Parental Aggravation and Adverse Childhood Experiences as Influential Factors in Adolescent Depression and Anxiety

Abstract

This study uses the National Survey of Children’s Health to examine the nationwide prevalence and severity of US adolescent mental health issues in the 12–17 age group between the years 2022 and 2023 in relation to parental mental health and exposure to adverse childhood experiences (ACEs). We used the NSCH data collected for 12–17-year-old adolescents. Descriptive statistics were generated for the selected sample and binary logistics regressions were conducted to examine influential factors for the presence and severity of adolescent depression and anxiety for the selected year. Adolescents aged 12–17 who experienced neighborhood violence had higher odds of being diagnosed with anxiety (OR = 1.369, p = 0.009) and depression (OR = 1.508, p = 0.004). Those living with someone who was mentally ill, suicidal, or severely depressed showed increased odds of anxiety (OR = 1.642, p < 0.001) and depression (OR = 1.587, p < 0.001). Adolescents judged unfairly due to a health condition or disability had markedly higher odds of anxiety (OR = 3.056, p < 0.001) and depression (OR = 1.835, p < 0.001), including severe forms (severe anxiety OR = 2.569; severe depression OR = 2.238; both p < 0.001). Poorer parental emotional health was consistently associated with higher adolescent anxiety and depression, with “fair” parental emotional health showing the strongest association for depression (OR = 7.320, p < 0.001). These findings demonstrate the need for better tailored mental health efforts towards both adolescents and their caregivers highlighting the harm of long-term environmental and familial stressors, and the gaps in community approaches in this population.

1. Introduction

Adverse childhood experiences (ACE) are defined as preventable and potentially traumatic events experienced by individuals less than 18 years old (Swedo, 2023). The main categories of the ACE questionnaire focus on assessing abuse, neglect, and household dysfunction (Chapman et al., 2007). These experiences are further divided into different types of abuse, such as physical, verbal or sexual abuse, and different types of neglect including physical and emotional neglect, while the household dysfunction category screens for parental conflict, mental illness, substance use, and incarcerated household members (Chapman et al., 2007). Some children can manifest symptoms of ACE, which include challenges in school, changes in mood, and difficulties in their relationships (Webster, 2022). The more adverse childhood experiences someone has, the more at risk they become for unfavorable health outcomes (Merrick et al., 2019). Experiencing ACEs in children is common, with females, non-Hispanic American Indian or Alaska Natives and non-Hispanic multiracial individuals ranking highest in terms of disclosing ACEs (Swedo, 2023). ACEs are associated with numerous negative outcomes such as poorer health outcomes, health risk behaviors, and socioeconomic challenges (Merrick et al., 2019). Not only do children experience negative consequences during childhood, but prolonged social, mental, and health consequences also affect them in adulthood. Some of these adverse health outcomes include depression, alcoholism, smoking, heart disease, suicide, unintended pregnancies, sexually transmitted infections, and cancer (Ramiro et al., 2010).

One of the major risk factors for experiencing ACEs in high-risk children is parental aggravation (Suh & Luthar, 2020). Some manifestations of parental aggravation include verbal abuse, physical abuse, poor mental health, and divorced parents’ households (Suh & Luthar, 2020). Some ACEs are experienced more than others, with more than a fifth of participants in one study experiencing parental divorce/separation as the leading ACE (Suh & Luthar, 2020). Impact of parental aggravation on adverse health outcomes were considerably larger than the influential roles of ACEs, affecting challenges children may face such as difficulties managing problems and regulating their emotions, in addition to longitudinal risk of morbidities and mortalities in the stages of adulthood (Suh & Luthar, 2020; Felitti et al., 1998).

