The longitudinal relationships among loneliness, source-specific perceived social support, and depressive symptoms in Chinese children and adolescents: a three-wave cross-lagged panel network analysis

Loneliness, perceived social support, and depressive symptoms are closely linked in childhood and adolescence; however, less is known about how depressive symptoms, loneliness, and source-specific deficits in perceived support are prospectively associated at different levels of measurement. Prior studies using aggregate scores have limited insights into how specific symptoms interact with distinct support sources over time. This three-wave cross-lagged panel network (CLPN) study examined these relationships in a large school-based sample of ~5000 Chinese children and adolescents.

Depressive symptoms were assessed using the Patient Health Questionnaire (PHQ-9), loneliness was measured with a single item, and perceived social support was evaluated across four sources: parents, teachers, classmates, and close friends. We estimated both cross-sectional and cross-lagged panel networks to examine centrality indices, bridge expected influence, and longitudinal predictive pathways. Network structures remained stable across waves.

Fatigue consistently emerged as a central depressive symptom, and low classmate support was central within the support domain. Loneliness showed the strongest bridge effect, linking depressive symptoms with low perceived social support. Longitudinally, fatigue and loneliness showed relatively high outward expected influence and prospectively predicted later increases in low perceived support, although these temporal pathways should not be interpreted as causal effects.

The associations between suicidal ideation and support were similar for parent and teacher sources but differed for peer support during a specific time period, demonstrating source-specific interpersonal correlates. These findings suggest that fatigue, loneliness, and source-specific support deficits may be important targets for hypothesis generation and future intervention research, while causal mechanisms require further confirmation using designs specifically suited for causal inference. The authors would like to thank all adolescents who participated in this study.

This study was supported by Yunnan Provincial Science and Technology Plan Project—Clinical Medical Research Center Special Program (202505AJ310004), the National Natural Science Foundation of China (NSFC; Nos. 72264019 and 82360670), the First-Class Discipline Team of Kunming Medical University (2024XKTDTS16), Yunnan Provincial Department of Education Scientific Research Fund for Postgraduate Students (2026Y0417), Yunnan Provincial Science and Technology Plan Project—Key Project of Basic Research Special Program (202301AS070026), Yunnan Provincial Clinical Medical Center Research Project (2024YNLCYXZX0078). These authors contributed equally: Ziyang Huang, Yiling Xie, Liya A. Psychiatric Department, First Affiliated Hospital of Kunming Medical University, Kunming, China Ziyang Huang, Yiling Xie, Linling Jiang, Runxu Yang, Zhenlei Peng, Wenjing Huang, Yiqing He, Xingmei Yin, Shuai Liu & Jin Lu NHC Key Lab of Drug Addiction Medicine (Kunming Medical University), Kunming, China Taylor’s University, Subang Jaya, Malaysia School of Public Health, Kunming Medical University, Kunming, China Department of General Practice, Traditional Chinese and Western Medicine Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China Correspondence to Yuanyuan Xiao, Yanxia Wu or Jin Lu.

The authors declare no competing interests. This study received approval from the Medical Ethics Committee of Kunming Medical University on April 7, 2020 (Approval No. The research adhered to the Declaration of Helsinki.