Breaking the silence: the effectiveness of a dialogue-based intervention on family functioning and psychological distress among young adults in a Chinese context

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Abstract
In many Chinese societies, cultural taboos surrounding death have hindered family communication, leading to psychological distress. This study evaluated a culturally sensitive, dialogue-based workshop aimed at helping adolescents and young adults in Macau enhance their ability to discuss life-and-death topics within the family. By using a quasi-experimental design, 123 participants were assigned to the intervention group ( n = 59) or the control group ( n = 64). Baseline and post-intervention data on family functioning (APGAR), psychological distress (PHQ-4), and life attitudes (SF-LAI) were collected. Linear mixed models showed that the intervention group significantly improved in family functioning ( p = 0.002), significantly reduced psychological distress ( p = 0.018), while no significant difference was observed in life attitudes. The study results indicate that in a cultural context where such topics are traditionally avoided, family dialogue-based education on life and death can may promote family relationships and mental health.

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