Mental health across the lifespan

O R I G I N A L P A P E R

Parenting style and mental disorders in a nationally representative sample of US adolescents

John David Eun1 • Diana Paksarian1 • Jian-Ping He1 • Kathleen Ries Merikangas1

Received: 2 March 2017 / Accepted: 16 August 2017 / Published online: 6 November 2017

� Springer-Verlag GmbH Germany (outside the USA) 2017

Abstract

Purpose We examined associations between parenting

style and past-year mental disorders in a nationally repre-

sentative cross-sectional survey of US adolescents and

whether the associations differed by adolescent demo-

graphic characteristics.

Methods The sample included 6483 adolescents aged

13–18 years who were interviewed for a full range of

DSM-IV mental disorders. Parenting style was assessed by

adolescent-reported maternal and paternal care and control

using items from the Parental Bonding Instrument. We

controlled for socio-demographics, parental history of

mental disorders, stressful life events, sexual violence,

inter-parental conflict, and household composition. We

also tested for two-way interactions between parental care

and control and adolescent age, sex, and race/ethnicity.

Results In adjusted models, high maternal care was asso-

ciated with lower odds of depressive, eating, and behav-

ioral disorders, and high maternal control was associated

with greater odds of depressive, anxiety, eating, and

behavioral disorders. High paternal care was associated

with lower odds of social phobia and alcohol abuse/de-

pendence. High paternal control was associated with

greater odds of agoraphobia and alcohol abuse/dependence

but with lower odds of attention-deficit/hyperactivity dis-

order. Associations of maternal and paternal control with

anxiety disorders and substance abuse/dependence differed

by sex. High paternal care was associated with lower odds

of anxiety disorders only among Hispanics and non-His-

panic blacks.

Conclusions Perceived parental care and control were

associated with adolescent mental disorders after control-

ling for multiple potential confounders. Differential pat-

terns of association were found according to adolescent sex

and race/ethnicity. Findings have implications for preven-

tion and intervention programs that incorporate familial

contextual factors.

Keywords Adolescent � Epidemiology � Mental disorders � National Comorbidity Survey � Parenting style

Introduction

Although family history of mental disorders is one of the

most consistent and potent risk factors for mental disorders

in offspring, both familial and non-familial environmental

factors are thought to play a role in etiology [1]. Many

aspects of parenting, ranging from daily interactions to

potentially traumatic experiences such as abuse and inter-

parental conflict, may be not only mechanisms through

which parental disorders confer increased risk to offspring

but also independent risk factors for mental disorders [2, 3].

Parents’ attitudes and behaviors in day-to-day interactions

with offspring, characterized as parenting style, have been

associated with offspring’s mental health in childhood

[4, 5], adolescence [6–11], and adulthood [12–14].

Among various measures of parenting style, the Parental

Bonding Instrument (PBI) was developed to assess two

principal dimensions of parenting style, care and control

[15]. The care dimension measures the informant’s per-

ception of affection and warmth expressed by the parent

& Kathleen Ries Merikangas [email protected]

1 Genetic Epidemiology Branch, Intramural Research Program,

National Institute of Mental Health, Building 35, Room

2E480, 35 Convent Drive, MSC #3720, Bethesda,

MD 20892, USA

123

Soc Psychiatry Psychiatr Epidemiol (2018) 53:11–20

https://doi.org/10.1007/s00127-017-1435-4

toward the offspring, whereas the control dimension mea-

sures the extent of a parent’s overprotection and authori-

tarianism (i.e., excessive interference with the offspring’s

autonomy). Low parental care and high parental control

during childhood and adolescence have been associated

with depression [14, 16–22], anxiety disorders [16, 21–23],

suicidal behavior, substance abuse or dependence

[14, 21, 22], and eating disorders [22] in adulthood. Some

of these studies found that the associations were specific to

only one parent. For example, high maternal control, but

not paternal control, has been associated mood and anxiety

disorders [17, 23]. In the National Comorbidity Survey,

patterns of association that differed for maternal and

paternal parenting style and by respondent sex were

demonstrated for multiple disorder outcomes [16]. Popu-

lation-based studies of adolescents have reported similar

associations of low parental care and high parental control

with depression, anxiety, and behavioral symptoms or

disorders [6–8, 24, 25]. However, these studies have not

consistently compared maternal parenting styles to paternal

parenting styles in their associations with adolescent

mental disorders.

