Fifty moves a year: is there an association between joint physical custody and psychosomatic problems in children?

Shared parenting and father involvement after divorce in Denmark

The Scandinavian countries make interesting samples for the study of shared parenting as they are characterized by some of the highest levels of father involvement and gender equality globally. Despite numerous studies, data from Denmark is noticeably absent in the international debate, partly due to a researcher preference for publishing in Danish. Here, I present an overview of the increase in father involvement in Denmark since the 1960s and on the increase in shared parenting across recent decades. I further examine Danish law, ministerial guidelines and guidelines from major Danish public and private institutions/organizations involved in deciding or advising on parenting practices post-divorce. I relate these to international research findings as well as to findings from Danish research. Overall, I find that Danish guidelines/practice have several reservations against shared parenting and substantial father involvement, which are not considered warranted by a substantial number of scientists and which are not supported by the majority of the available evidence. It thus appears that societal transition toward increased shared parenting has happened on a largely voluntary basis in spite of official law/practice. Updated law and/or ministerial guidelines are likely necessary if politicians desire that children experience the same high degree of father involvement post-divorce that they experience in society in general.

Systematic review and theoretical comparison of children's outcomes in post-separation living arrangements

The purpose of the systematic review was to synthesize the literature on children's outcomes across different living arrangements (nuclear families, shared physical custody [SPC], lone physical custody [LPC]) by extracting and structuring relevant theoretical hypotheses (selection, instability, fewer resources, and stressful mobility) and comparing the empirical findings against these hypotheses. Following the PRISMA guidelines, the review included 39 studies conducted between January 2010-December 2022 and compared the living arrangements across five domains of children's outcomes: emotional, behavioral, relational, physical, and educational. The results showed that children's outcomes were the best in nuclear families but in 75% of the studies children in SPC arrangements had equal outcomes. Children in LPC tended to report the worst outcomes. When compared with the different theoretical hypotheses, the results were the most consistent with fewer resources hypothesis which suggests that children especially in LPC families have fewer relational and economic resources whereas children in SPC families are better able to maintain resources from both parents.

Associations between parental relationship dissolution and child sleep: A systematic review

Parental relationship dissolution is considered one of the most common adverse childhood experiences. Although sleep is crucial for healthy development of children and very sensitive to environmental changes, it is poorly studied in the context of parental relationship dissolution. The aim of the current study was to systematically review and critically assess the existing literature on the associations between parental relationship dissolution and child sleep (0-18 years old; registered on PROSPERO (CRD42021272720)). PsycInfo, MEDLINE, Scopus, ProQuest Dissertations and Theses Global, Social Work abstracts, and Web of Science Core Collection were searched. Published empirical quantitative studies were included if they reported statistics regarding the association between parental relationship dissolution and any child sleep variable. Out of the 358 articles screened, 14 articles met inclusion criteria and reported on several sleep dimensions: sleep quality, dreams and nightmares, and sleep disorders (enuresis, night terrors, and bruxism). Out of the 14 articles, six were longitudinal studies and eight were cross-sectional studies. While most studies found that parental relationship dissolution was associated with some indices of poorer child sleep, studies were generally of low to moderate quality. Health professionals should assess child sleep in the context of a parental relationship dissolution.

Childhood adversities and mental health problems: A systematic review

The number of mental health problems in children and adolescents has been increasing. One of the causes of mental health problems is trauma in the family, such as childhood adversities. The aim of this study was to review the relationship between childhood adversities and mental health problems. The method in this study was a systematic review using three databases: CINAHL, PubMed, and SCOPUS. The results of the review were reported according to the PRISMA guidelines. The keywords used in this study were mental health or mental illness or mental disorder or psychiatric illness AND adolescents or teenagers or teenagers or youth AND parental divorce or parental separation OR parental death or parental loss or parentally bereaved. The inclusion criteria for the articles were English language and published from 2017 to 2021. This study recorded 477 articles, screened according to the topic, and then the final articles were 35. The results of the systematic review showed evidence that childhood adversities were related to mental health problems according to the ICD-10 diagnosis, ADHD and personality disorders, depression, post-traumatic, smoking behavior, and alcohol abuse, and distress. Interventions for children with childhood adversities were needed to prevent mental health disorders.

