001 |
Data were presented as OR (95% CI) P value
Model 1 adjust for: none
Model 2 adjust for: child age, child gender, maternal age
Model 3 adjust for: child age, child gender, maternal age, maternal education level, maternal marital status, annual household income, and number of children in the household
Abbreviation: CI Confidence interval, OR Odds ratio
Association between MDS and overreactive parenting
Linear regression analysis confirmed a robust positive association between MDS and overreactive parenting behaviors (Table 3). Mothers with CES-D scores ≥ 16 demonstrated significantly higher overreactive parenting scores compared to those with scores < 16 across all adjustment models. After full adjustment for covariates, MDS were associated with a 0.52-point increase in overreactive parenting scores (β = 0.52, 95% CI: 0.48–0.57, P < 0.0001).
Table 3.
The association between maternal depressive symptoms and overreactive parenting (N = 16,258)
| β (95% CI) P value | |||
|---|---|---|---|
| Model 1 | Model 2 | Model 3 | |
| Maternal CES-D Score | 0.04 (0.04, 0.05) < 0.0001 | 0.04 (0.04, 0.05) < 0.0001 | 0.04 (0.04, 0.05) < 0.0001 |
| Maternal CES-D Score | |||
| <16 | Reference | Reference | Reference |
| ≥16 | 0.54 (0.50, 0.59) < 0.0001 | 0.54 (0.49, 0.58) < 0.0001 | 0.52 (0.48, 0.57) < 0.0001 |
Data were presented as β (95% CI) P value
Model 1 adjust for: none
Model 2 adjust for: child age, child gender, maternal age
Model 3 adjust for: child age, child gender, maternal age, maternal education level, maternal marital status, annual household income, and number of children in the household
Abbreviation: CI Confidence interval
Association between overreactive parenting and child prosocial behavior problems
Overreactive parenting showed significant associations with children’s prosocial behavior across all adjustment models (Table 4). Each one-point increase in overreactive parenting score was associated with a 51%increase in the odds of lacking prosocial behavior (OR = 1.51, 95% CI: 1.46–1.55). The tertile analysis showed a clear gradient effect: compared with the low overreactive parenting group, children in the middle tertile had higher odds (OR = 1.74, 95% CI: 1.61–1.88), while those in the high tertile had substantially higher odds (OR = 2.77, 95% CI: 2.56–3.00) of exhibiting low prosocial behavior (Model 3).
Table 4.
The association between overreactive parenting and child prosocial behavior problems (N = 16,258)
| OR (95% CI) P value | |||
|---|---|---|---|
| Model 1 | Model 2 | Model 3 | |
| Overreactive parenting score |
1.49 (1.45, 1.54) < 0.0001 |
1.51 (1.47, 1.56) <0.0001 |
1.51 (1.46, 1.55) < 0.0001 |
| Overreactive parenting score tertile | |||
| Low | Reference | Reference | Reference |
| Middle |
1.73 (1.60, 1.87) < 0.0001 |
1.74 (1.61, 1.88) < 0.0001 |
1.74 (1.61, 1.88) <0.0001 |
| High |
2.72 (2.52, 2.94) < 0.0001 |
2.81 (2.60, 3.04) <0.0001 |
2.77 (2.56, 3.00) < 0.0001 |
Data were presented as OR (95% CI) P value
Model 1 adjust for: none
Model 2 adjust for: child age, child gender, maternal age
Model 3 adjust for: child age, child gender, maternal age, maternal education level, maternal marital status, annual household income, and number of children in the household
Abbreviation: CI Confidence interval, OR Odds ratio
Subgroup and interaction analyses
Interaction tests revealed significant effect modification by maternal education level (P for interaction = 0.0017) and child sex (P for interaction = 0.0064) (Table 5). Specifically, we observed an educational gradient wherein the association strengthened with higher educational attainment: junior high school or below (OR = 1.04, 95%CI:1.03–1.05), high school/junior college (OR = 1.05, 95%CI:1.04–1.06), undergraduate degree (OR = 1.07, 95%CI:1.06–1.08), and master’s degree or above (OR = 1.09, 95%CI:1.04–1.15). In sex stratification, the association was stronger in boys than girls. However, no significant interactions were observed for household income, maternal age, child age, marital status, number of children, or overreactive parenting score (all P for interaction > 0.05).
