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This study aimed to examine the association between family functioning and suicide among the elderly in rural China. This 1:1 paired case-control psychological autopsy study included 242 suicides at age 60 or more and an equal number of controls matched on age (±3 years), gender, and residency. Family functioning was assessed by the Family Adaptation Partnership Growth Affection Resolve Index. Family dysfunction was reported more frequently in suicides than in paired controls. Severe family dysfunction denoted a significant risk factor for suicide only in women after adjusting for potential confounding factors. Suicides with family dysfunction were prone to have unstable marital status, physical illness, mental disorders, family suicide history, and more stressful life events than those with good family functioning. The findings suggest that the intervention enhancing family functioning may be effective in decreasing suicide among the elderly in rural China. [ABSTRACT FROM AUTHOR]