Does it matter in what family constellations adolescents live? Reconsidering the relationship between family structure and delinquent behaviour

Objectives

This study examines the associations between ten family structure types and delinquency, including four groups of symmetrical and asymmetrical living arrangements. We also adjust for attachment to parents and parental monitoring.

Methods

Data are drawn from four cross-sectional surveys conducted between 2016 and 2019 in southern Sweden. The sample consists of 3,838 adolescents, aged 14–15. Negative binomial models were used to calculate the associations between family structure and delinquency.

Results

The results show that those living in single-father, single-mother, father-stepmother, mother-stepfather families report significantly more delinquency than adolescents living with both their parents. Adolescents living in “symmetrical” family arrangements, i.e. both parents are single or have a new partner, reported lower levels of delinquency, whereas adolescents living in “asymmetrical” family arrangements, i.e. where either the mother or the father, but not both, have a new partner, reported higher levels of delinquency. Most of the associations between family structure and delinquency decline when adjusted for attachment to parents and parental monitoring.

Discussion

This study shows that it is important to move on to the use of more detailed categorisations of family structure in relation to delinquency. We need to increase our knowledge about the group of adolescents that moves between parents and especially about the different constellations of asymmetrical and symmetrical living arrangements.

Post-Separation Physical Custody Arrangements in Germany: Examining Sociodemographic Correlates, Parental Coparenting, and Child Adjustment

Most children continue to live with their mother after a divorce or separation, yet paternal involvement in post-separation families has increased substantially in many Western nations. This shift has contributed to a growing share and more diverse set of post-separation parents opting for shared physical custody (SPC), which typically means that children alternate between the parental residences for substantive amounts of time. Profiling the case of Germany, where no legal regulations facilitating SPC are implemented to date, we examine the prevalence of SPC families, sociodemographic correlates of SPC, and its associations with parental coparenting and child adjustment. Using representative survey data sampled in 2019 (N = 800 minors of 509 separated parents), results revealed that only 6–8% of children practiced SPC. SPC parents were more likely to hold tertiary levels of schooling and to report a better coparenting relationship with the other parent. There was no link between SPC and child adjustment, yet conflictual coparenting was linked to higher levels of hyperactivity among SPC children. We conclude that the social selection into SPC and linkages between conflictual coparenting and hyperactivity among SPC children likely stem from the higher costs and the constant level of communication between the ex-partners that SPC requires.

Children’s Experiences of Stress in Joint Physical Custody

Background

Joint physical custody is a parental care arrangement in which children live roughly an equal amount of time with each parent after family dissolution, residing alternately in each of the two parental households. Because joint physical custody is characterised by fathers’ continued involvement in their children’s lives, this care arrangement is believed to compensate for the negative effects of family dissolution, and to contribute to children’s well-being in post-separation families.

Objective

This study aims to investigate potential differences in the experiences of stress of children living in joint physical custody and sole physical custody arrangements, while considering both the proportion of time the children spend with each of their parents and the number of transitions the children make between the parental households.

Methods

Based on data from the Family Models in Germany (FAMOD) study, a national convenience sample, linear regression models were estimated for 297 children between the ages of 11 and 14.

Results

The statistical analysis suggests that there was no significant association between the physical custody type (sole physical custody vs. joint physical custody) and the children’s levels of stress. In addition, the results revealed that children’s experiences of stress did not depend on how often they moved between their parents’ households.

Conclusions

This study does not corroborate the assumption that joint physical custody has a protective effect on children, but instead suggests that different physical custody arrangements are associated with different stressors that lead to similar levels of stress in children living in different post-separation families.

Living arrangements after parental separation have minimal impact on mental health at age 7 years

AIM

This study compared mental health after parental separation in 7-year-old children living in joint physical custody with sole physical custody family arrangements.

METHODS

The study population included 39 661 children from the Danish National Birth Cohort, living in a nuclear family at age 6 months. Child mental health was measured at age 7 years with maternal reports of the Strength and Difficulties Questionnaire (SDQ) operationalised as a high total score. Associations between living arrangements and mental health were analysed using logistic regression models, taking into account early childhood indicators of family relations, parental mental health and socioeconomic conditions.

RESULTS

There were no statistically significant differences between the living arrangements after parental separation with joint physical custody having an odds ratio (OR) of 1.37 (95% CI 1.10-1.70), sole physical custody without a new partner OR 1.33 (95% CI 1.19-1.47) and OR 1.55 (95% CI 1.30-1.84) for sole physical custody with new partner, with children in a nuclear family as reference.

