Family of Origin Dynamics as Route of Psychological Disorders

Indian J Psychol Med. 2017 Jul-Aug; 39(four): 457–463.

Effects of Family unit Structure on Mental Health of Children: A Preliminary Written report

Aniruddh Prakash Behere

^aneChild and Adolescent Psychiatrist, Maine Behavioral Healthcare, Rockland, Maine

^twoClinical Teacher, TUFTS Schoolhouse of Medicine, Boston, MA, The states

Pravesh Basnet

^threeKid and Adolescent Psychiatrist, Passavant Hospital, Jacksonville, USA

Pamela Campbell

⁴Associate Professor, Southern Illinois University, Springfield, IL, USA

Abstract

Background:

To detect whatsoever association betwixt family unit structure and rates of hospitalization equally an indicator for behavior problems in children.

Methods:

Retrospective chart review of 154 patients who were admitted to the preadolescent unit at Lincoln Prairie Behavioral Health Center betwixt July and December 2012.

Results:

We found that only xi% of children came from intact families living with biological parents while 89% had some kind of disruption in their family structure. 2-3rd of the children in the study population had been exposed to trauma with physical abuse seen in 36% of cases. Seventy-ane percent had reported either a parent or a sibling with a psychiatric disorder. Children coming from biologically family unit were less probable to accept been exposed to trauma. Children coming from single/divorced families were less probable to have been exposed to sexual abuse but more likely to accept a diagnosis of attention deficit hyperactivity disorder (ADHD) compared to other types of families. Strong association was found betwixt exposure to trauma and certain diagnoses in respect to hospitalization. ADHD predicted a 4 times likelihood of having more than one previous hospitalization, with mood disorder, oppositional defiant disorder, and physical corruption increasing the risk past more than than twice.

Conclusions:

Significant differences in family structure were demonstrated in our study of children beingness admitted to inpatient psychiatric hospitalization. The presence of trauma and family unit psychiatric history predicted college rates of readmission. Our report highlighted the part of psychosocial factors, namely, family structure and its adverse effects on the mental well-being of children.

Keywords: Family construction, hospitalization rates, unmarried parents, trauma

INTRODUCTION

The interest in family structure and its effects on children's mental health gained momentum in the 1960s and 1970s when there was a spike in divorce rates and unmarried-parent families. The chief focus was on separation and divorce and their affect on the well-being of children.[i] Over the years, in that location has been a change in the family unit construction reflected in the increased proportion of children living in a single-parent home which changed from 12% in 1960 to 28% in 2003.[two] These studies were as well able to certificate some of the long-term effects of stress equally a effect of separation on children.[1] Co-ordinate to 2001–2007, Centers for Disease Control (CDC) estimates about half of children live with their biological parents. This does vary beyond race and falls downward to most 24% when dealing with African-American children.

Single parents

Reviewing the literature, it too becomes clear that single parenthood becomes a articulate run a risk factor for mental health bug for both children and adults, leading to greater psychological distress and depression,[3] and puts women at a socioeconomic disadvantage further increasing the level of stress.[iv] Several studies have also documented the link between separation and depressive disorders most likely every bit a result of both social and economic reasons.[5] Weisman et al. 1987 constitute that single Caucasian women were almost twice as likely to suffer from low compared to married women.

Over the years, there has been a general consensus that unmarried-parent families are at a greater disadvantage compared to more traditional homes. The factors associated with worse outcome in single-parent families mayhap more than complicated than first evident. Unmarried-parent families are as well suggested to have less resilience when confronting stress. Single parenthood raises further economic challenges compounding the level of stress, possibly causing more difficulties in parent–child relationships. The prevalence of poverty in unmarried-parent family has been estimated to be as loftier every bit 50% compared to around 5% in two-parent intact families.[1] This economic disadvantage can further lead to higher rates of emotional and behavioral problems in children.[6] Factors which increase the likelihood that children will show disturbance over time include marital conflict, existence raised in poverty, teen and single parenthood, parental low, and hostile/angry parenting. Dysfunctional family backgrounds and socioeconomic arduousness have besides been attributed to suicide in young people. Babyhood arduousness including divorce and impaired parenting seems to crusade both short- and long-term problems, various childhood disorders, and after low in machismo. Single mothers take been institute twice as likely to come from families where a parent had a mental health problem. Studies have also reported as high as a threefold risk of depression, and substance use in unmarried mothers compared to married mothers. Children from single family were more than twice likely to report internalizing problems and more than three times likely to study externalizing problems compared to children from two-parent families.[ane] More than and more than research studies have underscored the importance of early on life experience in defining life trajectories.[7] Silver et al. besides suggested in their study that children who lived their mother and an unrelated partner had the poorest aligning and highest levels of deport problems compared to children who just lived their mothers. Studies have likewise suggested that adjustment problems in children with female parent-only families are comparable to mother and an unrelated partner or a stepfather. The risk slightly decreases with another developed like grandparent existence in the family unit.[viii]

