Association between co-residence with parents and General Anxiety Disorder in Korean adolescents

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Elements such as family dynamics, social pressures, and academic demands constitute substantial risks to adolescent mental health. Additionally, the shift toward nuclear family structures and economic challenges, which have reduced parental time with adolescents, have been identified as contributing factors to this issue. This study examined whether the association between parental co-residence and adolescent anxiety is warranted. Methods The study data were sourced from the 2020–2023 Youth Health Behavior Survey by the Korea Disease Control and Prevention Agency (sample of 208,891 Korean adolescents aged 13 to 18 years). Adolescent anxiety levels were measured using the Generalized Anxiety Disorder-7 (GAD-7) screening tool. To investigate the association between parental co-residence and GAD, multiple logistic regression analyses were conducted. Results Adolescents who were not residing with their parents had more anxiety compared to those residing with parents (Male: OR: 1.19, 95% CI: 1.10–1.28; Female: OR: 1.08, 95% CI: 1.00–1.17). Notably, adolescents co-residing with relatives had the most anxiety (Male: OR: 1.67, 95% CI: 1.35–2.08; Female: OR: 1.31, 95% CI: 1.05–1.64). Conclusion The study found that adolescents who were not residing with their parents faced an increased risk of anxiety. These adolescents therefore may require anxiety reduction-oriented care. parental co-residence generalized anxiety disorder family co-residence mental health physical health physical activity Figures Figure 1 1. Background Anxiety is a prevalent characteristic of contemporary society [ 1 ], and related disorders have remained the most common mental health condition globally. Between 1990 and 2019, the absolute number of anxiety disorder cases rose by 50% [ 2 ]. This high prevalence may be linked to its defining features [ 3 ]. Modern society is characterized by rapid, intense processes centered around labor, production, performance, and consumption. Within this fast-paced framework, many individuals may fail to engage in meaningful self-care practices, which are often fostered by authentic personal interactions and relationships. Their absence can thus result in heightened anxiety levels [ 4 ]. Challenges in forming such interpersonal relationships can also drive many people to prioritize attractiveness, social standing, and peer acceptance. However, such pursuits are associated with psychological distress and increased social anxiety [ 5 ]. Furthermore, modern society is characterized by multidimensional changes occurring rapidly across cultural, economic, and technological domains; this amplifies unpredictability and fosters a pervasive sense of uncertainty, which is also strongly correlated with heightened anxiety [ 6 ]. Given such characteristics of modern society, contemporary Korean adolescents are likely to experience heightened exposure to anxiety for numerous reasons. Adolescents face an elevated risk of developing mental health issues due to a combination of psychological, physiological, and social factors; thus, generalized anxiety disorder (GAD) represents a particular area of concern among adolescents. Various factors, including family environment [ 7 ], interpersonal relationships [ 8 ], neurological and hormonal changes [ 9 ], social pressures [ 10 ], and academic stress [ 11 ], can pose significant threats to adolescents’ mental well-being. Further, recent studies have identified additional factors that can contribute to the development of GAD among Korean adolescents, particularly in the post-COVID-19 context. These factors include gender, economic status, economic changes following the pandemic, and health-related behaviors such as habitual medication unrelated to treatment purposes, and excessive reliance on smartphones. Psychosocial factors, including subjective health perceptions, perceived daily stress, experiences of sadness and despair, suicidal ideation, and exposure to violence, can also significantly increase GAD risk among Korean adolescents [ 12 ]. Korean adolescents may be particularly vulnerable to anxiety not only due to their developmental stage but also because they must grapple with the dynamics of modern Korean society [ 13 ]. Several societal characteristics can have a significant impact on adolescent anxiety. First, it must be noted that South Korean society is marked by a pervasive culture of competition. Following rapid industrialization and economic growth, Korea has become highly competitive; this cultural quality extends beyond adult spheres, such as employment and property acquisition, to influence adolescents as well. Academic performance, clothing, and personal items have all become metrics for peer comparison among Korean adolescents, with social networking services further intensifying these comparisons and competitions [ 14 ]. This heightened competitive pressure may contribute significantly to increasing anxiety among Korean adolescents. Second, in recent decades, the Korean family structure has transformed from a traditional to a modern form. This shift from extended to nuclear families [ 15 ] has amplified parents’ roles in their adolescents’ lives; in this context, attachment and positive parental relationships are crucial for adolescents’ self-efficacy and their formation of healthy social relationships [ 16 ]. However, economic pressures, including escalating housing costs and volatile job markets [ 17 ], have led many parents to spend less time with their adolescents, and some are even unable to live together with their children. Thus, while the parental role has become more central, opportunities for building emotional bonds with adolescents have diminished. One previous study indicated that over 55% of children felt lonely when separated from their parents [ 18 ], suggesting that reduced parent-child interaction and co-residence could pose significant risks to adolescents’ emotional development. Given prior research’s identification of strong associations between parent-child relationships and adolescent mental health, the residential arrangements of Korean adolescents—specifically, whether they live with their parents—could constitute a crucial factor of their psychological well-being. However, little to no studies have explored the relationship between family environment, particularly parental co-residence, and adolescent mental health. The current study therefore aims to investigate the association between GAD in Korean adolescents and their parental co-residence. 2. Methods 2.1. Data This cross-sectional study sourced its relevant data from the 2020–2023 Youth Health Behavior Survey by the Korea Disease Control and Prevention Agency. Key variables included the number of adolescents residing with their parents and those not residing with their parents as well as the observed levels of GAD (Williams, 2014). To clarify residence classifications, participants were divided into two groups: adolescents who did not reside with their parents were classified as “Do not reside with parents,” while those living with their parents were classified as “Reside with parents.” The prevalence of GAD was assessed using the Generalized Anxiety Disorder-7 (GAD-7) scale, where scores of 5–9 indicate mild anxiety, scores of 10–14 indicate moderate anxiety, and scores of 15 or higher indicate severe anxiety. A score of 5 out of 21 was used as the threshold for determining the presence of GAD. The relevant analysis was conducted based on GAD severity levels. 