Liu Kaifeng, Fu En, Deng Ziyi, Zhang Minrui, Guo Yongxing, Gao Qiufeng, Gao Ruixiang, Mo Lei
Intelligence and Command Center, Tianhe District Branch of Guangzhou Public Security Bureau, 510655 Guangzhou, Guangdong, China.
Division of Behavioral Health Services and Policy Research, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
Alpha Psychiatry. 2025 Aug 18;26(4):45872. doi: 10.31083/AP45872. eCollection 2025 Aug.
Children's mental health is significantly influenced by family environments, where multiple risks often coexist, exert unequal impacts, and combine in different configurations that can result in diverse developmental outcomes. This study examines how different configurations of cumulative family risks influence mental health symptoms in Chinese children using a novel person-centered approach.
Data were collected through a large-scale, semester-based comprehensive survey of 34,041 children in Grades 4 to 6 in an economically underdeveloped county-level city in Guangdong, China, during November and December, 2022. Six family risk indicators were examined: incomplete family structure, parent-child separation, financial hardship, low parental education, lack of family intimacy, and family conflict. The Pediatric Symptom Checklist was used to measure children's mental health outcomes, consisting of internalizing problems, externalizing problems, and attention problems. Crisp-set qualitative comparative analysis was applied to identify specific configurations of family risks associated with different mental health outcomes.
No single risk factor was found necessary or sufficient to explain mental health outcomes; configurations of multiple risks were more predictive. Externalizing and attention symptoms shared one configuration, which also contributed to internalizing symptoms. Additionally, three distinct configurations were uniquely associated with internalizing symptoms. Only lack of family intimacy and family conflict consistently appeared as detrimental across all configurations.
This study reinforces the cumulative risk model and aligns with the concepts of multifinality and equifinality. It emphasizes the importance of monitoring children with coexisting risks and targeted interventions addressing one or two key factors rather than all factors simultaneously. Future research should adopt longitudinal designs and include broader factors.
儿童心理健康受到家庭环境的显著影响，在家庭环境中，多种风险往往并存，产生不平等的影响，并以不同的组合形式出现，从而导致不同的发展结果。本研究采用一种新颖的以个体为中心的方法，探讨累积家庭风险的不同组合形式如何影响中国儿童的心理健康症状。
2022年11月至12月，在中国广东省一个经济欠发达的县级市，对34041名四至六年级的儿童进行了大规模的、基于学期的综合调查，收集了相关数据。研究考察了六个家庭风险指标：家庭结构不完整、亲子分离、经济困难、父母教育程度低、缺乏家庭亲密感和家庭冲突。使用儿童症状清单来衡量儿童的心理健康结果，包括内化问题、外化问题和注意力问题。采用清晰集定性比较分析来确定与不同心理健康结果相关的家庭风险的具体组合形式。
没有发现单一风险因素足以解释心理健康结果；多种风险的组合形式更具预测性。外化症状和注意力症状共享一种组合形式，这种组合形式也会导致内化症状。此外，有三种不同的组合形式与内化症状有独特关联。在所有组合形式中，只有缺乏家庭亲密感和家庭冲突始终显示出有害影响。
本研究强化了累积风险模型，并与多终性和等终性概念相符。它强调了监测存在多种风险的儿童以及针对一两个关键因素而非同时针对所有因素进行有针对性干预的重要性。未来的研究应采用纵向设计，并纳入更广泛的因素。