Moreover, depression and anxiety are growing public health concerns among U.S. adolescents (Ghandour et al., 2019; Xiang et al., 2024; Daly, 2022; Jones et al., 2021). Depression is characterized by episodes of symptoms such as persistent sadness, lack of interest, and suicidal ideation (Zuckerbrot et al., 2018). Anxiety, on the other hand, involves excessive worry or fear that may interfere with daily life (Walter et al., 2020). National data from 2021 to 2022 showed that 4% and 10% of children and adolescents in the U.S. had diagnosed depression or anxiety, respectively (Xiang et al., 2024). Notably, increases in depression prevalence and incidence was highest among ages 14–22 years, females, and higher household income (Xiang et al., 2024). Similarly, anxiety prevalence and incidence increased, but was highest among ages 18–22 years, females, and non-Hispanic Whites (Xiang et al., 2024). ACE exposure is associated with significantly higher rates of depression and anxiety in adolescence, with these effects often extending into adulthood (Wang et al., 2021; Bomysoad & Francis, 2020; Yang et al., 2023). U.S. surveillance data found that 63.9% of adults reported at least one ACE, and 17.3% reported four or more (Jones et al., 2021). Parental aggravation, reflected in maltreatment (abuse and neglect) and family dysfunction (parental separation, mental health issues, domestic violence, etc.) was found to contribute to increased risks for poor mental health outcomes among adolescents (Daly, 2022; Wang et al., 2021). Notably, maltreatment ACEs were associated with increased risk for anxiety only, while family dysfunction contributed to both anxiety and depression (Wang et al., 2021). Additionally, socioeconomic disadvantage has been shown to contribute to poorer parental and child physical and mental health, with parental depression also being a key risk factor for youth mental health issues such as depression (Treanor & Troncoso, 2023). Social determinants of mental health (SDMH)—such as poverty/income inequality, ACEs, food insecurity, and discrimination—further exacerbate risk for depression and anxiety (Yang et al., 2023).

To reduce the impact of parental aggravation and Adverse Childhood Experiences (ACEs) on adolescent well-being in the U.S., a range of interventions and policies targeting both prevention and mitigation have been used. Public health initiatives and research aimed at determining and preventing the etiological factors contributing to ACEs have already been undertaken, and further work should be done focusing on social determinants of health (Treanor & Troncoso, 2023; Kim et al., 2025; Kingsbury et al., 2020). Despite these advancements, many gaps remain in accessing needed care.

Our study aimed to explore associations between parental aggravation and adverse childhood experiences as influential factors for depression and anxiety in US adolescents aged 12–17 years old. Our findings will aid in the identification of areas of concern in parental emotional and mental stability leading to exacerbated rates of adolescent depression and anxiety in the United States.

2. Methods

The National Survey of Children’s Health (NSCH) is a household survey administered by the U.S. Census Bureau that provides data on the physical and mental health of children aged 0–17 years living in the household, as well as their access to quality healthcare, and information about the child’s family, neighborhood, and social context (Data Resource Center for Child and Adolescent Health, 2016). The NSCH requires households to complete a pre-survey screener used to identify whether children are present in the household and to list those children, followed by a series of questions designed to identify children with special health care needs. From each eligible household, one child was randomly chosen to be the focus of a more in-depth topical questionnaire, completed by a guardian or adult familiar with the child’s health. For our study, we used compiled NSCH data for 12–17-year-old adolescents for the years 2022–2023 (n = 18,397). The overall survey response rate for each study year was 39.1% (2022) and 35.8% (2023). This study specifically concentrated on adolescents aged 12 to 17, as we found this group to demonstrate a significantly higher prevalence of depression and anxiety symptoms compared to younger children (ages 3 to 5 and 6 to 11) (Viswanathan et al., 2022; Juul et al., 2021). Focusing on this age group enables a more targeted examination of how parental and environmental adverse events contribute to the disproportionate prevalence of anxiety and depression amongst adolescents (Chapman et al., 2007; Webster, 2022). This paper was deemed exempt from the Florida Atlantic University IRB review because it consists of secondary data analysis from a public database.

2.1. Outcome Variables

All our outcome measures were derived from survey items in which parents or guardians reported whether their child had ever received a diagnosis for two specific adolescent mental health conditions. We analyzed two outcome variables measuring the prevalence of two mental health disorders (anxiety and depression) for adolescents aged 12–17 years old. Responses for each of the variables were collected based on the three questions evaluating each of the diagnosis of a mental health disorder, the current status of a mental health disorder, and their severity levels, if any, for adolescents aged 12–17 years old: (1) “Has a doctor or other health care provider EVER told you that this child has…” for anxiety and depression, followed by “If YES to any of the items, does this child CURRENTLY have these problems?” for presence of current diagnosis, and “Is it Mild, Moderate, or Severe?” for severity of the condition. For the outcome variables, the answers were coded as follows: “yes” = 1, “no” = 2, and logical skip and all other responses = systems missing. Severity was recoded into a new binary variable: “not severe” = 1 if the parents responded “mild” or “moderate”, and “severe” = 2 if the parents responded “severe.”

