The path of depression in rural children: A fuzzy-set qualitative comparative analysis across multiple provinces in China

Objectives: This study explores the combinations of conditional variables contributing to depressive symptoms in rural children. Methods: We analyzed data from 715 children from a rural mental health database, conducting detailed follow-up investigations on 129 children in Zhejiang and Henan provinces. We used fuzzy set Qualitative Comparative Analysis (fsQCA) and regression analysis to identify causal pathways leading to depression. Results: The results indicate that depression in rural children does not stem from a single, necessary condition but arises from multiple factors. Our findings highlight significant contributions from both maternal and paternal involvement. Specifically, maternal involvement, combined synergistically with peer support and problematic behaviors, as well as paternal involvement, together with peer support and anxiety, significantly affects depressive outcomes. Additionally, anxiety and strong peer relationships independently have a substantial impact on these outcomes. Effective mitigation strategies involve active parental engagement and robust peer support, reducing the influence of risk factors such as problematic behaviors and anxiety. Limitations: The generalizability of the results is limited by cultural and geographical variations. The study also does not account for all potential factors influencing depression in rural children. Conclusion: Depression in rural children results from multiple interacting factors. Tailored interventions addressing these specific combinations are recommended.