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已发表论文
家庭动态与儿童抑郁：理论模型及基于依恋关系的干预措施综合述评
Authors Xu YM, Hu CJ, Zhong BL
Received 9 August 2025
Accepted for publication 27 October 2025
Published 4 November 2025 Volume 2025:18 Pages 2259—2272
DOI https://doi.org/10.2147/PRBM.S559551
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Dr Gabriela Topa
Yan-Min Xu,1,2,* Chang-Jie Hu,3,4,* Bao-Liang Zhong1,4
1Department of Psychiatry, Wuhan Mental Health Center, Wuhan, Hubei Province, People’s Republic of China; 2Department of Psychiatry, Wuhan Hospital for Psychotherapy, Wuhan, Hubei Province, People’s Republic of China; 3School of Public Health, Wuhan University of Science and Technology, Wuhan, Hubei Province, People’s Republic of China; 4Collaborative Medical Talent Training and Scientific Innovation Base, Wuhan University of Science and Technology and Wuhan Mental Health Center, Wuhan, Hubei Province, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Bao-Liang Zhong, Department of Psychiatry, Wuhan Mental Health Center, No. 89, Gongnongbing Road, Jiang’an District, Wuhan, Hubei Province, 430012, People’s Republic of China, Email haizhilan@gmail.com
Purpose: Childhood depression is a significant global public health concern, and family dynamics are a primary context for its development. While the link between family life, attachment, and depression is established, the field lacks a coherent framework that systematically integrates the core, measurable dimensions from major family systems theories to explain the specific pathways to depression. This review aims to develop and propose such a framework by synthesizing these foundational theories through the lens of attachment theory.
Patients and Methods: A narrative review of the literature was conducted. Major English- and Chinese-language databases, including PubMed, PsycINFO, and China National Knowledge Infrastructure, were searched for seminal theoretical papers, meta-analyses, and empirical studies on family dynamics, parenting, attachment, and childhood depression published up to August 2025. A narrative synthesis methodology was employed to facilitate theory integration and development.
Results: The proposed integrative framework maps the core dimensions from four foundational models of family systems (Olson, Beavers, McMaster, Skinner)—such as communication, cohesion, affective involvement, and role performance—onto the mechanisms of attachment security. The framework posits that these dimensions of family dynamics collectively shape the quality of the parent-child attachment relationship, which serves as the central mediating pathway to childhood depression. Parental rejection and hostility are identified as particularly potent mechanisms within this pathway. The framework’s utility is illustrated using the case of China’s “left-behind children”, where systemic family disruption predictably elevates depression risk.
Conclusion: Dysfunctional family dynamics contribute to childhood depression primarily by undermining the security of the parent-child attachment bond. This integrative, attachment-centered model provides a robust theoretical foundation for research and clinical practice. It suggests that interventions such as Attachment-Based Family Therapy, which directly target the repair of attachment ruptures, represent a theoretically sound and evidence-informed strategy for preventing and treating childhood depression.
Keywords: family dynamics, childhood depression, attachment theory, parenting, family therapy
1Department of Psychiatry, Wuhan Mental Health Center, Wuhan, Hubei Province, People’s Republic of China; 2Department of Psychiatry, Wuhan Hospital for Psychotherapy, Wuhan, Hubei Province, People’s Republic of China; 3School of Public Health, Wuhan University of Science and Technology, Wuhan, Hubei Province, People’s Republic of China; 4Collaborative Medical Talent Training and Scientific Innovation Base, Wuhan University of Science and Technology and Wuhan Mental Health Center, Wuhan, Hubei Province, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Bao-Liang Zhong, Department of Psychiatry, Wuhan Mental Health Center, No. 89, Gongnongbing Road, Jiang’an District, Wuhan, Hubei Province, 430012, People’s Republic of China, Email haizhilan@gmail.com
Purpose: Childhood depression is a significant global public health concern, and family dynamics are a primary context for its development. While the link between family life, attachment, and depression is established, the field lacks a coherent framework that systematically integrates the core, measurable dimensions from major family systems theories to explain the specific pathways to depression. This review aims to develop and propose such a framework by synthesizing these foundational theories through the lens of attachment theory.
Patients and Methods: A narrative review of the literature was conducted. Major English- and Chinese-language databases, including PubMed, PsycINFO, and China National Knowledge Infrastructure, were searched for seminal theoretical papers, meta-analyses, and empirical studies on family dynamics, parenting, attachment, and childhood depression published up to August 2025. A narrative synthesis methodology was employed to facilitate theory integration and development.
Results: The proposed integrative framework maps the core dimensions from four foundational models of family systems (Olson, Beavers, McMaster, Skinner)—such as communication, cohesion, affective involvement, and role performance—onto the mechanisms of attachment security. The framework posits that these dimensions of family dynamics collectively shape the quality of the parent-child attachment relationship, which serves as the central mediating pathway to childhood depression. Parental rejection and hostility are identified as particularly potent mechanisms within this pathway. The framework’s utility is illustrated using the case of China’s “left-behind children”, where systemic family disruption predictably elevates depression risk.
Conclusion: Dysfunctional family dynamics contribute to childhood depression primarily by undermining the security of the parent-child attachment bond. This integrative, attachment-centered model provides a robust theoretical foundation for research and clinical practice. It suggests that interventions such as Attachment-Based Family Therapy, which directly target the repair of attachment ruptures, represent a theoretically sound and evidence-informed strategy for preventing and treating childhood depression.
Keywords: family dynamics, childhood depression, attachment theory, parenting, family therapy