2.2. Independent Variables

For the caregiver mental/emotional health independent variable, the answers were coded: “excellent” = 1, “very good” = 2, “good” = 3, “fair” = 4, and “poor” = 5 (with “excellent” mental or emotional health serving as the reference status). For the adverse childhood experiences variable with 9 sub-categories (parents or guardians divorced, parent died, parent spent time in prison, witnessed parent/adult hit one another in the home, witnessed violence in neighborhood, lived with anyone who was mentally ill, lived with anyone with alcohol or drug problems, treated unfairly due to race or ethnicity, treated unfairly due to health or disability), all were measured as binary categorical variables coded as “yes” = 1 and “no” = 2.

2.3. Covariates

Social determinants of health, including parental ability to afford the child’s medical care and food, housing stability, parental education level, and current employment status, were included as covariates in the series of binary regression analyses conducted.

2.4. Data Analysis

Data analysis was carried out with IBM SPSS Statistics (version 30). First, we selected responses for children between 12 and 17 years old, inclusive. We generated summary statistics for the selected sample by frequencies and counts for each of the dependent and independent variables for the 2022–2023 timeframe. We then ran binary logistic regressions for each mental health current status variable (anxiety and depression) and each of caregiver mental and emotional health and exposure to adverse childhood experiences variables. We also ran binary logistic regression variables to examine associations between severity levels of the mental health variables and caregiver mental or emotional health as well as exposure to adverse childhood experiences.

3. Results

Overall, 22.5% (n = 7618) of parental responses indicated a lifetime history of adolescent anxiety, and 20.3% (n = 6856) reported a current anxiety diagnosis in their adolescent child. Severity ratings among adolescents with anxiety showed 9.3% (n = 3156) having moderate symptoms, 8.8% (n = 2994) with mild symptoms, and 2.1% (n = 706) with severe anxiety. Depression was reported in 13.3% (n = 4515) of adolescents overall, with 10.7% (n = 3630) experiencing current depressive symptoms. Similar to anxiety, most depressive symptoms were classified as mild (5.0%, n = 1697) or moderate (4.6%, n = 1554), with fewer adolescents being reported as having severe depression (1.1%, n = 379) (

Table 1. Sample Characteristics of Adolescent Mental Health Status.

Adolescent Mental Health	Count (n)	Frequency (%)
Anxiety (Total)	7618	22.5
Anxiety (currently)	6856	20.3
Mild	2994	8.8
Moderate	3156	9.3
Severe	706	2.1
Depression (Total)	4515	13.3
Depression (currently)	3630	10.7
Mild	1697	5.0
Moderate	1554	4.6
Severe	379	1.1

).

The most frequently reported adverse childhood experiences were parental divorce or separation (29.7%, n = 10,067), living with someone who had an alcohol or drug problem (12.9%, n = 4382), and living with someone who was mentally ill, suicidal, or severely depressed (12.7%, n = 4309). These findings suggest that a substantial proportion of adolescents in the sample are exposed to household stressors that are well-established risk factors for developing emotional difficulties and mental health issues during adolescence and beyond. Caregiver-reported mental and emotional wellbeing tended to skew positively, with the largest share of the sample rating their health as “very good” (40.6%, n = 13,758), followed by “excellent” (28.8%, n = 9746), and “good” (23.8%, n = 8055). Lower ratings were relatively uncommon, with only 6.0% (n = 2041) reporting “fair” and 0.8% (n = 249) reporting “poor” mental and emotional health. With such, while the majority of caregivers reported positive emotional health, the presence of a smaller group experiencing fair or poor mental and emotional health highlights a potential source of added familial stress that could lead to downstream adverse effects on adolescent mental health (

Table 2. Sample Characteristics Regarding Parental Aggravation and Mental and Emotional Health.

