Long-term influences of parental divorce on offspring affective disorders: A systematic review and meta-analysis

Impact of parental marital status on self-harm in Chinese primary school students: the mediating role of depression and the moderating effect of classmate relationships

Background

Self-harm is an increasing global public health concern, with a growing prevalence in younger children. This study investigates the associations between parental marital status and self-harm behaviors among primary school students, with a focus on the mediating role of depressive symptoms and the moderating effect of classmate relationships.

Methods

A cross-sectional survey was conducted among 33,285 students (grades 3-6; mean age = 10.36 years) in the Shapingba District of Chongqing, China, from September to December 2020. Self-report measures included the Children's Depression Inventory (CDI), general demographic data, self-harm behaviors, and parental marital status. Data were analyzed using SPSS 26.0 for descriptive statistics and Mplus 8.1 for structural equation modeling (SEM), assessing the effects of parental marital status on self-harm.

Results

The reporting rates of depression and self-harm in grades 3-6 of primary school are 16.3% and 12.7%, respectively. Parental separation exhibited a more pronounced overall impact on self-harm (β = 0.120) compared to divorce (β = 0.105). Positive classmate relationships mitigated the indirect effect of separation on self-harm mediated by depression, reducing it from 0.098 to 0.072. Additionally, these relationships attenuated the direct effect of divorce on self-harm, decreasing it from 0.088 to 0.043. Depression significantly mediates the relationship between parental separation and children's self-harm, with direct and indirect effects accounting for 53% (β = 0.057) and 47% (β = 0.063) of the total effect, respectively.

Conclusion

The marital status of parents, especially in cases of separation, has a significant impact on self-harm behaviors among primary school students, with depression acting as a key mediating factor. Supportive classmate relationships can alleviate this effect, highlighting their importance in mental health interventions. These findings offer valuable insights for the development of policies aimed at reducing self-harm and enhancing psychological well-being among children.

The association between social capital and drug overdose mortality in the United States

BACKGROUND

Drug-related death is a significant public health challenge in the United States (U.S.). While social capital has emerged as a macro-social construct of interest in understanding the predictors of drug overdose, most research has examined this construct at the individual and neighborhood-level. This ecological study aims to investigate the association between county-level social capital and drug overdose mortality across 50 U.S. states and the District of Columbia.

METHODS

County-level social capital, as measured by a social capital index (SCI), was obtained from the U.S. Congress' Social Capital Project. The SCI incorporates indicators related to family structure stability, confidence and trust in institutions, community cohesion, social network structure and volunteerism. County drug overdose mortality data from 2017 to 2019 were obtained from the National Vital Statistics System restricted-use data files. The association between county-level social capital and drug overdose mortality was assessed by multi-level negative-binomial regression models.

RESULTS

In a sample of 2,992 counties, SCI ranged from -4.32 standard deviation below to 2.97 standard deviation above the average SCI across counties. After adjusting for covariates, a one standard deviation increase in SCI was associated with a 24 % decrease in drug overdose death rate (adjusted IRR: 0.76; 95 % CI: 0.71, 0.81).

CONCLUSION

In this study, counties with high social capital had significantly lower rates of drug overdose deaths than counties with low social capital. Policymakers may consider interventions aimed at promoting factors that mediate the effects of social capital on drug overdose mortality, as a way to tackle this public health challenge.

The impact of parental absence on the mental health of middle school students in rural areas of Western China

Background

Extensive research has established the association between parental absence and adolescent psychological well-being, particularly in the Chinese context. However, studies specifically examining the dual impact of parental separation and migration on psychological outcomes among adolescents in Western China remain relatively limited.

Aim

This study aims to systematically examine the association between various parental absence situations and mental health outcomes in early adolescence, with the objective of informing targeted interventions and policy formulations to optimize psychosocial support systems for vulnerable youth population.

Methods

The Wilcoxon rank-sum test was employed to analyze continuous and ordinal variables that exhibited non-normal distributions. To investigate the associations between various patterns of parental absence and psychological outcomes (depression, anxiety, and stress) among middle school students, binary logistic regression analysis was performed, while the model's goodness-of-fit was evaluated by using the Hosmer-Lemeshow test, with a p > 0.05 indicating satisfactory model fit.

Results

This cross-sectional study investigated mental health outcomes among a cohort of 8,606 middle school students, revealing notable prevalence rates of depressive symptoms (6.7%), anxiety (6.1%), and stress-related symptoms (8.1%). Multivariate analysis demonstrated that different forms of parental absence exerted substantial effects on mental health severity, with statistically significant associations for depression, anxiety, and stress (all p < 0.001). The results revealed that various forms of parental absence had a significant impact on depression, anxiety, and stress. Specifically, the combined impact of divorce and left-behind children (DLC) creates a synergistic effect, resulting in psychological risks (OR = 1.623-1.725, all p < 0.001), that are significantly higher than those associated with either factor individually (LBC/DC). Further analysis identified additional risk factors, including senior high school (OR = 1.486, p < 0.001), boarding school (OR = 1.155, p = 0.037), and girls (anxiety OR = 1.213, p < 0.001), all showing significant associations with adverse mental health outcomes.

Conclusion

Our study underscores significant mental health risks associated with diverse patterns of parental absence among adolescents in the Sichuan region. By fostering stronger parent-child bonds and providing targeted emotional support, it may be possible to mitigate the adverse psychological effects of parental absence and help adolescents better navigate these mental health challenges.

Adverse Childhood Experiences and Oral Health of Children and Adolescents: A Systematic Review and Meta-Analysis

Adverse childhood experiences (ACEs) can be extremely traumatic, and their impact on health throughout the life course has been a public policy issue all around the world. Oral health conditions significantly influence quality of life, but its relationship with ACEs among children and adolescents is not well defined. This systematic review investigated the association between ACEs and oral health outcomes in children and adolescents. The search was conducted across six databases and the gray literature, with no restrictions. It included studies evaluating the association between ACEs and oral health outcomes (oral health condition, utilization of dental services, oral hygiene habits, or oral health related to quality of life) in individuals aged 0 to 19. Data of included studies were extracted and methodological quality was assessed. Meta-analysis was used for quantitative synthesis, and the Grading of Recommendations Assessment, Development and Evaluation approach assessed evidence certainty. From the 12 included studies, 11 had a cross-sectional design, and 1 was a cohort study. Seventeen types of ACEs were investigated, including neglect; violence between parents or caregivers; alcohol and substance abuse; and peer, community, and collective violence. The methodological quality compliance ranged between 38% and 100%. The meta-analysis revealed associations between ACEs and lower use of dental services, toothache, gingival bleeding, and dental cavities. Cumulative exposure to more than three ACEs was associated with poorer oral health. The certainty of the evidence varied from low to very low. These results highlight that children and adolescents with ACEs are more likely to present higher oral health problems, including decreased use of dental services.

Adverse Childhood Experiences Are Associated with Mental Health Problems Later in Life: An Umbrella Review of Systematic Review and Meta-Analysis

INTRODUCTION

Evidence suggested a link between early adversity and mental health problems. However, it is unclear how much adverse childhood experiences (ACEs) contribute to mental health problems because researchers have produced inconsistent findings. Therefore, the objective of this umbrella review was to combine the contradictory data regarding the effect of ACEs on the development of mental health problems later in life in the global context.

METHODS

PubMed, Embase, Scopus, Web of Sciences, Cochrane Database of Systematic Reviews, Scopus, and Google Scholar which reported the effect of ACEs on the development of mental health problems was searched. The quality of the included studies was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR). A weighted inverse variance random-effects model was applied to find the pooled estimates. The subgroup analysis, heterogeneity, publication bias, and sensitivity analysis were also assessed.

RESULTS

Forty-three SRM with 14,707,614 study participants were included. The pooled effect of ACEs on the development of mental health problems later in life in the global context is found to be (AOR = 1.66 [1.46, 1.87]). Subgroup analysis based on country revealed (AOR = 1.67 [1.23, 2.11]) in UK, (AOR = 0.61 [0.41, 0.81]) in Canada, (AOR = 1.55 [1.40, 1.69]) in Brazil, (AOR = 5.65 [4.12, 7.18]) in Ethiopia, (AOR = 1.92 [1.45, 2.38]) in USA, (AOR = 2.30 [1.89, 2.72]) in Australia, and (AOR = 1.66 [1.46, 1.87]) in Ireland. While subgroup analysis based on types of adverse childhood adverse experience: domestic violence (AOR = 4.13 [1.96, 6.30]), maltreatment (AOR = 1.5 [0.79, 2.21]), physical abuse (AOR = 1.56 [1.43, 1.63]), sexual abuse (AOR = 2.07 [1.63, 2.51]), child abuse (AOR = 5.66 [4.12, 7.18]), parental mental health problem (AOR = 1.73 [1.39, 2.08]), bullying (AOR = 1.99 [1.69, 2.29], neglect (AOR = 2.11 [1.53, 2.69]), and parental divorce (AOR = 1.66 [1.46, 1.87]). Based on the type of mental health problem, the pooled effect size is 1.87 (1.45, 2.30) for depression and 1.67 (1.22, 2.13) for anxiety.

