Bidirectional pathways to suicide: how parent-child interactions shape adolescent depression and suicidality in China

Background Adolescent suicide, largely driven 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 the complex bidirectional dynamics between adolescents and their caregivers. Methods This qualitative study used purposive sampling to recruit 12 adolescent-parent dyads (N = 24) from a tertiary hospital in China. Adolescents met the ICD-10 criteria for depression, had recent suicide attempts, and were aged 11–18 years. Parents were the primary caregivers. Semi-structured interviews explored the bidirectional physical, emotional, and cognitive impacts of depression. Data were analyzed using Colaizzi’s phenomenological method, grounded in family systems theory and stress contagion models, with rigorous quality controls including member checking, triangulation, and negative case analysis. Results Four interconnected thematic domains emerged, revealing complex bidirectional dynamics. Bidirectional stress transmission manifested through reciprocal physical deterioration (most adolescents reported chronic fatigue, and approximately two-thirds of parents developed stress-related symptoms) and destructive psychological feedback mechanisms (all adolescents identified parental emotional states as suicidal triggers). Communication disruptions affected the majority of adolescents who ceased emotional disclosure, while most parents demonstrated limited understanding of depression. Family system destabilization included role confusion, relationship deterioration (more than half experiencing marital strain), and substantial economic burden, averaging 42,500 yuan annually, representing approximately one-third of the median household income in the study region. Systemic support deficiencies encompassed social stigma (nearly all families), healthcare delays averaging 5.3 months between symptom onset and appropriate psychiatric care, and institutional barriers to care. Conclusion This study illuminates the cyclical and relational nature of adolescent suicidality, demonstrating how bidirectional stress transmission, communication breakdowns, and systemic barriers maintain pathological cycles. The findings support comprehensive family centered intervention models that address patient and caregiver needs while providing integrated socioeconomic support.