Table 5.
Subgroup analysis of associations between maternal CES-D scores (per one-score increase) and child prosocial behavior problems (N = 16,258)
| Stratified variable | N | OR (95%CI) P value | P for interaction |
|---|---|---|---|
| Maternal age | 0.2502 | ||
| ≤30 | 2543 | 1.05 (1.04, 1.07) < 0.0001 | |
| >30 ≤ 40 | 12,176 | 1.05 (1.05, 1.06) < 0.0001 | |
| >40 | 1539 | 1.04 (1.02, 1.06) < 0.0001 | |
| Child age | 0.6085 | ||
| ≤4 | 3818 | 1.05 (1.04, 1.07) < 0.0001 | |
| >4 ≤ 5 | 5387 | 1.06 (1.05, 1.07) < 0.0001 | |
| >5 | 7053 | 1.05 (1.05, 1.06) < 0.0001 | |
| Child gender | 0.0064 | ||
| Boy | 8341 | 1.06 (1.05, 1.07) < 0.0001 | |
| Girl | 7917 | 1.04 (1.04, 1.05) < 0.0001 | |
| Maternal education level | 0.0017 | ||
| ≤Junior high school | 4541 | 1.04 (1.03, 1.05) < 0.0001 | |
| High school diploma and junior college | 7185 | 1.05 (1.04, 1.06) < 0.0001 | |
| Undergraduate degree | 4318 | 1.07 (1.06, 1.08) < 0.0001 | |
| ≥Master’s degree | 214 | 1.09 (1.04, 1.15) 0.0005 | |
| Maternal marital status | 0.1012 | ||
| Married | 15,883 | 1.05 (1.05, 1.06) < 0.0001 | |
| Unmarried | 375 | 1.03 (1.00, 1.05) 0.0318 | |
| Annual household income (¥) | 0.2604 | ||
| <¥100,000 | 13,339 | 1.05 (1.04, 1.05) < 0.0001 | |
| ≥¥100,000 <¥300,000 | 2754 | 1.06 (1.05, 1.08) < 0.0001 | |
| ≥¥300,000 | 165 | 1.06 (1.00, 1.12) 0.0450 | |
| Number of children in the household | 0.3161 | ||
| 1 | 4495 | 1.05 (1.04, 1.06) < 0.0001 | |
| ≥2 | 11,763 | 1.05 (1.05, 1.06) < 0.0001 | |
| Overreactive parenting score tertile | 0.1742 | ||
| Low | 5254 | 1.05 (1.04, 1.06) < 0.0001 | |
| Middle | 5362 | 1.04 (1.03, 1.05) < 0.0001 | |
| High | 5642 | 1.04 (1.03, 1.04) < 0.0001 |
Note: ¥, yuan renminbi (to convert to US dollar, multiply by 7.30)
Abbreviation: CI Confidence interval, OR Odds ratio
Indirect effect through overreactive parenting
The average proportion mediated by overreactive parenting was 35.9% (95% CI: 30.0%–43.9%, P < 0.001) (Table 6). Overreactive parenting accounts for 35.9% of the association between MDS and child prosocial behavior (Fig. 1). Following the guidelines of Fritz & Mackinnon (2007) [36], we conducted a post-hoc power analysis to assess the statistical power of our cross-sectional mediation model. Given the observed indirect effect estimate and a sample size of 16,258, the results indicated sufficient power (> 0.80) to detect this effect.
Table 6.
