The relationship between family functioning and adolescent depression: a systematic review and three-level meta-analysis

Background Depression is a common mental disorder worldwide, particularly among adolescents. Although previous studies have identified a correlation between family functioning and adolescent depression, the influence of family functioning’s core dimensions is still unclear. Exploration of the correlation between family functioning and its core dimensions and depression through a three-level meta-analysis, along with an analysis of its influencing factors, is necessary. Methods We searched and retrieved the literature published from 2000 to 2025 in Chinese database (China National Knowledge Infrastructure, Wanfang, and VIP China Science and Technology Journal Database) and English databases (PubMed, Scopus, Science Direct, Proquest and John Wiley). Then, we conducted a three-level meta-analysis of family functioning and adolescent depression using R and Revan software. Measuring tool, cultural context, age, gender, sample source, and publication year were used as moderating variables to test the moderating effect. Results A total of 17 studies were included in this study (84 effect sizes, N = 44,425). Meta-analysis showed a significantly positive association between poor family functioning and depression in adolescents ( r = 0.324, 95% CI [0.290, 0.357]). Family cohesion and overall family functioning were significantly negatively correlated with adolescent depression. The moderating effects of this study were insignificant. Conclusions The results of this study indicated that family functioning is of great significance for the prevention and intervention of adolescent depression, with general family functioning and family cohesion showing the strongest predictive effects. We should establish a family functional risk monitoring system for adolescent depression and pay attention to the emotional support and communication between adolescents and parents. Trial registration Not applicable. PROSPERO registration CRD420251082762.