CONCLUSION

This umbrella review revealed that ACE is significantly associated (with 66% increased risk) with anxiety and depression later in life in a global context. This association is most noticeable when one is subjected to domestic violence, maltreatment, physical abuse, sexual abuse, child abuse, parental mental health problems, bullying, neglect, and parental divorce. Childhood periods are a critical window of opportunity for reducing the risk of developing mental illness in the future and for implementing intervention measures. Preventing childhood maltreatment and addressing psychiatric risk factors can prevent psychopathology. Longitudinal studies are needed to optimize healthcare responses to ACEs. Increased awareness and public health interventions are needed to prevent childhood adversity and prevent mental problems among these victims. To optimize healthcare responses to unfavorable outcomes of childhood adversities, longitudinal and intervention research findings, more public health initiatives, and awareness are required.

The path of depression in rural children: A fuzzy-set qualitative comparative analysis across multiple provinces in China

OBJECTIVES

This study explores the combinations of conditional variables contributing to depressive symptoms in rural children.

METHODS

We analyzed data from 715 children from a rural mental health database, conducting detailed follow-up investigations on 129 children in Zhejiang and Henan provinces. We used fuzzy set Qualitative Comparative Analysis (fsQCA) and regression analysis to identify causal pathways leading to depression.

RESULTS

The results indicate that depression in rural children does not stem from a single, necessary condition but arises from multiple factors. Our findings highlight significant contributions from both maternal and paternal involvement. Specifically, maternal involvement, combined synergistically with peer support and problematic behaviors, as well as paternal involvement, together with peer support and anxiety, significantly affects depressive outcomes. Additionally, anxiety and strong peer relationships independently have a substantial impact on these outcomes. Effective mitigation strategies involve active parental engagement and robust peer support, reducing the influence of risk factors such as problematic behaviors and anxiety.

LIMITATIONS

The generalizability of the results is limited by cultural and geographical variations. The study also does not account for all potential factors influencing depression in rural children.

CONCLUSION

Depression in rural children results from multiple interacting factors. Tailored interventions addressing these specific combinations are recommended.

Associations of parental divorce with student mental health and academic outcomes: A quantitative study in rural China

BACKGROUND

This paper examines the prevalence, correlates, and developmental consequences of divorce among junior high school students in rural China. Specifically, we investigate the connections between parental divorce and student mental health and academic performance, while also examining whether a student's living arrangement after divorce influences these outcomes.

METHODS

Data were collected from 17,955 students across 122 rural junior high schools in China on their mental health, characteristics, and academic performance. Mental health was measured using the self-reported Strengths and Difficulties Questionnaire.

RESULTS

About 8.35 % of the students had divorced parents, with increased risk observed for students who were only children, had migrant mothers, or had higher educated mothers (ORs = 4.35, 29.94, and 1.78, respectively; Bonferroni-adjusted p < 0.05). Students with divorced parents exhibited a higher likelihood of internalizing (0.032), externalizing (0.052) abnormality (Bonferroni-adjusted p < 0.001) and scored 0.203 SD lower on the math test (Bonferroni-adjusted p < 0.001). Living arrangements post-divorce, either with a mother or a father, equally negatively impacted student mental health and academic performance, with a mitigating effect observed when grandparental childcare was provided.

LIMITATIONS

Our study faced limitations in assessing the influence of grandparental childcare on coping with parental divorce due to challenges in gauging the extent of such support for students residing with a parent after divorce. This study did not empirically find differences by ethnicity; further in-depth case study is needed to better illuminate the findings.

CONCLUSIONS

Parental divorce among young students in rural China is associated with adverse developmental outcomes. These findings underscore the importance of implementing targeted programs in rural China to mitigate these risks and provide support for young students with divorced parents.

Early-life risk factors for depression among young adults in the United States general population: Attributable risks and gender differences

BACKGROUND

This study adopts individual and societal-level approaches to examine the contribution of childhood risk factors to major depressive episodes (MDE) in 2526 American young adults.

METHODS

Nationally representative data from the 2017 U.S. Panel Study of Income Dynamics - Transition into Adulthood Supplement (PSID-TAS) were analyzed using multivariate methods to assess the impact of parental mental illness, childhood adversities, childhood mental disorders, and childhood physical conditions. Adjusted odds ratios and population attributable risk proportions (PARPs) are calculated to estimate the proportion of MDE cases related to risk factors.

RESULTS

The 12-month prevalence of positive screens for MDE was 25.4 %. Approximately 34 % of these were attributable to childhood mental disorders, 24 % to childhood physical conditions, 21 % to childhood adversities, and 16 % to parental mental illness. Childhood and parental depression were critical risk factors, both at the individual (odds ratio exceeding 2) and societal (PARP approximately 24 %) levels. Gender-specific risk factors were identified, with childhood physical abuse and childhood anxiety disorders constituting risk factors for females, and childhood externalizing disorders and childhood headaches as risk factors for males. Approximately 60 % of U.S. young adult MDE cases are attributable to risk factors before age 18.

LIMITATIONS

Possible over reporting of MDE may have biased the associations between predictors and depression.

CONCLUSIONS

Exposure to depression at a young age-one's own or parental depression-is a robust risk factor for both genders. Policies and interventions focused at alleviating the societal burden of depression should value its generational transmission.

The Long-Term Effect of Early-Life Uncertainty on Mental Health in Adolescence and Adulthood: A Meta-Analysis

Turbulent changes in early life are a hidden source of childhood trauma, increasing potential risks for mental illness. Many studies have identified the link between childhood uncertainty and mental health. However, research on the long-term effect of early-life uncertainty (EU) on mental health has not been systematically synthesized. This meta-analysis aims to provide a quantitative estimate of the association between EU and subsequent mental health outcomes. Eight electronic databases and gray literature were searched. Twenty-eight studies met our inclusion criteria: samples of non-clinical adolescents or adults and clear and valid assessments. Random-effect models were used to calculate the pooled effect sizes of EU on internalizing problems, externalizing problems, and well-being. Meta-regression and subgroup analysis were used to explore potential moderators. Results indicated small to moderate associations involving EU and internalizing problem (r = .28; 95% confidence interval [CI] [0.228, 0.326]) and externalizing problem (r = .16; 95% CI [0.102, 0.220]). EU was not significantly associated with well-being (r = -.41; 95% CI [-0.738, 0.071]). Furthermore, moderator analyses found that composite uncertain experiences in childhood had a stronger negative effect than single experiences. EU was a stronger predictor of mental health problems in adults than in adolescents. Cross-sectional studies would amplify the correlation between EU and mental illness compared to longitudinal studies. In the future, childhood uncertain and unpredictable risks should receive more attention. More research needs to focus on positive psychological indicators and samples from non-Western countries.

The mediation role of social support in the relationship between bullying and depressive symptoms among Jordanian adolescents

BACKGROUND

Bullying in school is a universal psychosocial issue that raises concerns about adolescents' safety and mental health and is positively associated with depressive symptoms. Social support could be a preventive factor that eases bullying and its psychological distress.

PURPOSE

The primary purpose of this study was to examine the mediating effect of social support in the relationship between bullying and depressive symptoms among adolescents in Jordan. Another aim was to investigate predictors of depression based on adolescents' sociodemographic factors.

METHODS

In this cross-sectional, non-experimental mediational study, a stratified and systematic sampling method was used to recruit 270 Jordanian adolescents.

RESULTS

Sociodemographic variables of being female, having divorced parents, having illiterate fathers, and being older in adolescence explained 12.2% of the variance in depressive symptoms. Family social support partially mediated the relationship between bullying and depressive symptoms.

