Factors within family of origin can be categorized into two aspects: risk (16) and protective (17) factors, which may interact in a buffering manner, jointly influencing offspring well-being. On the one hand, risk factors might attenuate the benefits of protective factors. For example, evidence showed that the benefits of having a married mother for children’s emotional support were weakened by an adverse family environment during upbringing (25). Conversely, protective factors may buffer the adverse effects of risk factors. Research on Intimate Partner Violence (IPV) reported that children who had contact with a less- or non-violent father could buffer the impact of IPV on their externalizing problems (26). Similarly, mother-child cohesiveness moderated the relationship between the persistence of domestic violence and children’s anger (27). These pieces of evidence support the buffering interactions between risk and protective family factors in determining offspring’s mental health outcomes.

In addition to buffering interactions, either risk or protective factors may exert a decisive effect on children’s mental health, since that some effects may be mutually buffered, while remained effects may still manifest. Wille et al. (28) reported that the presence of more risk factors in a family was associated with a higher prevalence of mental health problems in offspring. In contrast, substantial resources at the individual, family and social levels were associated with a reduced occurrence of mental health problems, particularly when children lived in families with fewer risk factors (28). In other words, the cumulative effects of both risk and protective family factors may determine which side predominates. In general, alert awareness and initiating action occur only after the harm has occurred (29), which takes a lot of time and energy to repair and rebuild. Thus, it is crucial to identify and foster appropriate protective factors before negative outcomes arise, especially in families with more risk factors.

Family conditions refer to a constant physical and psychological environment in which children grow up. The most representative stuff might be family economic status. Family poverty has been widely recognized as a significant risk factor, particularly linked to offspring’s mood disorders (6, 41), psychological distress (42), and behavioral disorders (43). It has also been associated with a higher external locus of control (44) and an increased risk of suicide among children (45). Moreover, low parental socioeconomic status and high residential instability have been related to elevated lifetime risks of depression, greater recurrence, and a reduced likelihood of remission (46). Adverse family event. In addition, children raised in families that experienced a high level of adverse life-events were more likely to develop lifetime depression (47). Likewise, adverse health events in childhood and early adolescence were significant predictors of late-adolescent attention-deficit/hyperactivity disorder (ADHD) (48). In conclusion, poor family economic status, residential instability, and frequent adverse family events are risk factors.

Family studies had consistently shown that first-degree relatives of bipolar patients were at increased risk for mood and anxiety disorders compared to those without such family histories (49). In particular, a history of parental psychiatric disorder strongly predicts the occurrence of mood disorders in offspring (6). Similarly, a family history of dysthymic disorder had been linked to higher levels of offspring’s depression (50) and greater likelihood of ADHD symptoms (51).

From a gender perspective, maternal mental disorders have been repeatedly associated with negative mental outcomes in children, including depression and psychological distress (42), chronic disabling fatigue (52), and higher risk in reduction of cerebral activity (53). Maternal early-life stress can alter cortisol responses to an ecologically relevant postpartum stressor, and this dysregulation was often mirrored in offspring (54). Both prenatal and postnatal maternal mood disturbances exerting impacts: prenatal depression and anxiety is associated with poor socio-emotional development in offspring (55), while postnatal depression increased the risk of offspring depression by the age of 16 (56). Longitudinal evidence spanning 81 months further demonstrated that maternal depression had increased the odds of child’s high emotionality (57). While the influence of paternal mental health had been less studied, available evidence suggests similar patterns. Paternal psychological distress had been mildly but positively linked to behavioral and emotional difficulties in children (58). A recent cross-lagged analysis also reported a reciprocal association between paternal psychological distress and subsequent child emotional symptoms across ages 3 to 14 (59).

In general, the influence of parents’ psychiatric disorders on mental health of offspring may be influenced by family genes. But studies of adoptive families have found that emotional instability in adoptive parents can also affect a child’s mental well-being (60). Therefore, the impact of parental mental wellness on offspring’s well-being requires consideration of both genetic and environmental issues.

Beyond the direct impact of parental psycho status, parents’ behavioral patterns also play a crucial role in shaping offspring’s psychological development. Evidence indicated that maternal conduct disorder was a stronger signal of “pre-schizophrenic” behavior in children, whereas paternal conduct disorder was a greater signal of externalizing behaviors (61). Family history of addiction was independently associated with offspring’s poor emotion regulation and negative moods (16). Specifically, frequency of alcohol consumption, drunkenness, and smoking were associated with offspring’s temperament and character dimensions in their early adulthood (62). Higher scores on harm avoidance among mothers and lower scores on self-directedness among fathers, were associated with an increased risk of suicide attempts among adolescents (63). In parents with autism spectrum disorder, self-directedness emerged as a potential autistic trait in offspring (64).

