Family dysfunction and risk of suicidal behavior in adolescents: A systematic review and meta-analysis

IMPORTANCE. Adolescents are at high risk for the occurrence of suicide. Previous meta-studies have mostly focused on the correlation between childhood maltreatment adversity and adolescent suicidal behavior, ignoring in-depth analyses of different categories of family dysfunction adversity. To conduct a systematic review and meta-analysis of cohort studies examining the association between family dysfunction and adolescent suicide, and to select the categories of family dysfunction that have the greatest impact on adolescent suicidal behavior. Embase, PubMed, Science Direct, Scopus, and Web of Science databases were searched between inception and November 2023. Population-based cohort studies investigating family dysfunction and adolescent suicidal behavior. This systematic review and meta-analysis was performed following the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. The review protocol was prospectively registered in PROSPERO. Pooled odds ratios (ORs) and 95 % CIs were derived from meta-analysis using STATA 17.0, and subgroup and sensitivity analyses were performed. The primary outcome was adolescent suicide symptoms. Measured by database data records, suicide scales, or adolescent self-reports. 12 cohort studies were included, with sample sizes ranging from 352 to 618,970 individuals. Adolescents experiencing family dysfunction a substantially higher risk of suicidal behaviors than those in the normal family functioning (pooled OR = 1.94; 95 % CI: 1.73–2.16). Specifically, parental suicide or attempted suicide had the greatest impact on adolescent suicidal behavior (OR = 2.70, 95 % CI:2.12–3.29) compared with parental mental disorders, imprisonment of a parent or family member. Family dysfunction, especially parental suicide or attempted suicide, is associated with an increased risk of adolescent suicidal behavior. The results of this study suggest that early screening and intervention for family functioning is important in preventing adolescent suicide. •Family dysfunction is associated with an increased risk of adolescent suicidal behavior.•Parental suicide is the category of family dysfunction that leads to the highest risk of youth suicide.•Early screening and intervention for family functioning is important in preventing adolescent suicide.