CONCLUSION

Our findings showed that a notable proportion of adolescents experienced bullying victimization and depressive symptoms, and a positive relationship exists between these two variables. These results further highlight the role of family social support in buffering the negative impact of bullying on depressive symptoms.

IMPLICATIONS TO PRACTICE

The study's results emphasize the significance of developing and implementing family-centered social support initiatives by nurses to lessen adolescents' bullying experiences and depressive symptomatology.

Predictors of loneliness among middle childhood and adolescence during the COVID-19 pandemic

Social contexts (e.g., family, friends) are important in predicting and preventing loneliness in middle childhood (MC) and adolescence; however, these social contexts were disrupted during the COVID-19 pandemic. Comparison of social context factors that may differentially contribute to loneliness at each developmental stage (MC vs. adolescence) during the COVID-19 pandemic have been overlooked. This study examined longitudinal predictors of loneliness, including social contexts and COVID-19 impact, within MC (8-12y) and adolescence (13-17y). Parents reported on demographic information, and their children completed surveys on COVID-19 impact, loneliness, and family functioning using the COVID-19 Exposure and Family Impact Survey (CEFIS), the NIH Toolbox Loneliness (Ages 8-17) measure, and the PROMIS Family Relationships Short Form 4a measure, respectively. Regression models examined time one (T1; May-June 2020) predictors of time two (T2; November 2020-January 2021) MC child (n=92, Mage=10.03) and adolescent (n=56, Mage=14.66) loneliness. For the MC child model, significant predictors of higher loneliness included worse family functioning as well as higher COVID-19 impact and lower family income. On the other hand, higher adolescent loneliness was significantly predicted by not having married/partnered parents and was marginally significantly predicted by higher COVID-19 impact. The regression model with the full sample and interaction terms revealed no significant interactions, but that lower family functioning and higher COVID-19 impact were significant predictors of higher loneliness. Lower family income and lower in-person communication were marginally significant predictors of higher loneliness in the combined interaction model. Lastly, further exploratory mediation analyses displayed that family functioning significantly mediated the relationship between COVID-19 impact and T2 loneliness only for MC children and the full sample. Results support future interventions focused on optimizing family functioning to help mitigate MC loneliness in the context of adversity, such as a global pandemic.

The role of parental divorce in the later vulnerability to perinatal depression and early parenting stress

OBJECTIVE

This study will examine the role of childhood experience of parental divorce on later perinatal depression and parenting stress.

METHODS

546 women were recruited at less than 20 weeks pregnancy into an ongoing pregnancy cohort study and followed up in pregnancy and the postpartum. Depression at recruitment was measured using the Structured Clinical Interview for the DSM and the Edinburgh Postnatal Depression Scale repeated in pregnancy and the postpartum. Parenting stress was measured at 12 months postpartum using Parenting Stress Index.

RESULTS

This study found 33% of women had experienced parental divorce. While we did not find a statistically significant relationship between the experience of parental divorce and perinatal depression, there was a higher rate of perinatal depression when parental divorce occured at a younger age. There was no association with parental divorce and parenting stress. Childhood divorce was significantly associated with other adverse childhood experiences.

CONCLUSIONS

Our findings did not support an impact of parental divorce on either maternal perinatal depression or on parenting stress, suggesting the experience of parental divorce for children may not inevitably impact their later experiences as parents. Further research on the association with age of parental divorce and later perinatal mental health is warranted.

Parental Divorce in Childhood and the Accelerated Epigenetic Aging for Earlier and Later Cohorts: Role of Mediators of Chronic Depressive Symptoms, Education, Smoking, Obesity, and Own Marital Disruption

We examine effects of parental divorce on epigenetic aging in later adulthood for two birth cohorts: one born in the early 20th century and the other born in the later 20th century. Using data from the Health and Retirement Study (n = 1,545), we examine the relationship between parental divorce in childhood and accelerated epigenetic aging in older adulthood as indicated by the Dunedin methylation Pace of Aging score. We assess how this relationship is mediated by chronic depressive symptoms, education, lifetime smoking, body mass index (BMI), and an older adult's own divorce. The mean age of the earlier cohort is 85.8 (SD = 3.9) and that of the later cohort is 60.2 (SD = 2.8). We find that parental divorce was related to faster aging in the later-born cohort, and that 56% of this relationship (b = 0.060) was mediated by chronic depressive symptoms (b = 0.013), lower education levels (b = 0.005), and smoking (b = 0.019). For the earlier cohort, there was no effect of parental divorce on epigenetic aging. Parental divorce in childhood may have lasting effects on later-life health, as reflected in the rate of epigenetic aging. However, the effects and mechanisms of this relationship differ across cohorts living in different social environments.

The effects of parent-child separation on the digital literacy of children and adolescents: A bidirectional perspective study

From a bidirectional perspective, the present cross-sectional study explored the impacts of parent-child separation on the digital literacy of children and adolescents. Drawing upon data from 1894 students (12-18 years, 49.33 % females) in Nanling county, China, we found that parent-child separation can negatively affect the digital literacy of children and adolescents, but effects differ between children experiencing parental migration or parental divorce. Parental mediation can act as a mediator in this process while children's digital feedback to parents may be considered as an auxiliary promoter. To further promote the digital literacy of children and adolescents experiencing parent-child separation, assigned tasks from adults in which children can practice knowledge and skills related to digital devices and the Internet are recommended.

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.

Deliberate self-harm among pediatric psychiatric inpatients in China: A single-center retrospective study

BACKGROUND

For children and adolescents, deliberate self-harm (DSH) is becoming a mental health problem of concern. Despite several studies on the prevalence and factors of DSH in the world, there is little information on DSH among children and adolescents in China. This study explores the prevalence, types, associated risk factors and tendency of DSH in pediatric psychiatric inpatients in China.

AIM

To understand the situation of DSH among hospitalized children and adolescents and its related factors.

METHODS

In this study, we retrospectively studied 1414 hospitalized children and adolescents with mental illness at Xiamen Mental Health Center from 2014 to 2019, extracted the demographic and clinical data of all patients, and analyzed clinical risk factors of DSH.

RESULTS

A total of 239 (16.90%) patients engaged in at least one type of DSH in our study. Cutting (n = 115, 48.12%) was the most common type of DSH. Females (n = 171, 71.55%) were more likely to engage in DSH than males (n = 68, 28.45%). DSH was positively associated with depressive disorders [OR = 3.845 (2.196-6.732); P < 0.01], female [OR = 2.536 (1.815-3.542); P < 0.01], parental marital status [OR = 5.387 (2.254-12.875); P < 0.01] and negative family history of psychiatric illness [OR = 7.767 (2.952-20.433); P < 0.01], but not with occupation, substance use and history of physical abuse.

CONCLUSION

Our findings suggest that for patients with depression, females, an abnormal marriage of parents, and no history of mental illness, attention should be paid to the occurrence of DSH.

Associations of childhood adversity with emotional well-being and educational achievement: A review and meta-analysis

BACKGROUND

Profound negative implications of adverse childhood experiences (ACEs) have raised public health concern worldwide.

METHOD

This systematic review and meta-analysis examined associations of three types of ACEs (abuse, neglect, and household dysfunctions) with experiential (emotional quality of momentary and everyday experiences) and reflective (judgments about life satisfaction, sense of meaning, and ability to pursue goals that can include and extend beyond the self) facets of emotional well-being (EWB) and educational achievement. The systematic review yielded 100 studies with 176 effect sizes that met criteria for inclusion in the meta-analysis.

RESULTS

ACEs were related particularly strongly to lower EWB, r = -0.32, p < .001; [95 % CI: -0.44 to 0.01], but also to lower educational achievement, r = -0.18, p < .001; [95 % CI: -0.21 to -0.05]. Associations were stronger for abuse and composite indicators of ACEs than for household dysfunctions. Associations of ACEs with EWB and educational achievement were stronger in childhood and adolescence than in emerging or later adulthood. Associations did not differ for males and females or for Eastern versus Western cultural groups. Analyses provided evidence for the causal role of ACEs in the development of lower EWB and academic achievement as well as their reciprocal associations.

LIMITATIONS

There is no standard conceptualization of well-being and studies are not always clear about the types of ACEs examined, with limited research on educational achievement.

CONCLUSION

Findings have important implications for mental health professionals, policy makers and social service agencies in developing resources and intervention services that target ACEs to protect individuals and promote well-being and academic achievement.

The mediating role of childhood maltreatment in the association between residence migration and adolescent depression

BACKGROUND

It is well established that residence migration can negatively affect the mental health of adolescents. However, the related factors that mediate the association between residence migration and depression are still uncertain.