Additional gaps exist in the literature regarding the

association between parenting style and adolescent mental

health. Parenting style is closely related to demographic

characteristics as well as a wide range of adverse experi-

ences among offspring [3, 22], but most previous studies of

adolescents have not adequately controlled for these fac-

tors. Potential confounders that have been associated with

adolescent mental disorders include family structure,

socioeconomic status [3], parental history of mental dis-

orders [14, 26, 27], stressful life events [28, 29], sexual

violence [2], and inter-parental conflict [30]. Although

some studies have controlled for parental marital status

[4, 7, 8, 14], others ignore aspects of household composi-

tion such as number of biological parents and siblings.

Second, few population-based studies in adolescents have

assessed whether the potential effects of parenting style

differ by adolescent demographic characteristics. System-

atic assessment of demographic differences is necessary

because a ‘‘one model fits all’’ approach might overlook

important contextual, cultural, and developmental influ-

ences [31] and differences in perceptions of parenting

between adolescents [4]. For example, two studies using

data from the National Longitudinal Study of Adolescent

Health reported that associations between parenting style

and adolescent smoking differed by racial/ethnic group

[32, 33]. To our knowledge, no population-based studies of

adolescents have examined whether associations between

parenting style and the full range of DSM-IV diagnoses

differ by demographic characteristics.

In this study, we examined the association between

perceived maternal and paternal care and control and past-

year mental disorders in adolescents, while addressing the

limitations of past research. We used data from the

National Comorbidity Survey Replication-Adolescent

Supplement (NCS-A), which assessed DSM-IV disorders in

a nationally representative sample of US adolescents aged

13–18. Unlike the previous community studies that used

smaller and homogeneous samples, the NCS-A’s large

sample size and broad range of measures allowed us to

assess: (1) socio-demographic correlates of parenting style,

(2) associations of parenting style with past-year mental

disorders when adjusted for potential confounders, and (3)

whether associations between parenting style and past-year

mental disorders differ by adolescent age, sex, and race/

ethnicity. We hypothesized that low perceived maternal

and paternal care and high maternal and paternal control

would be associated with increased odds of mental disor-

der. We further hypothesized that associations would differ

in magnitude by age, sex, and race/ethnicity.

Methods

Sample and procedures

The NCS-A is a nationally representative survey of 10,123

adolescents aged 13–18 years in the continental US, and

information on the sampling strategy, participation rates,

and instruments in the NCS-A are described in greater

detail elsewhere [34–37]. The survey was carried out in a

dual-frame sample that included a household subsample

(n = 879) and a school subsample (n = 9244), and the

overall NCS-A adolescent response rate was 75.6% [34].

Parents or guardians were mailed a self-administered

questionnaire (PSAQ) and were asked to provide infor-

mation on the adolescent’s mental and physical health and

other family-and community-level characteristics. Parents

of 6483 adolescents completed the PSAQ with conditional

response rates of 82.5 and 87.9% for household and school

subsamples, respectively. This subsample of 6483 adoles-

cents was used in this study. The human subjects com-

mittees of Harvard Medical School and the University of

Michigan approved the procedures.

Measures

Past-year mental disorders were measured using a modified

version of the World Health Organization (WHO) Com-

posite International Diagnostic Interview Version 3.0

(CIDI), a fully structured, lay-administered interview.