CONCLUSION

This study indicates that living arrangements after parental separation have a minimal influence on child mental health at age 7 years.

How do children and adolescents of separated parents sleep? An investigation of custody arrangements, sleep habits, sleep problems, and sleep duration in Sweden

OBJECTIVES

An increasing number of children and adolescents divide their time between their separated parents' homes. Although marital conflict is disadvantageous for children's sleep, little is known about how children of separated parents sleep. The objective was to investigate the association between children's custody arrangements and sleep habits and sleep initiation difficulties.

DESIGN

Cross sectional nationally representative samples of adolescents from the WHO study Health Behaviour in School-aged Children (HBSC) (n = 11,802).

SETTING

Sweden in 2013/2014 and 2017/2018.

PARTICIPANTS

Adolescents in grades 5, 7, and 9 from Swedish compulsory comprehensive school.

MEASUREMENTS

The survey included questions on sleep behaviors including bedtime, wake-up time and frequency of sleep onset problems. The analysis methods used were ordinary least squares and logistic regression.

RESULTS

The results show differences by custody arrangement, but they are not uniform across the dependent variables. Children and adolescents in sole maternal custody were less likely to sleep as much as recommended (P < .001), more likely to have late bedtimes (P < .001), report sleep initiation difficulties (P < .01) and to report social jetlag between school mornings and weekends (P < .05) compared to those in 2-parent families. Shared physical custody was associated with a higher likelihood of late bedtimes (P < .05) and sleep initiation difficulties (P < .05) compared to those in 2-parent families, but not of sleeping less than recommended or reporting social jetlag. Less-than-equal sharing was generally associated with worse sleep than in 2-parent families.

CONCLUSIONS

As custody arrangements seem to be associated with sleep, it is important to understand the mechanisms behind the findings.

Joint physical custody, parent–child relationships, and children’s psychosomatic problems

Aim

The prevalence of psychosomatic complaints among children and adolescents appears to be increasing. At the same time, the numbers of joint physical custody families are rising across Western countries. This study aimed to investigate the relationship between post-separation care arrangements (joint physical custody vs. sole physical custody) and children’s risks of psychosomatic problems, while considering the potential mediating role of parent–child relationships.

Subject and methods

Based on data from the Family Models in Germany (FAMOD) study, stepwise linear regression models and seemingly unrelated regression models were estimated for a sample of 473 children aged seven to 14 living in either sole physical custody or joint physical custody families.

Results

Children in joint physical custody families reported significantly fewer psychosomatic problems than children in sole physical custody families. Furthermore, living in a joint physical custody arrangement was associated with better parent–child relationships, although only the mother–child relationship was significantly related to children’s psychosomatic complaints, and partially mediated the association between physical custody arrangements and children’s psychosomatic complaints. No corresponding association could be found with respect to the father–child relationship.

Conclusion

The risk of psychosomatic problems was distributed unequally among post-separation families, as children living in joint physical custody arrangements suffered from fewer psychosomatic problems than children living in sole physical custody arrangements. Because part of this association was explained by the quality of the mother–child relationship, children’s relationships with other family members appear to be important factors to consider when seeking to promote children’s health in post-separation care arrangements.

Joint Physical Custody and Adolescents' Life Satisfaction in 37 North American and European Countries

Joint physical custody, a parental care arrangement in which a child lives with each parent about equally after separation or divorce, is an increasingly common phenomenon in many Western countries. Although attention from family scholars, practitioners, and law professionals is growing, there are hardly any numbers on the prevalence of joint physical custody (JPC). Moreover, studies using large-scale representative data on the effects of JPC for children's well-being are still rare. The data for this study come from Health Behaviour in School-Aged Children (HBSC), a representative cross-national survey of adolescents in 37 European and North American countries that was conducted in 2002, 2006, and 2010 and included information on students at the ages of 11, 13, and 15 years (N = 92,886). First, results revealed that symmetrical JPC after family dissolution is still very rare in the majority of countries (5% or less), but reaches 10-20% in some countries. Second, adolescents' life satisfaction in nonintact families is higher in symmetric JPC arrangements than in asymmetric care arrangements. However, after controlling for children and family characteristics, the differences disappear. Thus, it is not the symmetric JPC arrangement that induces adolescents' higher life satisfaction, but rather the children and family characteristics that are associated with the choice of such a custody arrangement by separated or divorced parents.

