The road home: intimacy with parents, trust, and depression

Depression, characterized by persistent sadness, anhedonia, and cognitive/physical symptoms, has risen substantially worldwide (e.g., 172 million in 1990 to 258 million in 2017). In China, age-standardized prevalence increased from 3224.6 to 3990.5 per 100,000, and DALY rates rose from 525.1 to 607.4 per 100,000 from 1990 to 2017, indicating a growing and more debilitating burden. Beyond biological factors, psychosocial determinants, including early relational experiences, are pivotal in depression’s genesis and trajectory. Prior work suggests that secure intimacy with parents and trustful relationships can protect against depression. Yet, a cohesive framework explaining how intimacy with parents and various forms of trust jointly influence depression—especially under modernization that blends Western and Eastern sociocultural norms—remains underdeveloped. In China’s context of rapid modernization alongside enduring Confucian values emphasizing family harmony and social stability, examining how intimacy with parents and trust relate to depression is particularly salient. Despite pressures toward individualism and mobility, traditional family-centered values remain influential, suggesting that strong familial and community ties can buffer mental health stressors during social transition.

Attachment theory (Bowlby, Ainsworth) posits that secure early caregiver bonds foster a sense of safety, trust, and positive self-concept, supporting emotional regulation and adaptability, while insecure attachment may contribute to distrust and depressive symptoms. Intimacy with parents supplies emotional support that helps manage stress and curb negative affect, fostering traits like self-esteem, self-efficacy, and optimism that guard against depression. Secure attachment tends to generalize to openness and trust in broader relationships (e.g., neighbors, friends), expanding supportive networks. The family serves as core infrastructure for building social trust and social capital, yet much prior work focuses on children/adolescents, leaving a gap on adults’ continuing reliance on familial intimacy. Modernization recalibrates family interactions, potentially eroding traditional bonds and transforming intimacy with parents, challenging classic attachment assumptions. Nonetheless, as societies fragment and uncertainty rises, personal relationships may become even more crucial. Modern stressors (social isolation, economic strain, information overload) can amplify depression, and attachment-informed intimacy and trust can mitigate these stressors. Despite narratives of family decline through individualism, families still play vital protective roles; however, how these protections function amid modern complexity warrants closer examination and adaptation of mental health strategies.

Data: The study uses the 2018 and 2020 waves of the China Family Panel Studies (CFPS), a nationally representative longitudinal survey covering 25 mainland provinces/regions with multi-stage probability sampling and CAPI-based data collection. Sample: Participants were matched across 2018 and 2020 using unique IDs. The independent variable (intimacy with parents) is from 2018; dependent, mediators, and controls are from 2020. Exclusions included recent parental death cases and incomplete/inapplicable responses, resulting in a final analytic sample of 3048 individuals who participated in both waves with complete data. Measures: Independent variable—Intimacy with parents measured via an adapted RRP10 (Denollet et al., 2007) using two CFPS items (one per parent), each rated 1–5 over the past six months; summed score ranges 2–10 (higher indicates greater intimacy). Dependent variable—Depression assessed with the 8-item CES-D (Radloff, 1977) in 2020; items rated 1–4 by frequency in the past week; summed with Cronbach’s alpha = 0.76 (higher indicates more severe symptoms). Mediators—Interpersonal trust based on Rotter’s approach: trust in parents, neighbors, strangers, local government officials, and physicians, each rated 0–10 (higher indicates greater trust). Controls—Sex, age, marital status (unmarried/married/cohabitating/divorced/widowed), self-rated health (1–5), smoking, alcohol use, education (1–9), household registration (rural/urban), employment status (unemployed/employed/out of labor force), annual income, income self-assessment (1–5), and frequency of exercise. Analytical strategy: Using Stata 16.0, the study proceeded in five stages: descriptive analysis; Spearman correlations; ordered logistic (ologit) regression of depression on intimacy with parents and controls; structural equation modeling (SEM) to assess direct and indirect (mediated by trust dimensions) effects; and robustness checks separating intimacy with father and intimacy with mother. Statistical significance was set at p < 0.05.

Descriptive statistics (N=3048): Intimacy with parents mean 8.57 (SD 1.38; range 2–10). Depression mean 13.28 (SD 3.63; range 8–32). Trust means: parents 9.56 (SD 1.01), neighbors 6.42 (SD 1.91), strangers 2.97 (SD 2.14), local officials 5.50 (SD 2.28), physicians 7.12 (SD 1.99). Correlations (Spearman): Intimacy with parents correlated negatively with depression (r = -0.15, p < 0.001). Trust in parents, neighbors, local officials, and physicians each correlated negatively with depression (r from -0.11 to -0.19, all p < 0.001). Trust in strangers also correlated negatively but smaller (r = -0.10, p < 0.001) and showed no significant correlation with intimacy with parents or trust in parents. Ordered logistic regression (depression as ordinal outcome): Intimacy with parents coefficient = -0.143 (SE 0.024, t = -6.01, p < 0.001), indicating higher intimacy predicts lower odds of higher depression. Other significant controls: married vs unmarried -0.181 (p = 0.047); divorced 0.455 (p = 0.021); self-rated health -0.418 (p < 0.001); education -0.170 (p < 0.001); income self-assessment -0.170 (p < 0.001). SEM (standardized effects): Direct effect of intimacy with parents on depression = -0.229 (SE 0.046, z = -4.96, p < 0.001). Indirect effects via trust: trust in parents = -0.028 (SE 0.009, z = -3.01, p = 0.003); trust in neighbors = -0.027 (SE 0.007, z = -3.83, p < 0.001); trust in strangers = 0.001 (ns, p = 0.382); trust in local officials = -0.003 (ns, p = 0.211); trust in physicians = -0.006 (marginal, p = 0.079). Robustness checks separating intimacy with father and mother showed similar significant negative direct effects on depression and significant mediation via trust in parents and neighbors.

The findings demonstrate that intimacy with parents continues to protect against depression into adulthood (18–52 years), extending attachment theory’s relevance beyond youth and adolescence. Trust operates in a layered manner: trust closely tied to intimate and proximal relationships (parents and neighbors) significantly mediates the intimacy–depression link, whereas trust in broader or role-based entities (strangers, local officials, physicians) shows minimal or non-significant mediation, likely reflecting the stronger influence of institutional and systemic factors on such trust. In China’s transitional context, trust cultivated in familial settings faces barriers when generalized to wider society, influenced by differential social structures, institutional credibility, and societal skepticism, which may hinder transmission of trust from intimate to generalized spheres. These results underscore the importance of reinforcing family and community bonds as buffers against depression and suggest that interventions should prioritize immediate relational trust rather than relying on generalized or institutional trust to influence mental health outcomes.

Using CFPS 2018–2020 data and a framework integrating attachment theory with modern societal shifts, the study shows that greater intimacy with parents directly reduces depression and that trust in parents and neighbors significantly mediates this relationship. Trust in strangers, local government officials, and physicians did not significantly mediate the effect. The results highlight the centrality of strong familial and community ties for depression mitigation and argue for nuanced consideration of trust types in policy and clinical practice within rapidly modernizing societies.

Key limitations include a relatively young sample due to exclusion of respondents whose parents were deceased and the greater likelihood of younger participants remaining in longitudinal follow-up. Consequently, generalizability to older adults or those experiencing parental loss is limited. Future research should examine broader age ranges, including older cohorts, and explore the psychological impacts of parental absence due to death. Cross-cultural studies are needed to assess how varying social norms shape intimacy with parents, trust formation, and mental health outcomes over the life course.