Family structure and trauma

Disruption in family construction can lead to several adverse events impacting both the mental health of children and their parents. Not all disruptions have equal furnishings. More emotional and behavioral problems occur in families disrupted past divorce than compared to other types of disruptions, for case, death of a parent. Certain characteristics have been identified in caregivers as well equally the children themselves that serve every bit hazard factors for corruption. Young age, depression, substance corruption, poverty, and history of mothers beingness separated from their ain mothers during childhood serve equally risk factors. Similar risk factors are as well seen in male person caregivers with unrelated male partner present at domicile interim as an additional gamble factor. Some xxx% children are expected to be living with unrelated surrogate father.[2] Studies have also found that the presence of a stepparent increases the run a risk of being abused by a staggering factor of 20–forty times in contrast to living with single mothers where the risk was about 14 times compared to living in a biologically intact family. Some risk factors accept also been identified within the children themselves such every bit low birth weight, physical, mental disabilities, assailment, and hyperactivity. Parents exposed to corruption in their childhood or domestic violence were also more decumbent to act aggressively toward their own children.[2] However, studies have not been able to decipher and document in the detail the different forms of abuse experienced past children who come from various types of disturbed family structures.

Parental mental health and its impact on children

History of parental psychopathology predisposes children to increased rates of depression and other psychopathology when compared to children of parents who do not accept any affective illness. Farther, studies have also indicated that the form of depression in these children may be more than chronic with increased rates of relapse. It also appears that mother's affective land has a more profound effect on the child than father's illness and the difference being statistically significant. Equally mentioned previously, parental marital impairments also impact kid'south take chances for psychopathology and probably intertwine with parental psychopathology further leading to marital discord.[9]

Family unit structure and hospitalization

A better appreciation of the web of social and psychosocial processes that environs the association between family construction and health outcomes needs to exist studied. This may affect early intervention strategies targeting reduction in morbidity and mortality. There have been a limited number of studies looking into family structure as a variable. There was a large influx of studies in the 1960s and 1970s, but over the years, the interest in this area has diminished. There are also a limited number of studies looking at hospitalization as a variable with very few being published in the recent past. Yampolskaya, 2013, et al.[10] plant that more one psychiatric diagnosis and severity of maltreatment increased the odds of psychiatric readmission. It was evident during the inpatient rotation that high numbers of children admitted were from some kind of disturbed family structure with additional history of abuse.

The primary aim of this study was to wait at any association between family unit structure and hospitalizations as this has never been done. Several other factors were also studied with hospitalization being the dependent variable. We were interested in finding whatsoever link betwixt these factors and if a certain type of family structure was predictive of higher rates of hospitalization, trauma, or specific diagnoses.

METHODS

This report was done at Lincoln Prairie Behavioral Wellness Heart (LPBHC) inpatient unit of measurement. Exempt condition was obtained from IRB/SCRIHS. Nosotros conducted retrospective chart review of 154 patient charts admitted to the preadolescent unit of measurement at LPBHC. Eleven charts were excluded for diverse reasons; bringing downward the number to 143 charts. Inclusion criteria: children ≤12 years of age, admitted between July and December of 2012, and having a psychosocial assessment done within 24 h of admission by a therapist were included in the study. Our dependent variable was number of hospitalization, with family structure being the principal independent variable. Family unit psychiatric history, exposure to trauma, and diagnosis were classified as secondary independent variables.

