Abstract
The present study examined the relationship between parent–adolescent conflict and adolescent suicidal ideation in Hong Kong, China. Depression and anxiety were investigated as possible mediators of this relationship. A cross-sectional survey was conducted, with 338 valid self-administered questionnaires completed by adolescents. The results indicated that parent–adolescent conflict is significantly associated with suicidal ideation among adolescents in Hong Kong. This effect was mediated by those adolescents who suffered from depression and anxiety. To decrease Chinese adolescent suicidal ideation resulting from parent–adolescent conflict and depression, prevention intervention is suggested, such as parenting programmes and more help for adolescents who have symptoms of depression.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bandura, A. (1986). The explanatory and predictive scope of self-efficacy theory. Journal of Social and Clinical Psychology, 4(3), 359–373. https://doi.org/10.1521/jscp.1986.4.3.359.
Barber, J. G., & Delfabbro, P. (2000). Predictors of adolescent adjustment: Parent-peer relationships and parent-child conflict. Journal of Child and Adolescent Social Work, 17, 275–288. https://doi.org/10.1023/A:1007546023135.
Bardone, A. M., Moffitt, T. E., & Caspi, A. (1998). Adult physical health outcomes of adolescent girls with conduct disorder, depression, and anxiety. Journal of the American Academy of Child Adolescent Psychiatry, 37, 594–601. https://doi.org/10.1097/00004583-199806000-00009.
Berndt, T. J., Cheung, P. C., Lau, S., Hau, K.-T., & Lew, W. J. F. (1993). Perceptions of parenting in mainland China, Taiwan, and Hong Kong: Sex differences and societal differences. Developmental Psychology, 29(19), 154–164. https://doi.org/10.1037/0012-1649.29.1.156.
Breslau, N., Schultz, L., & Peterson, E. (1995). Sex differences in depression: A role for preexisting anxiety. Psychiatry Research, 58(1), 1–12. https://doi.org/10.1016/0165-1781(95)02765-O.
Cash, S. J., & Bridge, J. A. (2009). Epidemiology of youth suicide and suicidal behavior. Current Opinion in Pediatrics, 21(5), 613–619.
Chan, Y. F., Leung, D. Y., Fong, D. Y., Leung, C. M., & Lee, A. M. (2010). Psychometric evaluation of the hospital anxiety and depression scale in a large community sample of adolescents in Hong Kong. Quality of Life Research, 19(6), 865–873. https://doi.org/10.1007/s11136-010-9645-1.
Costello, E. J., Mustillo, S., Erkanli, A., Keeler, G., & Angold, A. (2003). Prevalence and development of psychiatric disorders in childhood and adolescence. Archives of General Psychiatry, 60(8), 837–844. https://doi.org/10.1001/archpsyc.60.8.837.
Domitrovich, C. E., Cortes, R. C., & Greenberg, M. T. (2007). Improving young children’s social and emotional competence: A randomized trial of the preschool “PATHS” curriculum. The Journal of Primary Prevention, 28(2), 67–91. https://doi.org/10.1007/s10935-007-0081-0.
Edlund, M. J., Forman-Hoffman, V. L., Winder, C. R., Heller, D. C., Kroutil, L. A., Lipari, R. N., & Colpe, L. J. (2015). Opioid abuse and depression in adolescents: Results from the National Survey on drug use and health. Drug and Alcohol Dependence, 152, 131–138. https://doi.org/10.1016/j.drugalcdep.2015.04.010.
Esposito, C. L., & Clum, G. A. (2002). Psychiatric symptoms and their relationship to suicidal ideation in a high-risk adolescent community sample. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 44–51. https://doi.org/10.1097/00004583-200201000-00010.
Essau, C. A., Conradt, J., & Petermann, F. (2000). Frequency, comorbidity, and psychosocial impairment of anxiety disorders in German adolescents. Journal of Anxiety Disorders, 14(3), 263–279. https://doi.org/10.1016/S0887-6185(99)00039-0.