Importance of living arrangements and coparenting quality for young children's mental health after parental divorce: a cross-sectional parental survey

BACKGROUND

Parental separation has been associated with adverse child mental health outcomes in the literature. For school-aged children, joint physical custody (JPC), that is, spending equal time in both parents' homes after a divorce, has been associated with better health and well-being than single care arrangements. Preschool children's well-being in JPC is less studied. The aim of this study was to investigate the association of living arrangements and coparenting quality with mental health in preschool children after parental separation.

METHODS

This cross-sectional population-based study includes 12 845 three-year-old children in Sweden. Mental health was measured by parental reports of the Strength and Difficulties Questionnaire and coparenting quality with a four-item scale. The living arrangements of the 642 children in non-intact families were categorised into JPC, living mostly with one parent and living only with one parent.

RESULTS

Linear regression models, adjusted for sociodemographic confounders, showed an association between increased mental health problems and living mostly and only with one parent (B=1.18; 95% CI 0.37 to 2.00, and B=1.20; 95% CI 0.40 to 2.00, respectively), while children in intact families vs JPC did not differ significantly (B=-0.11; 95% CI -0.58 to 0.36). After adjusting the analyses for coparenting quality, differences in child mental health between the post divorce living arrangements were, however, minimal while children in intact families had more mental health problems compared with JPC (B=0.70; 95% CI 0.24 to 1.15). Factorial analysis of covariance revealed that low coparenting quality was more strongly related to mental health problems for children in intact families and JPC compared with children living mostly or only with one parent.

CONCLUSIONS

This study suggests that coparenting quality is a key determinant of mental health in preschool children and thus should be targeted in preventive interventions.

The association of family structure with health behavior, mental health, and perceived academic achievement among adolescents: a 2018 Korean nationally representative survey

BACKGROUND

Adolescence is a period during which physical, social, and mental abilities are rapidly developed, and during this time the family environment plays an important role. Differences in health behaviors, mental health, and academic achievement by family structure may affect future families, income, and employment. The purpose of the study was to investigate the association of family structure with health behaviors, mental health, and academic achievement in Korean adolescents.

METHOD

Data from the 2018 Korean Youth Risk Behavior Web-based Survey were analyzed. The study sample was comprised of 59,096 adolescents. Logistic regression, t-tests, and a variance analysis of a complex sample general linear model were used to examine the association of family structure with health behaviors, mental health, and academic achievement. The significance level was set at P < 0.05.

RESULTS

Non-intact families (single-mother families, single-father families, and restructured families) had significantly higher odds of smoking a cigarette, drinking a sip of alcohol, internet use, physical activity, and sexual experience, and mental health issues such as depression, suicidal ideation, perceived stress, and poor perceived health status than intact families (two-parent families). Also, non-intact families were significantly related to low perceived academic achievement compared to intact ones.

CONCLUSION

This study showed that family structure is a significant factor in adolescent health behavior, mental health, and perceived academic achievement. Adolescents who experience a transition in their family structure may be more vulnerable to health risks and exhibit lower academic achievement than those in an intact family.

Complex families and health complaints among adolescents: A population-based cross-sectional study

Aims: The structure of adolescents' families has become more complex over the last decades in several western countries. In parallel, health complaints among adolescents appear to have risen in the Nordic countries. This study aimed to examine the association between family structure and health complaints among Norwegian adolescents while capturing biological, half-, and stepsiblings (sibship-type) in the families. Methods: Data stem from the youth@hordaland study, an epidemiological study of adolescents aged 16-19 years (N = 10,257; participation rate = 53%) conducted in 2012. This study is based on a subsample of 8808 adolescents who lived with parent(s). The adolescents provided detailed information on sociodemographics, family structure, sibship-type, and common health complaints among youth (headache, dizziness, and abdominal, neck, back, and shoulder pain). Results: Adolescents in nuclear families and joint physical custody (JPC) reported significantly lower levels of health complaints compared to peers in single- or stepparent families. Independent of family structure, biological siblings were associated with lower levels of health complaints, while stepsiblings were associated with higher levels of health complaints, but only among girls. These findings were robust to adjustments of sociodemographic variables. Conclusions: Health complaints are frequent but unequally distributed across family structures. Adolescents in nuclear families and JPC report lower levels of health complaints compared to peers in single- or stepparent families. Considering siblings appears to be relevant, as biological- and stepsiblings were related to adolescents' symptoms, independent of family structure. In combination, knowledge about family structure and sibship-type may aid the identification of adolescents at risk of experiencing health complaints.

