Bidirectional Pathways to Suicide: How Parent-Child Interactions Shape Adolescent Depression and Suicidality in China

Background : Adolescent suicide, driven largely by depression, is a critical public health crisis in China, with depression affecting over 70% of cases and demonstrating recurrence rates exceeding 80% within one year. While parent-child interactions significantly influence suicidal trajectories, existing research has predominantly examined unidirectional perspectives, neglecting complex bidirectional dynamics between adolescents and their caregivers. Methods : A qualitative study using purposive sampling recruited 12 adolescent-parent dyads (N=24) from a tertiary hospital in China. Adolescents met ICD-10 criteria for depression, had recent suicide attempts, and were aged 11–18. Parents were primary caregivers. Semi-structured interviews explored bidirectional physical, emotional, and cognitive impacts of depression. Data were analyzed via Colaizzi’s phenomenological method, with rigorous quality controls (e.g., member checking, triangulation). Results : Four interconnected thematic domains emerged revealing complex bidirectional dynamics. Bidirectional stress transmission manifested through reciprocal physical deterioration (91.7% of adolescents reporting chronic fatigue, 66.7% of parents developing stress-related symptoms) and destructive psychological feedback mechanisms (100% of adolescents identifying parental emotional states as suicidal triggers). Communication disruptions affected 83.3% of adolescents who ceased emotional disclosure, while 75% of parents demonstrated limited depression understanding. Family system destabilization included role confusion, relationship deterioration (58.3% experiencing marital strain), and substantial economic burden averaging 42,500 yuan annually. Systemic support deficiencies encompassed social stigma (91.7% of families), healthcare delays (5.3 months average), and institutional barriers. Conclusion : This investigation illuminates the cyclical, relational nature of adolescent suicidality, demonstrating how bidirectional stress transmission, communication breakdowns, and systemic barriers maintain pathological cycles. Findings support comprehensive family-centered intervention models addressing patient and caregiver needs while providing integrated socioeconomic support.