Family Influence on mental health

• A growing number of children are struggling with their mental health, yet the majority are happy.
• By 2023, 1 in 5 individuals aged 8-25 had a mental disorder.
• Mental disorder rates are similar for boys and girls aged 8-16, but twice as high for young women aged 17-25.
• Self-harm and suicide rates are increasing, from 5% to 13%.
• There has been a 50% increase in the number of children referred to emergency mental healthcare.
• COVID-19 has worsened mental health issues, especially for struggling families.
• In 2022, the UK had the lowest average life satisfaction among 15-year-olds.
• Mental health services are under huge strain, with 40,000 young people waiting over 2 years for support.

Defining Family

• Families are organized, dynamic systems with rules, diverse and changing over time.
• Biological constraints and individual characteristics influence families.
• Families are embedded in physical, social, cultural, and political contexts.
• Child development occurs within these family systems.

Risk and Protective Factors

• Not everyone develops mental health disorders.
• A risk factor is a characteristic or event that increases the likelihood of developing a mental health problem.
• Understanding risk factors is important for intervention.
• Wellbeing is more than just the absence of a mental health disorder.
• Wellbeing and mental health are related but distinct.
• Poor mental health, positive wellbeing, positive outlook, sense of purpose and meaningful social connection are all possible simultaneously.

Sources of Family Risk

• Family structure
• Parental mental health
• Children of depressed mothers are more likely to experience depression.
• Family processes
• Economic hardship
• Genetic influence as inherited risk

Importance of Family-Level Factors

• Family factors consistently predict young people's mental health and wellbeing.
• The influence of family varies based on;
• The outcomes being assessed (mental health/wellbeing, clinical/subclinical)
• The reporter (child/parent)
• Whether family income/economic hardship is controlled for.
• Family factors can account for as much as 25% of the variability in young people's mental health.

Parental Mental Health – Direct Effects

• Twin, adoptee, and family studies show genetic influence on behavior.
• Some disorders have high heritability (60-90%), including;
• Autism
• Schizophrenia
• Bipolar disorder
• ADHD
• Some disorders have lower heritability (20-50%) including;
• Unipolar depression
• Generalized anxiety
• Genetics alone do not fully explain the heritability of these disorders.
• Environmental factors such childhood trauma, socio-economic status, and early life stressors can trigger or worsen underlying genetic susceptibilities.
• Direct effects of parental mental health are mediated by parenting, parent-child relationships, and the quality of relationships.
• The extent to which a parent's mental health problem impairs their parenting and relationships is more important than the presence of the problem itself.
• Depressed parents are less likely to cuddle, play, or read to their children.
• Depressed parents are less able to provide daily routines.
• Depressed parents are more easily irritated by their children.
• Depressed parents may be physically/verbally aggressive.
• Parenting stress refers to a parent's capacity to cope with the demands of parenthood.
• Parenting stress can lead to poor parenting, such as authoritarian, harsh, or negative parenting, which can cause child maladaptation.

Economic Hardship

• Persistent economic disadvantage affects children and families.
• Children and families suffer negative consequences when faced with economic hardship or low socioeconomic status (SES).
• Economic hardship places children at risk for adjustment difficulties.
• Markers of hardship include low income, high debts, and negative financial events.
• Direct effects of economic hardship include unmet material needs and perceived poverty relative to peers.

Family Stress Model (Conger, 2002) - Indirect Effects

• Angry responses to economic pressure increase couple conflict and despondency.
• This leads to withdrawal of supportive behaviors and reductions in pleasurable interactions.

Family Structure

• Two-parent families (opposite-sex parents)
• One-parent family (single parent or result of separation)
• Same-sex families
• Comparative studies show child adjustment is unrelated to parents’ sexual orientation.
• Golombok et al. (2014) compared children aged 3-9 in gay adoptive, lesbian adoptive, and heterosexual adoptive families using interviews, questionnaires, and parent-child observations.
• Gay and lesbian parents showed greater warmth, interaction, and responsiveness.
• There were no differences in child adjustment across family types.
• Genetically unrelated families
• Adoptive families
• Cohabiting families
• Divorced/separated families
• Children from divorced/separated families may score lower on wellbeing (emotional, behavioral, physical health, academic attainment).
• The effects of divorce vary greatly, and a large proportion of families overcome these challenges.
• 80% of children recover from temporary dips in wellbeing and develop into well-adjusted adults.
• Mediators of the impact of divorce include
• Financial security
• Quantity and quality of contact with non-residential parent
• Parents wellbeing
• Pre-divorce conflict
• Coparenting relationship
• A coparenting alliance involves;
• Putting conflict aside
• Making an effort to not expose children to conflict
• Not encouraging the child to form an alliance with one parent
• Engaging in positive communication.
• Non-traditional family structure does not consistently have a negative effect on young people’s mental health.

Family Processes

• Family processes are shared by all family types.
• Quality of parenting: Warm, responsive parenting is associated with better outcomes for young people.
• Parent-child relationships
• Sibling relationships
• Interparental relationships: Intense and frequent conflict is associated with less effective parenting and more negative outcomes.
• Co-parenting relationships

Family Systems Theory (Cox and Paley, 1997)

• Derived from general systems theory
• Complex, interrelated systems
• Dynamic and bi-directional
• Inter-parental relationships are central.
• There is a high probability of spillover from the couple relationship (spillover hypothesis).
• Interdependence of family members
• Direct and indirect influences
• Multiple units of analysis
• Transitions and reorganization
• Developmental change
• Importance of culture and history

Interparental Relationships

• Strong, supportive, and harmonious interparental relationships are linked to children’s enhanced psychological wellbeing and educational attainment.
• Parents satisfied in their relationship establish a relationship with their child that includes;
• Warmth
• Responsiveness
• Limit setting
• Maturity demands
• Children in households with high levels of conflict are at risk of negative psychological outcomes and score lower in;
• Emotional wellbeing
• Behavioral wellbeing
• Interpersonal relationships
• Physical health
• Academic attainment

Relationship Quality and Children – Why?

• Genetic predisposition for negative emotionality and relationship problems.
• Harold et al. (2013) examined associations among inter-parental conflict, parent-to-child hostility, and child externalizing problems in IVF (genetically related) and adoptive (genetically unrelated) families.

Intervention Research

• Strong and consistent evidence supports the effectiveness of parenting interventions for mental health outcomes (internalizing and externalizing).
• Parenting interventions have shown efficacy across different ages, countries, and cultures in reducing child behavior problems.
• Programs aim to improve parent-child relationships, parents’ emotion regulation, and communication.
• Triple P aims to enhance knowledge and improve confidence.
• Incredible Years program
• Cash transfer trials are used to bolster socioeconomic resources of poor families.
• Conditional cash transfers are dependent on family engagement.
• Unconditional cash transfers are free of any obligation.
• Poverty reduction and increased welfare can improve parenting.

School Children and Families

• Parents of children aged 5 years were studied in;
• Couples group focusing on parent-child issues
• Couples group focusing on issues between parents
• Brief consultation condition (control)
• Families in group interventions displayed improvements in parenting styles and outcomes for children.
• The marital-focus group displayed positive changes in parents’ relationship quality and higher levels of children’s attainment on achievement tests.
• 10 years later, positive outcomes were observed in parents’ relationship, couple communication, and children’s externalizing behaviors in groups with an emphasis on the couple.
• The parenting and control groups showed worse outcomes.