Parental Influential Factors	Count (n)	Percentage (%)
Exposure to Adverse Childhood Experiences (n = 30,683)
Divorce or separated	10,067	29.7
Parent or guardian death	1632	4.8
Parent or guardian served time in jail	2455	7.3
Child witness of domestic violence	2165	6.5
Victim of neighborhood violence	1853	5.5
Lived with anyone who was mentally ill, suicidal, or severely depressed	4309	12.7
Lived with anyone with an alcohol or drug problem	4382	12.9
Judged unfairly because of race or ethnic group	2118	6.3
Judged unfairly because of health condition or disability	1702	5.0
Caregiver Mental and Emotional Health (n = 33,849)
Excellent	9746	28.8
Very Good	13,758	40.6
Good	8055	23.8
Fair	2041	6.0
Poor	249	0.8

).

3.1. Bivariate Associations of Exposure to Adverse Childhood Experiences and Reported Adolescent Anxiety and Depression Levels

Binary logistics regression results showed that adolescents aged 12–17 who were victims of neighborhood violence had 1.369 times (95% CI (1.083–1.730), and p = 0.009) the odds of being diagnosed with anxiety and 1.508 times (95% CI (1.140–1.994), and p = 0.004) the odds of being diagnosed with depression compared to adolescents who were not exposed to this type of ACE.

Similarly, adolescents who lived with anyone who had a mental illness, was suicidal, or severely depressed (OR = 1.642, 95% CI (1.364–1.978), and p ≤ 0.001) as well as those who were judged unfairly because of health condition or disability (OR = 3.056, 95% CI (2.552–3.659), and p ≤ 0.001) had significantly higher odds of reporting being diagnosed with anxiety compared to adolescents living with parents who had no mental illness and were not judged because of a health issue. Additionally, adolescence who lived with anyone who was mentally ill, suicidal, or severely depressed and those who were judged unfairly because of health condition or disability also had 1.587 (CI 95% (1.246–2.022) and p ≤ 0.001) and 1.835 (CI 95% (1.437–2.344) and p ≤ 0.001) higher odds of being diagnosed with depression compared to adolescents who were not exposed to similar ACEs. All other associations were not significant (

Table 3. Bivariate Association of Exposure to Adverse Childhood Experiences and Reported Adolescent Anxiety and Depression Levels.

Exposure to Adverse Childhood Experiences	Adolescent Mental Health
	Anxiety					Depression
	Yes	No	OR	95% CI	p-Value	Yes	No	OR	95%	p-Value
None	Ref	Ref	Ref	Ref	Ref	Ref	Ref	Ref	Ref	Ref
Divorce or separated	2917	277	1.106	0.924–1.323	0.273	1836	393	1.000	0.785–1.273	0.997
Parent or gradian death	471	43	1.150	0.854–1.549	0.358	343	78	0.885	0.608–1.288	0.524
Parent or guardian served time in jail	858	74	0.930	0.717–1.206	0.582	631	115	1.176	0.869–1.590	0.293
Child witness of domestic Violence	891	71	1.049	0.807–1.365	0.719	656	105	0.884	0.643–1.215	0.448
Victim of neighborhood violence	865	63	1.369	1.083–1.730	0.009	668	107	1.508	1.140–1.994	0.004
Lived with anyone who was mentally ill, suicidal, or severely depressed	2019	139	1.642	1.364–1.978	<0.001	1408	230	1.587	1.246–2.022	<0.001
Lived with anyone with an alcohol or drug problem	1683	144	0.973	0.784–1.207	0.804	1173	206	1.251	0.956–1.638	0.103
Judged unfairly Because of race or ethnic group	631	69	1.209	0.946–1.547	0.130	415	99	1.197	0.877–1.633	0.257
Judged unfairly because of health condition or disability	1076	47	3.056	2.552–3.659	<0.001	708	78	1.835	1.437–2.344	<0.001

Note: Bold indicates p < 0.05.

).