2.2 Study Population The study sample consisted of 208,891 participants, comprising 107,326 males (51%) and 101,565 females (49%). As the study focused on “Korean adolescents” aged 13 to 18 years, non-Korean individuals, as well as Korean infants, children, and adults, were excluded from the analysis. 2.3 Variables GAD is commonly characterized by persistent worry and distress as well as difficulty in managing these symptoms. GAD presence was assessed using the GAD-7, a seven-item questionnaire developed by Spitzer et al [ 19 ]. This tool begins with a prompt—“During the past two weeks, how often have you been bothered by the following problems?” Responses are scored on a 4-point scale, with each item receiving a score between 0 and 3. The cumulative score across all items ranges from 0 to 21; scores of 0 to 4 indicate no anxiety, and scores of 5 or higher indicate GAD presence. This study’s primary independent variable was “residence type,” specifically focusing on “who one lives with.” Residence types were categorized into two groups. The “do not live with parents” category included adolescents residing with relatives, alone, in dormitories, or orphanages, while the “live with parents” category included those living with their parents. Data on residence type were collected through an interview survey that was integrated into a larger youth health behavior survey. The study population encompassed Korean adolescents aged 13 to 18 years, who were segmented based on individual age groups. Household income levels were classified as “High,” “Middle,” and “Low.” The participants’ geographical regions, categorized based on administrative divisions in Korea, were classified into “Metropolitan,” “Medium-sized city,” and “Rural.” The participants’ body mass index (BMI) was classified into “Underweight,” “Normal,” and “Obese.” Other variables included physical activity (60 minutes per day), smoking experience, and alcohol consumption experience, each of which required a “Yes” or “No” response. Self-rated health status was classified as “Healthy,” “Normal,” and “Unhealthy.” Stress perception was categorized as “Very,” “A little,” and “None.” Sleep adequacy was classified as “Enough,” “Normal,” and “Usual.” Academic performance was also categorized as “High,” “Middle,” and “Low.” The missing values for all the variables were excluded from the analysis. 2.4 Statistical Analysis The association between the frequency of adolescents’ parental co-residence and GAD risk was evaluated using a chi-square test. Factors influencing GAD risk were analyzed using multiple logistic regression, where the primary interest was placed on the variable distinguishing adolescents who lived with their parents from those who did not. Additionally, the relationship between this key variable and GAD was assessed through multiple logistic regression within each independent variable by dividing them into subgroups. The association between the primary variable and GAD was further examined through multiple logistic regression; the primary variable was consequently segmented into additional subgroups. Finally, GAD severity levels among adolescents who were not residing with their parents, compared to those who were, were analyzed using multinomial logistic regression; this allowed us to determine whether the non-cohabiting adolescents experienced higher levels of GAD. 3. Results Table 1 represents the study population’s general characteristics. Between 2020 and 2023, 208,891 Korean adolescents participated in the Youth Health Behavior Survey. Among the male participants, 30,353 students (28.3%) reported experiencing GAD, whereas this figure was 42,288 (41.6%) among the female participants. Furthermore, 28% of male participants who resided with their parents reported experiencing GAD, whereas 33.5% of male participants did not report experiencing it. Among the female participants, 41.4% of those residing with their parents reported experiencing GAD, whereas this figure was 47% for those who did not. Table 2 demonstrates that, GAD prevalence was approximately 1.19 times higher among males who resided with their parents than among males who did not. GAD prevalence was also approximately 1.08 times higher among females who resided with their parents compared with those who did not (Males: OR: 1.19, 95% CI: 1.10–1.28; Females: OR: 1.08, 95% CI: 1.00–1.17). Thus, parental co-residence was significantly associated with higher GAD risk. Regarding self-rated health status, adolescents who perceived themselves as being unhealthy showed markedly increased odds of developing GAD. Males who rated their health as being poor were 2.44 times more likely to experience GAD risk; furthermore, females in the same category were 2.56 times more likely to develop GAD compared with their counterparts who considered themselves healthy (Males: OR: 2.44, 95% CI: 2.31–2.57; Females: OR: 2.56, 95% CI: 2.43–2.70). In terms of sleep, insufficient sleep was also associated with higher GAD risk. Males who reported having inadequate sleep were 1.83 times more likely to develop GAD, while females who had insufficient sleep were 1.61 times more likely to develop GAD compared with their counterparts who had adequate sleep. Table 3 demonstrates the correlations between the interest variable and the dependent variable for several independent variables. Regarding BMI, the correlation between parental co-residence and GAD risk was most significant among males who were reported to be obese (Males: OR: 1.37, 95% CI: 1.16–1.61; Females: OR: 1.15, 95% CI: 0.92 − 1.43). Additionally, a general trend was observed across both sexes: higher BMI was associated with higher GAD prevalence. With respect to physical activity (60 minutes per day), an inverse correlation was observed between exercise levels and GAD prevalence, with lower levels of physical activity corresponding to higher GAD prevalence. In terms of stress perception, the correlation between parental co-residence and GAD was strongest among adolescents who reported experiencing no stress, irrespective of sex (Males: OR: 1.67, 95% CI: 1.35–2.07; Females: OR: 1.62, 95% CI: 1.19–2.21). Furthermore, a gradual trend was observed across the sexes, wherein higher perceived stress levels were linked to higher GAD prevalence. Regarding sleep, the correlation between parental co-residence and GAD was most significant among females who reported inadequate sleep (Females: OR: 1.10, 95% CI: 1.00–1.22). Additionally, a gradual trend emerged, indicating that decreased sleep duration was associated with increased GAD prevalence. Regarding academic performance, the correlation between parental co-residence and GAD prevalence was strongest among females who reported low academic performance (Females: OR: 1.16, 95% CI: 1.02–1.31). Furthermore, a gradual correlation was observed, suggesting that lower academic performance was linked to higher GAD prevalence. Table 4 presents the correlation between the variables of interest and GAD by dividing them into several subgroups. Notably, among males, the strongest association with GAD was observed in the “Living alone” residence category. (Males: OR: 1.70, 95% CI: 1.40–2.08; Females: OR: 1.05, 95% CI: 0.82–1.34). For females, the most significant correlation with GAD was identified in the “Co-residence with relatives” residence category. Figure 1 depicts the results of the multinomial regression analysis, which examined whether adolescents who were not residing with their parents exhibited more severe GAD levels compared to those who did. Adolescents were categorized into four groups based on their GAD scores: no GAD (0–4 points), mild GAD (5–9 points), moderate GAD (10–14 points), and severe GAD (15–21 points) (measured using the GAD-7). The figure illustrates the correlation between GAD severity and parental co-residence, with results stratified by sex. For females, a progressive increase in GAD severity was observed in relation to non-co-residence with parents, with this trend extending up to the severe GAD category (No GAD: 1; Mild: 1.071; Moderate: 1.08; Severe: 1.218). 