The indirect effect analysis of maternal depressive symptoms on child prosocial behavior through overreactive parenting (N = 16,258)
| Estimate | 95% CI lower | 95% CI upper | P-value | |
|---|---|---|---|---|
| Total effect | 0.132355 | 0.11144 | 0.153238 | < 0.0001 |
| Mediation effect (average) | 0.047498 | 0.042511 | 0.052806 | < 0.0001 |
| Direct effect (average) | 0.084858 | 0.06258 | 0.105715 | < 0.0001 |
| Proportion mediated (average) | 0.358866 | 0.300037 | 0.438931 | < 0.0001 |
Fig. 1.
The indirect effect analysis of maternal depressive symptoms on child prosocial behavior through overreactive parenting (N = 16,258)
Sensitivity analyses demonstrated consistency with the main findings. Dummy variables were constructed to indicate missing covariate information, and results remained stable after accounting for the influence of missing data (see Supplementary Table S4).
Discussion
In this cross-sectional study of 16,258 mother-child dyads, we unveiled a significant negative correlation between MDS and prosocial behavior among preschoolers aged 3–6 years from a city in western China. After demonstrating the associations of MDS with both overreactive parenting and child prosocial outcomes, indirect effects analysis revealed that overreactive parenting shared common variance with both variables. Specifically, 35.9% of the association between MDS and child prosocial behavior was accounted for overreactive parenting. Interaction tests revealed that the association between MDS and child prosocial behavior was significantly moderated by maternal education level and child sex, with stronger effects observed among mothers with higher education and among boys.
Our findings align with extensive international evidence demonstrating the detrimental impact of MDS on child prosocial behavior across diverse populations and developmental stages. Consistent with our results, Yamada et al. [22] found that MDS significantly increased the risk of low prosocial behavior in 5-year-old children among 1,199 mother-child pairs in Japan. Similarly, Koblinsky et al. [38] demonstrated that lower MDS were significantly associated with fewer behavioral problems and better social skills in urban African American preschoolers. Maruyama et al. [9] provided longitudinal evidence from their Brazilian birth cohort study of 3,437 mother-child dyads, demonstrating that persistent MDS were linked to reduced prosocial behavior in 11-year-old adolescents. These cross-cultural convergent findings, spanning different continents, age groups, and socioeconomic contexts, reinforce the universality and robustness of the connection between MDS and impaired prosocial development among children.
Our finding that overreactive parenting accounts for 35.9% of the association between MDS and child prosocial behavior in offspring is consistent with prior research. Studies examining negative parenting behaviors have shown similar patterns; Suzuki et al. [39] provided longitudinal evidence in school-age children demonstrating that overreactive parenting increases children’s problem behaviors while reducing prosocial behavior. Research on positive parenting practices has yielded parallel findings with contrasting mechanisms; Li et al. [40] found that parental warmth served as a mediator in the association between MDS and adolescent prosocial behavior. Additionally, studies examining parent-child interaction quality have identified mediating pathway with varying effect sizes. Liu et al. [41] found that mother-child interactions partially mediated the relationship between MDS and early childhood development in children aged 1–66 months (7.7%-10.3% of the total effect), while Ma et al. [42] demonstrated that early stimulation and responsive care mediated the effects of caregiver depression on developmental progress in children aged 0–3 years. Beyond parenting-related factors, other research has explored additional influences; for instance, Selman et al. [43] found that adequate sleep duration moderated the association between maternal depression and children’s internalizing and externalizing problems in preschool-age children. The current study extends this literature by examining overreactive parenting behaviors among children aged 3–6 years, a relatively understudied developmental period when prosocial competencies are rapidly emerging, and demonstrates that overreactive parenting accounts for a notably larger proportion of this association compared to some previous studies, underscoring the particular importance of this parenting dimension during early childhood.
