The association of family functioning and suicide in children and adolescents: positive behavior recognition and non-suicidal self-injury as sequential mediators

Xia Li ^1,2 Jiahe Liu ³ Yanling Hu ^1,2* Xi Huang ^1,2* Ying Xin Li ^1,2 Yuan Li ^1,2 Zeyao Shi ^1,2 Ru Yang ^1,2 Hanmei Peng ^1,2* Sisi Ma ^4* Xingli Wan ^2,5* Wei Peng ^6,7*

• ¹ Department of Neonatology Nursing, West China Second University Hospital, Sichuan University, Chengdu, China
• ² Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
• ³ School of Mathematics and Statistics, University of Melbourne, Parkville VIC 3052, Australia, Melbourne, Australia
• ⁴ Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
• ⁵ Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, China
• ⁶ Department of Oncology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
• ⁷ Research Center for Palliative Care, West China-PUMC C.C. Chen Institute of Health, Sichuan University, Chengdu, China

Background: Suicide is a major behavioral issue among children and adolescents, and family functioning potentially influencing its occurrence. Furthermore, positive behavior recognition, as a key component of positive youth development, may act as a mediating factor in the relationship between family functioning and suicide. Non-suicidal self-injury (NSSI) often co-occurs with suicide and may also mediate the impact of family functioning on suicide. Therefore, the aim of this study is to examine the role of family functioning in child and adolescent suicide, with positive behavior recognition and NSSI serving as sequential mediating factors.Methods: The participants in this study were recruited from the Chengdu Positive Child Development (CPCD) cohort study. The analysis was based on the second round of cross-sectional data from the CPCD cohort. They were required to complete questionnaires that included measures of family functioning, suicide, positive behavior recognition, and NSSI. SPSS 26.0 and Mplus 8.3 were used for descriptive statistical analysis, correlation analysis and mediation effect analysis.Results: A total of 8124 participants completed the questionnaires, with an average age of 11.00 ± 2.18 years. The sample comprised 4195 male and 3929 female participants. The findings indicate that 17.93% of children and adolescents reported suicide thoughts, 10.06% had formulated suicide plans, and 8.64% had attempted suicide. Poor family functioning shows a significant positive correlation with suicide (r=0.322, P<0.01). The multiple mediation effect of positive behavior recognition and NSSI in the association between family functioning and suicide was statistically significant (β = 0.034, 95% CI = 0.027, 0.042).Conclusion: This study found that poor family functioning is a risk factor for suicide in children and adolescents, with positive behavior recognition and non-suicidal self-injury acting as sequential mediating factors.