Ezpeleta, L., Keeler, G., Erkanli, A., Costello, E. J., & Angold, A. (2001). Epidemiology of psychiatric disability in childhood and adolescence. The Journal of Child Psychology and Psychiatry and Allied Disciplines, 42(7), 901–914. https://doi.org/10.1017/S0021963001007740.
Fergusson, D. M., Boden, J. M., & Horwood, L. J. (2007). Recurrence of major depression in adolescence and early adulthood, and later mental health, educational and economic outcomes. British Journal of Psychiatry, 191, 335–342. https://doi.org/10.1192/bjp.bp.107.036079.
Goldney, R. D., Wilson, D., Dal Grande, E., Fisher, L. J., & McFarlane, A. C. (2000). Suicidal ideation in a random community sample: Attributable risk due to depression and psychosocial and traumatic events. Australian and New Zealand Journal of Psychiatry, 34, 98–106. https://doi.org/10.1046/j.1440-1614.2000.00646.x.
Harris, T. L., & Molock, S. D. (2000). Cultural orientation, family cohesion, and family support in suicide ideation and depression among African American college students. Suicide and Life-threatening Behavior, 30(4), 341–353. https://doi.org/10.1111/j.1943-278X.2000.tb01100.x.
Hatch, S. L., & Wadsworth, M. E. (2008). Does adolescent affect impact adult social integration? Evidence from the British 1946 birth cohort. Sociology, 42(1), 155–177. https://doi.org/10.1177/0038038507087358.
Hayes, A. F. (2009). Beyond baron and Kenny: Statistical mediation analysis in the new millennium. Communication Monographs, 76(4), 408–420. https://doi.org/10.1080/03637750903310360.
Hesketh, T., Ding, Q. J., & Jenkins, R. (2002). Suicide ideation in Chinese adolescents. Social Psychiatry and Psychiatric Epidemiology, 37, 230–235. https://doi.org/10.1007/s00127-002-0536-9.
Hill, K. G., Hawkins, J. D., Catalano, R. F., Abbott, R. D., & Guo, J. (2005). Family influences on the risk of daily smoking initiation. Journal of Adolescent Health, 37, 202–210. https://doi.org/10.1016/j.jadohealth.2004.08.014.
Ialongo, N. S., Koenig-McNaught, A. L., Wagner, B. M., Pearson, J. L., McCreary, B. K., Poduska, J., & Kellam, S. (2004). African American children’s reports of depressed mood, hopelessness, and suicidal ideation and later suicide attempts. Suicide and Life-threatening Behavior, 34, 395–407. https://doi.org/10.1521/suli.34.4.395.53743.
Ingoldsby, E. M., Shaw, D. S., Winslow, E., Schonberg, M., Gilliom, M., & Criss, M. M. (2006). Neighborhood disadvantage, parent-child conflict, neighborhood peer relationships, and early antisocial behavior problem trajectories. Journal of Abnormal Child Psychology, 34, 303–331. https://doi.org/10.1007/s10802-006-9026-y.
Kandel, D. B., Raveis, V. H., & Davies, M. (1991). Suicidal ideation in adolescence: Depression, substance use, and other risk factors. Journal of Youth and Adolescence, 20, 289–309. https://doi.org/10.1007/BF01537613.
Kapadia, S., & Miller, J. (2005). Parent–adolescent relationships in the context of interpersonal disagreements: View from a collectivist culture. Psychology and Developing Societies, 17(1), 33–50. https://doi.org/10.1177/097133360501700103.
Keller, M. B., Lavoir, P., Wunder, J., Beardslee, W. R., Schwarts, C. E., & Roth, J. (1992). Chronic course of anxiety disorders in children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 100–110. https://doi.org/10.1097/00004583-199207000-00003.
Kuhlberg, J. A., Peña, J. B., & Zayas, L. H. (2010). Familism, parent-adolescent conflict, self-esteem, internalizing behaviors and suicide attempts among adolescent Latinas. Child Psychiatry & Human Development, 41, 425–440. DOI:0.1007/s10578-010-0179-0.