Our interaction analyses revealed a striking educational gradient wherein the association between MDS and child prosocial difficulties strengthened progressively with higher maternal education. This paradoxical pattern may reflect several mechanisms. Highly educated mothers may experience greater cognitive-affective dissonance when depression impairs their capacity to implement sophisticated parenting knowledge, potentially leading to emotional dysregulation that undermines prosocial socialization [44]. Additionally, depression-related withdrawal may be particularly detrimental in contexts where mothers typically serve as primary facilitators of children’s social-emotional learning through intentional scaffolding – when this engagement is diminished, children may lose critical prosocial learning opportunities [45]. Furthermore, children in advantaged families may be more sensitive to deviations from expected high-quality maternal engagement, as depression-related disruptions represent greater departure from normative functioning in these contexts [46]. These findings underscore that maternal mental health may constitute a fundamental prerequisite for translating socioeconomic resources into positive developmental outcomes during early childhood.
Our findings revealed that overreactive parenting linked MDS and children’s prosocial behavior. This finding aligns with Apter-Levi et al. [47], who demonstrated that mothers with chronic depression exhibit more negative parenting behaviors, and their children are more likely to develop psychopathological symptoms and social withdrawal problems. This association is further supported by a meta-analysis of 46 observational studies, which confirmed that maternal depression shows the strongest association with negative parenting behaviors [15]. Additionally, our stratified analysis by overreactive parenting score tertiles revealed a noteworthy pattern: the association between MDS and child prosocial difficulties appeared strongest in the low tertile and progressively attenuated in middle and high tertiles, though the interaction did not reach statistical significance. While we initially interpreted this pattern as potential child adaptation to chronic overreactive parenting, alternative explanations warrant consideration. The attenuation in high overreactive parenting contexts may reflect a ceiling effect, wherein consistently elevated overreactive parenting becomes the dominant proximal influence on child prosocial development, potentially obscuring the additional contribution of MDS [12]. Alternatively, this pattern may indicate measurement insensitivity, as children experiencing persistently high levels of overreactive parenting may exhibit prosocial difficulties approaching a threshold beyond which incremental increases in MDS produce diminishing marginal effects.
Limitations
Several limitations should be acknowledged. First, the cross-sectional design precludes causal inference and temporal ordering among MDS, overreactive parenting, and child prosocial behavior. Second, all measures were based on maternal self-reports, which may introduce shared method variance. Although mothers are primary caregivers in Chinese families with extensive daily observations, and informant consistency was maintained to examine maternal perspectives, reliance on a single informant limits our ability to capture context-specific variations in prosocial behavior (e.g., home vs. school) and formal statistical tests for common method bias were not conducted. Future research would benefit from multi-informant approaches including teacher reports and direct observations. Third, unmeasured confounders such as paternal psychopathology, interparental conflict, social support, and child temperament may have influenced observed associations. Finally, participants were recruited exclusively from Shaanxi Province in western China, which may limit generalizability to populations with diverse cultural or socioeconomic backgrounds.
Conclusion
The present study provides evidence for the association between MDS and prosocial behavior problems in preschoolers, while also indicating that overreactive parenting links this association. These findings underscore the potential of supportive strategies aimed at maternal mental health and parenting practices, informing public health initiatives and policies for early childhood social-emotional development.
Supplementary Information
Acknowledgements
We are grateful to all participants for their valuable contribution to this study.
Authors’ contributions
Xiaocong Chen: Data curation, Validation, Visualization, Writing – original draft, Writing – review & editing. Xin Zhang: Methodology, Data curation, Formal analysis, Writing – review & editing, Writing – original draft. Jihua Hu: Conceptualization, Methodology, Supervision, Writing – original draft, Writing – review & editing.
Funding
This work was supported by the Medical Research Project of Xi’an Municipal Bureau of Science and Technology (2019114813YX003SF036-5).
Data availability
The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.
Declarations
Ethics approval and consent to participate
The study was approved by the Medical Ethics Committee of the Affiliated Children’s Hospital of Xi’an Jiaotong University (20250225-21). All research procedures were conducted in accordance with the Declaration of Helsinki. All participants provided written informed consent.
Consent for publication
Not applicable.
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.