3.2. Bivariate Association of Exposure to Adverse Childhood Experiences and Reported Adolescent Anxiety and Depression Severity Levels

A second set of binary logistic regression examining associations between exposure to ACEs and reported adolescent and depression severity levels showed that adolescents aged 12–17 who lived with anyone who was mentally ill, suicidal, or severely depressed had 1.552 times (CI 95% (1.253–1.923) and p ≤ 0.001) the odds of being diagnosed with severe anxiety and 1.444 times (CI 95% (1.200–1.737) and p ≤ 0.001) the odds of being diagnosed with severe depression compared to those who did not experience those conditions. Moreover, adolescents who were judged unfairly because of a health condition or disability had 2.569 times (CI 95% (1.876–3.517) and p ≤ 0.001) the odds of being diagnosed with severe anxiety and 2.238 times higher odds (CI 95% (1.726–2.900) and p ≤ 0.001) of being diagnosed with severe depression compared to those who did not experience similar ACEs. All other associations were not significant (

Table 4. Bivariate Association of Exposure to Adverse Childhood Experiences and Reported Adolescent Anxiety and Depression Severity Levels.

Exposure to Adverse Childhood Experiences	Adolescent Mental Health
	Anxiety					Depression
	Severe	Non-Severe	OR	95%	p Value	Severe	Non-Severe	OR	95%	p Value
None	Ref	Ref	Ref	Ref	Ref	Ref	Ref	Ref	Ref	Ref
Divorce or Separated	366	2538	1.151	0.968–1.369	0.112	219	1612	1.031	0.876–1.214	0.712
Parent or gradian death	65	400	0.904	0.644–1.270	0.561	38	303	1.052	0.799–1.385	0.716
Parent or guardian served time in Jail	123	728	0.963	0.716–1.295	0.803	96	530	0.954	0.742–1.226	0.713
Child witness of domestic Violence	145	739	1.042	0.760–1.430	0.797	99	553	1.185	0.904–1.555	0.220
Victim of neighborhood violence	161	699	1.115	0.822–1.512	0.483	120	545	1.166	0.909–1.496	0.226
Lived with anyone who was mentally ill, suicidal, or severely depressed	331	1677	1.552	1.253–1.923	<0.001	211	1191	1.444	1.200–1.737	<0.001
Lived with anyone with an alcohol or drug problem	236	1436	1.034	0.820–1.303	0.778	62	351	1.191	0.967–1.466	0.101
Judged unfairly Because of race or ethnic group	523	5889	0.790	0.601–1.037	0.090	171	995	0.781	0.610–1.000	0.050
Judged unfairly because of health condition or disability	260	810	2.569	1.876–3.517	<0.001	129	574	2.238	1.726–2.900	<0.001

Note: Bold indicates p < 0.05.

).

3.3. Bivariate Association of Parental Emotional Health and Reported Adolescent Anxiety and Depression Levels

A third set of binary logistic regression examining associations between parental emotional health and reported adolescent and depression levels showed that parents who reported “very good” emotional health had 1.738 times (CI 95% (1.411–2.140), and p ≤ 0.001) the odds of having an adolescent report being diagnosed with anxiety and 2.095 times (CI 95% (1.702–2.580), and p ≤ 0.001) the odds of reporting an adolescent diagnosed with depression compared to parents who reported having “excellent” emotional health. Additionally, parents who reported having “good” (OR = 3.132, CI 95% (2.249–4.362), and p ≤ 0.001), “fair” (OR = 4.333, CI 95% (1.749–10.737), and p = 0.002), or “poor” emotional health (OR = 2.059, CI 95% (1.225–3.461), and p = 0.006) all had higher odds of reporting their adolescent being diagnosed with anxiety compared to parents who reported “excellent” emotional health. Similarly, parents who report having “good” (OR = 3.788, CI 95% (2.806–5.113), and p ≤ 0.001), “fair” (OR= 7.320, CI 95% (3.159–16.963), and p ≤ 0.001), or “poor” emotional health (OR = 1.685, CI 95% (1.104–2.573), and p = 0.016) had higher odds of reporting an adolescent being diagnosed with depression compared to parents who reported having “excellent” emotional health (

Table 5. Bivariate Association of Parental Emotional Health and Reported Adolescent Anxiety and Depression Levels.

