How Is the Loneliness Affected by Family and Friend Support in Adolescents With Depressive Disorder: The Mediating Role of Coping Strategies

Xiaoli Huan; Xuejun Li; Yuehua Cao; Xuan Lei; Wenzhao Chen; Yanni Wang; Yongjie Zhou

doi:10.30773/pi.2025.0455

Psychiatry Investig > Volume 23(6); 2026 > Article

Huan, Li, Cao, Lei, Chen, Wang, and Zhou: How Is the Loneliness Affected by Family and Friend Support in Adolescents With Depressive Disorder: The Mediating Role of Coping Strategies

Original Article

Psychiatry Investigation 2026;23(6):797-808.

Published online: June 8, 2026

DOI: https://doi.org/10.30773/pi.2025.0455

How Is the Loneliness Affected by Family and Friend Support in Adolescents With Depressive Disorder: The Mediating Role of Coping Strategies

Xiaoli Huan¹

, Xuejun Li¹

, Yuehua Cao¹

, Xuan Lei¹

, Wenzhao Chen¹

, Yanni Wang^1,²

, Yongjie Zhou³

¹School of Public Health, Lanzhou University, Lanzhou, China

²Mental Health Center, Second Provincial People’s Hospital of Gansu, Lanzhou, China

³Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China

Correspondence: Yanni Wang, MD, PhD School of Public Health, Lanzhou University, Lanzhou 730000, China Tel: +86-931-8915008, Fax: +86-0931-8915008 E-mail: wangyann@lzu.edu.cn

Correspondence: Yongjie Zhou, MD, PhD Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen 518000, China Tel: +86-755-82921024, Fax: +86-0755-82921024 E-mail: qingzhu1108@126.com

Received December 16, 2025 Revised March 11, 2026 Accepted April 12, 2026

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

Perceived social support (PSS) buffers against loneliness, but family and friend support may differ in effects. This study constructed a mechanism model mediated by coping strategies to examine the pathways through which PSS, family and friend support influence loneliness.

Methods

Adolescents aged 12-18 with depressive disorder were recruited from 14 psychiatric hospitals across 9 Chinese provinces. They completed the Coping Strategies Scale for Middle School Students, the Multidimensional Scale of Perceived Social Support, and the UCLA Loneliness Scale. Path analysis explored relationships among PSS, family and friend support, loneliness, as well as the indirect effects mediated by coping strategies.

Results

A total of 2,343 adolescents participated. PSS negatively predicted loneliness (β=-0.46, p<0.001). Problem-focused coping mediated the relationship between PSS and loneliness (β=0.48, p<0.001), while emotion-focused coping did not (β=-0.04, p>0.05). Both family and friend support directly predicted loneliness with coefficients of -0.13 and -0.39, respectively. Problem-focused coping mediated the associations of both family support (β=0.32, p<0.001) and friend support (β=0.28, p<0.001) with loneliness. Emotion-focused coping weakly mediated the effect of family support (β=-0.09, p<0.001), but not friend support (β=0.04, p>0.05).

Conclusion

Both family and friend support reduce loneliness by promoting problem-focused coping, with friend support showing a stronger effect. Family support also alleviates loneliness by reducing emotion-focused coping. Enhancing PSS and adaptive coping strategies may alleviate loneliness.

Keywords: Depressive disorder, Adolescent, Perceived social support, Coping strategies, Loneliness

INTRODUCTION

Loneliness is a pervasive and distressing emotional experience characterized by an interpersonal deficit resulting from fewer satisfying personal relationships than desired [1]. This experience exhibits a high prevalence among adolescents [2], particularly those with preexisting psychological and behavioral problems, such as depression.

Emerging evidence has consistently shown a significant association between depression and loneliness [3,4]. On the one hand, long-term loneliness triggers the accumulation of negative emotions, such as sadness and anxiety, which in turn exacerbate depressive symptoms [3]. On the other hand, individuals with depression often face challenges in establishing and maintaining close relationships due to psychosocial factors such as negative cognitive patterns and social withdrawal [4]. Coupled with the impact of neurobiological factors on social motivation and perception [5], these factors contribute to the heightened loneliness prevalence observed in patients with depression. This interaction forms a vicious cycle of “loneliness-depression-loneliness exacerbation,” highlighting the critical need to unravel the underlying mechanisms of loneliness and depression. Such insights hold practical significance for preventing and intervening in loneliness among adolescents with depressive disorder.