References
- 1.Costa Martins M, Santos C, Fernandes M, Veríssimo M. Attachment and the development of prosocial behavior in children and adolescents: A systematic review. Child (Basel). 2022;9(6):874. [DOI] [PMC free article] [PubMed]
- 2.Svetlova M, Nichols SR, Brownell CA. Toddlers’ prosocial behavior: from instrumental to empathic to altruistic helping. Child Dev. 2010;81(6):1814–27. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Hay DF, Paine AL, Perra O, Cook KV, Hashmi S, Robinson C, Kairis V, Slade R. Prosocial and aggressive behavior: A longitudinal study. Monogr Soc Res Child Dev. 2021;86(2):7–103. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Nantel-Vivier A, Kokko K, Caprara GV, Pastorelli C, Gerbino MG, Paciello M, Côté S, Pihl RO, Vitaro F, Tremblay RE. Prosocial development from childhood to adolescence: a multi-informant perspective with Canadian and Italian longitudinal studies. J Child Psychol Psychiatry. 2009;50(5):590–8. [DOI] [PubMed] [Google Scholar]
- 5.Obsuth I, Eisner MP, Malti T, Ribeaud D. The developmental relation between aggressive behaviour and prosocial behaviour: A 5-year longitudinal study. BMC Psychol. 2015;3(1):16. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Polanczyk GV, Salum GA, Sugaya LS, Caye A, Rohde LA. Annual research review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. J Child Psychol Psychiatry. 2015;56(3):345–65. [DOI] [PubMed] [Google Scholar]
- 7.Caputi M, Lecce S, Pagnin A, Banerjee R. Longitudinal effects of theory of Mind on later peer relations: the role of prosocial behavior. Dev Psychol. 2012;48(1):257–70. [DOI] [PubMed] [Google Scholar]
- 8.Goodman SH, Rouse Mh Fau - Connell AM, Connell Am Fau - Broth MR, Broth Mr Fau - Hall CM, Hall Cm Fau - Heyward, Heyward D. D: Maternal depression and child psychopathology: a meta-analytic review. (1573–2827 (Electronic)). [DOI] [PubMed]
- 9.Maruyama JM, Pastor-Valero M, Santos IS, Munhoz TN, Barros FC, Matijasevich A. Impact of maternal depression trajectories on offspring socioemotional competences at age 11: 2004 Pelotas birth cohort. J Affect Disord. 2019;253:8–17. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Li X, Chen SH, Lee CY, Li A, Gao M, Cai X, Hsueh SC, Chiang YC. Mediating effects of academic Self-Efficacy and depressive symptoms on Prosocial/Antisocial behavior among youths. Prev Science: Official J Soc Prev Res. 2024;25(5):711–23. [DOI] [PubMed] [Google Scholar]
- 11.Hay DF, Pawlby S, Waters CS, Sharp D. Antepartum and postpartum exposure to maternal depression: different effects on different adolescent outcomes. J Child Psychol Psychiatry. 2008;49(10):1079–88. [DOI] [PubMed] [Google Scholar]
- 12.Brett BE, Stern JA, Gross JT, Cassidy J. Maternal depressive symptoms and preschoolers’ Helping, Sharing, and comforting: the moderating role of child attachment. J Clin Child Adolesc Psychology: Official J Soc Clin Child Adolesc Psychol Am Psychol Association Div. 2022;53(5):623–36. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Belsky J. The determinants of parenting: a process model. Child Dev. 1984;55(1):83–96. [DOI] [PubMed] [Google Scholar]
- 14.Davidov M, Grusec JE. Untangling the links of parental responsiveness to distress and warmth to child outcomes. Child Dev. 2006;77(1):44–58. [DOI] [PubMed] [Google Scholar]
- 15.Lovejoy MC, Graczyk PA, O’Hare E, Neuman G. Maternal depression and parenting behavior: a meta-analytic review. Clin Psychol Rev. 2000;20(5):561–92. [DOI] [PubMed] [Google Scholar]
- 16.Taraban L, Shaw DS, Leve LD, Natsuaki MN, Ganiban JM, Reiss D, Neiderhiser JM. Parental Depression, overreactive Parenting, and early childhood externalizing problems: moderation by social support. Child Dev. 2019;90(4):e468–85. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Henrich J, Heine SJ, Norenzayan A. The weirdest people in the world? Behav Brain Sci. 2010;33(2–3):61–83. discussion 83–135. [DOI] [PubMed] [Google Scholar]