Parental Emotional Health	Adolescent Mental Health
	Anxiety					Depression
	Yes	No	OR	95%	p Value	Yes	No	OR	95%	p Value
Excellent	Ref	Ref	Ref	Ref	Ref	Ref	Ref	Ref	Ref	Ref
Very Good	2719	355	1.738	1.411–2.140	<0.001	1302	378	2.095	1.702–2.580	<0.001
Good	2450	235	3.132	2.249–4.362	<0.001	1460	303	3.788	2.806–5.113	<0.001
Fair	902	48	4.333	1.749–10.737	0.002	601	69	7.320	3.159–16.963	<0.001
Poor	130	5	2.059	1.225–3.461	0.006	101	6	1.685	1.104–2.573	0.016

Note: Bold indicates p < 0.05.

).

3.4. Bivariate Association of Parental Emotional Health and Reported Adolescent Anxiety and Depression Severity Levels

A final set of binary logistic regression examining associations between parental emotional health and reported adolescent and depression severity levels showed that parents who reported “very good” parental emotional health had 1.572 times (CI 95% (1.216–2.031), and p ≤ 0.001) the odds of reporting an adolescent diagnosed with severe anxiety compared to parents who reported “excellent” emotional health. Moreover, parents who reported “good” (OR = 2.405, CI 95% (1.809–3.199), and p ≤ 0.001) or “fair” emotional health (OR = 3.541, CI 95% (2.222–5.644), and p ≤ 0.001) had higher odds of reporting an adolescent diagnosed with severe anxiety compared to parents who reported “excellent” emotional health. Similarly, parents who reported having “good” (OR = 2.111, CI 95% (1.399–3.185), and p ≤ 0.001) or “fair” emotional health (OR = 3.919, CI 95% (2.220–6.920), and p ≤ 0.001) had higher odds of reporting an adolescent diagnosed with severe depression compared to parents who had “excellent” emotional health. All other findings were not significant (

Table 6. Bivariate Association of Parental Emotional Health and Reported Adolescent Anxiety and Depression Severity Levels.

Parental Emotional Health	Adolescent Mental Health
	Anxiety					Depression
	Severe	Non-Severe	OR	95%	p Values	Severe	Non-Severe	OR	95%	p-Values
Excellent	Ref	Ref	Ref	Ref	Ref	Ref	Ref	Ref	Ref	Ref
Very Good	196	2512	1.572	1.216–2.032	<0.001	100	1194	1.404	0.957–2.061	0.083
Good	286	2148	2.405	1.809–3.199	<0.001	153	1298	2.111	1.399–3.185	<0.001
Fair	152	746	3.541	2.222–5.644	<0.001	90	508	3.919	2.220–6.920	<0.001
Poor	30	100	1.548	0.957–2.506	0.075	25	76	1.408	0.720–2.753	0.317

Note: Bold indicates p < 0.05.

).

4. Discussion

The present study seeks to investigate how parental aggravation and adverse childhood experiences impact depression and anxiety in US adolescents aged 12–17 years old. Our findings emphasized the key underlying issues in parental emotional and mental stability driving the increasing trends of anxiety and depression among US adolescents.

Research has shown that exposure to adverse childhood experiences and parental aggravation factors (divorce, neighborhood and domestic violence, living with a parent who is mentally ill, and being judged unfairly because of disability) in adolescents aged 12–17 years old exacerbated anxiety and depression rates, as well as worsened severity rates of these two conditions (Zare et al., 2018). A cross-sectional study found that children exposed to four or more ACEs were more likely to have anxiety and depression compared to those with exposure to less than four ACEs (Elmore & Crouch, 2020). Furthermore, a systematic review highlighted strong evidence of the role of parental factors, such as aversiveness and inter-parental conflict, in increasing the risk for depression and internalizing problems (Yap & Jorm, 2015). Childhood maltreatment was also found to only increase the risk of anxiety in early adulthood (Wang et al., 2021). Moreover, a study demonstrated a strong correlation between lower family economic status and higher number of ACEs experienced by children, as well as how this directly and indirectly contributes to higher levels of anxiety and depression among adolescents (Barnhart et al., 2022). To further explore ACE-associated disparities in mental health outcomes, Matthews et al. adopted a racial and ethnic lens and found that when exposed to at least three ACEs, the risk of developing anxiety and depression was higher for Black and White children compared to other racial and ethnic groups (Matthews et al., 2024).