These included six classes of DSM-IV disorders: mood

(major depression or dysthymia, bipolar I or II), anxiety

[panic disorder, agoraphobia, social phobia, specific pho-

bia, generalized anxiety disorder (GAD), separation

12 Soc Psychiatry Psychiatr Epidemiol (2018) 53:11–20

123

anxiety disorder (SAD], post-traumatic stress disorder

(PTSD)], attention-deficit/hyperactivity disorder (ADHD),

behavioral [oppositional defiant disorder (ODD), conduct

disorder (CD)], substance use (alcohol abuse/dependence,

drug abuse/dependence), and eating (anorexia nervosa,

bulimia nervosa, and binge eating). Mood, anxiety, eating,

and substance use disorder diagnoses were based on ado-

lescent reports because previous research has indicated that

adolescents more accurately report emotional symptoms

and substance use [38]. Behavioral disorder diagnoses

included information from parents derived from the PSAQ.

For ODD and CD, information from the parent and the

adolescent were combined at symptom level, whereas only

parent reports were employed for diagnoses of ADHD due

to low validity of adolescent reports [38–40].

In the CIDI childhood experience module, adolescents

were asked eight items from the PBI. These items were

asked twice: once regarding the biological mother or other

woman who ‘‘spent the most time raising’’ the adolescent,

and once regarding the biological father other man who

‘‘spent the most time raising’’ the adolescent. Responses

were coded as five ordinal categories ranging from ‘‘not at

all’’ to ‘‘a lot.’’ Exploratory factor analysis suggested two

factors: ‘‘care’’ (four items: ‘‘How much love and affection

did she/he give you?’’, ‘‘How much did she/he really care

about you?’’, ‘‘How much could she/he understand your

problems and worries?’’, ‘‘How much could you open up

and talk to her/him about things that were bothering you?’’)

and ‘‘control’’ (three items: ‘‘How much did she/he stop

you from doing things that other kids your age were

allowed to do?’’, ‘‘How strict was she/he with her/his rules

for you?’’, ‘‘How overprotective was she/he?’’). One item

(‘‘How much did she/he expect you to do your best in

everything you did?’’) did not load well onto either factor

and was not considered for further analysis. The distribu-

tions of responses were skewed, particularly in parental

care toward the ‘‘a lot’’ category. Graphical inspection

revealed it would be inappropriate to assume a linear

relationship between parental care/control and the odds of

mental disorder. Thus, care and control were dichotomized

as ‘‘high’’ if the response was ‘‘a lot’’ to all four items of

care or all three items of control, and as ‘‘low’’ otherwise.

Potential confounders, drawn from the adolescent CIDI

report, included socio-demographics (age, sex, race/ethnicity,

parental education, family income-to-poverty ratio, number

of biological parents in the household, birth order, and

number of siblings) [41], parental history of mental disorders

(parent report of depression, GAD, panic disorder, substance

use disorder, or suicide), adolescent reported lifetime expe-

riences of rape or sexual violence, drawn from the CIDI PTSD

module, any past-year stressful life event (e.g., family or

financial loss, parental divorce and separation) [28], drawn

from a CIDI module on stressful life events, and inter-parental

conflict (verbal conflict and physical abuse) [30], drawn from

a CIDI module on childhood experiences. The coding and

distribution of each covariate is displayed in Table 1.

Statistical analysis

Complete data including PBI items and potential con-

founders were available for analysis for 5838 adolescents.

All statistical analyses were completed with the SAS 9.3

software package (the SAS Inc. Cary, NC). Standard errors

and 95% confidence intervals were estimated using Taylor

series linearization to account for the complex survey

design. Cross-tabulations were used to describe the distri-

bution of parental care and control by socio-demographic

characteristics and potential confounders. Logistic regres-

sion was used to estimate odds ratios (ORs) and 95%

confidence intervals (CIs) for the associations between

parental care and control and 12-month psychiatric diag-

noses. As there was no evidence of interaction between

parenting style dimensions, each dimension was considered

separately. Unadjusted models included only one parenting

dimension and one outcome. Adjusted models additionally

included the other three parenting dimensions and all

adolescent demographics and potential confounders. Two-

way interactions between parenting style dimensions and

demographic characteristics (age, sex, race/ethnicity) were

assessed for outcomes of MDD/dysthymia, any anxiety

disorder, and any substance use disorder. Significant tests

were evaluated using Wald v2 tests based on design-ad- justed variance–covariance matrices. p values less than

0.05 were considered statistically significant.