Information were first entered into excel format and so converted to SPSS (IBM) to derive the descriptive statistics (frequencies). Another excel data prepare was converted to SAS to run the inferential statistics. Chi-square analysis was run between the dependent variable and the main independent variable. Similar tests were as well run betwixt dependent variable and the secondary independent variables. Chi-square analysis served every bit a screening test. A logistic regression model was practical to whatever event that came out to be significant statistically on Chi-square analysis to find the strength of the association between the two variables.

RESULTS

Descriptive statistics

Later on gathering the data, a frequency analyses were run in SPSS to appraise for preliminary trends in the data. Frequency data (manner) were calculated along with the corresponding percent.

Demographic characteristics

The almost common age in our report was 12 years with the majority of children lying between seven and 12 years of age constituting about 90% of the study population. Males predominated with but over ii-third of the study population. Over 76% were Caucasian with African-Americans making up only fifteen% [Figures ​ ane and ​ 2].

Age distribution of children

Sex activity and race distribution

Family unit structure

One of the principal goals of this study was to look at the family structure and its influence on mental well-beingness of children. Surprisingly, only 11% of children came from intact families living with biological parents while the other 89% had some kind of variations in their family structure. 40-iv percent came from one-parent homes including single and divorced parents. Around 23% were under the intendance of the land including foster families and residential intendance, and fourteen% were from blended family unit either a combination of stepmother or begetter. A very small percentage (7%) of children was adopted [Effigy 3].

Three-member families stood equally the well-nigh common with but over quarter of the cases. The traditional iv-fellow member family or fewer constituted about 61% of the population with v or members making upwardly the rest (33%) [Figure 4].

Hospitalization

For ane-tertiary of the children, this was their first psychiatric hospitalization, with 90% of children having three or less previous psychiatric hospitalizations. Ane child had thirty hospitalizations [Figure 5].

No. of previous hospitalizations

Corruption

Nearly 2-tertiary of the children in the report population had been exposed to some blazon of abuse in the past with almost similar number having some kind of involvement with Department of Children and Family Services either currently or in the past. Physical corruption stood out as the near common form of abuse presents in 36% of cases followed by neglect, emotional, and sexual abuse [Figure 6].

Diagnoses

We looked at trends in both the primary diagnoses that the children had based on what was listed as the get-go diagnoses on their discharge summary and also the overall frequencies of all the diagnoses taken together. As expected attending deficit hyperactivity disorder (ADHD) was present in nearly 60% of the children every bit the master diagnoses, followed by mood disorder in 25% of the children. Feet disorders were prevalent in <5% of population equally a primary disorder with conduct and oppositional defiant disorder (ODD) making up about vii% [Effigy seven].

Psychiatric diagnosis among the written report population

When distributions of total diagnosis were considered ADHD once more came up as the most prominent one encompassing about 76% of children. Threescore-6 percent of children had some kind of mood disorder including depression and bipolar disorder. Anxiety and ODD were as present in about xxx% while PDD in 10%.

Family psychiatry history

A preponderance of children (71%) had reported either a parent or a sibling with a psychiatric disorder. Mood disorder was the nigh common psychiatric inability in mothers nowadays in 48% of cases followed by substance use and anxiety. Twenty-one percent of fathers had mood disorder followed by xiv% with substance utilise issues. The nearly common comorbidity among siblings was ADHD, followed by mood disorder and then anxiety disorder reflecting a similar pattern to children themselves. Xx-ii percentage of children reported a sibling with a psychiatric diagnosis.

Eighty-vii percent of cases had Medicaid insurance.

Inferential statistics

A Chi-square assay was run between the family structure and hospitalization which was the dependent variable. Hospitalization was run both as an absolute count of admission and besides equally a dichotomous variable (no previous hospitalization vs. one or more previous hospitalizations). Absolute count of admission and dichotomous variable group was used for all the secondary consequence variables equally well.

No meaning statistical significance was found between family unit construction and hospitalization. Nevertheless, statistically significant results were found between family unit psychiatric history, exposure to trauma, and diagnosis when looked at with hospitalization as a dependent variable [Tabular array 1].

