An Investigation of Family Functioning Among Caregiver-Adolescent Dyads Seeking Emergency Department Care for Adolescent Suicide Risk.

Rising adolescent suicide rates in the United States call for the identification of relevant risk and protective factors. Family dysfunction (FD) is consistently linked to adolescent mental health. Prior literature suggests that discrepancies in FD reports (e.g., caregivers vs. adolescents) could be a clinical indicator of adolescent mental health. However, there has been limited research examining multi-informant perspectives on FD within adolescent suicide literature, and no research has examined which contextual factors may be associated with discrepant reports of FD between adolescents at elevated suicide risk and their caregivers. This study addresses these gaps by examining FD among 116 caregiver-adolescent dyads (Mage = 15.29 (SDage =1.46); 65.5% female; 75.9% White) who sought emergency department (ED) services related to adolescent suicide risk. Cross-sectional findings revealed that caregiver-adolescent FD discrepancy was associated with greater adolescent self-rated suicide risk, depression, and anxiety. Similarly, adolescent-reported FD was associated with higher anxiety and depression, whereas caregiver-reported FD was not associated with adolescent mental health outcomes. Contextual factors such as lower caregiver stress, higher caregiver emotional support, and lower adolescent-perceived family relationship quality were associated with greater caregiver-adolescent FD discrepancies. It is possible that parents who receive additional emotional support and experience lower stress in their lives may perceive all areas of their lives, including their relationship with their teen, as improved – thereby amplifying discrepancies between parent and youth reports. Findings highlight the importance of understanding FD from multi-informant perspectives and suggest that improving family processes for adolescents at high-risk is an important treatment target.