Results

Table 1 presents the weighted proportions of high parental

care and control by socio-demographic characteristics and

potential confounders. All but age and history of sexual vio-

lence were associated with at least one parenting style

dimension. Females were more likely than males to report

high paternal control and less likely to report high paternal

care. Maternal care reports differed by parental education, and

both maternal and paternal control reports varied by house-

hold income level. No characteristics or confounders were

significantly associated with all four parenting dimensions.

Table 2 presents unadjusted and adjusted ORs (AORs)

and 95% CIs of past-year mental disorders in associations

with parental care and control. High maternal care was

associated with lower odds of MDD or dysthymia, eating

disorders, and CD or ODD, with adjusted ORs ranging

from 0.43 (95% CI = 0.29–0.63) to 0.58 (95%

CI = 0.40–0.82). High maternal care was associated with

lower odds of specific phobia and alcohol and drug abuse/

Soc Psychiatry Psychiatr Epidemiol (2018) 53:11–20 13

123

Table 1 Proportions of high parental care and control by adolescent and household characteristics among adolescents aged 13–18 years in the National Comorbidity Survey-Adolescent Supplement, United States

Correlates Maternal Paternal

High care,

% (SE)

p value High control,

% (SE)

p value High care,

% (SE)

p value High control,

% (SE)

p value

Sex 0.55 0.40 B0.01 B0.01

Female 45.7 (1.3) 9.5 (1.1) 23.0 (1.0) 13.2 (1.3)

Male 44.6 (1.2) 8.4 (0.7) 32.1 (1.6) 6.5 (0.7)

Age 0.19 0.68 0.08 0.60

13–14 47.5 (1.7) 9.4 (1.2) 31.0 (1.6) 8.8 (1.2)

15–16 43.7 (1.3) 8.4 (0.8) 26.8 (1.4) 10.0 (0.8)

17–18 43.9 (1.6) 9.1 (1.3) 24.2 (2.2) 10.8 (1.7)

Race/ethnicity 0.04 B0.01 0.32 B0.01

Hispanic 40.0 (2.9) 13.8 (2.7) 28.2 (2.6) 13.5 (1.6)

NH Black 48.6 (2.1) 12.8 (1.2) 31.7 (3.0) 14.4 (1.6)

Other 32.0 (4.5) 9.2 (2.4) 20.5 (4.7) 7.4 (2.4)

NH White 46.5 (1.2) 6.9 (0.6) 27.4 (1.1) 8.2 (0.9)

Parents’ education 0.02 0.13 0.67 0.18

\HS 40.3 (2.3) 12.2 (2.2) 28.8 (4.0) 12.0 (2.2) HS grad 48.9 (1.9) 8.4 (0.7) 25.9 (1.6) 11.5 (1.3)

Some college 45.4 (2.3) 11.0 (1.9) 28.6 (2.1) 9.3 (1.0)

College grad 43.6 (1.3) 7.0 (1.2) 28.3 (1.2) 8.0 (1.0)

Family income 0.13 B0.01 0.76 0.01

PIR B 1.5 49.2 (1.7) 11.9 (1.6) 28.0 (2.7) 13.9 (2.2)

PIR B 3 44.6 (2.4) 11.4 (1.1) 28.4 (2.6) 12.7 (1.4)

PIR B 6 44.6 (1.9) 7.9 (1.1) 28.6 (1.2) 8.6 (1.3)

PIR [ 6 44.2 (1.6) 7.2 (1.3) 26.4 (1.7) 7.6 (0.9) A parent had a mental disorder 0.11 0.06 0.03 0.50

No 46.2 (1.1) 7.8 (0.7) 29.0 (1.3) 9.5 (0.9)