Table 1

Child psychiatry hospitalization as a dependent variable

Further, logistic regression was run to await for strength of association. No clan was constitute betwixt family psychiatric history and number of hospitalization. Strong association was establish between certain diagnosis too as trauma in respect to hospitalization. ADHD predicted a 4 times likelihood of having more than 1 previous hospitalization, with mood disorder and ODD increasing the risk by more than twice [Table 2].

Tabular array two

Hospitalization rates as predicted past diagnosis

Exposure to whatsoever type of trauma and specifically physical corruption increased the likelihood of having more one previous psychiatric hospitalization by two fold.

We were able to run certain other logistic regression models to look at association betwixt types of family structure to history of abuse and diagnosis. Children coming from a biological family unit were less likely to accept been exposed to trauma. Children coming from single/divorced families were less probable to accept been exposed to sexual corruption but more likely to have a diagnosis of ADHD compared to other types of families [Table 3].

Table 3

Family unit structure and its relationship to other dependent variables

DISCUSSION

This was a pilot study looking into the association between psychosocial factors and risk of hospitalization. Nosotros were able to look at various factors that may accept contributed toward children having recurrent hospitalizations. In respect to family structure, meaning differences were identified amongst the children who admitted to inpatient psychiatric unit of measurement. Nosotros were able to highlight that only to eleven% of children came from biologically intact families and the remaining 89% had some kind of disruption in their family unit construction. This does appear to significantly contrast information from CDC when looking at distribution of children under the age of 18 years and their family structure. By various estimates, about fifty% of children come up from biologically intact families. This may as well vary co-ordinate to race with higher rates of biologically intact families among Caucasian children compared to African-American children.

In our study, nosotros were not able to find any statistically significant clan between family construction and number of hospitalization. We were, however, able to demonstrate strong associations between certain traumas and diagnosis in predicting higher rates of rehospitalization. We were too able to highlight in our study the adverse effect of certain family types and their predisposition for higher rates of exposure to trauma or carrying higher rates of a detail diagnosis.

The biopsychosocial model of wellness has been used extensively to empathise the role of various factors in man functioning in the context of health or illness. This interrelation is important more so in the context of mental wellness. Psychological factors are not but interdependent on each other just also tin can also bear on biological factors. This was clearly demonstrated in a study released by researchers at Duke University who demonstrated that "Children who experienced at to the lowest degree ii types of exposure to violence showed significantly more telomere erosion betwixt ages five and x than did controls subjects." This shows that psychosocial factors tin can influence biological factors and stress in fact lead to significant changes in chromosome of children when they are young and near vulnerable.

Changing trajectory is a term that has been used extensively in inquiry related to wellness of children. Two important variables have become important in this concept, one being early identification, the other early intervention. By the time, many adults seek mental health services, they take had to endure many years of chronic stress, and the role of primary and secondary intervention becomes obsolete. In case of children, at that place is a major emphasis on primary and secondary prevention that tin can lead to meaning changes in their development trajectory and lead to normalization. This has been further emphasized in a recent statement by CDC (2013) - "More than comprehensive surveillance is needed to develop a public health approach that will both help prevent mental disorders and promote mental health amongst children."

Nosotros were able to arrive at the following conclusions from our study:

• Significant differences in family unit structure were demonstrated in our study of children being admitted to inpatient psychiatric hospitalization. Only 11% were residing with biologically intact families. Significant differences were also evident between Caucasians and non-Caucasians within blended and residential groups

• The presence of trauma and family psychiatric history predicted higher rates of readmission

• ADHD, ODD, mood disorder, and physical trauma predicted higher rates of readmission

• Children from biological families were less probable to exist exposed to trauma

• Children from single/divorced families were more than likely to have an ADHD diagnosis but less likely to take been sexually driveling.

Limitations

• Sample size was limited to 143 charts which reduced the power of the study

• No comparison group was present in the study

• Study was based on retrospective nautical chart review leading to recall bias

• Data were based on parent report which may have led to over- or underreporting of factors and were nerveless past a therapist and not directly by the investigators.

In our study, we have highlighted the role of psychosocial factors, namely, family structure, trauma, and family unit psychiatric history and its adverse furnishings on the well-beingness of children. The importance lies in recognizing at risk populations, including children and families, and intervening early on so equally to become back on normal trajectory. This may impact early intervention strategies targeting reduction in morbidity and mortality.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of involvement.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5559994/

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