4. Discussion This study, after adjusting for potential covariates, found that Korean adolescents residing with their parents had a lower likelihood of developing GAD compared to their peers who did not. Notably, there was a consistent pattern of gender similarity in the incidence of GAD across age groups. Specifically, a decline in GAD incidence was observed among males aged 15–17 and females aged 14–17, suggesting an overall trend of decreasing GAD prevalence with increasing age. This finding aligns with previous research indicating that GAD incidence generally decreases with age and that females were more likely to recognize mental health issues and engage in proactive efforts to address them [ 20 ]. However, a significant increase in GAD incidence was identified among 18-year-olds of both genders compared to those aged 16 and 17 years. This phenomenon may be attributed to the heightened socio-cultural pressures faced by Korean adolescents at this age. In particular, the stress associated with preparing for university entrance exams—a common and significant milestone in Korea—likely contributes to this marked rise in GAD incidence [ 21 ]. The study also confirmed a strong association between household income level and GAD prevalence. While no significant difference was observed in GAD prevalence among adolescents from high- or middle-income households, those from low-income households exhibited a significantly higher prevalence. These findings are consistent with prior research demonstrating the detrimental impact of economic deprivation on adolescent well-being [ 22 ]. Furthermore, self-rated health status, stress perception, and sleep quality were found to have substantial effects on GAD prevalence. Additionally, engagement in physical activity (60 minutes per day) was found to significantly alleviate GAD risk. This aligns with previous study findings indicating that physical and mental health are significantly related [ 23 ], that post-traumatic stress is positively correlated with anxiety [ 24 ], and that sleep improvement reduces anxiety, loneliness, and depression while facilitating recovery from fatigue [ 25 ]. Additionally, a prior study has suggested that sleep disturbances may comprise core features of anxiety disorders [ 26 ]. Therefore, efforts to improve sleep quality and efforts to enhance health status through physical activity may be considered effective for mitigating anxiety disorders [ 27 ]. It should be noted, however, that self-rated health status may have limitations in accurately representing objective measures of physical health. When the types of residence were further subdivided and analyzed, notable findings emerged. Adolescents co-residing with relatives exhibited the highest incidence of GAD. In contrast, those living in dormitories or orphanages did not show significant differences in GAD prevalence compared to those co-residing with their parents. These findings highlight a distinct difference in psychological impact between residing with parents and residing with relatives, which is potentially attributable to the differing levels of psychological comfort provided by parents versus relatives. Regarding the lack of significant differences in GAD prevalence between adolescents living in dormitories or orphanages and those co-residing with their parents, we inferred that the diminished influence of parental attachment might be attributable to early adaptation to environments without parental presence and that adolescents in such living situations may have developed alternative coping mechanisms or attachments, thus mitigating the impact of parental absence on their mental health outcomes. Moreover, we thought that the duration of co-residence could also influence psychological comfort. Prior studies on attachment formation and development during adolescence and early adulthood have indicated that sustained interactions within specific relationships play a significant role in the stabilization of attachment [ 28 ]. However, the lack of data regarding the duration of residence in specific settings has limited the possibility of conducting a more detailed analysis in this regard. Overall, adolescents who did not reside with their parents exhibited more severe GAD symptoms compared to those who did. Among females, a gradual increase in the GAD severity was identified in correlation with adolescents’ non-co-residence with their parents. However, for males, while this trend persisted up to moderate levels of GAD, it deviated in cases of severe GAD. This deviation may be attributable to the smaller sample size of males with severe GAD or the influence of other significant independent variables unrelated to co-residence with parents. The study findings highlight the importance of further exploring the relationship between co-residence with parents and the prevalence of GAD. However, several current research limitations must be addressed. First, the study establishes a correlation rather than a causal relationship, making it insufficient to definitively determine the causes of GAD or identify factors that mitigate or prevent its onset. Second, GAD diagnosis in this study relied on self-assessment using the GAD-7 scale. As such, the term “having GAD” cannot conclusively confirm the presence of a clinical anxiety disorder. Third, while the study focused on “co-residence with parents” as a key variable, it did not differentiate between living with one parent versus both parents due to the unavailability of specific data. Finally, the lack of information regarding the duration of residence prevented the inclusion of this factor in the analysis. Incorporating such data could have enhanced the reliability and depth of the findings, enabling a more comprehensive understanding of the influence of residence duration on GAD outcomes among adolescents. Despite these limitations, this study demonstrates several notable strengths. First, the use of representative sample data from the Youth Health Behavior Survey ensures that the findings reflect the broader experiences of Korean adolescents. Consequently, these results can inform the development of policies for improving Korean adolescents’ mental health. Second, the study’s focus on residence type among Korean adolescents is particularly timely, given the ongoing shifts in household structures within Korean society. By addressing these changes, the research offers valuable insights into the evolving social dynamics that could influence Korean adolescents’ well-being. Third, the exploration of the relationship between GAD and parental co-residence underscores a critical avenue for future research. This focus highlights potential areas for intervention and deeper investigation into the role of family living arrangements in adolescent mental health outcomes. 