METHODS

The participants were 16,037 adolescents in junior middle schools. A self-administered questionnaire was used for the survey. In addition to collecting general demographic characteristics of the participants, including age, gender, local residence status, only child status, parental marriage status and parent-child relationship, the questionnaire also contained the 9-item Patient Health Questionnaire, the short form of the Childhood Trauma Questionnaire and the Connor-Davidson Resilience Scale. Data analysis was conducted using SPSS software.

RESULTS

A total of 14,059 valid questionnaires were collected, resulting in 12,122 local adolescents, defined as being born and raised locally, and 1937 migrant adolescents, defined as being transferred from other regions. Meanwhile, 53.3 % of local adolescents and 58.2 % of migrant adolescents reported depressive symptoms. This result indicated that residence migration might contribute to depression symptoms(OR = 1.136, 95%CI: 1.013-1.273, p < 0.05). Childhood maltreatment and parental divorce are risk factors for depression in migrant adolescents. For all adolescents, resilience and a good parent-child relationship may reduce the risk of depression. Childhood maltreatment completely mediates residence migration-related depression(95 % bootstrap CI = 0.146, 0.323).

CONCLUSION

This study revealed that residence migration could contribute to adolescent depression, and childhood maltreatment may largely mediate this process, providing new insight into the relationship between adolescent depressive symptoms and residence migration. Reducing childhood maltreatment may effectively improve the depressive symptoms of migrant adolescents.

What About the Children? Co-Occurrence of Child Maltreatment and Parental Separation

The aim of this study was to investigate (a) the extent to which child maltreatment co-occurs with parental separation and (b) associations between different types of child maltreatment and various types of separation-associated interparental conflict. Professionals working with children (N = 785) reported each case of suspected child maltreatment they observed during a 3-month period and indicated whether parental divorce or separation was about to take place or had taken place. This resulted in 530 reported cases that matched the definitions of child maltreatment for which information on parental relationship status was available. Most of the maltreated children (60%) also experienced (impending) parental separation. In 69% of these cases child maltreatment was associated with parental separation. Particularly, cases of emotional neglect, and emotional abuse co-occurred with parental separation. In addition, four clusters of separation-associated interparental conflict were distinguished- No observed conflict, Non-physical conflict, Verbal and physical conflict, and Multiple conflict-which were associated with child and family characteristics and specific types of child maltreatment. The results of this study suggest that child maltreatment often co-occurs with parental separation, especially when there is a considerable amount of interparental conflict.

Teacher Autonomy Support and Internalizing Problems of Adolescents from Divorced and Intact Families: Moderation by Personality Typologies

The present research compared internalizing problems of adolescents who experienced parental divorce with those of adolescents who remained in intact families. Furthermore, this research investigated the association of teacher autonomy support with adolescents' internalizing problems for the whole sample and further ascertained whether this association was moderated by distinctive personality profiles using a person-centered approach and family structures (divorced vs. intact families). A sample of 2756 Chinese adolescents (8.5% from divorced families), aged 13-18 years, participated in the present research. They completed a set of self-reported questionnaires during school hours. Results based on ANCOVA showed that adolescents who experienced parental divorce reported higher internalizing problems than did those who remained in intact families. Moreover, latent profile analysis revealed three personality profiles: psychopathic (22.7%), normative (56.4%), and resilient (20.9%). In addition, teacher autonomy support was negatively related to adolescents' internalizing problems in the overall sample. However, interaction analyses further exhibited that this association was insignificant for psychopathic adolescents who experienced parental divorce. The current findings indicate that although teacher autonomy support may protect adolescents from internalizing problems, psychopathic adolescents whose parents got divorced should be paid exceptional attention by mental health professionals and school counselors.

Parents' experiences of their child's participation in divorce groups in Norway: A phenomenological study

BACKGROUND

Children and youth who experience divorce are found to have increased risk of emotional and behavioural adjustment problems. Different prevention programmes have been developed to help and support children. Previous studies have focused on the child or the group leader's experience with divorce groups, but studies describing parent's experience are missing. The aim of this study was to explore parents' experiences of their child's participation in divorce groups.

METHODS

An inductive, qualitative and descriptive design was applied with philosophical orientation in naturalistic inquiry based on the outlines of a phenomenological perspective. Two fathers and three mothers from two different counties in Norway participated whereof four of them were interviewed twice. Systematic text condensation was used for the analysis.

RESULTS

Three themes emerged from the analysis: encouraging the child, missing communication and challenging situations. Parents described how they encouraged the child to attend divorce groups and hoped they would gain a deeper understanding of their parents' divorce and their own feelings. Missing communication relates to lack of information about the groups from the school, the group leader and from the child. Missing information was found to be a challenge for the parents and made them think that the divorce group was beneficial for the child but maybe not always for the family. Parents described challenging situations due to the divorce, and they struggled to understand their child and their own behaviour.

CONCLUSIONS

The opportunity for the child to talk to other children in the same situation in divorce groups was positive for the parents. To be beneficial for both children and their parents, structured information and cooperation among the school, the child and both parents are important. The knowledge from this study can support the development and use of intervention programmes in the future.

A hard pill to swallow? Parental health shocks and children's mental health

Based on comprehensive administrative health record data from Austria, this study examines how children's mental health responds to a severe parental health shock. To account for the endogeneity of a serious parental illness, our sample is restricted to children who experience the health shock of a parent at some point in time and we exploit the timing of shocks in a dynamic DID setting. We find a positive causal effect of parental health shocks on children's mental health care utilization. Affected children have higher medical attendance for the treatment of mental illnesses, consume more psychotropic drugs, and are more likely to be hospitalized with mental and behavioral disorders. A significant increase in the utilization of antidepressants, anxiolytics, and sedatives can be observed for older children, girls and children with a white-collar family background. Our findings have important policy implications for children's access to psychotherapies and mental health care after experiencing a traumatic household event.

Mental health and its determinants among adolescents living in families with separated or divorced parents in an urban area of Vietnam

BACKGROUND

We assessed the prevalence of stress, anxiety, and depression among adolescents living in families with separated or divorced parents in Hue City, Vietnam and identified factors associated with these conditions.

METHODS

This cross-sectional study enrolled 309 adolescents, aged 12 to 17 years, living in families with separated or divorced parents in Hue City, Vietnam. The depression anxiety stress scale-21 (DASS-21) was used to measure stress, anxiety, and depression. Predictors of overall and individual mental health problems were identified using ordered and binary logistic regression, respectively.

RESULTS

The DASS-21 scale revealed a 49.2% prevalence of stress, while anxiety and depression had s prevalence rates of 61.5%. Among participants, 42.4% experienced all 3 mental health issues. Several factors were identified as significant predictors of mental health problems, including poor to average economic status (adjusted odds ratio [aOR], 2.00; 95% confidence interval [CI], 1.21-3.31; p=0.007); being in high school (aOR, 5.02; 95% CI, 2.93-8.60; p<0.001); maternal occupation of teacher, healthcare professional, or official (aOR, 2.39; 95% CI, 1.13-5.03; p=0.022); longer duration of family separation or divorce (aOR, 1.24; 95% CI, 1.05-1.45; p=0.009); living with one's mother (aOR, 1.69; 95% CI, 1.03-2.76; p=0.04); alcohol consumption (aOR, 1.70; 95% CI, 0.99-2.92; p=0.050); and being bullied (aOR, 5.33; 95% CI, 1.10-25.69; p=0.037). Most of these factors were associated with stress, anxiety, and depression. Additionally, smoking was associated with stress.

CONCLUSION

Adolescents with separated or divorced parents were at increased risk of stress, anxiety, and depression. The findings of this study provide important implications for prevention programs.

Association between parental separation, childhood trauma, neuroticism, and depression: a case control study

Background

Parental separation has been suggested to be associated with depression development in offspring. The new family constellation subsequent to separation could be associated with elevated scores of childhood trauma, shaping more emotionally instable personalities. This could ultimately be a risk factor for mood disorders and particularly the development of depression in life.

Methods

To test this hypothesis, we investigated the associations between parental separation, childhood trauma (CTQ) and personality (NEO-FFI) in a sample of N = 119 patients diagnosed with depression and N = 119 age and sex matched healthy controls.

