Experience of Child-Parent Separation and Later Risk of Violent Criminality

Parental absence as an adverse childhood experience among young adults in sub-Saharan Africa

BACKGROUND

Parental absence in childhood has been associated with multiple negative consequences, such as depression and anxiety in young adulthood.

OBJECTIVE

To assess whether parental absence for six months or more in childhood is associated with poor mental health and substance use in young adulthood and whether parental absence accounts for additional variance beyond those explained by other adverse childhood experiences (ACEs) among youth in sub-Saharan Africa.

PARTICIPANTS AND SETTINGS

We used combined Violence Against Children and Youth Survey (VACS) data from Cote d'Ivoire (2018), Lesotho (2018), Kenya (2019), Namibia (2019), and Mozambique (2019). Analyses were restricted to 18-24-year-olds (nf = 7699; nm = 2482).

METHODS

We used logistic regression to examine sex-stratified relationships between parental absence in childhood (defined as biological mother or father being away for six months or more before age 18) and mental health problems and substance use and whether parental absence explained additional variance beyond those explained by other ACEs.

RESULTS

In sub-Saharan Africa, parental absence in childhood was common (30.5 % in females and 25.1 % in males), significantly associated with poor mental health and substance use among females and males and accounted for additional variance beyond those explained by conventional ACEs. For example, after controlling for study covariates and other ACEs, females who experienced any parental absence had 1.52 (95 % CI = 1.02-2.26) higher odds of experiencing moderate/serious psychological distress compared with those who did not.

CONCLUSION

The observed association between parental absence and poor mental health suggests that this experience has significant adverse consequences and merits consideration as an ACE.

The Relationship between Sense of Belonging and Well-Being Outcomes in Emerging Adults with Care Experience

Robust social resources that lead to a healthy sense of belonging are imperative during emerging adulthood. However, young adults with alternative care experience, such as residential or foster care, often lack the social resources necessary to transition to adulthood successfully. Though some research has examined the importance of social resources in this population, less is known about a sense of belonging, which is associated with these social resources. The current study examined the association between care experience, belonging, and well-being outcomes among emerging adults (n = 703) who were separated from their biological parents during care and received alternative care in 16 nations. The presence of belonging was associated with type of alternative care, age at separation, and reason for separation. There was also an association between belonging and well-being outcomes, including homelessness and suicidal ideation. Adults lacking a sense of belonging reported higher rates of homelessness and suicidal ideation, lower life satisfaction, and lower resilience. The study has global implications for enhancing social support for emerging adults with care experience in order to facilitate a sense of belonging as a social resource.

Disentangling the multigenerational transmissions of socioeconomic disadvantages and mental health problems by gender and across lineages: Findings from the Stockholm Birth Cohort Multigenerational Study

There is a paucity of research examining the patterning of socioeconomic disadvantages and mental health problems across multiple generations. The current study therefore aimed to investigate the interconnected transmissions of socioeconomic disadvantages and mental health problems from grandparents to grandchildren through the parents, as well as the extent to which these transmissions differ according to lineage (i.e., through matrilineal/patrilineal descent) and grandchild gender. Drawing on the Stockholm Birth Cohort Multigenerational Study, the sample included 21,416 unique lineages by grandchild gender centered around cohort members born in 1953 (parental generation) as well as their children (grandchild generation) and their parents (grandparental generation). Based on local and national register data, socioeconomic disadvantages were operationalized as low income, and mental health problems as psychiatric disorders. A series of path models based on structural equation modelling were applied to estimate the associations between low income and psychiatric disorders across generations and for each lineage-gender combination. We found a multigenerational transmission of low income through the patriline to grandchildren. Psychiatric disorders were transmitted through both the patriline and matriline, but only to grandsons. The patriline-grandson transmission of psychiatric disorder partially operated via low income of the fathers. Furthermore, grandparents' psychiatric disorders influenced their children's and grandchildren's income. We conclude that there is evidence of transmissions of socioeconomic disadvantages and mental health problems across three generations, although these transmissions differ by lineage and grandchild gender. Our findings further highlight that grandparents' mental health problems could cast a long shadow on their children's and grandchildren's socioeconomic outcomes, and that socioeconomic disadvantages in the intermediate generation may play an important role for the multigenerational transmission of mental health problems.