Yes 42.6 (1.7) 11.3 (1.5) 24.9 (1.4) 10.4 (1.1)

Any past-year stressful life event B0.01 0.06 \0.01 0.06 No 49.5 (1.4) 7.6 (0.8) 31.8 (1.5) 8.5 (1.1)

Yes 42.0 (1.1) 9.9 (0.9) 24.8 (1.5) 10.6 (0.7)

Any lifetime sexual violence 0.07 0.20 0.55 0.11

No 45.5 (0.9) 8.8 (0.6) 28.0 (1.1) 9.4 (0.7)

Yes 37.7 (4.3) 10.6 (3.0) 22.0 (3.7) 15.8 (4.0)

Household composition 0.07 B0.01 0.07 0.74

Single mother 42.3 (3.0 13.6 (2.0) 29.1 (1.2) 10.1 (4.6)

Composite 44.7 (2.4) 11.1 (1.0) 22.6 (4.6) 10.5 (1.3)

Two biological parents 45.8 (1.2) 7.0 (0.6) 23.2 (1.8) 9.4 (0.9)

Other 42.6 (5.7) 19.2 (6.4) 26.4 (3.7) 12.3 (2.8)

Inter-parental conflict B0.01 0.11 B0.01 0.11

None 52.5 (1.4) 8.3 (0.8) 36.5 (1.7) 8.7 (0.9)

Minor 41.2 (1.8) 6.9 (1.0) 23.0 (1.3) 8.4 (1.0)

Major 37.0 (1.7) 11.7 (1.7) 18.4 (1.6) 12.7 (1.6)

Birth order 0.08 0.24 0.49 0.02

Oldest 47.1 (1.4) 8.8 (1.1) 29.0 (1.5) 9.7 (1.0)

Youngest 46.2 (2.0) 7.6 (1.1) 27.5 (1.7) 7.7 (1.0)

Others 41.9 (1.6) 10.1 (1.2) 26.4 (1.6) 11.6 (1.2)

14 Soc Psychiatry Psychiatr Epidemiol (2018) 53:11–20

123

dependence in unadjusted models only. High maternal

control was associated with greater odds of MDD or dys-

thymia, social phobia, panic disorder, SAD, PTSD, eating

disorders, and CD or ODD with AORs ranging from 1.93

(95% CI = 1.02–3.68) to 3.86 (95% CI = 1.41–10.6).

High paternal care was associated with lower odds of social

phobia (AOR = 0.40, 95% CI = 0.22–0.74) and alcohol

abuse/dependence (AOR = 0.51, 95% CI = 0.27–0.95) in

both adjusted and unadjusted models. A number of protective

associations did not withstand adjustment: mood disorders,

social phobia, specific phobia, PTSD, alcohol and drug abuse/

dependence, and CD or ODD. High paternal control was

associated with greater odds of agoraphobia (AOR = 3.37,

95% CI = 1.31–8.69) and alcohol abuse/dependence

(AOR = 2.16, 95% CI = 1.16–4.05) but with lower odds of

ADHD (AOR = 0.43, 95% CI = 0.20–0.91). High paternal

control was associated with specific phobia and SAD only in

unadjusted models.

Figure 1 presents group-specific associations between

parental care and control and past-year mental disorders by

sex and race/ethnicity, where an interaction was present.

High maternal control was associated with greater odds of

anxiety disorders in females only (p \ 0.01, Fig. 1a). High paternal care was associated with lower odds of anxiety

disorders among Hispanics and non-Hispanic blacks, but

not among non-Hispanic whites or those in the ‘‘other’’

racial/ethnic group (p \ 0.01, Fig. 1b). Whereas high maternal control was associated with greater odds of sub-

stance abuse/dependence in females (p \ 0.01, Fig. 1c), high paternal control was associated with greater odds in

males (p = 0.02, Fig. 1d). No other interaction tests were

statistically significant (not shown).