Child living arrangements following separation and mental health of parents in Sweden

Father involvement and joint physical custody in post-separation families are increasingly common. In Sweden, 35 percent of the children of separated parents live equally much with both parents. Since parenthood is gendered, the associations between child living arrangement and parental health may vary between women and men. This study analyzes the association between children's living arrangement and mental health of parents, and how this interacts with material and social circumstances. Drawing on The Swedish Survey of Living Conditions (ULF) 2008–2013, the association between child living arrangements and mental health (worry/anxiety) of parents in five family structures: two biological parents, reconstituted with joint or main/sole custody arrangements, single with joint physical custody, and single with main or sole custody, were analyzed. Data on 9,225 mothers and fathers with resident children aged 0–17 were analyzed by logistic regressions for average marginal effects adjusting for socio-demographic, socio-economic and social factors. Analyses of interaction effects were made using the synergy index.

Substantial family type differences were found in mental health between two biological parent family and all other family types for mothers, and two biological parent family and single parents for fathers. For the single mothers, the higher risk for worry and anxiety was still found following controls for socioeconomic factors. For fathers, the only differences that remained following control for socioeconomic factors was that of single fathers with children in joint physical custody. Interaction effects were found for the combination of single motherhood and non-employment, indicating a higher risk of mental health problems for single mothers (both with joint and sole custody), than would be expected from a simple addition of these exposures, suggesting that this is a vulnerable group. The results indicate that joint custody is associated with higher risk for worry and anxiety for the parents, especially for mothers both re-partnered and single, but also for single fathers.

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Economic and social conditions explain part of the differences in mental health.

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Single mothers lacking employment is a particularly vulnerable group.

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Shared residence is associated with higher risk for worry and anxiety in parents.

Factors associated with depressive symptoms and suicidal ideation and behaviours amongst sub-Saharan African adolescents aged 10-19 years: cross-sectional study

OBJECTIVE

This study aimed to determine the burden of depression, suicidal ideation and suicidal behaviour amongst adolescents at sites in six sub-Saharan African countries and examine associated risk and protective factors.

METHODS

Household-based cross-sectional study involving male and female adolescents ages 10-19 years. A total of 7,662 adolescents from eight sites in six countries participated in the survey. Three sites were urban: Dar es Salaam (Tanzania), Harar (Ethiopia) and Ibadan (Nigeria); five were rural: Dodoma (Tanzania), Iganga/Mayuge (Uganda), Kersa (Ethiopia), Ningo Prampram (Ghana) and Nouna (Burkina Faso). Log-binomials models were used to estimate relative risks and confidence intervals for factors associated with depression and suicidal behaviour. This was supplemented using log-Poisson models as needed.

RESULTS

The prevalence of suicidal behaviour over the last 12 months ranged between 1.2% and 12.4% in the eight sites. Depressive symptoms and suicidal ideation/behaviours were associated with older age, female sex, food insecurity, poor access to health care and substance use. Depression was strongly associated with increased risk of suicidal behaviour at two sites where the multivariate model converged: Harar, Ethiopia (RR = 3.5, 95% CI 1.8, 7.0, P < 0.05) and Ibadan, Nigeria (RR = 3.7, 95% CI 2.2, 6.3, P < 0.0001).

CONCLUSIONS

Depressive symptoms and suicidal behaviour are common amongst sub-Saharan African adolescents at these 8 sites. Most factors associated with depressive symptoms are modifiable and preventable. Routine screening for depressive symptoms in services frequented by adolescents in these and similar communities would be crucial in early detection and prompt intervention.