5. Conclusion Our findings revealed the association that co-residence with parents mitigate GAD in Korean adolescents. Through a meticulous analysis of variables such as self-rated health status, sufficiency of sleep, physical activity and stress perception by sex, we deduced that self-rated health status, stress perception were significantly correlated with GAD. Additionally, we inferred that the presence of GAD among adolescents not residing with their parents may be alleviated through adequate sleep and regular physical activity. Therefore, to prevent the onset of mental health disorders such as GAD in Korean adolescents, it is crucial to establish public health policies that promote physical activity and adequate sleep, particularly for adolescents who do not reside with their parents. Abbreviations Generalized anxiety disorder (GAD) Generalized Anxiety Disorder-7 (GAD-7) Body mass index (BMI) Declarations Ethics approval and consent to participate This study utilized publicly available data from the Korean National Health and Nutrition Examination Survey (KNHANES) and the Korean Youth Risk Behavior Survey (KYRBS), both managed by the Korea Disease Control and Prevention Agency (KDCA). The KYRBS was exempted from ethical approval by the Institutional Review Board (IRB) under the Bioethics and Safety Act and is publicly available for academic use. This study was conducted in accordance with the ethical standards outlined in the Declaration of Helsinki. Consent for publication Not applicable. Availability of data and materials The datasets analyzed during the current study are publicly available through the Korean National Health and Nutrition Examination Survey (KNHANES) website [https://knhanes.kdca.go.kr]. Competing interests The authors declare no competing interests. Funding Not applicable Authors' contributions Kyung-cheol Kim: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Writing – original draft, Writing – review & editing. Seong-mo Yoon: Conceptualization, Formal analysis, Investigation, Methodology. Seung-won Song: Formal analysis, Methodology. Su-Min Park: Conceptualization, Investigation, Methodology, Writing – review & editing. Eun-Cheol Park: Conceptualization, Investigation, Methodology, Supervision, Writing – review & editing. Acknowledgements We acknowledge the Korea Disease Control and Prevention Agency (KDCA) for providing access to the Korean National Health and Nutrition Examination Survey (KNHANES) data. 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The Moderating Effect of Ego-Resilience on the Relationship between Posttraumatic Stress and Anxiety in Veterans of the National War. J Digit Convergence 2018, 16(3). Scott AJ, Webb TL, Martyn-St James M, Rowse G, Weich S. Improving sleep quality leads to better mental health: A meta-analysis of randomised controlled trials. Sleep Med Rev. 2021;60:101556. Mellman TA. Sleep and anxiety disorders. Psychiatric Clin. 2006;29(4):1047–58. Jayakody K, Gunadasa S, Hosker C. Exercise for anxiety disorders: systematic review. Br J Sports Med. 2014;48(3):187–96. Kim S. The Effect of Unmarried person’s Adult Attachment in Early adulthood on Relationship Addiction: Focusing on the Mediating Effect of Self-Control and the Moderating Effect of Social Support. 2019. Tables Table 1 to 4 are available in the Supplementary Files section. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5767906","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":399906131,"identity":"7cbf3e47-e569-4503-a659-39d95ad4e752","order_by":0,"name":"Kyung-cheol Kim","email":"","orcid":"","institution":"Yonsei University College of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Kyung-cheol","middleName":"","lastName":"Kim","suffix":""},{"id":399906132,"identity":"ef7aa1da-a362-4d7a-be59-67e3c196a0f8","order_by":1,"name":"Seong-mo Yoon","email":"","orcid":"","institution":"Yonsei University College of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Seong-mo","middleName":"","lastName":"Yoon","suffix":""},{"id":399906133,"identity":"b42d4559-8ecc-4ae3-a49d-3a08b3be9fff","order_by":2,"name":"Seung-won Song","email":"","orcid":"","institution":"Yonsei University College of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Seung-won","middleName":"","lastName":"Song","suffix":""},{"id":399906134,"identity":"08cd601f-9059-45b9-9c8a-4190208b9aa2","order_by":3,"name":"Su-Min Park","email":"","orcid":"","institution":"Yonsei University","correspondingAuthor":false,"prefix":"","firstName":"Su-Min","middleName":"","lastName":"Park","suffix":""},{"id":399906135,"identity":"a11577a5-f834-4ccf-b63a-c63dceab9786","order_by":4,"name":"Eun-Cheol Park","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAt0lEQVRIiWNgGAWjYBAC+/bzDw7/bLNhYJAgVosBT47hY96eNFK0SOgYG/POOEySFh4zad4N5xM33G5/wPCjhggt9hL8z6R/PriduOHOGQPGnmPE2cIm/RCk5UYOAwNvA3Fa2H8bbjgH1JL+gPEvcVp02KQlZxwAakkwYCbOFp4cNmnenmTjmTdyDA7LEOMX+/YzQC1tdrJ9N9IfPnxDTIjBgCPISQdI0AC0jSTVo2AUjIJRMLIAAND4Oz/gY7RhAAAAAElFTkSuQmCC","orcid":"","institution":"Yonsei University College of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Eun-Cheol","middleName":"","lastName":"Park","suffix":""}],"badges":[],"createdAt":"2025-01-05 13:08:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5767906/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5767906/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":73701091,"identity":"6f207f73-565b-4b8d-ab0a-ed8adaf418de","added_by":"auto","created_at":"2025-01-13 17:11:59","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":59925,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5767906/v1/205a28ad86acff341b007d15.jpg"},{"id":75146765,"identity":"2d91e377-ef92-40da-9e2b-cc2c076f3633","added_by":"auto","created_at":"2025-01-31 07:08:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":537297,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5767906/v1/814eb333-31db-4dac-b764-9c0d23fa8756.pdf"},{"id":73699794,"identity":"e6974f7c-26df-429d-85b8-be33f36d1416","added_by":"auto","created_at":"2025-01-13 16:55:59","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":125428,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-5767906/v1/42bbe4d8b339e4ad5452831c.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Association between co-residence with parents and General Anxiety Disorder in Korean adolescents","fulltext":[{"header":"1. Background","content":"\u003cp\u003eAnxiety is a prevalent characteristic of contemporary society [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], and related disorders have remained the most common mental health condition globally. Between 1990 and 2019, the absolute number of anxiety disorder cases rose by 50% [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. This high prevalence may be linked to its defining features [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Modern society is characterized by rapid, intense processes centered around labor, production, performance, and consumption. Within this fast-paced framework, many individuals may fail to engage in meaningful self-care practices, which are often fostered by authentic personal interactions and relationships. Their absence can thus result in heightened anxiety levels [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Challenges in forming such interpersonal relationships can also drive many people to prioritize attractiveness, social standing, and peer acceptance. However, such pursuits are associated with psychological distress and increased social anxiety [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Furthermore, modern society is characterized by multidimensional changes occurring rapidly across cultural, economic, and technological domains; this amplifies unpredictability and fosters a pervasive sense of uncertainty, which is also strongly correlated with heightened anxiety [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGiven