Yating Qi,1,2 Jiayue Qiu,2,3 Yunyi Zhang,2,4 Yaoyao Shi,2,5 Chenjia Xie,1,2 JingXuan Zhou,1,2 Youjia Wu,2,6 Yuexia Gao1,2 

1Department of Health Management, School of Public Health, Nantong University, Nantong, People’s Republic of China; 2Institute for Health Development, Nantong University, Nantong, People’s Republic of China; 3Department of Bioengineering, Imperial College London, London, UK; 4Public Health College, Harbin Medical University, Harbin, People’s Republic of China; 5School of Environment, Education and Development, University of Manchester, Manchester, UK; 6Department of Pediatrics, Affiliated Hospital of Nantong University, Nantong, People’s Republic of China

Correspondence: Yuexia Gao, Department of Health Management, School of Public Health, Nantong University, 9 Seyuan Road, Nantong, Jiangsu, 226019, People’s Republic of China, Email yxgao@ntu.edu.cn

Purpose: The implementation of the three-child policy brings about changes to family structures and resource distributions. However, little research has explored the effects of birth order on adolescent mental health in this context. This study aims to bridge the gap by investigating the relationship between birth order and mental health and discovering the underlying factors.
Patients and Methods: In this cross-sectional study, 3581 adolescents from 42 schools across 17 cities in China were recruited. Data on mental health (the adapted Chinese version of the Strengths and Difficulties Questionnaire, SDQ), parenting styles (the Parenting Styles Scale), birth order, duration of parental company, and demographic characteristics were assessed. Hierarchical multiple regression analysis analyzes the relationships among these factors.
Results: Compared with only-child adolescents, first-borns had higher scores of total SDQ (β= 0.74, p< 0.01), emotional symptoms (β= 0.22, p< 0.05), conduct symptoms (β= 0.18, p< 0.01), and peer relationship symptoms (β= 0.29, p< 0.001). They experienced less emotionally warm (β= − 0.54, p< 0.001) and trust-encouraged (β= − 0.34, p< 0.01) parenting styles, with shorter durations of parental company (β= − 0.26, p< 0.001). Middle-born adolescents had higher peer relationship symptoms scores and more neglectful parenting styles. Last-born adolescents were more likely to receive spoiled parenting styles.
Conclusion: This study elucidates the effects of birth order on adolescent mental health in the three-child policy era, revealing that parenting styles vary by birth order. First-borns may experience suboptimal parenting styles and shorter parental company, increasing mental health risks. Middle-borns may encounter neglectful parenting styles, while last-borns experience spoiled parenting styles. These findings emphasize the need for tailored support from parents and schools to address each child’s unique needs and foster better psychological development. Limitations include reliance on self-reported data and the cross-sectional design that restricts causal inference. Future research should adopt longitudinal designs and explore cultural and regional variations.

Keywords: birth order, parenting style, adolescent mental health, duration of parental company, Chinese adolescents