Perceived social support and loneliness

According to the social support buffering hypothesis, social support protects individuals from stressful events and promotes mental health [6,7]. Specifically, social support can buffer the effects of risk factors by providing individuals with a greater sense of security and intimacy [6,8]. Therefore, social support may serve as a protective factor against negative emotions such as loneliness [9]. Social support refers to the mental and material resources obtained from one’s social network, which make individuals feel cared for, loved, esteemed, and valued [10,11]. Social support is a broad term encompassing a variety of constructs. Only perceived social support (PSS) is regarded as consistently linked to health outcomes and more closely related to the individual trait [11-13]. PSS reflects an individual’s belief and subjective experience of support received from family, friends, and significant others, emphasizing the subjective aspects of social support [11]. It includes three dimensions: family support, friend support, and significant other support, and provides psychological resources that buffer the harmful effects of stressors or illness. Many studies have shown that when individuals receive adequate social support and emotional resonance, their loneliness levels decrease significantly [14]. However, individuals with depressive disorder often experience difficulties in perceiving external resources due to negative biases and cognitive distortions. Consequently, they may struggle to effectively receive or utilize social support, weakening their ability to form meaningful connections and rely on others. Despite these perceptual challenges, social support remains a vital buffering resource that positively influences mental health, especially in the context of depressive distress. Therefore, the current study hypothesized that PSS is significantly negatively correlated with loneliness among adolescents with depressive disorder (Hypothesis 1).

While the relationship between PSS and loneliness has been extensively studied, research specifically examining how its three dimensions (family support, friend support, and significant other support) differentially influence loneliness remains scarce. According to the developmental theory, the salience of specific sources of social support shifts across life stages, implying that each dimension of PSS may play a distinct role in mitigating loneliness. Accordingly, exploring the interplay among these dimensions may provide novel insights for targeted interventions aimed at reducing loneliness [15].

Previous studies have shown that for teenagers, family support is usually a crucial source of social support [16]. It not only represents the most sustainable buffer against psychological issues, such as depression and anxiety [17,18], but also enhances mental health by fostering feelings of belonging, love, and acceptance [19], thereby significantly reducing loneliness [20]. Concurrently, as adolescents pursue greater independence, their social support preferences transition from parental figures to peers [21]. This shift elevates the significance of friend support: an integrative review highlights its role as a critical mental health protector, particularly among depressed adolescents in need of psychological care [22]. Friend support ameliorates loneliness through mechanisms such as emotional validation and shared experiences [23]. In addition to family and friend support, support from significant others is also recognized as a crucial component of PSS, typically referring to both emotional and instrumental assistance provided by romantic partners or close non-family adults [24]. Previous studies have demonstrated that support from significant others can enhance adolescents’ subjective well-being [25] and improve their school adjustment [26]. One study has even proposed that, during late adolescence, the intimacy and emotional validation provided by significant others may surpass that of family and friends [27]. However, during early to middle adolescence, the applicability of significant other support remains unclear, as youths at this stage seldom establish stable romantic relationships or form deep attachments with non-family adults [28], resulting in relatively limited accessibility and consistency of such support. Given the age characteristics of the sample and the focus of this study, the current study did not include significant other support as a separate dimension in the analysis.

Although existing research suggests that family support has the strongest impact on reducing loneliness [29], a large-scale meta-analysis revealed that the association between friend support and loneliness is significantly stronger than that of family support [14]. This inconsistency underscores the lack of scholarly consensus regarding whether family or friend support plays a more pivotal role in alleviating loneliness. To disentangle the differential effects of family and friend support on loneliness in adolescents with depressive disorder, the present study hypothesizes that family support and friend support influence loneliness levels in distinct ways, exhibiting differential associative patterns (Hypothesis 2).

The mediating role of coping strategies

According to Lazarus and Folkman’s stress and coping theory, when faced with stress, individuals first conduct a primary appraisal of the stressful event and then a secondary appraisal of their available coping resources [30]. Social support is considered a significant coping resource, and its perceived availability can influence an individual’s cognitive appraisal of stress, subsequently shaping their choice of coping strategies.

Coping strategies refer to psychological adaptation strategies employed by individuals to alleviate mental stress when confronting internal or external life events that exceed their perceived capacity [30]. According to Folkman and Moskowitz [31], coping strategies can be broadly categorized into two types: problem-focused coping and emotion-focused coping. Problem-focused coping involves active efforts to resolve the stressor directly, such as problem-solving and seeking support. In contrast, emotion-focused coping aims to regulate the emotional response to stress, encompassing strategies such as avoidance, fantasy, cognitive reappraisal, and self-blame [32].

