Violence exposure and depression in Chinese adolescents: Mediation by health-risk behaviors and alleviation by family health

As the social environment evolves, adolescents face increasing exposure to violence and psychological stress. Adolescent violence is a global public health issue that not only severely impacts their mental health but also profoundly affects their long-term well-being. Fewer studies have explored the mediating role of health-risk behaviors in the association between violence and depressive symptoms among adolescents, particularly the moderating effect of family health. Using cross-sectional data from the 2021 Psychological and Behavioral Investigation of Chinese Residents (PBICR) involving 1065 adolescents aged 12–18, results showed: Violence exposure significantly predicted elevated depressive symptoms, with 42.9% of this association mediated by health-risk behaviors. Family health moderated these relationships, significantly attenuating the impacts of violence on both health-risk behaviors and depressive symptoms. Higher family health levels correlated with reduced engagement in maladaptive coping strategies and lower depression severity. The study emphasized family health's dual role in buffering psychological trauma and reducing risk behaviors, proposing practical pathways to alleviate depression associated with violence exposure through interventions targeting health-risk behaviors and strengthening family support systems. Policy recommendations included advancing family mental health service systems under the Healthy China 2030 initiative.