Associations Between Parenting Stress, Family Support, Emotion Regulation, and Parental Burnout in Parents of Adolescents with Mood Disorders: A Cross-Sectional Structural Equation Modeling and Fuzzy-Set Qualitative Comparative Analysis Study.

AIM: Parents of adolescents with mood disorders are at high risk of parental burnout. Existing research has examined risk and resource factors in isolation, with limited attention to the role of emotion regulation in relation to parental burnout. The present study integrates the Balance between Risks and Resources Theory and the Emotion Regulation Process Model and aims to examine both the net effects and potential configurations of parental burnout. METHODS: A cross-sectional study was conducted between July and October 2025 using a consecutive sampling strategy. A total of 212 parents of adolescents diagnosed with mood disorders were recruited from psychiatric outpatient and inpatient settings. Data were collected using the Short Parenting Stress Scale, the Family APGAR Index, the Emotion Regulation Questionnaire, and the Chinese version of the Short Parental Burnout Assessment. Structural equation modeling (SEM) and fuzzy-set qualitative comparative analysis (fsQCA) were used for data analysis. RESULTS: The SEM demonstrated good model fit (χ2/df = 1.071, CFI = 0.982, IFI = 0.982, TLI = 0.981, GFI = 0.858, RMR = 0.043, RMSEA = 0.018). Parenting stress and family support were indirectly associated with parental burnout via expressive suppression (β = 0.130, 95% CI [0.054, 0.237]; β = -0.116, 95% CI [-0.223, -0.052]), whereas cognitive reappraisal was not significantly associated with parental burnout in the model. FsQCA identified three configurations linked to high parental burnout. Low cognitive reappraisal emerged as a core condition in two configurations. The most prominent configuration was characterized by high parenting stress, unemployment, low family support, low cognitive reappraisal, and high expressive suppression. CONCLUSION: This study identified multiple patterns of association in parental burnout among caregivers of adolescents with mood disorders. Expressive suppression may represent an important emotional correlate linking risk-resource imbalance and parental burnout. Resource deprivation across economic, social, and psychological domains characterized a typical high-burnout configuration. Given the cross-sectional design, these findings should be interpreted as associational rather than causal. Enhancing family support and promoting adaptive emotion regulation strategies may help mitigate parental burnout, particularly among families with limited economic, social, and psychological resources.