Configurations of Family Risk Factors and Mental Health Symptoms Among Grade 4-6 Children in Guangdong, China: A Large-Scale Crisp-Set Qualitative Comparative Analysis Based on a Cumulative Risk Model.

Background: 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.

Materials and methods: 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.

Results: 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.

Conclusions: 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.