Discussion

To our knowledge, this is the first study to systematically

assess associations between perceived parenting style and a

wide range of past-year mental disorders in a nationally

representative sample of US adolescents. At least one

parenting style was associated with most of the major

subtypes of mental disorders. Some, but not all, associa-

tions were robust to control for multiple confounders

including socio-demographics, parental mental health,

family structure, and multiple indicators of adversity. We

also show specific patterns of associations by adolescent

sex and race/ethnicity.

Maternal and paternal parenting styles were differen-

tially associated with adolescent mental disorders when

adjusted for potential confounders. Low maternal, but not

paternal, care and high control were associated with

depression, eating disorders, and behavioral disorders in

adolescents. In contrast, only low paternal care and high

paternal control were associated with alcohol abuse or

dependence and phobias. We found no association in which

maternal and paternal care or maternal and paternal control

were both associated with the same mental disorder. This

contrasts with some previous population-based studies of

adults and adolescents that have reported both low mater-

nal and low paternal care to be associated with depression

[7, 16, 17, 22]. It is consistent, however, with some existing

studies that found parent differences for parental control as

well as for other mental disorders [16, 17, 23, 24], and

suggests that future studies of adolescents that examine

parent differences might be needed.

Several group differences emerged when we examined

interactions of parental care and control with offspring sex

and race/ethnicity. We found three associations that were

specific to either mother-daughter or father-son relation-

ships. High maternal control was associated with anxiety

and substance use disorders in only females, which might

explain the lack of association in the pooled sample. In

addition, high paternal control was associated with sub-

stance use disorders only among males. The existence of

sex differences is consistent with results from the National

Comorbidity Survey, a representative sample of US adults

[16]. In that study, maternal care was associated with

anxiety disorders and alcohol abuse in women but not in

Table 1 continued

Correlates Maternal Paternal

High care,

% (SE)

p value High control,

% (SE)

p value High care,

% (SE)

p value High control,

% (SE)

p value

Number of siblings 0.40 0.02 0.22 0.73

1 48.2 (3.7) 8.6 (2.3) 30.7 (3.3) 9.0 (1.8)

2 48.4 (2.6) 6.7 (0.8) 30.0 (1.6) 8.8 (1.6)

3 43.8 (2.3) 7.7 (1.3) 28.0 (2.1) 9.4 (1.6)

4? 43.2 (1.5) 11.5 (1.1) 25.5 (1.6) 10.9 (1.1)

Average 43.7 (0.8) 8.4 (0.5) 27.6 (0.9) 10.2 (0.6)

SE standard error, NH non-Hispanic, PIR poverty index ratio

Soc Psychiatry Psychiatr Epidemiol (2018) 53:11–20 15

123

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16 Soc Psychiatry Psychiatr Epidemiol (2018) 53:11–20

123

men. Similarly, paternal care was associated with nine

lifetime mental disorders in men but only with one in

women, and paternal overprotection and authoritarianism

were associated with mental disorders only among men

[16]. Sex-specific associations are consistent with the tra-

ditional theoretical importance of same-sex parent–child

relationships in adolescent development [42]. However, for

most of the associations we assessed between parental

bonding and mental disorder, no sex interactions were

detected. This is broadly consistent with the lack of gender

differences reported by systematic reviews of general

parenting and child and adolescent mental disorder

[5, 43, 44].

In contrast to previous studies [32, 33], we did not find

racial/ethnic differences in the association between par-

enting style and substance abuse/dependence. However, we

did find that high paternal care was protective for anxiety

disorders among Hispanics and non-Hispanic blacks, but

not among non-Hispanic whites. Differences in associations

between parental bonding and mental disorder by racial/

ethnic subgroup may be due to cultural influences on par-

enting norms and perceptions of parenting among offspring.