Children's and Parents' Well-Being in Joint Physical Custody: A Literature Review

Joint physical custody (JPC), a parental care arrangement in which a child lives with each parent for at least 25-50% of the time after separation or divorce, is increasingly common in many Western societies. This is a major shift from the standard of sole physical custody, with mostly mothers providing primary childcare after a parental separation or divorce. The increasing share of separated or divorced parents who practice JPC, which in some countries, US states, and regions reaches 30% and more, results from increasing gender equality due to mothers participating considerably in the labor force and fathers being actively involved in their children's daily lives. This review focuses on the effects of JPC on children's and parents' well-being, based on 40 studies from North America, Australia, and Europe published between 2007 and 2018. In sum, there is empirical evidence from different countries that suggests that JPC arrangements can have positive effects on the well-being of children and of parents. However, the existing studies are conceptually, methodologically, and contextually very heterogeneous. In addition, self-selected highly educated parents with a high socio-economic status, a low conflict level, and children between the ages of 6-15 practicing JPC dominate the samples. Thus, the risks and benefits of JPC are not clear yet and are heavily debated by advocates and academics. The review concludes with suggestions for future research.

Parental relationship dissolution and child development: the role of child sleep quality

We utilized the Fragile Families and Child Wellbeing longitudinal dataset to evaluate associations among a maternal relationship dissolution, childhood sleep, and child development, specifically externalizing and internalizing symptoms, attention and social difficulties, as well as cognitive ability, when children were ages 5 (n = 3590) and 9 (n = 3062). A maternal relationship dissolution was related to poorer child sleep quality at ages 5 and 9. There was evidence of an indirect relation from a maternal relationship dissolution to child development through poor sleep quality when the child was 5 and 9 years old. The implications of this work are discussed.

Living in Two Worlds - Children's Experiences After Their Parents' Divorce - A Qualitative Study

PURPOSE

The aim of this study was to gain a deeper understanding of how children living in two homes after parents' separation experience their everyday lives.

DESIGN AND METHODS

An inductive qualitative design was chosen for the study using a hermeneutic phenomenological approach. Twelve children aged 10-13 years, and living in two homes, were interviewed. The data analysis used the four fundamental lifeworld existential dimensions: "lived body", "lived time", "lived space" and "lived human relations" as guidelines for reflections during the research process.

RESULTS

The overall understanding of the children's experience was that living in two homes was like living in two worlds. The children struggled with feelings of loss, loyalty and attachment. The children's experiences are described in four themes and nine subthemes. The themes are: Facing a changing home, Bridging new relations, Longing for continuity, Feeling loyalty.

CONCLUSIONS

Parents' separation and living in two homes can be stressful for children. Children felt torn between their feelings of loyalty toward their parents, and their longing for calm and stability in their everyday life. A child-centered approach is therefore important to develop support focusing on the children's needs and perspectives after their parents' divorces.

PRACTICE IMPLICATIONS

A deeper understanding of children's experience of living in two homes provides nurses who care for children in the community or health care service with knowledge of children's need for support. Children whose parents have recently divorced, and children who live in families with parents experiencing high levels of conflict after the separation need special attention.

Preschool children living in joint physical custody arrangements show less psychological symptoms than those living mostly or only with one parent

AIM

Joint physical custody (JPC), where children spend about equal time in both parent's homes after parental separation, is increasing. The suitability of this practice for preschool children, with a need for predictability and continuity, has been questioned.

METHODS

In this cross-sectional study, we used data on 3656 Swedish children aged three to five years living in intact families, JPC, mostly with one parent or single care. Linear regression analyses were conducted with the Strengths and Difficulties Questionnaire, completed by parents and preschool teachers, as the outcome measure.

RESULTS

Children in JPC showed less psychological problems than those living mostly (adjusted B 1.81; 95% CI [0.66 to 2.95]) or only with one parent (adjusted B 1.94; 95% CI [0.75 to 3.13]), in parental reports. In preschool teacher reports, the adjusted Betas were 1.27, 95% CI [0.14 to 2.40] and 1.41, 95% CI [0.24 to 2.58], respectively. In parental reports, children in JPC and those in intact families had similar outcomes, while teachers reported lower unadjusted symptom scores for children in intact families.

CONCLUSION

Joint physical custody arrangements were not associated with more psychological symptoms in children aged 3-5, but longitudinal studies are needed to account for potential preseparation differences.

[Psychosomatic symptoms as an expression of the deterioration of the health-related quality of life in adolescents]

Objetivo

Analizar, en una población de adolescentes escolarizados, la relación entre síntomas psicosomáticos y calidad de vida relacionada con la salud (CVRS) diferenciando por sexo y grupo de edad.