Kwak, K. (2003). Adolescents and their parents: A review of intergenerational family relations for immigrant and non-immigrant families. Human Development, 46, 115–136. https://doi.org/10.1159/000068581.
Kwok, L., Sylvia, Y. C., & Shek, D. T. (2010). Hopelessness, parent-adolescent communication, and suicidal ideation among Chinese adolescents in Hong Kong. Suicide and Life-Threatening Behavior, 40(3), 224–233. https://doi.org/10.1521/suli.2010.40.3.224.
Lai, K. W., & McBride-Chang, C. (2001). Suicidal ideation, parenting style, and family climate among Hong Kong adolescents. International Journal of Psychology, 36(2), 81–87. https://doi.org/10.1080/00207590042000065.
Langley, A. K., Bergman, R. L., McCracken, J., & Piacentini, J. C. (2004). Impairment in childhood anxiety disorders: Preliminary examination of the child anxiety impact scale–parent version. Journal of Child and Adolescent Psychopharmacology, 14(1), 105–114. https://doi.org/10.1089/104454604773840544.
Lau, S. (1992). Collectivism’s individualism: Value preference, personal control, and the desire for freedom among Chinese in mainland China, Hong Kong and Singapore. Personality and Individual Differences, 13(3), 361–366. https://doi.org/10.1016/0191-8869(92)90115-6.
Lau, S., & Kwok, L. K. (2000). Relationship of family environment to adolescents’ depression and self-concept. Social Behavior. & Personality: An International Journal, 28(1), 41–51. https://doi.org/10.2224/sbp.2000.28.1.41.
Lau, S., & Yeung, P. W. (1996). Understanding Chinese child development: The role of culture in socialization. In S. Lau (Ed.), Growing up the Chinese way: Chinese child and adolescent development (pp. 29–44). Hong Kong, China: Chinese University of Hong Kong Press.
Laursen, B., & Collins, W. A. (1994). Interpersonal conflict during adolescence. Psychological Bulletin, 115, 197–197. https://doi.org/10.1037/0033-2909.115.2.197.
Lee, M. T., Wong, B. P., Chow, B. W. Y., & McBride-Chang, C. (2006). Predictors of suicide ideation and depression in Hong Kong adolescents: Perceptions of academic and family climates. Suicide and Life-Threatening Behavior, 36, 82–96. https://doi.org/10.1521/suli.2006.36.1.82.
Leung, C. Y. W., McBride-Chang, C., & Lai, B. P. Y. (2004). Relations among maternal parenting style, academic competence, and life satisfaction in Chinese early adolescents. The Journal of Early Adolescence, 24(2), 113–143. https://doi.org/10.1177/0272431603262678.
Leung, C. M., Wing, Y. K., Kwong, P. K., & Shum, A. L. K. (1999). Validation of the Chinese-Cantonese version of the hospital anxiety and depression scale and comparison with the Hamilton rating scale of depression. Acta Psychiatrica Scandinavica, 100(6), 456–461.
Linehan, M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York, NY: Guilford Press.
Lipsitz, J. D., Martin, L. Y., Mannuzza, S., Chapman, T. F., Liebowitz, M. R., Klein, D. F., & Fyer, A. J. (1994). Childhood separation anxiety disorder in patients with adult anxiety disorders. The American Journal of Psychiatry, 151(6), 927–929. https://doi.org/10.1176/ajp.151.6.927.
Litwiller, B. J., & Brausch, A. M. (2013). Cyber bullying and physical bullying in adolescent suicide: The role of violent behavior and substance use. Journal of Youth and Adolescence, 42, 675–684. https://doi.org/10.1007/s10964-013-9925-5.
Low, S. M., & Stocker, C. (2005). Family functioning and children’s adjustment: Associations among parents’ depressed mood, marital hostility, parent-child hostility, and children’s adjustment. Journal of Family Psychology, 19(3), 394–403. https://doi.org/10.1037/0893-3200.19.3.394.
Low, Y. T. (2013). Can parenting programme reduce parent-adolescents conflicts in Hong Kong? Revista de Cercetare şi Intervenţie Socială, 42, 7–27 Retrieved from https://search.proquest.com/docview/1665205935?accountid=10134.