Results

While parental separation was associated with elevated scores of childhood trauma, there was no association between parental separation and Neuroticism. Furthermore, in a logistic regression analysis, Neuroticism and childhood trauma were found to be significant predictors for depression diagnosis (yes/no), but not parental separation (yes/no).

Conclusion

Parental separation might be associated with depression only indirectly via childhood trauma. Childhood trauma or Neuroticism seem more directly related to the development of depression. However, it is worthwhile to install prevention programs helping parents and children to cope with parental separation in order to minimize the impact of separation and associated stressors.

Comparing relationships between single types of adverse childhood experiences and health-related outcomes: a combined primary data study of eight cross-sectional surveys in England and Wales

OBJECTIVES

Adverse childhood experiences (ACEs) show strong cumulative associations with ill-health across the life course. Harms can arise even in those exposed to a single ACE type but few studies examine such exposure. For individuals experiencing a single ACE type, we examine which ACEs are most strongly related to different health harms.

DESIGN

Secondary analysis of combined data from eight cross-sectional general population ACE surveys.

SETTING

Households in England and Wales.

PARTICIPANTS

20 556 residents aged 18-69 years.

MEASURES

Ten self-reported outcomes were examined: smoking, cannabis use, binge drinking, obesity, sexually transmitted infection, teenage pregnancy, mental well-being, violence perpetration, violence victimisation and incarceration. Adjusted ORs and percentage changes in outcomes were calculated for each type of ACE exposure.

RESULTS

Significance and magnitude of associations between each ACE and outcome varied. Binge drinking was associated with childhood verbal abuse (VA), parental separation (PS) and household alcohol problem (AP), while obesity was linked to sexual abuse (SA) and household mental illness. SA also showed the biggest increase in cannabis use (25.5% vs 10.8%, no ACEs). Household AP was the ACE most strongly associated with violence and incarceration. PS was associated with teenage pregnancy (9.1% vs 3.7%, no ACEs) and 5 other outcomes. VA was associated with 7 of the 10 outcomes examined.

CONCLUSION

Exposure to a single ACE increases risks of poorer outcomes across health-harming behaviours, sexual health, mental well-being and criminal domains. Toxic stress can arise from ACEs such as physical and SA but other more prevalent ACEs (eg, VA, PS) may also contribute substantively to poorer life course health.

Societal factors and psychological distress indicators associated with the recent rise in youth suicide in Taiwan: A time trend analysis

OBJECTIVE

We investigated recent trends in youth suicide and their associations with societal and psychological factors in Taiwan.

METHODS

Suicide data (1971-2019) for 10-24 year olds were extracted from Taiwan's national cause-of-death data files. We investigated changes in trends in youth suicide rates, societal factors (gross domestic product per capita, Gini index, overall and youth unemployment rates, divorce rates in people aged 40-59 years [i.e. the age of most 15-24 year olds' parents] and Internet use rates) and psychological distress indicators (youth self-harm rates and the prevalence of worry-related insomnia, and suicide ideation, plan and attempt) using joinpoint regression and graphic examinations. The associations of these factors with youth suicide rates were examined using Prais-Winsten regression.

RESULTS

Suicide rates in Taiwan's 10-24 year olds changed from a downward trend (2005-2014) to an upward trend in 2014 and increased 11.5% (95% confidence interval = [5.2%, 18.1%]) annually between 2014 and 2019. There was also an upturn in divorce rates among females aged 40-59 years in 2014 and self-harm rates among 15- to 24-year-old youth in 2013. The prevalence of self-reported insomnia and suicide ideation, plan and attempt in youth started to increase from 2013 to 2016. In the regression analysis, Internet use, female divorce rates and youth self-harm rates were positively associated with youth suicide rates.

CONCLUSION

Suicide rates and the prevalence of suicidal behaviors began to increase in Taiwanese youth in the 2010s. These increases may be associated with concurrent rises in parental divorce rates, Internet use and poor sleep. Further research is needed to examine the mechanisms underlying recent increases in youth suicide risk.

Effect of parental absence during infancy and early childhood on cognition and depression in later life: A national household longitudinal study

BACKGROUND

Early life experiences may have a persistent influence throughout life. However, little is known about the effect of parental absence during infancy and early childhood on offspring's cognition and risk of depression.

METHODS

Data were obtained from the China Family Panel Studies (CFPS). We examined the effect of parental absence during infancy and early childhood on cognitive development and depression in later life using weighted linear regression models. A series of sensitivity analyses and subgroup analyses were also conducted.

RESULTS

Parental absence during infancy and early childhood was associated with poor mathematics performance and high depression scores measured 8 years later. The coefficients of association between parental absence and math test performance and depression were -0.012 (95%CI: -0.024, -0.001, P = 0.031) and 0.009 (95%CI: 0.001, 0.017, P = 0.028) in adjusted models, respectively. Moreover, a similar association was observed among children who were females, urban dwellers, and had more years of education.

LIMITATIONS

Recall bias may exist for the exposure measure, and the current study cannot control residual confounders.

CONCLUSION

Long parental absence during infancy and early childhood may attenuate the cognitive process and increase risk of depression in later life, indicating the necessity of parental care as an intervention initiative.

Associations between school difficulties and family type and the role of socioeconomic, behavior and health-related difficulties in early adolescents: a population-based study

OBJECTIVES

Nowadays many early adolescents are living in non-intact families (parents divorced/separated, reconstructed families or single parents) and have many school difficulties (learning difficulty, skipping school, school absence due to family problems, grade repetition, low school performance, and school dropout ideation). This study assessed the associations between school difficulties and family type which remain little addressed and the confounding role of socioeconomic adversities and behavior, social support and health-related difficulties (BSSHDs).

METHODS

The study population included 1559 middle-school adolescents from north-eastern France (mean age 13.5 ± 1.3). They completed at the end of school-year a questionnaire gathering socioeconomic adversities, school difficulties and BSSHDs (being obese, substances use, sustained physical/verbal violence, sexual abuse, perpetrated violence, poor social support, depressive symptoms, and suicide attempt; cumulated number noted BSSHD_CM). Data was analyzed using logistic regression models.

RESULTS

The adolescents with parents divorced/separated, reconstructed families or single parents had a much higher risk for various school difficulties than those in intact families (sex-age-adjusted odds ratios 1.60-4.70, mostly with p < 0.001). These risks were robust and remained significant (often with p < 0.01/0.001) after adjustment for socioeconomic adversities and BSSHD_CM. The contributions of socioeconomic adversities plus BSSHD_CM to the risks were mostly elevated (>40%, reaching 65%) while those of socioeconomic adversities alone were mostly moderate (<30%, but reaching 52%).

CONCLUSIONS

Family type plays a strong role in school difficulties among early adolescents, mainly due to socioeconomic adversities and BSSHD_CM. Our results may help primary care providers identify at-risk adolescents and their problems and establish timely prevention and care.HighlightsLearning difficulty, school absence, grade repetition, low academic performance, and school dropout ideation are common in early adolescents.The adolescents with parents divorced/separated, reconstructed families or single parents have up to 4.7-time higher risk for these school difficulties than those in intact families.These risks are robust after adjustment for socioeconomic, behavior and health-related difficulties which explain up to 65% of the risks.School-difficulty prevention should consider family features and include early monitoring behavior and health-related difficulties in adolescents.

The association between adverse childhood experiences and common mental disorders and suicidality: an umbrella review of systematic reviews and meta-analyses

Adverse childhood experiences (ACEs) are related to increased risk of common mental disorders. This umbrella review of systematic reviews and meta-analyses aimed to identify the key ACEs that are consistently associated with increased risk of mental disorders and suicidality. We searched PsycINFO, PubMed, and Google Scholar for systematic reviews and meta-analyses on the association between ACEs and common mental disorders or suicidality published from January 1, 2009 until July 11, 2019. The methodological quality of included reviews was evaluated using the AMSTAR2 checklist. The effect sizes reported in each meta-analysis were combined using a random-effects model. Meta-regressions were conducted to investigate whether associations vary by gender or age of exposure to ACEs. This review is registered with PROSPERO (CRD42019146431). We included 68 reviews with moderate (55%), low (28%) or critically low (17%) methodological quality. The median number of included studies in these reviews was 14 (2-277). Across identified reviews, 24 ACEs were associated with increased risk of common mental disorders or suicidality. ACEs were associated with a two-fold higher odds of anxiety disorders (pooled odds ratios (ORs): 1.94; 95% CI 1.82, 2.22), internalizing disorders (OR 1.76; 1.59, 1.87), depression (OR 2.01; 1.86, 2.32) and suicidality (OR 2.33; 2.11, 2.56). These associations did not significantly (P > 0.05) vary by gender or the age of exposure. ACEs are consistently associated with increased risk of common mental disorders and suicidality. Well-designed cohort studies to track the impact of ACEs, and trials of interventions to prevent them or reduce their impact should be global research priorities.