Empirical evidence indicates that problem-focused coping is generally more effective than emotion-focused coping [33-36]. Some studies have found that adopting problem-focused coping strategies not only contributes to improving life satisfaction [33] but also boosts psychological resilience [34]. In contrast, although emotion-focused coping provides short-term relief, it is often linked to detrimental outcomes—such as intensified negative affect and compromised interpersonal relationships—due to its failure to address core stressors [35,36]. When individuals perceive higher levels of social support, their confidence and capacity to manage problems are enhanced, thereby promoting a preference for problem-focused strategies such as taking direct action [37]. Conversely, a lack of PSS may amplify stressor threat appraisals, fuel feelings of helplessness, and drive reliance on emotion-focused coping [38]. Such individuals often resort to strategies like emotional venting to alleviate distress [39,40]. Nonetheless, some studies suggested specific forms of social support may unintentionally reinforce the propensity to adopt emotion-focused coping strategies [41,42]. Overprotective behaviors can encourage adolescents to rely on emotional reassurance rather than active problem-solving in stressful contexts [42]. Therefore, family support may not exert a positive influence on children’s development of coping strategies.

Cognitive stress theory posits that psychosocial outcomes such as mental health and well-being are shaped not by the stressor itself, but by the coping strategies individuals adopt in response [43]. Loneliness, a prevalent psychological concern, has been found to be influenced by the coping strategies individuals adopt [44,45]. Cross-sectional studies demonstrated a significant negative association between problem-focused coping and loneliness, and a positive association with emotionfocused coping [46,47]. Problem-focused coping may mitigate loneliness by fostering higher-quality social interactions [46]. In contrast, emotion-focused strategies offer temporary relief from negative affect but fail to address the structural deficit underlying loneliness—a lack of meaningful social ties [48]. A study found that avoidance-focused emotional coping strategies exacerbate social isolation, creating a feedback loop that intensifies loneliness [47]. Collectively, these findings suggest that problem-focused coping and emotion-focused coping serve as key mediators in the development and persistence of loneliness.

Taken together, this study hypothesized that problem-focused coping strategies and emotion-focused coping strategies mediate the relationship between perceived social support and loneliness, but the mediating effect of family support versus friend support on loneliness will differ (Hypothesis 3).

The current study

Although the direct effects of PSS on loneliness have been widely investigated, depressed individuals exhibit unique characteristics that distinguish them from non-clinical populations. Previous research has not explicitly examined how coping strategies mediate the relationship between social support and loneliness among adolescents with depression. Furthermore, given that the source and quality of social support are critical determinants of coping strategy selection and loneliness alleviation, this study focuses on two key dimensions— family support and friend support—to more precisely unpack the mechanisms underlying perceived social support’s impact on loneliness.

Building on this framework, the study hypothesizes:

Hypothesis 1: Among adolescents with depressive disorder, perceived social support is significantly and negatively correlated with loneliness (H1).

Hypothesis 2: Family support and friend support influence loneliness levels in distinct ways, exhibiting differential associative patterns (H2).

Hypothesis 3: Coping strategies mediate the relationship between perceived social support and loneliness, but the mediating effect of family support versus friend support on loneliness will differ (H3).

METHODS

Ethical considerations

Informed consent was procured from both participants and their guardians for this study. The research protocol received approval from the Shenzhen Kangning Hospital Research Ethics Committee (IRB: 2020-k021-02).

Participants and procedure

The study recruited inpatients and outpatients from 14 psychiatric hospitals or psychiatric departments of general hospitals in 9 provinces across China to conduct the questionnaire survey. Participants were consecutively recruited from December 2020 to December 2022. As a result, 2,343 patients completed the survey.

Inclusion criteria were as follows: 1) aged between 12 and 18 years, 2) meeting DSM-V criteria for diagnosis of depressive episode or bipolar depressive episode, 3) having completed at least 6 years of schooling (make sure that participants could accurately comprehend the questionnaire). Exclusion criteria included: 1) having any severe chronic physical disease, infectious diseases, or immune system diseases, 2) having a history of traumatic brain injury, epilepsy, or other severe neurological or organic brain disease, 3) having a history of severe mental disorder such as schizophrenia, or 4) having a history of intellectual disability.

The adolescents were given the questionnaire link (set on www.WJX.cn) with a tablet and completed the questionnaires independently in a room in the hospital. Throughout the survey period, trained investigators with professional knowledge and experience with all measures were available to assist participants only when participants requested answers to their doubts about the questionnaire.

Measures

Demographic profile

Self-administrated questionnaire was used to collect the participant’s socio-demographic data, including age, sex, annual household income, etc.