Low, Y. T. (2014). Parents’ perception of effective components of a parenting programme for parents of adolescents in Hong Kong. Revista de Cercetare şi Intervenţie Socială, 46, 162–181 Retrieved from https://search.proquest.com/docview/1665217474?accountid=10134.
Ma, C. M. S., Shek, D. T. L., & Chen, J. M. T. (2019). Changes in the participants in a community-based positive youth development program in Hong Kong: Objective outcome evaluation using a one-group pretest-posttest design. Applied Research Quality Life, 14(4), 961–979.
Mazza, J. J., & Reynolds, W. M. (1998). A longitudinal investigation of depression, hopelessness, social support, and major and minor life events and their relation to suicidal ideation in adolescents. Suicide and Life-threatening Behavior, 28(4), 358–374. https://doi.org/10.1111/j.1943-278X.1998.tb00972.x.
Naicker, K., Galambos, N. L., Zeng, Y., Senthilselvan, A., & Colman, I. (2013). Social, demographic, and health outcomes in the 10 years following adolescent depression. Journal of Adolescent Health, 52(5), 533–538. https://doi.org/10.1016/j.jadohealth.2012.12.016.
Nock, M. K., Hwang, I., Sampson, N. A., & Kessler, R. C. (2010). Mental disorders, comorbidity and suicidal behavior: Results from the National Comorbidity Survey Replication. Molecular Psychiatry, 15, 868–876. https://doi.org/10.1038/mp.2009.29.
Ozdemir, Y. (2014). Parent-adolescent conflict and depression symptoms of adolescents: Mediator role of self-esteem. Düşünen Adam: The Journal of Psychiatry and Neurological Sciences, 27(3), 211–220 Retrieved from https://search.proquest.com/docview/1613117980?accountid=10134.
Phinney, J. S., Ong, A., & Madden, T. (2000). Cultural values and intergenerational value discrepancies in immigrant and non-immigrant families. Child Development, 71, 528–539. https://doi.org/10.1111/1467-8624.00162.
Pine, D. S., Cohen, P., Gurley, D., Brook, J., & Ma, Y. (1998). The risk for early-adulthood anxiety and depressive disorders in adolescents with anxiety and depressive disorders. Archives of General Psychiatry, 55(1), 56–64. https://doi.org/10.1001/archpsyc.55.1.56.
Pollack, M. H., Otto, M. W., Sabatino, S., Majcher, D., Worthington, J. J., McArdle, E. T., & Rosenbaum, J. F. (1996). Relationship of childhood anxiety to adult panic disorder: Correlates and influence on course. The American Journal of Psychiatry, 153(3), 376–381. https://doi.org/10.1176/ajp.153.3.376.
Richman, J. (1986). Family therapy for suicidal people. New York, NY: Springer.
Rigby, K., & Slee, P. (1999). Suicidal ideation among adolescent school children, involvement in bully–victim problems, and perceived social support. Suicide and Life-threatening Behavior, 29(2), 119–130. https://doi.org/10.1111/j.1943-278X.1999.tb01050.x.
Roberts, R. E., & Chen, Y. W. (1995). Depressive symptoms and suicidal ideation among Mexican-origin and Anglo adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 81–90. https://doi.org/10.1097/00004583-199501000-00018.
Robin, A. L., & Foster, S. L. (1989). Negotiating parent-adolescent conflict: A behavioral family systems approach. New York, NY: Guilford Press.
Rosenthal, D., Ranieri, N., & Klimidis, S. (1996). Vietnamese adolescents in Australia: Relationships between perceptions of self and parental values, intergenerational conflict, and gender dissatisfaction. International Journal of Psychology, 31, 81–92. https://doi.org/10.1080/002075996401106.
Rudd, M. D., Joiner, T. E., & Rumzek, H. (2004). Childhood diagnoses and later risk for multiple suicide attempts. Suicide and Life-threatening Behavior, 34(2), 113–125. https://doi.org/10.1521/suli.34.2.113.32784.