Injuries, Poisonings, and Other External Causes of Morbidity among Drug Crime Offenders: A Follow-Up Study of Former Adolescent Psychiatric Inpatients

INTRODUCTION

Criminal offenders have high incidences of injury- and substance-related emergency department visits. Very few studies focus on drug crime offenders or the medical specialties involved in treating these offenders. We aimed to study how drug crime offenders' treatment events in specialized health care due to injuries, poisonings, or other external causes of morbidity differed from treatment of non-criminal controls and which of the medical specialties were involved in their care.

METHODS

The study population included 508 former adolescent psychiatric inpatients (age 13-17 years), who were followed up through Finnish national registers. A total of 60 had committed a drug crime during the 10-15 years' follow-up. They were matched with 120 non-criminal controls from the study population. Hazard ratios (HRs) with 95% confidence intervals (Cl) for drug crime offending were assessed using a Cox regression model.

RESULTS

Almost 90% of drug crime offenders had treatment events in specialized health care due to injuries, poisonings, and other external causes of morbidity, compared to 50% of non-criminals. The majority of the drug crime offenders had been treated for accidental injuries (65% vs. 29%; p < 0.001) in comparison to non-criminal controls. More drug crime offenders had been treated for intentional poisonings (42% vs. 11%; p < 0.001) than non-criminal controls. For drug crime offenders, the lifetime probability of a treatment event due to poisoning was almost doubled (HR: 1.89, 95% CI: 1.26-2.84; p = 0.002), and for treatments due to injury, there was a 2.5-fold increase (HR: 2.54, 95% CI: 1.69-3.82; p < 0.001) in comparison to non-criminal controls.

CONCLUSION

In emergency care, substance use screening and referral for appropriate psychiatric and substance abuse treatment services should be considered for all adolescents and young adults attending hospitals due to injuries or poisonings.

Adverse Childhood Experiences and Risk of Subsequently Engaging in Self-Harm and Violence towards Other People-"Dual Harm"

The etiology of “dual harm” (the co-occurrence of self-harm and externalized violence in the same individual) is under-researched. Risk factors have mostly been investigated for each behavior separately. We aimed to examine adversities experienced between birth and age 15 years among adolescents and young adults with histories of self-harm and violent criminality, with a specific focus on dual harm. Three nested case-control studies were delineated using national interlinked Danish registers; 58,409 cases in total aged 15–35 were identified: 28,956 with a history of violent criminality (but not self-harm), 25,826 with a history of self-harm (but not violent criminality), and 3987 with dual-harm history. Each case was matched by date of birth and gender to 20 controls who had not engaged in either behavior. We estimated exposure prevalence for cases versus controls for each of the three behavior groups, and incidence rate ratios (IRRs). Experiencing five or more childhood adversities was more prevalent among individuals with dual-harm history (19.3%; 95% CI 18.0, 20.8%) versus self-harm (10.9%; 10.5, 11.3%) and violence (11.4%; 11.0%, 11.8%) histories. The highest IRRs for dual harm were linked with parental unemployment (5.15; 95% CI 4.71, 5.64), parental hospitalization following self-harm (4.91; 4.40, 5.48) or assault (5.90; 5.07, 6.86), and parental violent criminality (6.11; 5.57, 6.70). Growing up in environments that are characterized by poverty, violence, and substance misuse, and experiencing multiple adversities in childhood, appear to be especially strongly linked with elevated dual-harm risk. These novel findings indicate potential etiologic pathways to dual harm.

Mother-child separation among women living with HIV and their children in the first four years postpartum in South Africa

OBJECTIVES

Mother-child pairs may separate during early life, yet the health impacts thereof are unclear. We explored the patterns and impact of separation among women living with HIV (WLHIV) and their children in South Africa.

METHODS

WLHIV who had initiated antiretroviral therapy (ART) during pregnancy received HIV viral load (VL) testing and completed a timeline questionnaire of mother-child separation since delivery at 3-5 years post-partum. Health care usage was abstracted from routine medical records. We examined associations between separation and (a) maternal health outcomes (engagement in HIV care and HIV viral suppression, [VS]) and (b) child health outcomes (post-breastfeeding HIV testing and immunisation completion), using logistic regression.

RESULTS

Of 346 mother-child pairs (median maternal age at antenatal ART initiation, 28 years), 24% were ever separated (median time to first separation 20 months, interquartile range [IQR] 9, 31). Most separated children were living with their grandmothers (65/83, 78%). Mothers who ever separated were younger, and more likely to be employed, and to reside in informal housing than those who never separated. Any separation reduced the odds of VS ≤ 50 copies/mL at four years post-partum (odds ratio 0.57; 95% CI 0.34-0.93); associations were similar for VL ≤ 1000 copies/mL and maternal engagement in care. No association was found between separation and child confirmatory HIV testing or immunisation completion.