Adolescent Mental Health and Family Economic Hardships: The Roles of Adverse Childhood Experiences and Family Conflict

Rising and economically disproportionate rates of adverse mental health outcomes among children and youth warrant research investigating the complex pathways stemming from socioeconomic status. While adverse childhood experiences (ACEs) have been considered a possible mechanism linking socioeconomic status (SES) and child and youth psychopathology in previous studies, less is understood about how family environments might condition these pathways. Using data from a longitudinal, multiple-wave study, the present study addresses this gap by examining the direct relationships between family economic status and youth internalizing and externalizing symptoms, if ACEs mediate these relationships, and if conflictual family environments moderate these direct and indirect relationships. The data were obtained from 5510 youth participants [mean age at baseline = 9.52 (SD = 0.50), 47.7% female, 2.1% Asian, 10.3% Black, 17.6% Hispanic, 9.8% Multiracial/Multiethnic, 60.2% White] and their caretakers from the baseline, 1-year, and 2-year follow up waves. Conditional process analysis assessed the direct, indirect, and moderated relationships in separate, equivalent models based on youth- versus caregiver-raters of ACEs and youth psychopathology to capture potential differences based on the rater. The results of both the youth- and caregiver-rated models indicated that lower family economic status directly predicted higher levels of externalizing symptoms, and ACEs indirectly accounted for higher levels of internalizing and externalizing symptoms. Additionally, family conflict moderated some, but not all, of these relationships. The study's findings highlight that lower family economic status and ACEs, directly and indirectly, contribute to early adolescent psychopathology, and conflictual family environments can further intensify these relationships. Implementing empirically supported policies and interventions that target ACEs and family environments may disrupt deleterious pathways between SES and youth psychopathology.

The association between the social environment of childhood and adolescence and depression in young adulthood - A prospective cohort study

BACKGROUND

Good social relationships with parents and peers protect children and adolescents from developing mental disorders in adulthood while several negative experiences increase the risk of depression in later life.

METHODS

We used population-based cohort data from the Northern Finland Birth Cohort (NFBC) 1986. Participants (n = 6147), their teachers and parents reported factors associated with the social environment of children and adolescents. Diagnoses of depression of cohort members were derived from Finnish nationwide registers. We conducted regression analyses to assess which factors of the social environment of childhood and adolescence were associated with depression in young adulthood.

RESULTS

Bullying victimization in adolescence was the strongest predictor of depression in young adulthood among girls (OR 2.23: 95% CI 1.47-3.39) and boys (OR 2.44: 95% CI 1.49-4.00). Loneliness and bullying behavior in childhood were associated with depression in boys only. Loneliness in adolescence (OR 1.63: 95% CI 1.30-2.04) was associated with depression among both genders. Spending with the family seemed to protect against the negative impact of bullying and loneliness.

LIMITATIONS

We used single-item study questions to measure social relationships. These questions do not necessarily describe the phenomena as accurately as the measures validated for them.

CONCLUSION

Problems in social relationships with peers in childhood and adolescence are associated with depression in young adulthood. Time spent with the family is emphasized in situations in which adolescents have problems in peer-relationships.

Life course trajectories of affective symptoms and their early life predictors

BACKGROUND

Life course trajectories of affective symptoms (depression and anxiety) are heterogenous. However, few studies have investigated the role of early life risk factors in the development of these trajectories. The present study aimed to: (1) derive latent trajectories of affective symptoms over a period of more than 50 years (ages 13-69), and (2) examine early life risk factors for associations with specific life course trajectories of affective symptoms.

METHOD

Participants are from the MRC National Survey of Health and Development (NSHD) (n = 5,362). Affective symptoms were measured prospectively at ages 13, 15, 36, 43, 53, 60-64 and 69. A latent variable modelling framework was implemented to model longitudinal profiles of affective symptoms. Twenty-four prospectively measured early life predictors were tested for associations with different symptom profiles using multinomial logistic regression.

RESULTS

Four life course profiles of affective symptoms were identified: (1) absence of symptoms (66.6% of the sample); (2) adolescent symptoms with good adult outcome (15.2%); (3) adult symptoms only (with no symptoms in adolescence and late life) (12.9%); (4) symptoms in adolescence and mid adulthood (5.2%). Of the 24 early life predictors observed, only four were associated with life course trajectories, with small effect sizes observed.

CONCLUSIONS

People differ in their life course trajectories of anxiety and depression symptoms and that these differences are not largely influenced by early life factors tested in this study.

Authoritative Parenting Style and Proactive Behaviors: Evidence from China?

Parenting style plays an important role in children’s development. This study examines the influence mechanism of authoritative parenting style on individuals’ proactive behavior. We propose a chain mediation model for the linkage between authoritative parenting style and proactive behavior through self-esteem and growth mindset. Based on a survey of 388 undergraduate students in coastal areas of China, we find a significant positive impact of authoritative parenting style on college students’ proactive behavior. In addition, our study provides evidence of a chain mediation effect on the relation among authoritative parenting style, self-esteem, growth mindset, and proactive behavior. Our results suggest that under authoritative parenting, individuals can stimulate more proactive behaviors by improving their self-esteem and developing their growth mindset.

A mediational analysis of adverse experiences in childhood and quality of life in adulthood

OBJECTIVES

This study examined associations of three prevalent adverse childhood experiences (ACEs) - parents' problematic alcohol use (PPAU), parental separation/divorce, and lack of support from a trusted adult-with adult quality of life (QoL), and potential mediators of associations.

METHODS

Data were from a representative survey (N = 28,047) in Norway that assessed ACEs, QoL, and potential mediators: enduring perceptions of childhood hardships (Difficult Childhood Questionnaire; DCQ), current mental distress, and current social isolation. Latent regression analyses examined potential mediators.

RESULTS

Each ACE was positively associated with perceptions of childhood as difficult (higher DCQ scores). In turn, ACEs were negatively associated with adult QoL through indirect effects. Lack of support from a trusted adult had the strongest negative association with adult QoL, compared to PPAU and parental separation/divorce. The association between the ACEs and QoL was explained through the mediators of mental distress and social isolation.

CONCLUSIONS

Of the examined ACEs, lack of support from a trusted adult had the strongest negative impact on adult QoL. Adult support to vulnerable children could potentially ameliorate adult consequences of ACEs. In addition, adults reporting difficulties due to childhood adversities may benefit from therapeutic interventions that address both psychological distress and isolation.

A Gap Between Children's Rights and Curricular Content in Health, Social Care, and Teacher Education Programs: An Exploratory Cross-Sectional Study

INTRODUCTION

Exposure to child maltreatment is a social and public health challenge that will require interprofessional collaboration to overcome. Evidence indicates that professional students in health, social care, and teacher education programs receive inadequate training in recognizing and responding to child maltreatment. The aims are to 1) assess the extent to which these students found that their uniprofessional education and a large-scale interprofessional learning (IPL) course had taught them about children in general, children's rights, and vulnerable/at-risk children; and 2) explore differences in student responses according to age and educational background.

METHODS

A cross-sectional study. Students (n=2811) completed questionnaires prior to or after IPL courses held in 2019 and 2020 (hybrid case-based, small-group, on-campus courses targeting children, young people, and their families as end users).

FINDINGS

The majority (>90%) agreed that it was important to learn about child-related topics. Only 4.3% disagreed that it was important to learn about vulnerable/at-risk children. Health and social care students enhanced their insight into all the child-related topics (p<0.001) after the IPL course. Teacher education and child welfare students reported decreased insight into children in general (p<0.001 in 2019 and p=0.008 in 2020) but increased insight into vulnerable/at-risk children in 2020 (p=0.001). According to stratified analyses, there was a significantly increased insight into all child-related topics among physiotherapy and Mensendieck physiotherapy students (p<0.001), decreased insight into children in general among teacher education students (p<0.02), and increased insight into vulnerable/at-risk children among teacher education students (p ≤ 0.001) in both 2019 and 2020. Age was of minor importance. The response rates ranged from 16.0% to 36.0%.

