Is Familial Expressed Emotion Associated with Self-Harm and Suicidality in Childhood and Adolescence? A Systematic Review

Abstract

Youth self-harm and suicidality are internationally considered serious health concerns, and while multiple studies in recent decades suggest that familial Expressed Emotion may increase risk, the existing research has not previously been systematically reviewed. Addressing this important gap, a comprehensive systematic search was undertaken to identify studies investigating associations between familial Expressed Emotion and youth self-harm and/or suicidality. Of the 2050 articles identified, 20 studies were included, consisting of 13 cross-sectional and seven longitudinal designs and a total population of 5752 youth (mean age 11.32 years, 64% female) and 2690 parents (74% female). Findings suggest that total/high negative Expressed Emotion, and specifically parental criticism, are positively associated with youth self-harm and suicidality. Results for other Expressed Emotion sub-dimensions (e.g., emotional over-involvement, hostility), were either more mixed or absent in the current literature. Other variables, such as self-criticism, perfectionism, parental alienation, thwarted belongingness, depressive symptoms, and parent/child gender, mediated or moderated these associations in some studies. This review highlights that the field is limited by a lack of longitudinal investigation and sample diversity, cultural bias, and measurement heterogeneity. Further, existing evidence does not yet determine whether familial Expressed Emotion is a risk factor for, or response to, youth self-harm and suicidality.