Depressive symptom

The Chinese version of Patient Health Questionnaire-9 (PHQ-9) was used to assess depressive symptoms [49]. The 9 items of this scale were measured on a 4-point Likert ranging from 0 “not at all” to 3 “nearly every day.” Cronbach’s alpha coefficient was 0.901 in this study.

Anxiety symptom

The Generalized Anxiety Disorder scale (GAD-7) was developed and validated to assess anxiety symptoms [50]. The seven items of this scale were measured on a 4-point Likert scale ranging from 0 “not at all” to 3 “nearly every day,” yielding a total score from 0 to 21, with higher scores indicating greater severity. Cronbach’s alpha coefficient was 0.913 in this study.

Coping strategies

Coping Strategies Scale for Middle School Students (CSSMSS), adapted by Chen et al. [51], was used to evaluate coping strategies. The CSSMSS included two subscales: problem-focused coping and emotion-focused coping. The former includes strategies of problem-solving, seeking support, and rationalizing explanations, while the latter contains coping strategies of endurance, avoidance, emotional venting, and fantasy/denial. There were 36 items in total, rated on a 4-point Likert scale ranging from 1 (never) to 4 (often). And higher scores indicate a greater tendency to adopt problem-focused coping or emotion-focused coping. Cronbach’s alpha coefficient was 0.842 in this study.

PSS

Multidimensional Scale of Perceived Social Support (MSPSS), developed by Zimet et al. [52], was used to assess PSS [53]. It consisted of 12 items which were rated on a 7-point scale to measure PSS. The MSPSS included three subscales: family support (4 items), friend support (4 items), and significant others support (4 items). A higher subscales score indicated greater PSS from family, friends, and significant others. PSS assessed individuals’ satisfaction or adequacy of social support [15]. Total score was aggregated by 12 items. Cronbach’s alpha coefficient was 0.922 in this study.

Loneliness

University of California at Los Angeles (UCLA) Loneliness Scale (Version 3) was used to evaluate an individual’s subjective feelings of loneliness [54]. Version 3 of the scale was a 4-point Likert scale, including 20 items (9 positive items and 11 negative items). A higher total score referred to a higher degree of feelings of loneliness. Cronbach’s alpha coefficient was 0.908.

Statistical analysis

The data were preliminarily analyzed using IBM SPSS statistics 25.0 (IBM Corp.). First, the common method bias for data validity was examined by Harman’s single factor test. Second, skewness and kurtosis coefficients were applied to examine the normal distribution of continuous variables, and all the scale scores were normally distributed. Therefore, mean± standard deviation (SD) was used to describe the scale scores. Pearson correlation analysis was adopted to evaluate the correlation between each scale. Third, the collinearity test among variables was conducted.

The path analysis was computed by AMOS 28.0 (IBM Corp.) to assess the relationship between independent variables and the outcome variable. Independent variables were PSS and two aspects (family support and friend support). The outcome variable was loneliness. We established the first model to examine the relationships between PSS, coping strategies, and loneliness (Model 1). Subsequently, the mediation effects of coping strategies on the association between family support and friend support and loneliness were distinguished in the second model (Model 2). Age and sex were included as control variables in both Model 1 and Model 2 to account for their potential confounding effects, as they are widely recognized in psychological, sociological, and medical research as common confounding factors [55-57]. Controlling for these variables helps reduce potential confounding effects. All tests were twotailed, and statistical significance was defined at p<0.05. The bootstrapping method was applied to examine the significance of all the effects and produced 95% bias-corrected confidence intervals (CIs) of these effects from 5,000 resamples of the data. CIs that did not include zero indicated significant effects. This study used the following goodness-of-fit indicators to evaluate the fit of the model58: chi-square/freedom ratio (χ²/df), Tucker-Lewis index (TLI), comparative fit index (CFI), root mean square error of approximation (RMSEA), and standard root mean-square residual (SRMR). When the model fits well, it is recommended that χ²/df is no more than 3, CFI and TLI values are greater than 0.95, SRMR values are less than 0.08, and RMSEA is less than 0.06.

RESULTS

Common method bias

Common method bias was assessed by Harman’s single factor test before processing data. The results showed that 11 factors’ eigenvalues were larger than 1. The load of the first factor was 23.64%, which was less than 40% of the covariance among all the items. It suggested that there was no serious common method bias in this study.

The demographic and psychological characteristics of participants

A total of 2,343 adolescents with depressive disorder were included. Participants had a mean age of 15.0 years (SD=1.6), and the majority were female (77.9%). Among the participants, 67.4% lived in cities, and the mean years of education was 9.2. The mean score on PHQ-9 was 16.86 (SD=7.17), and the mean score on GAD-7 was 12.10 (SD=6.25). Detailed characteristics of the participants were shown in Table 1.