To sum up, parental psychiatric, behavioral, and personality disorders are risk factors.

Studies have shown the effects of family disruptions on offspring. It was reported that family dissolution increased the likelihood of mood disorders (6), suicidal ideation (45), and the lifetime risk of depression (46) in offspring. Importantly, parental divorce had a long-term influence on the early antecedents of depression and antisocial behavior in adulthood (65). An early experience of family disruption was significantly associated with delinquent behavior at age 11 (66). Children who spent equal time with both parents after parental divorce might find life easier (67), while not living with one of the parents was associated with poorer outcomes (68). The possible reason was that a divorced family not only implied the “loss” of the family itself but also the loss of opportunities to interact with one of the parents (69). Moreover, parental divorce was associated with lower relationship commitment and confidence, particularly for women, which increased the potential risk for their own marital development (70, 71). Moreover, individuals who experienced parents’ relationship instability before age 5 were more likely to report a history of sexual partnerships at age 16 or an episode of major depression during adolescence (72).

Some divorced people eventually remarry, and these remarriages often involve children from previous unions, thus forming stepfamilies. Compared to children in single-parent families, those who live in stepfamilies are more likely to experience unintentional injuries, which was attributed to higher exposure to psychosocial risks (73). However, the negative impact of stepfamilies on offspring has not been widely acknowledged. For example, Nicholson et al. (74) noted that although young people living in a stepfamily had increased risks of poor psychosocial outcomes, many of these associations arose from confounding social, contextual, and individual factors rather than the stepfamily per se. Therefore, the invisible harm might be partially present in the family of origin and subsequently manifest in the stepfamily.

Living in a 2-parent household has no guarantee of good child outcomes. The happiness of offspring after parental divorce decreases significantly when they live with a low-conflict parent, whereas it is even lower for those who remain with a high-conflict parent in an intact marriage (75). Parental conflict resulted in deleterious consequences for children’s mood, health, and behavior (76–78). Highly troubled marriages have significant and sometimes underappreciated negative effects on children’s adjustment (79). This conclusion was confirmed by later studies, in that high levels of depression in children were associated with disturbed family relationships (42, 80). Constant parental conflict increases negative emotions such as depression and anger due to an accumulation of insecurity (81).

In summary, family disruption and marital discord were regarded as risk factors for children’s mental health.

Among different types of parenting, parental indifference has been identified as a risk factor for children’s development, which increased the risk for both depression and anxiety in adulthood (84). In addition, low parental care is associated with increased risk of abuse by a biologically unrelated perpetrator before the age of 11, which makes an independent contribution to the affective symptoms (85).

In females, higher levels of sociotropy were related to greater maternal protection (86). Indeed, perceived parental overprotection was significantly related to heart-focused anxiety (87), dysfunctional attitudes about achievement and dependency (88), functional somatic symptoms (89), as well as sleep disturbance in adulthood (90). Similarly, the perceptions of ‘not having a controlling mother’,’ having a caring father’, and ‘not having controlling parents’, were associated with a lower risk of mental illness (91).

Exposure to victimization in early-life family environment has been associated with a wide range of mental health problems, such as depression, anxiety, post-traumatic stress disorder (PTSD) (9, 92, 93), and antisocial behavior in adulthood (65). Childhood physical and sexual abuse was associated with suicide attempts (94). Maltreated children were more likely to describe their early parental bonding experiences as “affectionless control” or “weak or absent” bonding (95), which was further associated with suicidal behavior (96). The most commonly reported adversities were emotional abuse, physical abuse, and witnessing household members being subjected violence (42.3%, 39.9%, and 34.6%, respectively), which showed dose-response relationships with poor mental health, including but not limited to, severe depression, anxiety, and reduced well-being and happiness (97).

Lower education or early parenthood might lead to a greater likelihood of inadequate parenting, such as maltreatment or being rigid and restrictive (98), which result in poorer mental health among offspring. Maternal education was negatively associated with major depressive episodes in early-adulthood (99). Low parental education significantly predicted the persistence and severity of mental disorder (41). Indeed, having the lowest level of parental education continued to be the strongest risk factor for parent-reported child mental health problems (100). In addition, early parenthood was also confirmed as a predictor of later developmental disorder (101).

In discussion of parenting styles, parental indifference, parental overprotection, family abuse, and low parental education or early parenthood were regarded as risk factors.

Attachment is shaped during infancy, which has far-reaching effects on offspring’s lifelong well-being. Insecure attachment is associated with problems including depression (103) and suicidal behavior (45). Specifically, “disorganized” patterns of attachment, have the strongest negative impact on both concurrent and later psychopathology in offspring (104).