such characteristics of modern society, contemporary Korean adolescents are likely to experience heightened exposure to anxiety for numerous reasons. Adolescents face an elevated risk of developing mental health issues due to a combination of psychological, physiological, and social factors; thus, generalized anxiety disorder (GAD) represents a particular area of concern among adolescents. Various factors, including family environment [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], interpersonal relationships [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], neurological and hormonal changes [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], social pressures [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], and academic stress [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], can pose significant threats to adolescents\u0026rsquo; mental well-being. Further, recent studies have identified additional factors that can contribute to the development of GAD among Korean adolescents, particularly in the post-COVID-19 context. These factors include gender, economic status, economic changes following the pandemic, and health-related behaviors such as habitual medication unrelated to treatment purposes, and excessive reliance on smartphones. Psychosocial factors, including subjective health perceptions, perceived daily stress, experiences of sadness and despair, suicidal ideation, and exposure to violence, can also significantly increase GAD risk among Korean adolescents [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eKorean adolescents may be particularly vulnerable to anxiety not only due to their developmental stage but also because they must grapple with the dynamics of modern Korean society [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Several societal characteristics can have a significant impact on adolescent anxiety. First, it must be noted that South Korean society is marked by a pervasive culture of competition. Following rapid industrialization and economic growth, Korea has become highly competitive; this cultural quality extends beyond adult spheres, such as employment and property acquisition, to influence adolescents as well. Academic performance, clothing, and personal items have all become metrics for peer comparison among Korean adolescents, with social networking services further intensifying these comparisons and competitions [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. This heightened competitive pressure may contribute significantly to increasing anxiety among Korean adolescents.\u003c/p\u003e \u003cp\u003eSecond, in recent decades, the Korean family structure has transformed from a traditional to a modern form. This shift from extended to nuclear families [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] has amplified parents\u0026rsquo; roles in their adolescents\u0026rsquo; lives; in this context, attachment and positive parental relationships are crucial for adolescents\u0026rsquo; self-efficacy and their formation of healthy social relationships [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. However, economic pressures, including escalating housing costs and volatile job markets [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], have led many parents to spend less time with their adolescents, and some are even unable to live together with their children. Thus, while the parental role has become more central, opportunities for building emotional bonds with adolescents have diminished. One previous study indicated that over 55% of children felt lonely when separated from their parents [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], suggesting that reduced parent-child interaction and co-residence could pose significant risks to adolescents\u0026rsquo; emotional development.\u003c/p\u003e \u003cp\u003eGiven prior research\u0026rsquo;s identification of strong associations between parent-child relationships and adolescent mental health, the residential arrangements of Korean adolescents\u0026mdash;specifically, whether they live with their parents\u0026mdash;could constitute a crucial factor of their psychological well-being. However, little to no studies have explored the relationship between family environment, particularly parental co-residence, and adolescent mental health. The current study therefore aims to investigate the association between GAD in Korean adolescents and their parental co-residence.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Data\u003c/h2\u003e \u003cp\u003eThis cross-sectional study sourced its relevant data from the 2020\u0026ndash;2023 Youth Health Behavior Survey by the Korea Disease Control and Prevention Agency. Key variables included the number of adolescents residing with their parents and those not residing with their parents as well as the observed levels of GAD (Williams, 2014). To clarify residence classifications, participants were divided into two groups: adolescents who did not reside with their parents were classified as \u0026ldquo;Do not reside with parents,\u0026rdquo; while those living with their parents were classified as \u0026ldquo;Reside with parents.\u0026rdquo;\u003c/p\u003e \u003cp\u003eThe prevalence of GAD was assessed using the Generalized Anxiety Disorder-7 (GAD-7) scale, where scores of 5\u0026ndash;9 indicate mild anxiety, scores of 10\u0026ndash;14 indicate moderate anxiety, and scores of 15 or higher indicate severe anxiety. A score of 5 out of 21 was used as the threshold for determining the presence of GAD. The relevant analysis was conducted based on GAD severity levels.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Study Population\u003c/h2\u003e \u003cp\u003eThe study sample consisted of 208,891 participants, comprising 107,326 males (51%) and 101,565 females (49%). As the study focused on \u0026ldquo;Korean adolescents\u0026rdquo; aged 13 to 18 years, non-Korean individuals, as well as Korean infants, children, and adults, were excluded from the analysis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Variables\u003c/h2\u003e \u003cp\u003eGAD is commonly characterized by persistent worry and distress as well as difficulty in managing these symptoms. GAD presence was assessed using the GAD-7, a seven-item questionnaire developed by Spitzer et al [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. This tool begins with a prompt\u0026mdash;\u0026ldquo;During the past two weeks, how often have you been bothered by the following problems?\u0026rdquo; Responses are scored on a 4-point scale, with each item receiving a score between 0 and 3. The cumulative score across all items ranges from 0 to 21; scores of 0 to 4 indicate no anxiety, and scores of 5 or higher indicate GAD presence.\u003c/p\u003e \u003cp\u003eThis study\u0026rsquo;s primary independent variable was \u0026ldquo;residence type,\u0026rdquo; specifically focusing on \u0026ldquo;who one lives with.\u0026rdquo; Residence types were categorized into two groups. The \u0026ldquo;do not live with parents\u0026rdquo; category included adolescents residing with relatives, alone, in dormitories, or orphanages, while the \u0026ldquo;live with parents\u0026rdquo; category included those living with their parents. Data on residence type were collected through an interview survey that was integrated into a larger youth health behavior survey.\u003c/p\u003e \u003cp\u003eThe study population encompassed Korean adolescents aged 13 to 18 years, who were segmented based on individual age groups. Household income levels were classified as \u0026ldquo;High,\u0026rdquo; \u0026ldquo;Middle,\u0026rdquo; and \u0026ldquo;Low.