Correlations among variables

Table 2 showed the mean, SD, and correlation coefficients of the measured variables. A normal distribution test showed that skewness coefficients and kurtosis coefficients of the variables were smaller than 1, indicating that all scores of the scales were normally distributed and subsequent data analyses could be conducted.

Significant correlations were found between PSS, loneliness, and problem-focused coping strategies. Specifically, PSS was positively correlated with problem-focused coping strategies (r=0.511, p<0.01) and negatively correlated with loneliness (r=-0.609, p<0.01). Problem-focused coping strategies were negatively correlated with loneliness (r=-0.506, p<0.01). In contrast, emotion-focused coping strategies showed no significant correlation with PSS (r=-0.028, p>0.05), but were positively correlated with loneliness (r=0.296, p<0.01).

Family support was negatively associated with loneliness (r=-0.457, p<0.01) and positively associated with problemfocused coping strategies (r=0.478, p<0.01). A weak negative correlation was observed between family support and emotion-focused coping strategies (r=-0.069, p<0.01).

Similarly, friend support was negatively associated with loneliness (r=-0.572, p<0.01) and positively associated with problem-focused coping strategies (r=0.441, p<0.01), but showed no significant correlation with emotion-focused coping strategies (r=-0.003, p>0.05).

Collinearity test

The variance inflation factor of all predictive variables (1.004- 1.434) was less than 5, and tolerance (0.698-0.990) was greater than 0.1, indicating that there was no serious multicollinearity in the data.

Path analysis

Two models were established using multi-group structural equation modeling to dissect the role path of PSS and its core dimensions (family and friend support) on coping strategies and loneliness.

In Model 1, age and sex were entered as control variables, with PSS specified as the independent variable, problem-focused/emotion-focused coping as mediating variables, and loneliness as the latent outcome variable. Model 1 demonstrated an acceptable global fit with TLI=0.971, CFI=0.999, RMSEA=0.047, and SRMR=0.0099, all meeting the established thresholds. Although χ²/df=6.089 exceeded the recommended threshold, this may be due to the large sample size, which can inflate the χ² value. Therefore, this study primarily relied on other goodness-of-fit indices [59], and the Model 1 fits well.

The results indicated that PSS negatively predicted loneliness (β=-0.46, p<0.001) and positively predicted problem-focused coping (β=0.48, p<0.001), but showed no significant association with emotion-focused coping (β=-0.04, p=0.093). Problem-focused coping negatively predicted loneliness (β=-0.28, p<0.001), whereas emotion-focused coping positively predicted loneliness (β=0.29, p<0.001), as illustrated in Figure 1.

As shown in Table 3, the total effect, direct effect, and the indirect effect mediated by problem-focused coping strategies were statistically significant as their 95% bootstrap CIs excluded zero. Conversely, the indirect effect mediated by emotion-focused coping was non-significant (p>0.05). The indirect effect of PSS on loneliness through problem-focused coping aligned directionally with the direct effect (-0.136 vs. -0.459), accounting for 22.48% of the total effect.

Model 2 examined the effects of family and friend support on loneliness through the mediating roles of problem-focused and emotion-focused coping. Model 2 demonstrated an acceptable global fit with TLI=0.949, CFI=0.999, RMSEA=0.058, and SRMR=0.0102, all meeting established thresholds. Although χ²/df=8.969 exceeded the recommended threshold, this may be attributed to the chi-square test’s sensitivity to sample size, resulting in a higher χ²/df. Therefore, this study mainly relied on other goodness-of-fit indices, such as CFI [59], and since the critical paths were significant, the model fits well.

As shown in Figure 2, family support (β=-0.13, p<0.001) and friend support exerted direct negative effects on loneliness (β=-0.39, p<0.001). In the pathway mediated by problem-focused coping, both family and friend support were positively associated with problem-focused coping (β=0.32, p<0.001; β=0.28, p<0.001). In turn, problem-focused coping demonstrated a significant negative relationship with loneliness (β=-0.28, p<0.001), reinforcing its role as a protective mediator.

In the pathway mediated by emotion-focused coping, only family support showed a weak negative association with emotion-focused coping (β=-0.09, p<0.001), whereas friend support showed no significant association with emotion-focused coping (β=0.04, p>0.05). Emotion-focused coping positively predicted loneliness (β=0.29, p<0.001).