Both internal (e.g., cultural beliefs, attitudes, values, family

roles, expectations) and external (discrimination, prejudice,

poverty, neighborhood context, access to resources) factors

may impact parenting practices in different racial/ethnic

Fig. 1 Group-specific associations of high parental care and control with anxiety disorders and substance abuse/dependence, by adolescent sex and race/ethnicity: National Comorbidity Survey-Adolescent Supplement, United States

Soc Psychiatry Psychiatr Epidemiol (2018) 53:11–20 17

123

groups and lead to differences in what constitutes optimal

parenting [31]. In addition, racial/ethnic group may be a

proxy for other risk factors, such as exposure to adversity

and trauma, that may modify the effect of parental bonding

on mental health [45, 46].

The presence of group-specific associations by sex and

race/ethnicity underscores the complexity of the relation-

ships between parenting style and adolescent mental dis-

orders. Defining optimal levels of parental control may be

especially challenging during adolescence due to dynamic

parent–child interactions and increasing adolescent auton-

omy. Parental behaviors that limit adolescent autonomy

and are thus perceived as strict or overprotective might

have negative consequences in certain contexts, but posi-

tive or no consequences in others. Parents may also adapt

parenting styles in response to their offspring’s symptoms

and behaviors [4]. This effect heterogeneity may result in

observed associations between parental control and mental

disorders that are modest or null. A recent meta-analysis

found that the link between parental control and adolescent

depression and anxiety might be smaller than previously

suggested [6]. The mean effect size of parental control for

anxiety disorders was not significant in longitudinal studies

and small in both retrospective and cross-sectional studies.

The inverse association we found between paternal

control and odds of ADHD has not been previously

reported in studies using the PBI. This could be attributed

to a more structured home environment characterized by

increased parental monitoring that might be protective

against ADHD. Earlier research showed that paternal

rejection, which is another measure of parenting style, was

associated with offspring’s ADHD symptoms at follow-up

and not vice versa [4]. However, the lack of uniformity

across instruments that assess dimensions of parenting style

complicates integration of findings across studies.

The findings in this study should be considered in the

context of its limitations and strengths. First, the temporal

associations between parental care and control and mental

disorders could not be assessed in these data. Adolescents’

mental health status may influence both parental behavior

and adolescents’ perception of parental care and control.

For example, adults who are currently in a depressive

episode, but not those who are in remission, might differ

from controls in their reports of parental behavior [47].

However, studies in adults have shown that the current

mood state does not distort recall of adverse experiences

[48, 49]. Second, the use of an abbreviated PBI instead of

the original 25-item PBI, as well as dichotomization of

parental care and control measures, could have contributed

to the differences from previous studies. Finally, we did not

have complete mental health history of both parents

because only one parent completed a self-administered

questionnaire. The strengths of this study are the

measurement of DSM-IV diagnoses, access to data from a

large nationally representative sample, and measures of a

broad range of potential confounders.

We found that low parental care and high maternal

control were associated with a number of past-year mental

disorders in adolescents. Yet, associations differed both by

parent, outcome, and adolescent characteristics, highlight-

ing the complexity of the relationship between parenting

style and mental health. Our findings suggest that future

studies should account for potential differences based on

characteristics such as sex and race/ethnicity. In addition,

because parenting factors have been targeted in interven-

tions aimed at preventing mental health problems among

adolescents (e.g., [50]) research that examines parenting

style in relation to a variety of mental disorders against the

background of genetic risk and environmental context

[14, 51–53] may ultimately inform the incorporation of

familial factors in prevention and intervention programs.

Acknowledgements The National Comorbidity Survey Adolescent Supplement (NCS-A) is supported by Grants U01-MH60220, R01-

MH66627, and U01MH060220-09S1 from the National Institute of

Mental Health) with supplemental support from the National Institute

of Drug Abuse, the Substance Abuse and Mental Health Services

Administration, the Robert Wood Johnson Foundation (Grant

044780), and the John W. Alden Trust. This work was supported by

the Intramural Research Program of the National Institute of Mental

Health (ZIAMH002808). The authors have no conflict of interest. The

views and opinions expressed in this article are those of the authors

and should not be construed to represent the views of any of the

sponsoring organizations, agencies, or US Government.

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