\u0026rdquo; The participants\u0026rsquo; geographical regions, categorized based on administrative divisions in Korea, were classified into \u0026ldquo;Metropolitan,\u0026rdquo; \u0026ldquo;Medium-sized city,\u0026rdquo; and \u0026ldquo;Rural.\u0026rdquo; The participants\u0026rsquo; body mass index (BMI) was classified into \u0026ldquo;Underweight,\u0026rdquo; \u0026ldquo;Normal,\u0026rdquo; and \u0026ldquo;Obese.\u0026rdquo; Other variables included physical activity (60 minutes per day), smoking experience, and alcohol consumption experience, each of which required a \u0026ldquo;Yes\u0026rdquo; or \u0026ldquo;No\u0026rdquo; response. Self-rated health status was classified as \u0026ldquo;Healthy,\u0026rdquo; \u0026ldquo;Normal,\u0026rdquo; and \u0026ldquo;Unhealthy.\u0026rdquo; Stress perception was categorized as \u0026ldquo;Very,\u0026rdquo; \u0026ldquo;A little,\u0026rdquo; and \u0026ldquo;None.\u0026rdquo; Sleep adequacy was classified as \u0026ldquo;Enough,\u0026rdquo; \u0026ldquo;Normal,\u0026rdquo; and \u0026ldquo;Usual.\u0026rdquo; Academic performance was also categorized as \u0026ldquo;High,\u0026rdquo; \u0026ldquo;Middle,\u0026rdquo; and \u0026ldquo;Low.\u0026rdquo; The missing values for all the variables were excluded from the analysis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Statistical Analysis\u003c/h2\u003e \u003cp\u003eThe association between the frequency of adolescents\u0026rsquo; parental co-residence and GAD risk was evaluated using a chi-square test. Factors influencing GAD risk were analyzed using multiple logistic regression, where the primary interest was placed on the variable distinguishing adolescents who lived with their parents from those who did not. Additionally, the relationship between this key variable and GAD was assessed through multiple logistic regression within each independent variable by dividing them into subgroups.\u003c/p\u003e \u003cp\u003eThe association between the primary variable and GAD was further examined through multiple logistic regression; the primary variable was consequently segmented into additional subgroups. Finally, GAD severity levels among adolescents who were not residing with their parents, compared to those who were, were analyzed using multinomial logistic regression; this allowed us to determine whether the non-cohabiting adolescents experienced higher levels of GAD.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003eTable\u0026nbsp;1 represents the study population\u0026rsquo;s general characteristics. Between 2020 and 2023, 208,891 Korean adolescents participated in the Youth Health Behavior Survey. Among the male participants, 30,353 students (28.3%) reported experiencing GAD, whereas this figure was 42,288 (41.6%) among the female participants. Furthermore, 28% of male participants who resided with their parents reported experiencing GAD, whereas 33.5% of male participants did not report experiencing it. Among the female participants, 41.4% of those residing with their parents reported experiencing GAD, whereas this figure was 47% for those who did not.\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;2 demonstrates that, GAD prevalence was approximately 1.19 times higher among males who resided with their parents than among males who did not. GAD prevalence was also approximately 1.08 times higher among females who resided with their parents compared with those who did not (Males: OR: 1.19, 95% CI: 1.10\u0026ndash;1.28; Females: OR: 1.08, 95% CI: 1.00\u0026ndash;1.17). Thus, parental co-residence was significantly associated with higher GAD risk. Regarding self-rated health status, adolescents who perceived themselves as being unhealthy showed markedly increased odds of developing GAD. Males who rated their health as being poor were 2.44 times more likely to experience GAD risk; furthermore, females in the same category were 2.56 times more likely to develop GAD compared with their counterparts who considered themselves healthy (Males: OR: 2.44, 95% CI: 2.31\u0026ndash;2.57; Females: OR: 2.56, 95% CI: 2.43\u0026ndash;2.70). In terms of sleep, insufficient sleep was also associated with higher GAD risk. Males who reported having inadequate sleep were 1.83 times more likely to develop GAD, while females who had insufficient sleep were 1.61 times more likely to develop GAD compared with their counterparts who had adequate sleep.\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;3 demonstrates the correlations between the interest variable and the dependent variable for several independent variables. Regarding BMI, the correlation between parental co-residence and GAD risk was most significant among males who were reported to be obese (Males: OR: 1.37, 95% CI: 1.16\u0026ndash;1.61; Females: OR: 1.15, 95% CI: 0.92 \u0026minus;\u0026thinsp;1.43). Additionally, a general trend was observed across both sexes: higher BMI was associated with higher GAD prevalence. With respect to physical activity (60 minutes per day), an inverse correlation was observed between exercise levels and GAD prevalence, with lower levels of physical activity corresponding to higher GAD prevalence. In terms of stress perception, the correlation between parental co-residence and GAD was strongest among adolescents who reported experiencing no stress, irrespective of sex (Males: OR: 1.67, 95% CI: 1.35\u0026ndash;2.07; Females: OR: 1.62, 95% CI: 1.19\u0026ndash;2.21). Furthermore, a gradual trend was observed across the sexes, wherein higher perceived stress levels were linked to higher GAD prevalence. Regarding sleep, the correlation between parental co-residence and GAD was most significant among females who reported inadequate sleep (Females: OR: 1.10, 95% CI: 1.00\u0026ndash;1.22). Additionally, a gradual trend emerged, indicating that decreased sleep duration was associated with increased GAD prevalence. Regarding academic performance, the correlation between parental co-residence and GAD prevalence was strongest among females who reported low academic performance (Females: OR: 1.16, 95% CI: 1.02\u0026ndash;1.31). Furthermore, a gradual correlation was observed, suggesting that lower academic performance was linked to higher GAD prevalence.\u003c/p\u003e\n\u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e presents the correlation between the variables of interest and GAD by dividing them into several subgroups. Notably, among males, the strongest association with GAD was observed in the \u0026ldquo;Living alone\u0026rdquo; residence category. (Males: OR: 1.70, 95% CI: 1.40\u0026ndash;2.08; Females: OR: 1.05, 95% CI: 0.82\u0026ndash;1.34). For females, the most significant correlation with GAD was identified in the \u0026ldquo;Co-residence with relatives\u0026rdquo; residence category.\u003c/p\u003e\n\u003cp\u003eFigure \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e depicts the results of the multinomial regression analysis, which examined whether adolescents who were not residing with their parents exhibited more severe GAD levels compared to those who did. Adolescents were categorized into four groups based on their GAD scores: no GAD (0\u0026ndash;4 points), mild GAD (5\u0026ndash;9 points), moderate GAD (10\u0026ndash;14 points), and severe GAD (15\u0026ndash;21 points) (measured using the GAD-7). The figure illustrates the correlation between GAD severity and parental co-residence, with results stratified by sex. For females, a progressive increase in GAD severity was observed in relation to non-co-residence with parents, with this trend extending up to the severe GAD category (No GAD: 1; Mild: 1.071; Moderate: 1.08; Severe: 1.218).