Purpose <p>Individuals with physical disabilities are at a higher risk of suicide due to daily activity limitations and dependency on others. Family relationships are important to their mental health and well-being. This study investigated the impact of changes in the family relationship status of physically disabled individuals on suicidal ideation.</p> Methods <p>We used data from the Disability and Life Dynamics Panel for 2018–2022. A total of 3,704 individuals were used in the analysis. Family relationships were classified into four groups: 1) good → good, 2) poor → good, 3) good → poor, and 4) poor → poor. We assessed suicidal ideation and attempts based on self-reported questionnaires. A generalized estimating equation model was used to analyze the impact of changes in family relationships on suicidal ideation in people with physical disabilities.</p> Results <p>Individuals with physical disabilities whose family relationships declined were 1.63 times more likely to have suicidal ideation (95% CI 1.22–2.19) compared to those with consistently good family relationship. Among the subfactors of family relationships, family problem-solving ability showed the strongest association with suicidal ideation when it deteriorated (OR 1.34, 95% CI 1.03–1.74). Individuals with consistently poor family relationships were 1.78 times more likely to have suicidal ideation alone (95% CI 1.33–2.38) and 2.29 times more likely to have both suicidal ideation and attempts (95% CI 0.89–5.93).</p> Conclusion <p>Our findings suggest the importance of addressing family relationships in suicide prevention strategies and mental health interventions for individuals with physical disabilities.</p>