Family-Related Stress, Perceived Family Help-Seeking Availability, and Suicide-Related Events in Adolescents with Adjustment Disorder: A Cross-Sectional Study in Japan

BACKGROUND: Adjustment disorder (AD) is frequently diagnosed among adolescents presenting with suicide-related events; however, the roles of family-related stress and perceived availability of family as a help-seeking resource remain unclear within this population. This study examined whether family-related stress and limited perceived access to family support were associated with suicide-related events among adolescents with AD. METHODS: This cross-sectional study included 314 adolescents diagnosed with AD at two specialized outpatient clinics in Japan. Suicide-related events were assessed using two yes/no self-report items referring to suicide planning and suicide attempts within the past two weeks. Logistic regression analyses were conducted adjusting for age, sex, and depressive symptoms (PHQ-9). Multiple imputation under the missing-at-random assumption was applied to predictor variables; participants with missing outcome data were excluded from regression analyses. RESULTS: Adolescents reporting both family-related stress and unavailability of family as a help-seeking resource exhibited the highest odds of suicide-related events. Perceived availability of family support was consistently associated with lower odds across models, even after adjusting for non-family stressors and non-family help-seeking sources. CONCLUSIONS: Among adolescents with AD, suicide-related risk was more consistently associated with perceived inaccessibility of family support than with family-related stress alone. Suicide risk assessment should therefore evaluate not only stress exposure but also whether adolescents perceive family members as accessible sources of support.