Multifinality and equifinality in the effects of family risks on adolescent mental health: A population-based configurational analysis in Southern China.

Drawing on a large population-based sample of 32,726 Chinese middle school students (15,605 females), this study applied qualitative comparative analysis to examine how six family risk factors-incomplete family structure, parent-child separation, poor parental education, financial hardship, lack of family intimacy, and family conflict-combine to shape eleven dimensions of adolescent mental health, including obsessive symptoms, paranoia, hostility, interpersonal sensitivity, depression, anxiety, learning stress, maladjustment, emotional instability, psychological imbalance, and suicidal ideation. Grounded in the developmental psychopathology framework, which emphasizes how diverse developmental pathways can arise from similar or different risk conditions, the study provided empirical support for two core principles: equifinality and multifinality. First, while mental health problems did not stem from any single necessary factor but rather from conjunctural risk configurations, a core combination-poor parental education, lack of family intimacy, and high family conflict-was consistently associated with multiple symptoms. Second, gender-specific pathways were identified: girls were more susceptible to emotional-relational risk configurations, whereas boys were more influenced by objective environmental conditions such as financial hardship and parental absence. Third, a reverse analysis of suicidal ideation showed that, although its onset followed diverse and complex pathways, its absence could be reliably predicted by two stable protective configurations. These findings underscore the value of configurational approaches in identifying both risk and protective pathways and highlight the potential of targeted, gender-sensitive family interventions to promote adolescent mental health. CLINICAL TRIAL REGISTRATION: This study was not a clinical trial and thus was not registered.