The bootstrap test was used to further analyze the direct and indirect effects of family and friend support on loneliness, as shown in Tables 4 and 5. The indirect effects of family support via problem-focused coping (effect size=-0.091) and emotion-focused coping (effect size=-0.027) aligned with the direction of the direct effect (effect size=-0.131), suggesting that family support alleviated loneliness both directly and through these two coping mechanisms. The mediating effects of problem-focused coping and emotion-focused coping accounted for 36.55% and 10.84% of the total effect of family support, respectively. Ultimately, family support negatively predicted loneliness.

It is noteworthy that friend support exerted an indirect effect on loneliness through a single pathway—mediation by problem-focused coping—whereas the pathway through emotion-focused coping was non-significant (p>0.05). The indirect effect of friend support via problem-focused coping (effect size=-0.078) aligned with the direct effect (effect size=-0.393) in direction, confirming its mediating role. Specifically, problem-focused coping accounted for 16.96% of the total effect of friend support on loneliness, reinforcing the negative predictive relationship of friend support with loneliness.

DISCUSSION

This study examined the relationship between PSS and loneliness, considering the mediating role of coping strategies in the sample of Chinese adolescents with depressive disorder. Correlation analysis revealed that PSS was negatively correlated with loneliness, which is consistent with previous studies [14,60,61]. When individuals received more support from family, friends, and significant others, they were more likely to perceive greater levels of care and assistance from others when confronting life stressors and adversities, thereby exhibiting significantly reduced perceptions of loneliness [62].

Moreover, the study indicates that both family and friend support significantly and negatively predict loneliness, consistent with previous findings [63,64]. Notably, friend support appears to be more effective in alleviating loneliness among adolescents with depressive disorder. This may be because adolescents often seek understanding and emotional resonance from their peers [65]. Friends play a crucial role in both academic and daily life, and shared experiences and similar emotional challenges allow adolescents to achieve deeper mutual understanding and provide more direct and efficient support [66], such as by coaching each other’s homework and participating in collective activities.

We further investigated the role of coping strategies in PSS and its two key dimensions (family and friend support) and loneliness through multi-group structural equation modeling. The study found that problem-focused coping partially mediated the relationship between PSS and loneliness, in line with both the social support buffer hypothesis and cognitive stress theory [6,7]. Specifically, individuals with higher levels of PSS are more likely to perceive support and understanding from their environment, which enhances their confidence and motivation to seek solutions when facing stress, thereby alleviating loneliness associated with distress [67-69]. Both family support and friend support also negatively predicted loneliness through their associations with problem-focused coping. It indicated that support from family or friends reduced loneliness through mechanisms similar to PSS by encouraging individuals to adopt proactive problem-solving strategies when encountering challenges [70]. Consequently, families, schools, and society should work together to provide sufficient PSS for depressed adolescents, including emotional care, practical help, and other forms of support, to help them adopt more positive coping strategies.

Notably, in the correlation analysis and model construction, only family support had an inhibitory effect on loneliness through a weak negative association with emotion-focused coping, friend support demonstrated no significant relationship with emotion-focused coping. One possible explanation was that the family is the social support system that individuals first contact with and depend on for a long time [71]. Compared to friend support, family support is often more emotionally profound and stable, offering more direct emotional comfort and a stronger sense of identity when individuals experience emotional distress, particularly among adolescents [72]. When facing emotional difficulties, they are often more willing to confide in family members and share their inner vulnerabilities [73]. This may help explain why family support can, to some extent, prevent individuals from adopting emotionfocused coping strategies. Friendships during adolescence are often unstable, and the continuity and consistency of support are relatively low, which may limit their ability to stabilize emotional response patterns [74]. Moreover, friends are more likely to provide distraction through shared activities, rather than directly addressing emotional experiences [75]. Consequently, the influence of friend support on emotion-focused coping strategies may be relatively indirect or limited.

Furthermore, in Model 2 of this study, family support showed only a weak negative association with emotion-focused coping, suggesting a relatively limited pathway of influence. This finding contrasts with some previous studies. Some studies have suggested that close familial relationships may help reduce adolescents’ negative emotional processing, thereby decreasing the likelihood of adopting emotion-focused coping strategies, such as rumination and self-blame [76,77]. However, although many studies emphasize the importance of family support, some have failed to detect a consistent and significant predictive effect on the use of emotion-focused coping [78]. An increasing number of studies indicate that individuals’ preferred coping strategies in stressful situations are largely shaped by personality traits, psychological conditions, early attachment experiences, and even genetic susceptibility [79-83]. For instance, individuals with high neuroticism or insecure attachment styles are more likely to adopt emotion-focused strategies such as internalization, avoidance, and self-blame [81,82]. In addition, low self-efficacy and poor emotion-regulation abilities significantly increase the likelihood of relying on emotion-focused coping [83]. Findings from neuroscience further suggest that emotional responses to stress are supported by relatively stable neural mechanisms—such as prefrontal regulatory functions and amygdala activation—which are partly heritable and trait-like [84,85]. Therefore, it is reasonable to infer that emotionfocused coping strategies may not be primarily determined by external social support, but rather by intrinsic individual characteristics. When these internal factors are not considered, the observed influence of social support on emotion-focused coping tendencies may naturally appear limited or inconsistent.

