Family functioning and anxiety in children: a narrative review

Anxiety is a prevalent emotional problem in children, with family functioning serving as a protective factor. This review examines the relationship between family functioning and childhood anxiety to inform the development of interventions aimed at reducing childhood anxiety within the theoretical framework of family systems.

A literature search was conducted in the PubMed and China National Knowledge Infrastructure (CNKI) electronic databases. The search included Chinese- and English-language studies on family functioning and anxiety in children, with publication dates ranging from the inception of the databases to January 1, 2025.

The reviewed literature indicates a bidirectional relationship between family functioning and childhood anxiety. Healthy family functioning is associated with a lower risk of childhood anxiety, whereas childhood anxiety can negatively impact parental emotions and contribute to poor family functioning. The parent-child attachment relationship appears to mediate the link between family functioning and anxiety. Secure attachment relationships may mitigate the detrimental effects of specific family structures (e.g., single-parent and grandparent-headed households) and adverse parenting practices (e.g., overindulgence, neglect, and indifference) on children's mental health. However, existing research has predominantly focused on the cohesion and adaptability dimensions of family functioning, identifying cohesion as a significant predictor of childhood anxiety.

Future research should further investigate how different dimensions of family functioning and secure attachment relationships can reduce the risk of childhood anxiety. Additionally, future studies should explore the multifaceted pathways through which other aspects of family functioning influence childhood anxiety and consider strategies that integrate the strengths of families, schools, and communities to promote children's mental health. From a clinical psychotherapy perspective, this review offers insights and practical guidance on the impact of family functioning on childhood anxiety, with the overarching goal of mitigating the risk of mental health problems.