\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis study, after adjusting for potential covariates, found that Korean adolescents residing with their parents had a lower likelihood of developing GAD compared to their peers who did not. Notably, there was a consistent pattern of gender similarity in the incidence of GAD across age groups. Specifically, a decline in GAD incidence was observed among males aged 15\u0026ndash;17 and females aged 14\u0026ndash;17, suggesting an overall trend of decreasing GAD prevalence with increasing age. This finding aligns with previous research indicating that GAD incidence generally decreases with age and that females were more likely to recognize mental health issues and engage in proactive efforts to address them [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. However, a significant increase in GAD incidence was identified among 18-year-olds of both genders compared to those aged 16 and 17 years. This phenomenon may be attributed to the heightened socio-cultural pressures faced by Korean adolescents at this age. In particular, the stress associated with preparing for university entrance exams\u0026mdash;a common and significant milestone in Korea\u0026mdash;likely contributes to this marked rise in GAD incidence [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe study also confirmed a strong association between household income level and GAD prevalence. While no significant difference was observed in GAD prevalence among adolescents from high- or middle-income households, those from low-income households exhibited a significantly higher prevalence. These findings are consistent with prior research demonstrating the detrimental impact of economic deprivation on adolescent well-being [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFurthermore, self-rated health status, stress perception, and sleep quality were found to have substantial effects on GAD prevalence. Additionally, engagement in physical activity (60 minutes per day) was found to significantly alleviate GAD risk. This aligns with previous study findings indicating that physical and mental health are significantly related [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], that post-traumatic stress is positively correlated with anxiety [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], and that sleep improvement reduces anxiety, loneliness, and depression while facilitating recovery from fatigue [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Additionally, a prior study has suggested that sleep disturbances may comprise core features of anxiety disorders [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Therefore, efforts to improve sleep quality and efforts to enhance health status through physical activity may be considered effective for mitigating anxiety disorders [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. It should be noted, however, that self-rated health status may have limitations in accurately representing objective measures of physical health.\u003c/p\u003e \u003cp\u003eWhen the types of residence were further subdivided and analyzed, notable findings emerged. Adolescents co-residing with relatives exhibited the highest incidence of GAD. In contrast, those living in dormitories or orphanages did not show significant differences in GAD prevalence compared to those co-residing with their parents. These findings highlight a distinct difference in psychological impact between residing with parents and residing with relatives, which is potentially attributable to the differing levels of psychological comfort provided by parents versus relatives. Regarding the lack of significant differences in GAD prevalence between adolescents living in dormitories or orphanages and those co-residing with their parents, we inferred that the diminished influence of parental attachment might be attributable to early adaptation to environments without parental presence and that adolescents in such living situations may have developed alternative coping mechanisms or attachments, thus mitigating the impact of parental absence on their mental health outcomes.\u003c/p\u003e \u003cp\u003eMoreover, we thought that the duration of co-residence could also influence psychological comfort. Prior studies on attachment formation and development during adolescence and early adulthood have indicated that sustained interactions within specific relationships play a significant role in the stabilization of attachment [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. However, the lack of data regarding the duration of residence in specific settings has limited the possibility of conducting a more detailed analysis in this regard.\u003c/p\u003e \u003cp\u003e Overall, adolescents who did not reside with their parents exhibited more severe GAD symptoms compared to those who did. Among females, a gradual increase in the GAD severity was identified in correlation with adolescents\u0026rsquo; non-co-residence with their parents. However, for males, while this trend persisted up to moderate levels of GAD, it deviated in cases of severe GAD. This deviation may be attributable to the smaller sample size of males with severe GAD or the influence of other significant independent variables unrelated to co-residence with parents.\u003c/p\u003e \u003cp\u003eThe study findings highlight the importance of further exploring the relationship between co-residence with parents and the prevalence of GAD. However, several current research limitations must be addressed. First, the study establishes a correlation rather than a causal relationship, making it insufficient to definitively determine the causes of GAD or identify factors that mitigate or prevent its onset. Second, GAD diagnosis in this study relied on self-assessment using the GAD-7 scale. As such, the term \u0026ldquo;having GAD\u0026rdquo; cannot conclusively confirm the presence of a clinical anxiety disorder. Third, while the study focused on \u0026ldquo;co-residence with parents\u0026rdquo; as a key variable, it did not differentiate between living with one parent versus both parents due to the unavailability of specific data. Finally, the lack of information regarding the duration of residence prevented the inclusion of this factor in the analysis. Incorporating such data could have enhanced the reliability and depth of the findings, enabling a more comprehensive understanding of the influence of residence duration on GAD outcomes among adolescents.\u003c/p\u003e \u003cp\u003eDespite these limitations, this study demonstrates several notable strengths. First, the use of representative sample data from the Youth Health Behavior Survey ensures that the findings reflect the broader experiences of Korean adolescents. Consequently, these results can inform the development of policies for improving Korean adolescents\u0026rsquo; mental health. Second, the study\u0026rsquo;s focus on residence type among Korean adolescents is particularly timely, given the ongoing shifts in household structures within Korean society. By addressing these changes, the research offers valuable insights into the evolving social dynamics that could influence Korean adolescents\u0026rsquo; well-being. Third, the exploration of the relationship between GAD and parental co-residence underscores a critical avenue for future research. This focus highlights potential areas for intervention and deeper investigation into the role of family living arrangements in adolescent mental health outcomes.