Diseño

Estudio transversal.

Emplazamiento

Cinco Institutos de Educación Secundaria.

Participantes

Ochocientos cuarenta y cuatro adolescentes de entre 15 y 18 años que cursaban 3.° y 4.° de Educación Secundaria Obligatoria y Bachillerato.

Mediciones principales

CVRS mediante KIDSCREEN-52 y síntomas psicosomáticos con la escala de problemas psicosomáticos (PSP).

Resultados

Las chicas y los adolescentes de 17-18 años presentaron síntomas psicosomáticos significativamente más altos, ambos grupos también puntuaron peor en todas las dimensiones de CVRS aunque solo alcanzaron significación las dimensiones relacionadas con bienestar físico, bienestar mental y estado de ánimo y estrés. Todos los síntomas psicosomáticos se asociaron de forma inversa con las 10 dimensiones del KIDSCREEN-52. Los modelos de regresión realizados mostraron que tristeza, dificultad de concentración y dificultad para dormir fueron los predictores de peor CVRS en ambos sexos y grupos de edad, y estas variables explicaron entre un 30 y un 41% de la varianza de la CVRS de los adolescentes.

Conclusiones

Los síntomas psicosomáticos son más frecuentes en las chicas y en los adolescentes mayores, y predictores de peor CVRS. Es importante diferenciarlos de afecciones médicas para evitar intervenciones innecesarias. Como expresiones de malestar emocional deben ser evaluados y tratados de forma integral porque interfieren en la vida cotidiana y aumentan la vulnerabilidad propia de la adolescencia.

Parental separation in childhood as a risk factor for depression in adulthood: a community-based study of adolescents screened for depression and followed up after 15 years

BACKGROUND

Earlier research has investigated the association between parental separation and long-term health outcomes among offspring, but few studies have assessed the potentially moderating role of mental health status in adolescence. The aim of this study was to analyze whether parental separation in childhood predicts depression in adulthood and whether the pattern differs between individuals with and without earlier depression.

METHODS

A community-based sample of individuals with adolescent depression in 1991-93 and matched non-depressed peers were followed up using a structured diagnostic interview after 15 years. The participation rate was 65% (depressed n = 227; non-depressed controls n = 155). Information on parental separation and conditions in childhood and adolescence was collected at baseline. The outcome was depression between the ages 19-31 years; information on depression was collected at the follow-up diagnostic interview. The statistical method used was binary logistic regression.

RESULTS

Our analyses showed that depressed adolescents with separated parents had an excess risk of recurrence of depression in adulthood, compared with depressed adolescents with non-separated parents. In addition, among adolescents with depression, parental separation was associated with an increased risk of a switch to bipolar disorder in adulthood. Among the matched non-depressed peers, no associations between parental separation and adult depression or bipolar disorder were found.

CONCLUSIONS

Parental separation may have long-lasting health consequences for vulnerable individuals who suffer from mental illness already in adolescence.

Family Dynamics and Child Outcomes: An Overview of Research and Open Questions

Previous research has documented that children who do not live with both biological parents fare somewhat worse on a variety of outcomes than those who do. In this article, which is the introduction to the Special Issue on "Family dynamics and children's well-being and life chances in Europe," we refine this picture by identifying variation in this conclusion depending on the family transitions and subpopulations studied. We start by discussing the general evidence accumulated for parental separation and ask whether the same picture emerges from research on other family transitions and structures. Subsequently, we review studies that have aimed to deal with endogeneity and discuss whether issues of causality challenge the general picture of family transitions lowering child well-being. Finally, we discuss whether previous evidence finds effects of family transitions on child outcomes to differ between children from different socioeconomic and ethnic backgrounds, and across countries and time-periods studied. Each of the subsequent articles in this Special Issue contributes to these issues. Two articles provide evidence on how several less often studied family forms relate to child outcomes in the European context. Two other articles in this Special Issue contribute by resolving several key questions in research on variation in the consequences of parental separation by socioeconomic and immigrant background, two areas of research that have produced conflicting results so far.