Another part of the reason may be the uniqueness of the depressed adolescents in the study [86]. Previous studies showed that depressed individuals have different characteristics from the general population in PSS [87]. Adolescents with depression often have negative cognitive bias and excessive vigilance against external support [88,89]. Family support tends to be more stable and unconditional, and more easily penetrates the psychological defense of depressed individuals than the support of friends [90]. Thus, depressed adolescents may be more sensitive to their lack of family support [64].

Previous studies have documented the relationships among social support, coping, and loneliness in community-based or school-based adolescent samples. Consistent with our findings, among community samples, high levels of PSS may help reduce loneliness in adolescents [91]. During adolescence, the recognition and company of friends often play a more direct role in alleviating feelings of loneliness compared to the support from parents [92]. However, in contrast to our conclusions, some studies have reported different findings. For example, Dai et al. [93] found that while PSS were significantly positively associated with problem-focused coping, it was also significantly linked to emotion-focused coping. However, within our sample of depressed adolescents, PSS was significantly associated with problem-focused coping but showed no significant relationship with emotion-focused coping. However, research on how family and friend support influences coping strategies in community samples of adolescents is limited. Therefore, it is uncertain whether the impact of these two sources of support on coping strategies is similar between healthy adolescents and those with depression.

The research results may help prevent the increase of loneliness in depressed adolescents. Firstly, increasing PSS among depressed adolescents may be an effective approach to reducing loneliness. Parents should provide adequate support, strengthen parent-child communication and help adolescents solve problems. Likewise, schools and communities should promote positive peer interactions and create supportive environments to enhance adolescents’ confidence and reduce negative emotions. Secondly, increasing the use of problem-focused coping strategies may help lower the likelihood of loneliness. Although emotion-focused coping did not mediate the relationship between PSS and loneliness in this study, it still plays an important role in emotional regulation, social support utilization, and psychological resilience. When used adaptively, it can help alleviate negative emotions and support mental wellbeing. Therefore, interventions should guide adolescents toward more adaptive coping strategies. Finally, educators and mental health professionals should help adolescents identify and adjust maladaptive coping strategies, strengthen healthy emotion-regulation skills, and more effectively promote their overall psychological health.

The study had some limitations that should be considered. Firstly, all scales used in the current study were self-reporting questionnaires, which might be subjective, and the study subjects may conceal certain sensitive issues and have some reporting bias. Secondly, the ratio of boys and girls was not balanced due to the characteristics of the adolescents with depressive disorder. And the generalization of conclusions was limited due to cultural differences between China and foreign countries. Thirdly, this study is a cross-sectional study, so it is not possible to derive relevant causal relationships. Longitudinal studies are needed to further examine the reciprocal relationships among PSS, coping strategies and loneliness.

Conclusion

This study highlights the significant role of PSS in alleviating loneliness among adolescents with depressive disorder. Both family and friend support were associated with reduced loneliness, with friend support demonstrating a comparatively stronger effect. These forms of support can reduce loneliness by promoting problem-focused coping. Additionally, family support demonstrated a weak negative association with emotion-focused coping, suggesting an alternative indirect pathway. Based on these findings, interventions aimed at enhancing PSS, fostering the use of problem-focused coping strategies, and helping adolescents identify and adjust maladaptive emotion-focused coping—while promoting healthier emotional regulation—may be effective in reducing loneliness in this population.

Notes

Availability of Data and Material

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Conflicts of Interest

The authors have no potential conflicts of interest to disclose.

Author Contributions

Conceptualization: Yanni Wang. Data curation: Xiaoli Huan, Xuejun Li, Yuehua Cao, Xuan Lei, Wenzhao Chen. Funding acquisition: Yongjie Zhou. Investigation: Xuejun Li, Yuehua Cao, Xuan Lei, Wenzhao Chen. Methodology: Xiaoli Huan. Project administration: Yongjie Zhou. Supervision: Yongjie Zhou. Writing—original draft: Xiaoli Huan. Writing—review & editing: Yanni Wang.