Inadequate parenting and separation from parents might cause children’s feelings of alienation toward their parents. Researches have evaluated the link between emotional alienation toward parents and depression in left-behind children (LBC) using longitudinal designs (197) and have also highlighted the higher level of maternal alienation in LBC (105).

Individuals with frequent fear of a family member showed the strongest association between childhood adversities and the use of psychotropic drugs, and this association was stronger among those with poor parent-child relationships (106). Persistent mental disorders were found in 16.9% of pregnant women which were partly predicted by fear of a family member (T. D. 107).

Early maternal separation and isolation rearing has been linked to depressive behaviors (108). Individuals who experienced prolonged separation (i.e., lasting one year or longer) developed depressive systems in response to lower levels of life stress (109). Among adoptees, extended early deprivation was associated with long-term deleterious effects on well-being that appear resistant to years of nurturance and support in adoptive families (110). Importantly, parental death is a special and severe form of separation, which is a strong predictor of clinical depression in adolescents (92). Moreover, early-life parental death was associated with increased adult suicide risk beforeage50 (111).

Policies protecting unauthorized immigrant mothers resulted in improved mental health among their children (115 Certainly, the safe and stable nurturing environment was associated with reduced biological markers of toxic stress, as well as improved clinical outcomes (116).

One’s perception of family values may be reflected in familism and a sense of family pride, both of which may serve as protective factors for the mental well-being of the younger generation. Familism emphasizes close family relationships, interconnectedness, and prioritizing family over the self (117). A previous study has shown that higher levels of familism predicted lower loneliness and depression among family members (118). Similarly, the related concept of family pride, which signifies one’s positive sentiment toward the family, is also associated with positive outcomes. It was found that family pride was associated with higher self-esteem, greater family-responsive happiness among adolescents who grew up in a collectivist cultural background (119), and greater experiences of joy among emerging adults (120).

Children demonstrated better outcomes when their families believed they were part of a community with shared values and mutual obligations (121). Consistently, parents’ perceived support strongly influenced child-rearing practices. A supportive family relationship during a child’s upbringing can buffer responses to toxic stress that result from extreme or prolonged activation of the body’s stress-response systems in a maladaptive developmental environment (122, 123).

In conclusion, the safe and stable family environment, familism and familial pride, and family social support were protective factors.

Importantly, parents who were satisfied with their marriages served as more attractive role models for their children, making them more likely to emulate family-related ideals modeled by their happily married parents (125).

Coparenting has been identified as a key factor that promotes children’s psychological adjustment (126, 127). A child’s positive affect was significantly associated with maternal-perceived coparenting support (128). Moreover, coparenting quality positively affects parent’s marital relationship, which in turn benefits children’s mental outcomes. Specifically, parent’s coparenting quality was linked with both their own and their partner’s perceived relationship quality, including relationship adjustment and negative interactions (129).

Importantly, based on the 76-year longitudinal grant study, the warmth of childhood relationships with parents had the greatest positive impact on “life satisfaction” (130). High parental warmth was associated with a decreased risk of developing an insecure attachment style (103), as well as reduced anxiety and depression (131). Moreover, warm parenting was associated with a marked reduction in children’s internalizing and externalizing problems over time (132).

In brief, parental sensitivity, optimal coparenting and parental warmth were protective factors of offspring’s mental health.

Specifically, the touch-sensitive attachment between mother and infant contributed to the child’s long-term emotional and mental stability (133); maternal attachment softened the impact of early adversity (17). Importantly, a secure attachment to the father was not enough to reduce infant stress reactivity when the infant-mother attachment was insecure (134), indicates a mother preference again. However, the paternal role is still important. For example, Waldegrave (135) suggested that maintaining paternal involvement during imprisonment was vital in promoting and maintaining positive infant mental health, which might increase the infant’s attachment to the father. For adolescents, a secure attachment in infancy was associated with more appropriate emotional expression than that of insecure peer (136).

Regardless of whether or not they lived with two biological parents during childhood, individuals who perceived love from caregivers had significantly lower odds (by 42-43%) of lifetime suicidal thought (137).

Frequent contact with nonresidential parents helps reduce the risk of mental health symptoms (138). Moreover, higher-quality and more frequent interactions with biological parents predicted a delayed onset of sexual behaviors, which were linked to negative outcomes for adolescents (139).

Taken together, the results suggested that insecure attachment, alienation from parents, fear of family members, and separation from parents were risk factors, whereas secure attachment, frequent contact with parents, and perceived love from caregivers served as protective factors.