CONCLUSIONS

In this setting, mother-child separation is common in the first four years of life and appears associated with suboptimal maternal outcomes. Further research is required to understand the drivers and implications of mother-child separation.

Family structure and alcohol use disorder: a register-based cohort study among offspring with and without parental alcohol use disorder

AIMS

To assess whether parental alcohol use disorder (AUD) is associated with higher risks of living in a non-intact family and assess whether non-intact family structure is associated with higher risks of AUD in the offspring.

DESIGN

Prospective cohort study.

SETTING

Danish nation-wide registries.

PARTICIPANTS

A total of 9948 parental AUD offspring and 98 136 reference offspring from the Danish population.

MEASUREMENTS

Family structure assessed at birth and at each birthday until age 15 as intact or non-intact (with mother only, father only or neither parent); years lived in an intact family defined as total number of years lived with both parents from birth until the 15th birthday; AUD defined as registration in medical, treatment and cause of death registries. Data were analyzed by Cox regression.

FINDINGS

At birth, 30.9% [95% confidence interval (CI) = 29.1-32.6] of parental AUD offspring and 10.7% (95% CI = 10.3-11.0) of reference offspring lived in a non-intact family. At age 15, the numbers were 84.6% (95% CI = 83.9-85.3) and 38.4% (95% CI = 38.1-38.7). Parental AUD was associated with a higher risk of offspring AUD [hazard ratio (HR) = 1.88, 95% CI = 1.74-2.02]. Offspring were at lower risk of AUD if they lived 15 years in an intact family compared with offspring who never lived in an intact family (HR = 0.67, 95% CI = 0.52-0.87 for those with parental AUD, and HR = 0.53, 95% CI = 0.48-0.59 for those whose parents did not have AUD). Findings were inconclusive as to whether or not an association was present between family structure and AUD among offspring with parental AUD and reference offspring.

CONCLUSIONS

The prevalence of non-intact family structure appears to be higher in offspring of parents with alcohol use disorder (AUD) than among offspring from the general population. Parental AUD appears to be associated with increased risk of offspring AUD, and non-intact family structure appears to be associated with increased risk of offspring AUD regardless of parental AUD.

Associations between early life parent-child separation and shortened telomere length and psychopathological outcomes during adolescence

BACKGROUND

Given the ethical limitations of exposing children to experimentally manipulated adverse experiences, evidence of the effects of parent-child separation on subsequent psychopathology are based mostly on animal studies. Left-behind children phenomenon resulting from rural-urban mobility in China offers unique "natural experiments" to explore the long-term physical and mental health consequences of parent-child separation in childhood.

OBJECTIVE

To test the associations between parent-child separation with telomere length (TL) and psychopathology during adolescence.

METHOD

A total of 710 adolescents (age: M = 16.86, SD = 1.52) were recruited from local schools in rural area of Fuyang, one of the top inland areas for outward migration in Anhui province, China. Parent-child separation was collected through face to face interview. The MacArthur Health & Behavior Questionnaire (HBQ) was used to assess internalizing and externalizing symptoms. Quantitative polymerase chain reaction was used to measure buccal TL.

RESULTS

Nearly 60% (399/695) of the participants experienced separation from both parents. Childhood or persistent separation from parents was associated with increased internalizing symptoms (childhood: β = 0.13, 95% CI: 0.02, 0.23; persistent: β  = 0.23, 95% CI: 0.14, 0.31), increased externalizing symptoms (childhood: β = 0.17, 95% CI: 0.03, 0.32; persistent: β  = 0.23, 95% CI: 0.10, 0.35) and shorter telomere length (childhood: β = -0.16, 95% CI: -0.26, -0.05; persistent: β = -0.13, 95% CI: -0.22, -0.03). Shortened TL was estimated to explain 15.2% and 12.7% of the total effect of separation on internalizing and externalizing symptoms, while internalizing and externalizing symptoms explained 23.4% and 12.3% of the effect of separation on shortened TL.

CONCLUSION

Childhood and persistent parent-child separation, as experienced by rural left-behind children in China, associates with increased vulnerability for psychopathological symptoms and makers of cellular aging. The challenge for future research is to determine whether short telomere length is in fact a long-term consequence or an underlying vulnerability factor for future mental disorders.