Caregiver-Level Mental Health as a Contextual Effect in the Association Between Generalized Anxiety Disorder and Suicidal Ideation Among Adolescents: A Multilevel Analysis.

Background: Suicidal ideation poses a significant risk for suicidal behavior among adolescents globally. While studies have highlighted the association between anxiety and suicidal ideation, little is known regarding these behaviors in the Chinese adolescent population, as well as possible contextual factors that may influence this relationship. This study explores the association between generalized anxiety disorder (GAD) and suicidal ideation in an urban Chinese in-school adolescent population and investigates the contextual influence of primary caregiver mental health, considering comorbid symptoms of depression, anxiety, and insomnia. Methods: Data from the Students' Mental Health Network (SMHN) project in Wuhan, China, involving 7967 adolescents and their primary caregivers, were analyzed. The study assessed adolescents' and primary caregivers' mental health, including depression, insomnia, and GAD. Suicidal ideation was measured using the 9th item of Patient Health Questionnaire-9 (PHQ-9). Multilevel ordinal logistic regression models were used to examine associations between GAD and suicidal ideation, adjusting for covariates. Contextual effects were explored to determine how the mental health of the primary caregiver influences suicidal ideation. Results: The study found that GAD is independently associated with suicidal ideation among adolescents after accounting for other mental health covariates. Specifically, adolescents with more severe GAD symptoms, particularly subtype symptoms of "Restlessness" and "Irritability," had a higher likelihood of experiencing suicidal ideation. There were significant contextual effects on adolescent suicidal ideation at the caregiver mental health level. Adolescents with caregivers experiencing depression and anxiety symptoms had an increased risk of suicidal ideation. Conclusions: This research highlights the importance of recognizing GAD as an independent risk factor for suicidal ideation among Chinese adolescents. It also emphasizes the role of caregiver mental health as a contextual factor. The findings suggest a need for holistic interventions addressing both adolescents' and caregivers' mental well-being, ultimately enhancing suicide prevention efforts.