The Living Conditions of Children with Shared Residence - the Swedish Example

Among children with separated parents, shared residence - i.e., joint physical custody where the child is sharing his or her time equally between two custodial parents' homes - is increasing in many Western countries and is particularly common in Sweden. The overall level of living among children in Sweden is high; however, the potential structural differences between children in various post-separation family arrangements have not been sufficiently studied. Potential risks for children with shared residence relate to the daily hassles and stress when having two homes. This study aims at investigating the living conditions of children with shared residence compared with children living with two custodial parents in the same household and those living with one custodial parent, respectively. Swedish national survey data collected from children aged 10-18 years (n ≈ 5000) and their parents were used. The outcomes were grouped into: Economic and material conditions, Social relations with parents and peers, Health and health behaviors, Working conditions and safety in school and in the neighborhood, and Culture and leisure time activities. Results from a series of linear probability models showed that most outcomes were similar for children with shared residence and those living with two custodial parents in the same household, while several outcomes were worse for children living with one parent. However, few differences due to living arrangements were found regarding school conditions. This study highlights the inequalities in the living conditions of Swedish children, with those living with one parent having fewer resources compared with other children.

New approaches to divorce with children: A problem of public health

This broad review elaborates on the most up-to-date knowledge on biochemical and psychobiological aspects of parental loss and other childhood adversities during divorce involving minor children. So far, divorce involving minor children was unfortunately considered by authorities only as a purely juridical problem, and this approach has often allowed a completely different approach according to the Courts. Now, scientific research, also making use of animal models, is demonstrating the biological basis of the problem and the indisputable consequences on the well-being and health of children. The innovative conclusion of this review is that this argument (because of its frequency and gravity) is primarily a question of public health and that it is necessary to further harmonize practices in this area.

Psychological complaints among children in joint physical custody and other family types: Considering parental factors

AIMS

Increasing proportions of Scandinavian children and children in other Western countries live in joint physical custody, moving between parents' homes when parents live apart. Children and parents in non-intact families are at risk of worse mental health. The potential influence of parental ill-health on child well-being in the context of differing living arrangements has not been studied thoroughly. This study investigates the psychological complaints of children in joint physical custody in comparison to children in sole parental care and nuclear families, while controlling for socioeconomic differences and parental ill-health.

METHODS

Data were obtained from Statistics Sweden's yearly Survey of Living Conditions 2007-2011 and child supplements with children 10-18 years, living in households of adult participants. Children in joint physical custody (n=391) were compared with children in sole parental care (n=654) and children in nuclear families (n=3,639), using a scale of psychological complaints as the outcome measure.

RESULTS

Multiple regression modelling showed that children in joint physical custody did not report higher levels of psychological complaints than those in nuclear families, while children in sole parental care reported elevated levels of complaints compared with those in joint physical custody. Adding socioeconomic variables and parental ill-health only marginally attenuated the coefficients for the living arrangement groups. Low parental education and parental worry/anxiety were however associated with higher levels of psychological complaints.

CONCLUSIONS

Psychological complaints were lower among adolescents in joint physical custody than in adolescents in sole parental care. The difference was not explained by parental ill-health or socioeconomic variables.

Family residency and psychosomatic problems among adolescents in Sweden: The impact of child-parent relations

AIMS

Profound changes in family structure took place in many countries, during the second part of the previous century. The purpose of this paper is to analyse the association between the type of family residency and psychosomatic problems in younger and older adolescents, particularly focusing on alternate residency, and to examine the impact of child-parent relations.

METHODS

We used data collected in 2009 by Statistics Sweden among 172,298 Swedish students in Grade 6 and Grade 9 (approximate ages 12 and 15 years old); comprising 80% and 86%, respectively, of the entire population of students in those grades. We collected the data with a questionnaire, completed anonymously in school: We used the Psychosomatic Problems (PSP) scale as the outcome measure.

RESULTS

The type of family residency showed a weaker association with psychosomatic problems than the child-parent relationships did. Living in non-intact families increased the probability of adolescent psychosomatic problems by 0-0.05, compared to intact families. In Grade 9, there were no differences in psychosomatic problems between the students in alternate residency and those living with their two parents; and in Grade 6, these differences were relatively small. In comparison, a worse relationship with parents increased the probability of psychosomatic problems by 0.11-0.17, depending on the school grade and type of family residency.

CONCLUSIONS

The structure of the family, as well as the child-parent relationships needs to be taken into account, to properly estimate the magnitude of the family situation as a determinant of adolescent psychosomatic problems. Our results justify universal intervention at the policy level.