CONCLUSION

After the IPL course, the health and social care students significantly enhanced their insight into child-related topics, whereas the students in teacher education and child welfare gained increased insight into vulnerable/at-risk children.

Impact of parental divorce versus separation due to migration on mental health and self-injury of Chinese children: a cross sectional survey

BACKGROUND

There has been an increasing prevalence of parental separation in China due to divorce or migration for work in recent decades. However, few studies have compared the impacts of these two types of separation on children's mental health. This study aimed to investigate how parental divorce and parental migration impact children's mental health and self-injurious thoughts and behaviors (SITB), while considering positive factors, including parent-adolescent communication and psychological resilience.

METHODS

We randomly recruited participants in grades 5-8 from 18 schools in 2 counties in Anhui Province. A self-administered questionnaire was conducted to measure children's mental health, SITB, parent-adolescent communication, psychological resilience, and socio-demographic characteristics.

RESULTS

Data from 1026 children with both parents migrating (BLBC), 1322 children with one parent migrating (SLBC), 475 children living in a divorced family (DC) and 1160 children with non-migrating parents (NLBC) were included. Regression model results showed that, compared to the other three groups (BLBC, SLBC, NLBC), DC exhibited higher internalizing problems (p < 0.05), higher externalizing problems (p < 0.01), less prosocial behaviors (p < 0.05), and higher rates of suicidal ideation (SI) (p < 0.05) and non-suicidal self-injury (NSSI) behaviors (p < 0.05) when adjusting for social-demographic variables. However, when further adjusting for parent-adolescent communication and psychological resilience, DC no longer had higher levels of internalizing problems, externalizing problems, NSSI and SI than left-behind groups (BLBC, SLBC).

CONCLUSIONS

The experience of separation from divorced parents had stronger negative effects on the mental health of children than was observed in LBC. The Chinese government should design special policy frameworks that provide support to DC.

Association between parental divorce and mental health outcomes among Lebanese adolescents: results of a national study

Background

In Lebanon, divorce rates have jumped from nearly 7000 in recent years to 8580 in 2017, an increase of 22.5%, with North Lebanon recording the highest number, followed by Beirut, likely resulting in increased behavioral problems in the offspring of divorced parents. Furthermore, one out of two Lebanese adolescents whose biological parents were divorced, separated, or deceased has a psychiatric disorder. More information regarding the impact of divorce on the mental health of Lebanese adolescents is still missing. The objective of this study was to explore the association between divorce and mental health outcomes, particularly depression, anxiety, and suicidal ideation among Lebanese adolescents.

Methods

A cross-sectional study conducted between January and May 2019 enrolled 1810 adolescents aged 14 to 17 years, using a simple randomization method to choose schools. A proportionate number of schools was selected from each of the five Lebanese Mohafazat (Beirut, Mount Lebanon, North, South, and Beqaa), based on the list of the Ministry of Education and Higher Education. A total of 18 private schools were approached; two declined, and 16 accepted to participate.

Results

The mean age of participants was 15.42 ± 1.14 years, with 53.3% females. After adjustment for the covariates (age, sex, and house crowding index), the results showed that adolescents whose parents are separated compared to living together had more social fear (Standardized Beta (SB = 0.270) and avoidance (SB = 0.188), higher depression (SB = 0.045), and higher suicidal ideation (SB = 0.370).

Conclusion

Our findings reveal that teens with divorced parents had higher social fear and avoidance, depression, and suicidal ideation, highlighting the need for adequate prevention programs to support both children and parents during this emotionally difficult period.

The Mediating Role of Loneliness Between Social Support and Depressive Symptoms Among Chinese Rural Adolescents During COVID-19 Outbreak: A Comparative Study Between Left-Behind and Non-left-behind Students

Introduction: The COVID-19 pandemic has greatly impacted people's life across the globe. In a public health crisis, rural adolescents are more prone to mental health problems. The current study aimed to investigate the prevalence of depressive symptoms among Chinese rural adolescents during the COVID-19 outbreak, and examine the association between perceived social support and depressive symptoms and its underlying mechanisms. Method: Perceived Social Support Scale, UCLA Loneliness Scale, Patient Health Questionnaire-9 were administrated to 826 rural adolescents from Anhui Province, China, amid the COVID-19 crisis. Mackinnon's four-step procedure was employed to examine the mediating effect, while Hayes PROCESS macro was utilized to test the moderated mediation model. Results: The results showed the rate of depressive symptoms among rural adolescents in China was 77.6% during the outbreak of COVID-19. Female left-behind students and non-left-behind students from disrupted families experienced more depressive symptoms (all P < 0.05). Loneliness mediated the association between perceive social support and depressive symptoms and the indirect effect was stronger in left-behind adolescents in comparison to non-left-behind adolescents during the COVID-19 pandemic. Conclusion: Depressive symptoms are extremely prevalent among Chinese rural adolescents during the COVID-19 outbreak, and perceived social support plays a protective role against depressive symptoms. Chinese rural adolescents, especially left-behind students, could benefit from the interventions aimed at enhancing the perceived social support and reducing loneliness during the COVID-19 pandemic.

"It is a matter of life or death": Spotlighting Children in the Context of HIPD as Perceived by Frontline Practitioners

It is a wide consensus that high-intensity parental disputes (HIPD) might result in negative ramifications for children. The current study wishes to advance the knowledge regarding what children undergo during the acute time of the dispute, as portrayed by experienced frontline social workers mandated by the court to intervene with parents and their children in the context of HIPD. Ninety-four social workers participated in ten focus groups and five in-depth interviews. A thorough analysis of the narratives revealed three main themes. The first relates to their tremendous fear for the children's wellbeing, often displayed by the words "burn" and "death." The second theme addresses the practitioners' reflections with respect to the various experiences the children undergo during the acute time of HIPD and their risk assessments. The third theme addresses the practitioners' struggle in identifying how to protect the children during these times. The discussion spotlights the exposure of children to HIPD as a prolonged and chronic risk, with potentially adverse emotional and physical impacts. Key conclusions address the need to advance children's rights and the protection of children in the context of HIPD.

The whole is greater than the sum of its parts: profiles of multiple mental health risk factors using Latent class analysis

BACKGROUND

The exposure to an accumulation of various risk factors during childhood and adolescence relative to a single risk is associated with poorer mental health. Identification of distinct constellations of risk factors is an essential step towards the development of effective prevention strategies of mental disorders. A Latent class analysis (LCA) extracts different combinations of risk factors or subgroups and examines the association between profiles of multiple risk and mental health outcomes.

METHODS

The current study used longitudinal survey data (KiGGS) of 10,853 German children, adolescents and young adults. The LCA included 27 robust risk and protective factors across multiple domains for mental health.

RESULTS

The LCA identified four subgroups of individuals with different risk profiles: a basic-risk (51.4%), high-risk (23.4%), parental-risk (11.8%) and social-risk class (13.4%). Multiple risk factors of the family domain, in particular family instability were associated with negative mental health outcomes (e.g. mental health problems, depression, ADHD) and predominately comprised late adolescent girls. The social environment represented a more common risk domain for young males.

CONCLUSION

The understanding of multiple risk and different risk "profiles" helps to understand and adjust targeted interventions with a focus on vulnerable groups.

Non-Parental Investment in Children and Child Outcomes after Parental Death or Divorce in a Patrilocal Society

Children rely on support from parental helpers (alloparents), perhaps especially in high-needs contexts. Considerable evidence indicates that closer relatives and maternal relatives are the most likely to provide this care, as inclusive fitness theory suggests, but whether this is equally true across different family types and in culturally patrilocal societies requires investigation. This structured interview study (N = 208 respondents with 323 dependent children) focuses on who helps raise children in rural Bangladesh after the father’s or mother’s death, or divorce, in comparison to families with both parents present or the father temporarily a migrant laborer. Family types differed in where and with whom children resided, who served as their primary and secondary caregivers, and who provided material support, but mother’s kin played a major role, and were the primary providers of material resources from outside the child’s household in all family types. Despite the patrilineal ideology, only one-quarter of children of divorce lived with the father or his family, and even after the death of the mother, only 59% remained with father or other paternal kin. Household income varied by family type and was a strong predictor of child height and weight. The children of deceased mothers moved between successive caregivers especially frequently, and were uniquely likely to have no schooling. The typology of Bangladeshi society as patrilocal obscures the extent to which matrilateral family support children’s well-being.