Funding Statement

This work was supported by Sanming Project of Medicine in Shenzhen (No.SZSM202011014), Shenzhen Fund for Guangdong Provincial Highlevel Clinical Key Specialties (No.SZGSP013), Shenzhen Key Medical Discipline Construction Fund (No.SZXK072), and Science and technology research and Development Fund for Sustainable development project (No. KCXFZ20201221173613036).

Acknowledgments

All authors share responsibility for the final version of the work submitted and published and take responsibility for the integrity of the data in the study and the accuracy of the data analysis for this scoping review. We would like to thank all the participants. We also acknowledge the collaboration of the staff of Shenzhen Kangning Hospital and other hospitals involved in the study.

Figure 1.

Path model diagram of PSS, coping strategies and loneliness (Model 1). **p<0.001. PSS, perceived social support.

Figure 2.

Path model diagram of family and friend support, coping strategies, and loneliness (Model 2). **p<0.001.

Table 1.

Demographic and psychological characteristics of the participants (N=2,343)

Variables	Value
Sex
Boy	517 (22.1)
Girl	1,826 (77.9)
Place of residence
City	1,580 (67.4)
Rural	763 (32.6)
Single-child family
Yes	684 (29.2)
No	1,659 (70.8)
Annual household income (RMB)
<50,000	614 (26.2)
50,000-100,000	408 (17.4)
>100,000	562 (24.0)
Unknown	759 (32.4)
Family history of mental disorders
Yes	222 (9.5)
No	2,121 (90.5)
Age (yr)	15.0±1.6
Year of education	9.2±1.7
PHQ-9 score	16.86±7.17
GAD-7 score	12.10±6.25

Values are presented as N (%) or mean±standard deviation. PHQ-9, Patient Health Questionnaire-9; GAD-7, The Generalized Anxiety Disorder scale.

Table 2.

Descriptive analysis and correlation analysis of scale scores

	Mean±SD	Skewness	Kurtosis	1	2	3	4	5	6
1. PSS	47.07±16.85	-0.025	-0.557	1
2. Family support	15.10±6.14	0.098	-0.588	0.739^*	1
3. Friend support	16.10±6.82	-0.103	-0.879	0.878^*	0.445^*	1
4. Problem-focused coping	43.49±11.74	0.208	-0.346	0.511^*	0.478^*	0.441^*	1
5. Emotion-focused coping	45.20±8.51	-0.245	-0.058	-0.028	-0.069^*	-0.003	0.031	1
6. Loneliness	47.95±11.41	-0.707	0.375	-0.609^*	-0.457^*	-0.572^*	-0.506^*	0.296^*	1

^* p<0.01.

SD, standard deviation; PSS, perceived social support.

Table 3.

Total, direct, and indirect effects of perceived social support on loneliness

Effect	Path	Effect	Boot SE	95% CI	p
Total effect	X → Y	-0.605	0.015	-0.634 to -0.576	<0.001
Direct effect	X → Y	-0.459	0.018	-0.493 to -0.423	<0.001
Indirect effect	X → M₁ → Y	-0.136	0.011	-0.158 to -0.115	<0.001
Indirect effect	X → M₂ → Y	-0.010	0.007	-0.024 to -0.003	0.125

X=perceived social support, M₁=problem-focused coping strategies, M₂=emotion-focused coping strategies, Y=loneliness. SE, standard error; CI, confidence interval.

Table 4.

Direct and indirect effects of family support on loneliness

Effect	Path	Effect	Boot SE	95% CI	p
Total effect	X₁ → Y	-0.249	0.020	-0.288 to -0.212	<0.001
Direct effect	X₁ → Y	-0.131	0.019	-0.167 to -0.093	<0.001
Indirect effect	X₁ → M₁ → Y	-0.091	0.008	-0.109 to -0.076	<0.001
Indirect effect	X₁ → M₂ → Y	-0.027	0.007	-0.041 to -0.014	<0.001

X₁=family support, M₁=problem-focused coping strategies, M₂=emotion-focused coping strategies, Y=loneliness. SE, standard error; CI, confidence interval.

Table 5.

Direct and indirect effects of friend support on loneliness

Effect	Path	Effect	Boot SE	95% CI	p
Total effect	X₂ → Y	-0.460	0.017	-0.492 to -0.425	<0.001
Direct effect	X₂ → Y	-0.393	0.018	-0.426 to -0.356	<0.001
Indirect effect	X₂ → M₁ → Y	-0.078	0.008	-0.095 to -0.064	<0.001
Indirect effect	X₂ → M₂ → Y	0.011	0.007	-0.002 to 0.024	0.109

X₂=friend support, M₁=problem-focused coping strategies, M₂=emotion-focused coping strategies, Y=loneliness. SE, standard error; CI, confidence interval.

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