Such findings highlight the need for more cost-effective strategies and early intervention to reduce the financial burden of mental health issues (Dickson et al., 2020). Low-income families cannot afford the high costs associated with child therapy and adolescent psychiatry. Childhood mental health disorders impose a significant economic burden on children, families, and society. In the United States, outpatient services for youth mental health issues were $2673, with average costs of mental health services ranging from $1079 for psychotherapy, $683 for assessment, $227 for collateral services, $161 for case management, and $186 for medication support (Dickson et al., 2020). However, barriers to receiving adolescent mental health services remain widely prevalent. When a mental illness like depression goes untreated, it tends to worsen, leading to increased productivity losses in the future, which can cause an even larger cost on a family (Dickson et al., 2020). Moreover, child behaviors and emotions develop and change throughout adolescence, making it difficult for their surroundings to detect mental, behavioral, or emotional disorders early (Sturm et al., 2001). About 9% of youth are estimated to need help in managing their emotional health, but over 70% of children and adolescents with mental health disorders go without care (Koppelman, 2004). Research has also shown that families with lower socioeconomic status are directly linked to higher levels of ACEs and higher levels of ACEs are linked to increased internalizing symptoms, which can negatively impact adolescents’ mental health (Barnhart et al., 2022). Hence, families with lower socioeconomic status who are unable to afford clinical mental health help, are more likely to struggle with mental health issues. Internalizing symptoms of ACEs can affect youth outcomes and can lead to adolescents becoming more aggressive and externalizing those feelings without intervention (Barnhart et al., 2022).

Additionally, our study and previous research suggests that worse parental emotional health can exacerbate anxiety and depression rates in adolescents aged 12–17 years old (Reid, 2015; Lent et al., 2024). A study found that children in Florida were about five times more likely to have a mood or anxiety disorder among those living with a parent who reported poor emotional health compared to good emotional health (Reid, 2015). Similarly, nationally the odds are much higher for children to have anxiety when their caregivers reported “fair” or “poor” mental and emotional health (Koppelman, 2004). Our findings highlight a gradient between parental emotional health and adolescent mental health outcomes, where adolescents of parents with less-than-excellent emotional health had higher odds of anxiety and depression, including severe forms (Goodman & Gotlib, 1999; Repetti et al., 2002; Thompson & Goodman, 2016; Amone-P’Olak et al., 2019). Interestingly, even parents who reported “very good” or “good” emotional health showed significantly elevated odds compared to those with “excellent” emotional health (Goodman & Gotlib, 1999). These results suggest that the relationship between parental and adolescent emotional well-being may not be strictly dichotomous, but rather continuous across the full range of parental emotional functioning (excellent–poor) (Goodman & Gotlib, 1999; Repetti et al., 2002). One potential explanation is that subclinical levels of parental stress or emotional strain—even when perceived as “good” or “very good”—may negatively affect parenting behaviors, family communication, and emotional well-being of all members of the household. Prior research has shown that children are highly sensitive to parental emotional cues and stress, which can shape their own affect regulation and coping patterns (Goodman & Gotlib, 1999; Repetti et al., 2002). Thus, parents who experience moderate stress, fatigue, or mild anxiety may still inadvertently model less adaptive coping strategies or emotional responses, contributing to heightened vulnerability in adolescents. The finding that “good” and “very good” emotional health still predict elevated odds of severe adolescent anxiety or depression underscores the complex, interdependent nature of family emotional systems (Thompson & Goodman, 2016). It suggests that optimal (“excellent”) parental emotional functioning may serve as a particularly strong protective factor, rather than simply the absence of distress (Thompson & Goodman, 2016). Finally, “very good” parental emotional health may coexist with other contextual stressors, such as economic strain, time pressures, or limited social support, which can indirectly impact adolescents’ well-being even if the parent self-identifies as emotionally healthy overall (Amone-P’Olak et al., 2019). Future research should further examine this gradient using longitudinal data and multi-informant assessments to capture subtle variations in family emotional dynamics.