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eOur findings revealed the association that co-residence with parents mitigate GAD in Korean adolescents. Through a meticulous analysis of variables such as self-rated health status, sufficiency of sleep, physical activity and stress perception by sex, we deduced that self-rated health status, stress perception were significantly correlated with GAD. Additionally, we inferred that the presence of GAD among adolescents not residing with their parents may be alleviated through adequate sleep and regular physical activity. Therefore, to prevent the onset of mental health disorders such as GAD in Korean adolescents, it is crucial to establish public health policies that promote physical activity and adequate sleep, particularly for adolescents who do not reside with their parents.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eGeneralized anxiety disorder (GAD)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGeneralized Anxiety Disorder-7 (GAD-7)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBody mass index (BMI)\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study utilized publicly available data from the Korean National Health and Nutrition Examination Survey (KNHANES) and the Korean Youth Risk Behavior Survey (KYRBS), both managed by the Korea Disease Control and Prevention Agency (KDCA). The KYRBS was exempted from ethical approval by the Institutional Review Board (IRB) under the Bioethics and Safety Act and is publicly available for academic use. This study was conducted in accordance with the ethical standards outlined in the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets analyzed during the current study are publicly available through the Korean National Health and Nutrition Examination Survey (KNHANES) website [https://knhanes.kdca.go.kr].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKyung-cheol Kim: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Writing \u0026ndash; original draft, Writing \u0026ndash; review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003eSeong-mo Yoon: Conceptualization, Formal analysis, Investigation, Methodology.\u003c/p\u003e\n\u003cp\u003eSeung-won Song: Formal analysis, Methodology.\u003c/p\u003e\n\u003cp\u003eSu-Min Park: Conceptualization, Investigation, Methodology, Writing \u0026ndash; review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003eEun-Cheol Park: Conceptualization, Investigation, Methodology, Supervision, Writing \u0026ndash; review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe acknowledge the Korea Disease Control and Prevention Agency (KDCA) for providing access to the Korean National Health and Nutrition Examination Survey (KNHANES) data. Additionally, we express our gratitude to the researchers and professors at the Institute of Health Services Research at Yonsei University for their invaluable support and guidance throughout this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHuman Ethics and Consent to Participate declarations: not applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFreeston MH, Rh\u0026eacute;aume J, Letarte H, Dugas MJ, Ladouceur R. Why do people worry? Pers Indiv Differ. 1994;17(6):791\u0026ndash;802.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang X, Fang Y, Chen H, Zhang T, Yin X, Man J, Yang L, Lu M. 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Child Youth Serv Rev. 2004;26(8):785\u0026ndash;801.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKandola A, Vancampfort D, Herring M, Rebar A, Hallgren M, Firth J, Stubbs B. Moving to beat anxiety: epidemiology and therapeutic issues with physical activity for anxiety. Curr psychiatry Rep. 2018;20:1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim T, Kim y. The Moderating Effect of Ego-Resilience on the Relationship between Posttraumatic Stress and Anxiety in Veterans of the National War. J Digit Convergence 2018, 16(3).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eScott AJ, Webb TL, Martyn-St James M, Rowse G, Weich S. Improving sleep quality leads to better mental health: A meta-analysis of randomised controlled trials. Sleep Med Rev. 2021;60:101556.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMellman TA. Sleep and anxiety disorders. Psychiatric Clin. 2006;29(4):1047\u0026ndash;58.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJayakody K, Gunadasa S, Hosker C. Exercise for anxiety disorders: systematic review. Br J Sports Med. 2014;48(3):187\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim S. The Effect of Unmarried person\u0026rsquo;s Adult Attachment in Early adulthood on Relationship Addiction: Focusing on the Mediating Effect of Self-Control and the Moderating Effect of Social Support. 2019.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 to 4 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"parental co-residence, generalized anxiety disorder, family co-residence, mental health, physical health, physical activity","lastPublishedDoi":"10.21203/rs.3.rs-5767906/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5767906/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eGeneralized anxiety disorder (GAD) is a significant mental health concern, especially among Korean adolescents, who exhibit a heightened vulnerability to anxiety due to psychological, physiological, and social factors. Elements such as family dynamics, social pressures, and academic demands constitute substantial risks to adolescent mental health. Additionally, the shift toward nuclear family structures and economic challenges, which have reduced parental time with adolescents, have been identified as contributing factors to this issue. This study examined whether the association between parental co-residence and adolescent anxiety is warranted.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe study data were sourced from the 2020\u0026ndash;2023 Youth Health Behavior Survey by the Korea Disease Control and Prevention Agency (sample of 208,891 Korean adolescents aged 13 to 18 years). Adolescent anxiety levels were measured using the Generalized Anxiety Disorder-7 (GAD-7) screening tool. To investigate the association between parental co-residence and GAD, multiple logistic regression analyses were conducted.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAdolescents who were not residing with their parents had more anxiety compared to those residing with parents (Male: OR: 1.19, 95% CI: 1.10\u0026ndash;1.28; Female: OR: 1.08, 95% CI: 1.00\u0026ndash;1.17). Notably, adolescents co-residing with relatives had the most anxiety (Male: OR: 1.67, 95% CI: 1.35\u0026ndash;2.08; Female: OR: 1.31, 95% CI: 1.05\u0026ndash;1.64).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe study found that adolescents who were not residing with their parents faced an increased risk of anxiety. These adolescents therefore may require anxiety reduction-oriented care.\u003c/p\u003e","manuscriptTitle":"Association between co-residence with parents and General Anxiety Disorder in Korean adolescents","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-13 16:55:53","doi":"10.21203/rs.3.rs-5767906/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b4f98541-c4b3-4650-b40c-e426395a432c","owner":[],"postedDate":"January 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-01-31T07:08:13+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-13 16:55:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5767906","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5767906","identity":"rs-5767906","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}