- 18.Wang J, Huang X, Li Z, Chen K, Jin Z, He J, Han B, Feng L, Meng N, Yang C, et al. Effect of parenting style on the emotional and behavioral problems among Chinese adolescents: the mediating effect of resilience. BMC Public Health. 2024;24(1):787. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Goodman SH, Gotlib IH. Risk for psychopathology in the children of depressed mothers: a developmental model for Understanding mechanisms of transmission. Psychol Rev. 1999;106(3):458–90. [DOI] [PubMed] [Google Scholar]
- 20.Wang H, Zhao J, Yu Z, Pan H, Wu S, Zhu Q, Dong Y, Liu H, Zhang Y, Jiang F. Types of On-Screen content and mental health in kindergarten children. JAMA Pediatr. 2024;178(2):125–32. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Zhang X, Lv T, Leavey G, Zhu N, Li X, Li Y, Chen Y. Does depression affect the association between prosocial behavior and anxiety? A cross-sectional study of students in China. Front Public Health. 2023;11:1274253. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Yamada M, Tanaka K, Arakawa M, Miyake Y. Perinatal maternal depressive symptoms and risk of behavioral problems at five years. Pediatr Res. 2022;92(1):315–21. [DOI] [PubMed] [Google Scholar]
- 23.Du Y, Kou J, Coghill D. The validity, reliability and normative scores of the parent, teacher and self report versions of the strengths and difficulties questionnaire in China. Child Adolesc Psychiatry Ment Health. 2008;2(1):8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Fang J, Cheng W, Li H, Yang C, Zhang N, Zhang B, Zhang Y, Zhang M. Social isolation mediates association between depressive symptoms and cognitive function: evidence from China health and retirement longitudinal study. J Affect Disord. 2025;388:119465. [DOI] [PubMed] [Google Scholar]
- 25.Li H, Zheng D, Li Z, Wu Z, Feng W, Cao X, Wang J, Gao Q, Li X, Wang W, et al. Association of depressive symptoms with incident cardiovascular diseases in Middle-Aged and older Chinese adults. JAMA Netw Open. 2019;2(12):e1916591. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26.Park SH, Yu HY. How useful is the center for epidemiologic studies depression scale in screening for depression in adults? An updated systematic review and meta-analysis(). Psychiatry Res. 2021;302:114037. [DOI] [PubMed] [Google Scholar]
- 27.Park S-H, Lee H. Is the center for epidemiologic studies depression scale as useful as the geriatric depression scale in screening for late-life depression? A systematic review. J Affect Disord. 2021;292:454–63. [DOI] [PubMed] [Google Scholar]
- 28.Pelham WE, West SG, Lemery-Chalfant K, Goodman SH, Wilson MN, Dishion TJ, Shaw DS. Depression in mothers and the externalizing and internalizing behavior of children: an attempt to go beyond association. J Abnorm Psychol. 2021;130(1):60–77. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 29.Becht AI, Prinzie P, Deković M, van den Akker AL, Shiner RL. Child personality facets and overreactive parenting as predictors of aggression and rule-breaking trajectories from childhood to adolescence. Dev Psychopathol. 2016;28(2):399–413. [DOI] [PubMed] [Google Scholar]
- 30.Xu B, Wu Q, La R, Lu L, Abdu FA, Yin G, Zhang W, Ding W, Ling Y, He Z, et al. Is systemic inflammation a missing link between cardiometabolic index with mortality? Evidence from a large population-based study. Cardiovasc Diabetol. 2024;23(1):212. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 31.Imai K, Keele L, Tingley D. A general approach to causal mediation analysis. Psychol Methods. 2010;15(4):309–34. [DOI] [PubMed] [Google Scholar]
- 32.Klemp MT, Dose C, Hautmann C, Jendreizik LT, Mühlenmeister J, Plück J, Wähnke L, Döpfner M. Parenting behaviors as mediators of the association between parental internalizing symptoms and child externalizing symptoms. Child Psychiatry Hum Dev. 2024;55(4):916–28. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 33.Longobardi C, Lin S, Fabris MA. Daytime sleepiness and prosocial behaviors in kindergarten: the mediating role of Student-Teacher relationships quality. Front Educ. 2022;7:710557.