Shaffer, D., Fisher, P., Dulcan, M. K., Davies, M., Piacentini, J., & Schwab-Stone, M. E… Canino, G. (1996). The NIMH diagnostic interview schedule for children version 2.3 (DISC-2.3): Description, acceptability, prevalence rates, and performance in the MECA study. Journal of the American Academy of Child & Adolescent Psychiatry, 35(7), 865–877. https://doi.org/10.1097/00004583-199607000-00012.
Shagle, S. C., & Barber, B. K. (1993). Effects of family, marital, and parent-child conflict on adolescent self-derogation and suicidal ideation. Journal of Marriage and the Family, 55(4), 964–974. https://doi.org/10.2307/352776.
Sheeber, L., Hops, H., Alpert, A., Davis, B., & Andrews, J. (1997). Family support and conflict: Prospective relations to adolescent depression. Journal of Abnormal Child Psychology, 25(4), 333–344. https://doi.org/10.1023/A:1025768504415.
Sheeber, L., & Sorensen, E. (1998). Family relationships of depressed adolescents: A multimethod assessment. Journal of Clinical Child Psychology, 27(3), 268–277.
Shek, D. T. (1997). The relation of family functioning to adolescent psychological well-being, school adjustment, and problem behavior. The Journal of Genetic Psychology, 158(4), 467–479. https://doi.org/10.1080/00221329709596683.
Shek, D. T. (1998). A longitudinal study of the relations between parent-adolescent conflict and adolescent psychological well-being. The Journal of Genetic Psychology, 159(1), 53–67. https://doi.org/10.1080/00221329809596134.
Shek, D. T., Lin, L., Ma, C. M., et al. (2020a). Perceptions of adolescents. Teachers and Parents of Life Skills Education and Life Skills in High School Students in Hong Kong. Applied Research Quality Life. https://doi.org/10.1007/s11482-020-09848-9.
Shek, D. T., & Ma, C. M. (2012). Impact of the Project P.A.T.H.S. in the junior secondary school years: objective outcome evaluation based on eight waves of longitudinal data. Scientific World Journal. https://doi.org/10.1100/2012/170345.
Shek, D. T., & Ma, H. K. (2001). Parent-adolescent conflict and adolescent antisocial and prosocial behavior: A longitudinal study in a Chinese context. Adolescence, 36(143), 545–555 Retrieved from https://search.proquest.com/docview/195941378?accountid=10134.
Shek, D. T., & Siu, A. M. (2019). "UNHAPPY" environment for adolescent development in Hong Kong. The Journal of Adolescent Health, 64(6S), S1–S4.
Shek, D. T., & Yu, L. (2012). Longitudinal impact of the project PATHS on adolescent risk behavior: What happened after five years? Scientific World Journal. https://doi.org/10.1100/2012/316029.
Shek, D. T. L., & Zhu, X. (2019). Paternal and maternal influence on delinquency among early adolescents in Hong Kong. International Journal on Environmental Research and Public Health, 16(8), 1338. https://doi.org/10.3390/ijerph16081338.
Shek, D. T. L., Zhu, X., & Dou, D. (2019). Influence of family processes on internet addiction among late adolescents in Hong Kong. Frontiers in Psychiatry, 10, 113. https://doi.org/10.3389/fpsyt.2019.00113.
Shek, D. T. L., Zhu, X., Dou, D., & Chai, W. (2020b). Influence of family factors on substance use in early adolescents: A longitudinal study in Hong Kong. Journal of Psychoactive Drugs, 52(1), 66–76. https://doi.org/10.1080/02791072.2019.1707333.
Shek, D. T. L., & Zhu, Z. Q. (2020). Promotion of thriving among Hong Kong Chinese adolescents: Evidence from eight-wave data. Research on Social Work Practice, 30(8), 870–883.
Spirito, A., Valeri, S., Boergers, J., & Donaldson, D. (2003). Predictors of continued suicidal behavior in adolescents following a suicide attempt. Journal of Clinical Child and Adolescent Psychology, 32(2), 284–289. https://doi.org/10.1207/S15374424JCCP3202_14.