Parental long working hours and adult children's depression in South Korea: a cross-sectional study

This study investigated the association between parental long working hours and the depression of children living with their parents even after becoming adults in South Korea. Data from two years of the Korean National Health and Nutrition Examination Survey (KNHANES) in 2014 and 2016 were analyzed using a cross-sectional study. Logistic regression analyses were performed to determine the association between parental long working hours and their adult children's depression. Adult children of mothers who worked more than 60 hours per week were more likely to have depression than 40 hours or less per week. Comprehending aging mothers' weekly working hours is an important factor for understanding the reason of adult children's depression.

Nonresident Fathers' and Grandparents' Early Years Support and Middle Childhood Socio-Emotional Adjustment

OBJECTIVE

This study investigates how different patterns of nonresident father support for children and mothers in the early years predict middle childhood adjustment, and whether grandparent support has compensating effects.

BACKGROUND

Nonresident fathers' involvement in children's lives benefits socio-emotional adjustment, but it is unclear whether support directed at children is compromised by interparental tensions, or whether other factors may compensate for weaker patterns of father support.

METHOD

Latent class analyses identified patterns of nonresident father support for single mothers and their 34-month-old child (None 35%, Low 16%, Moderate 21%, High 28%) and grandparent support (Low 15%, Moderate Maternal 33%, High Maternal 43%, High Maternal and Paternal 9%), using a sample of 648 families from the Growing Up in Scotland cohort. Effects of father support on children's internalizing and externalizing problems from age 46 to 122 months were explored (n = 352), together with moderating effects of grandparent support.

RESULTS

Low, Moderate and No father support had similar estimated effects on higher externalizing and internalizing problem levels, and steeper increases in internalizing problems. Compared to Low grandparent support, High Maternal and Paternal grandparent support reduced effects of weaker father support on both types of problem; and was more protective than High Maternal grandparent support against internalizing problems.

CONCLUSION

Weaker patterns of nonresident father support in early childhood, characterized by low involvement and interparental tensions or by no contact, were associated with poorer middle childhood adjustment. Support from both sets of grandparents offered children most protection against the effects of weaker father support.

Parental divorce and offspring smoking and alcohol use: a systematic review and meta-analysis of observational studies

OBJECTIVE

This study was conducted to investigate the relationship between parental divorce and smoking and alcohol consumption in offspring, which is based on a systematic review method and ultimately meta-analysis. Method: In a systematic search, three databases were selected. The manuscripts were searched based on the keywords and the time limit for the search was published manuscripts in English until November 2020. For the relationship between parental divorce and smoking/alcohol use in offspring, one main analysis, and four analyses based on sex, study design, adjusted level, and continents were performed. Result: Forty-three studies were synthesized from the collection of manuscripts. The odds of smoking in offspring whose parents were separated was 1.45 (CI 1.37-1.54) and this odds in men was equal to 1.38 (CI 1.11-1.71; Z = 2.91; p = 0.004; I² = 81.5%) and in women, 1.78 (CI 1.51-2.10; Z = 6.88; p < 0.001; I² = 69.6%). The odds of alcohol use in offspring whose parents were separated was 1.43 (CI 1.15-1.77) and this odds in men was equal to 1.69 (CI 1.16-2.47; Z = 2.73; p = 0.006; I² = 99.6%) and in women 1.79 (CI 1.07-2.99). Discussion: The findings of the present study can be used in health-related policies, prevention, and clinical interventions. This study was a subject with limitations, also.

The Mediating Role of Bullying and Victimisation on the Relationship Between Problematic Internet Use and Substance Abuse Among Adolescents in the UK: The Parent-Child Relationship as a Moderator

Over the last decade, research into the negative effects of problematic internet use has greatly increased. The current study adopted a mediation-moderation model in exploring the relationship between problematic internet use and substance abuse (drinking, drug use, and smoking tobacco cigarettes) among 1,613 adolescents (aged 10-16) in the UK. The findings of the study revealed a significant positive correlation between problematic internet use and substance abuse, which is mediated by traditional and cyber bullying and victimisation. Furthermore, the parent-child relationship was found to be a protective factor that moderated the correlation between problematic internet use and substance abuse and the correlation between problematic internet use and traditional bullying. The study emphasises the critical need to reduce problematic internet use among adolescents as a risk factor for involvement in bullying as perpetrators and victims, in addition to substance abuse. Furthermore, the findings of the study highlight the importance of a good parent-child relationship as a protective factor among adolescents. In light of the findings of the study, interventions for reducing problematic internet use taking into account bullying and the parent-child relationship are needed among adolescents.

Parental divorce in childhood does not independently predict maternal depressive symptoms during pregnancy

Background

This study sought to investigate if parental divorce in childhood increases the risk for depressive symptoms in pregnancy.

Methods

Women were recruited during their ultrasound screening in gestational week (gwk) 12. The final study sample consisted of 2,899 pregnant women. Questionnaires (including the Edinburgh Postnatal Depression Scale) were completed at three measurement points (gwk 14, 24 and 34). Prenatal depressive symptoms were defined as Edinburgh Postnatal Depression Scale score ≥ 13. Parental divorce and other stressful life events in childhood were assessed at gwk 14. Parental divorce was defined as separation of parents who were married or cohabiting. Questionnaire data was supplemented with data from Statistics Finland and the Finnish Medical Birth Register.

Results

Parental divorce in childhood increased the risk for depressive symptoms during pregnancy (OR 1.47; 95% CI 1.02–2.13), but the connection was no longer significant after adjusting for socioeconomic status, family conflicts and witnessing domestic violence in the childhood family (OR 0.80; 95% CI 0.54–1.18).

Conclusions

Parental divorce alone does not predict depressive symptoms during pregnancy.

[Parental Separation - Is the Accumulation with Other Adverse Childhood Experiences the Main Burden? Analysis of a Representative Sample of the German Population]

INTRODUCTION

Adverse childhood experiences (ACEs) tend to co-occur. The more forms of childhood adverse are experienced, the higher are the psychological and physical impairments in adulthood. The present study therefore examines the extent to which the experience of parental separation is related to the risk of other forms of ACEs and the extent to which the accumulation of ACEs is related to impairment in adulthood.

METHODS

A cross-sectional analysis of a representative sample of the German population from the age of 18 onwards was performed (N=2466; mean age=49.5 years (18-93); f: 1368 (55.5%); m: 1098 (44.5%)). The demographic data were assessed by interview, the remaining data were collected by questionnaires. Current depressive and anxiety symptoms self-perceived somatic health and life quality were assessed, while ACEs were assessed retrospectively by the Adverse Childhood Experiences (ACE)-Questionnaire.

RESULTS

Child maltreatment and mental illness of household members, substance abuse of household members, incarceration of household members and violence against the mother were more frequent when participants reported separation of parents. Parental separation was not associated with an increased rate of psychological impairment and, in women, physical impairment when no other forms of ACEs were present.

CONCLUSION

Children and adolescents whose parents have separated more often experience other forms of ACEs than their peers. It seems to be this accumulation of ACEs that is associated with impairments in adulthood.

The Rearing Environment and Risk for Major Depression: A Swedish National High-Risk Home-Reared and Adopted-Away Co-Sibling Control Study

OBJECTIVE

The authors sought to clarify the role of rearing environment in the etiology of major depression.

METHODS

Defining high risk as having at least one biological parent with major depression, the authors identified a Swedish National Sample of 666 high-risk full sibships and 2,596 high-risk half sibships containing at least one home-reared and one adopted-away sibling. Major depression was assessed from national medical registries.

RESULTS

Controlling for sex, parental age at birth, and, for half siblings, history of major depression in the nonshared parent, the risk for major depression in the matched adopted compared with home-reared full and half siblings was reduced by 23% (95% CI=7-36) and by 19% (95% CI=10-38), respectively. This protective rearing effect was not influenced by the relative educational status of the biological and adoptive parents. However, in both full and half sibships, the protective effect of adoption disappeared when an adoptive parent or stepsibling had major depression or the adoptive home was disrupted by parental death or divorce.

CONCLUSIONS

In matched full and half sibships at high risk for major depression, compared with individuals raised in their home environment, those reared in adoptive homes (homes selected in Sweden for their high-quality rearing environment) had a significantly reduced risk for major depression. This protective effect disappeared if an adoptive parent had major depression or if the adoptive home experienced parental death or divorce during childhood/adolescence. The rearing environment has a meaningful impact on risk for major depression, and this effect is likely mediated both by parental depression and the continuity or disruption of the home environment.