- 34.Hayes AF. Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. Second ed. New York, NY: Guilford Press; 2018. [Google Scholar]
- 35.Maxwell SE, Cole DA, Mitchell MA. Bias in Cross-Sectional analyses of longitudinal mediation: partial and complete mediation under an autoregressive model. Multivar Behav Res. 2011;46(5):816–41. [DOI] [PubMed] [Google Scholar]
- 36.Fritz MS, Mackinnon DP. Required sample size to detect the mediated effect. Psychol Sci. 2007;18(3):233–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 37.Chang L, Chen X, Lian C. The association between the non-HDL-cholesterol to HDL-cholesterol ratio and 28-day mortality in sepsis patients: a cohort study. Sci Rep. 2022;12(1):3476. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 38.Koblinsky SA, Kuvalanka KA, Randolph SM. Social skills and behavior problems of urban, African American preschoolers: role of parenting practices, family conflict, and maternal depression. Am J Orthopsychiatry. 2006;76(4):554–63. [DOI] [PubMed] [Google Scholar]
- 39.Suzuki K, Kita Y, Kaga M, Takehara K, Misago C, Inagaki M. The association between children’s behavior and parenting of caregivers: A longitudinal study in Japan. Front Public Health. 2016;4:17. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 40.Li W, Huebner ES, Tian L. Maternal depressive symptoms, parental warmth, and adolescent prosocial behavior: disentangling within- and between-family effects. J Affect Disord. 2025;385:119416. [DOI] [PubMed] [Google Scholar]
- 41.Liu X, Yang C, Yang Y, Huang X, Wang Y, Gao Y, Song Q, Wang Y, Zhou H. Maternal depressive symptoms and early childhood development: the role of mother-child interactions among mother-child dyads in rural areas of central and Western China. PeerJ. 2021;9:e11060. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 42.Ma G, Li M, Shi H, Tan C, Zhao C, Dou Y, Duan X, Wang X, Zhang J. Early stimulation and responsive care: A mediator of caregivers’ depression on the suspected developmental delay of left-behind children in China. J Affect Disord. 2023;341:88–95. [DOI] [PubMed] [Google Scholar]
- 43.Selman SB, Gurel BF, Dilworth-Bart JE. Sleep matters: attentional and behavioral outcomes among preschool age children of mothers with depression. J Child Fam Stud. 2025;34(9):2432–43. [Google Scholar]
- 44.Taraban L, Shaw DS, Leve LD, Wilson MN, Dishion TJ, Natsuaki MN, Neiderhiser JM, Reiss D. Maternal depression and parenting in early childhood: contextual influence of marital quality and social support in two samples. Dev Psychol. 2017;53(3):436–49. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 45.Tuovinen S, Lahti-Pulkkinen M, Girchenko P, Lipsanen J, Lahti J, Heinonen K, Reynolds RM, Hämäläinen E, Kajantie E, Laivuori H, et al. Maternal depressive symptoms during and after pregnancy and child developmental milestones. Depress Anxiety. 2018;35(8):732–41. [DOI] [PubMed] [Google Scholar]
- 46.Harris RA, Santos HP. Maternal depression in Latinas and child socioemotional development: A systematic review. PLoS ONE. 2020;15(3):e0230256. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 47.Apter-Levi Y, Pratt M, Vakart A, Feldman M, Zagoory-Sharon O, Feldman R. Maternal depression across the first years of life compromises child psychosocial adjustment; relations to child HPA-axis functioning. Psychoneuroendocrinology. 2016;64:47–56. [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.