Several interventions currently exist for parents including psychological interventions and parenting interventions to improve parenting capacity/relationships which include Cognitive Behavioral Therapy (CBT), Psycho-Social, Parenting Skills and Training, Integrated approaches, and home visits (Barrett et al., 2024). Different approaches work differently for each of the parental factors such as mental health, substance use, and intimate partner violence and abuse (Barrett et al., 2024). While those interventions have been shown effective for parents struggling with mental health, there is a lot of overlap of those interventions which have been effective for adolescents as well. Specifically, CBT has been found to be effective in adolescents, particularly in treatment of depression and anxiety disorders (Karukivi et al., 2021). Another effective method of treatment for mental health illnesses in adolescents include interpersonal therapy for young people (IPT-A), which focuses on linking improving interpersonal functioning to depressive symptoms and therefore improves mood (Karukivi et al., 2021). As our research has shown, it is very common for children with mental illness to live with a caregiver who also struggles with a mental disorder (Yoder et al., 2024). This in turn led to comprehensive family-centered interventions, also known as family-based treatment (FBT), involving both children and parents alike (Yoder et al., 2024). This type of treatment also focuses on individual and group CBT with the members of the family in combination with medication management, which has been effective for both anxiety and depression (Yoder et al., 2024). Due to cost restrictions, some of these resources can be hard to obtain, but community-based approaches have been found to address mental health. Specifically youth-focused programs and informal counseling were effective with underserved populations (Goodman & Gotlib, 1999). As different cultures value eclectic social norms and cultural beliefs, a community-based approach is particularly important as components can be culturally tailored towards what the individual needs in a way that is respectful of their beliefs (Goodman & Gotlib, 1999). Finally, ensuring sustainable resources to support parental mental health longitudinally is a necessity to prevent worsening of diagnosed mental health disorders and provide needed help to address newly emerging adverse outcomes affecting both parental and child well-being (Barrett et al., 2024; Goodman & Gotlib, 1999).

5. Limitations

This study is subject to several limitations. First, the data rely on self-reported information from parents or caregivers, which may be influenced by recall bias, social desirability bias, or misinterpretation of survey questions. These factors can impact the accuracy of reports, especially regarding the subjective nature of mental health diagnoses in adolescents. Second, the NSCH uses an address-based sampling methodology, thereby excluding non-housed populations such as homeless families or those without stable mailing addresses. This exclusion likely results in the underrepresentation of highly vulnerable groups who may experience greater health-related challenges, particularly that the response rate reported was less than 40% for both 2022 and 2023. Future efforts in the annual dissemination of the NSCH survey should involve more rigorous recruitment strategies, effective follow-up methods, enhanced incentive options, and adequate statistical adjustment to address non-response. Third, the NSCH does not incorporate clinical evaluations or medical record verification; all diagnoses of depression, anxiety, and other health conditions are based on caregiver reports of provider-diagnosed conditions, which may not meet standardized clinical criteria. Lastly, the cross-sectional design of the NSCH captures data at a single point in time, limiting the ability to infer causal relationships or observe changes and trends in adolescent mental health over time. Future longitudinal studies should be conducted to address the limitations of this study and provide a more in-depth avenue for the interpretation of findings related to caregiver emotional and mental health, early exposure to ACEs, and adolescent depression and anxiety levels.

6. Conclusions

In summary, this study examined the associations between parental aggravation, adverse childhood experiences, and adolescent depression and anxiety using nationally representative data from the NSCH. Our findings revealed that adolescents exposed to higher levels of parental aggravation and ACEs (including domestic and neighborhood violence, parental mental illness, and perceived discrimination) are more likely to report both increased prevalence and severity of depression and anxiety. Furthermore, caregiver emotional well-being was found to be a significant predictor, with adolescents of caregivers reporting fair or poor emotional health experiencing worsened mental health outcomes. These results underscore the need for holistic, family-centered public health strategies that address both adolescent and caregiver mental health. To mitigate the rising burden of adolescent mental illness, future interventions must be evidence-based, culturally tailored, and inclusive of vulnerable populations. By enhancing community mental health resources and increasing awareness of the long-term impact of familial and environmental stressors, we can better support youth mental health and build more resilient future generations.