Strauss, C. C., Frame, C. L., & Forehand, R. (1987). Psychosocial impairment associated with anxiety in children. Journal of Clinical Child Psychology, 16(3), 235–239. https://doi.org/10.1207/s15374424jccp1603_8.
Sun, R. C., Hui, E. K., & Watkins, D. (2006). Towards a model of suicidal ideation for Hong Kong Chinese adolescents. Journal of Adolescence, 29, 209–224. https://doi.org/10.1016/j.adolescence.2005.05.005.
Thompson, E. A., Mazza, J. J., Herting, J. R., Randell, B. P., & Eggert, L. L. (2005). The mediating roles of anxiety, depression, and hopelessness on adolescent suicidal behaviors. Suicide and Life-threatening Behavior, 35(1), 14–34. https://doi.org/10.1521/suli.35.1.14.59266.
Tse, J. W. L., Bagley, C., & Yau, M. L. (2002). The suicidal risk scale for Hong Kong students. In J. W. L. Tse & C. Bagley (Eds.), Suicidal behaviour, bereavement and death education in Chinese adolescents (pp. 62–110). Aldershot, UK: Ashgate.
Unger, D. G., McLeod, L. E., Brown, M. B., & Tressell, P. A. (2000). The role of family support in interparental conflict and adolescent academic achievement. Journal of Child and Family Studies, 9(2), 191–202. https://doi.org/10.1023/A:1009419005136.
Van Ameringen, M., Mancini, C., & Farvolden, P. (2003). The impact of anxiety disorders on educational achievement. Journal of Anxiety Disorders, 17(5), 561–571. https://doi.org/10.1016/S0887-6185(02)00228-1.
Wagner, B. M., Silverman, M. A. C., & Martin, C. E. (2003). Family factors in youth suicidal behaviors. American Behavioral Scientist, 46(9), 1171–1191. https://doi.org/10.1177/0002764202250661.
Wang, M. T., & Kenny, S. (2014). Longitudinal links between fathers’ and mothers’ harsh verbal discipline and adolescents’ conduct problems and depressive symptoms. Child Development, 85, 908–923. https://doi.org/10.1111/cdev.12143.
Weissman, M. M., Wolk, S., Goldstein, R. B., Moreau, D., Adams, P., Greenwald, S., & Klier, C…Wickramaratne, P. (1999). Depressed adolescents grown up. Jama, 281(18), 1707–1713. https://doi.org/10.1001/jama.281.18.1707.
Wong, I. N., De Man, A. F., & Leung, P. W. (2002). Perceived parental child rearing and suicidal ideation in Chinese adolescents. Social Behavior and Personality: An International Journal, 30(1), 19–24. https://doi.org/10.2224/sbp.2002.30.1.19.
Wu, C., & Chao, R. K. (2011). Intergenerational cultural dissonance in parent-adolescent relationships among Chinese and European Americans. Developmental Psychology, 47(2), 493–508. https://doi.org/10.1037/a0021063.
Yau, J., & Smetana, J. G. (1996). Adolescent-parent conflict among Chinese adolescents in Hong Kong. Child Development, 63(3), 1262–1275. https://doi.org/10.1111/j.1467-8624.1996.tb01794.x.
Yip, P. S. F., Liu, K. Y., Lam, T. H., Stewart, S. M., Chen, E., & Fan, S. (2004). Suicidality among high school students in Hong Kong, SAR. Suicide & Life-Threatening Behavior, 34(3), 284–297. https://doi.org/10.1521/suli.34.3.284.42772.
Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67(6), 361–370. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x.
Zhu, X., & Shek, D. T. L. (2020). Impact of a positive youth development program on junior high school students in mainland China: A pioneer study. Children and Youth Services Review, 114, 105022.
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Low, Y.T.A. Family Conflicts, Anxiety and Depressive Symptoms, and Suicidal Ideation of Chinese Adolescents in Hong Kong. Applied Research Quality Life 16, 2457–2473 (2021). https://doi.org/10.1007/s11482-021-09925-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11482-021-09925-7