Effects of family structure on mental health of children and adolescents

SUMMARY Existing evidence holds that mental health is just as important as physical health for optimal development throught the life. Mental health is an essential parameter that links learning ability, school success, adaptability and well-being in general. A significant aspect is the correlation between the parenting style and the positive adaptation of the child, a parenting style that involves consistent discipline, parental monitoring, and involvement in empathetic and open communication with the child. The structure of the family and its effects on the mental health of the children is studied since the divorce rate has increased and also the single-parent families, focusing on the relationship between separation / divorce and their impact on the mental health of the children. Analyzing the literature, it becomes clear that single parenting becomes a clear risk factor for mental health problems, both for children and adults. Several studies have also documented the link between separation and depressive disorders, most likely due to both social and economic reasons. Familial factors that increase the likelihood that some children will develop disorders over time are: marital conflict, increasing poverty, raising adolescents and single parents, depression of one parent, hostile parents. The family structure has psychological and psychopathological consequences on the child. Keywords: divorce, single parenting, mental health, conflict, optimal development
The birth of a child in a family represents a change in the family dynamics, a reason for joy and fulfillment, but at the same time it involves many responsibilities and brings a load of emotions, behaviors and thoughts, both functional and dysfunctional. The mental health of the child and adolescent depends on the risk and protective factors. Psychiatric vulnerability is influenced by individual, environmental and family factors. The family influences the development of the personality of the child and adolescent through beliefs about the world and life, behaviors and emotional experiences. The disorganized family structure during the extremely sensitive period of neuro-psychiatric development of the child and adolescent has negative effects with major impact on the health status. Nowadays, children and adolescents are more predisposed to psychiatric disorders due to changes in family systems. When there is a change in the family structure with negative impact on mental health, they develop deficient coping mechanisms that increase their risk of developing a psychiatric disorder. The loss of a family member during this period through death, divorce, separation, conflicts; neglect; physical or emotional abuse; the somatic or mental illness of a parent during childhood and adolescence determines a high prevalence of psychopathology. The interest in family structure and its effects on children’s mental health began in the 1960s and 1970s when there was a spike in divorce rates and single
parent families. The main focus was on separation and divorce and their impact on the well-being of children [1]. Over the years, there has been a change in the family structure reflected in the increased proportion of children living in a single-parent home which changed from 12% in 1960 to 28% in 2003[2]. These studies were also able to document some of the long-term effects of stress as a result of separation on children [1]. According to 2001–2007, Centers for Disease Control (CDC) estimates about half of children live with their biological parents. This procent vary across race and decreases to almost 24% when dealing with African-American children. Analizing the literature, it also becomes clear that single parenthood becomes a clear risk factor for mental health problems for both children and adults, leading to greater psychological distress and depression, [3] and puts women on a socioeconomic disadvantage and increase the level of stress [4]. Several studies have also documented the link between separation and depressive disorders most likely as a result of both social and economic reasons [5]. Weisman et al. 1987 found that single Caucasian women has almost double risk to suffer from depression compared to married women. Over the years, there has been a general consens that the single-parent families have a big disadvantage compared to more traditional families.
The factors associated with worse outcome in single-parent families maybe more complicated than first evident. Single-parent families are also suggested to have less resilience on stress. Single parenthood raises more economic challenges wich increase the level of stress, possibly causing more difficulties in parent–child relationships. The prevalence of poverty in single-parent family has been estimated to be as high as 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, being raised in poverty, teen and single parenthood, parental depression, and hostile/angry parenting. Dysfunctional family backgrounds and socioeconomic adversity have also been attributed to suicide in young people. Childhood adversity including divorce and impaired parenting seems to cause both short- and longterm problems, various childhood disorders, and subsequently depression in adulthood. Single mothers have been found 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 single 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 report externalizing problems compared to children from two-parent families [1]. More and more research studies have underscored the importance of early life experience in defining life trajectories [7]. It is also suggested that children who lived with their mother and an unrelated partner had the poorest adjustment and highest levels of conduct problems compared to children who lived just with their mothers. Studies have also suggested that adjustment problems in children with mother-only families are comparable to mother and an unrelated partner or a stepfather. The risk slightly decreases with another adult like grandparent being in the family [8]. Divorce is a family transition with a substantial impact on each member, and especially on children, and nowadays occupies an important place in the social structure. Divorce is a major source of stress for family members and can be a risk factor for children. Compared with children from families with married
parents, children with divorced parents have lower academic outcomes and a higher level of school absenteeism, more emotional and behavioral problems, lower self-esteem and face more emotional difficulties. A very important role in the adaptation of the child after divorce is represented by the child- parent relationship. A positive parenting environment,
accompanied by family warmth, provides support and good communication, ensures firm parental control and good discipline and does not lastly meet the needs of the child. Sometimes divorce can be a better solution for the child than growing up in an inadequate family environment that creates a marked
intrapsychic tension. Consistency between educational styles is especially important when children are in the custody of both parents [11]. FAMILY STRUCTURE AND TRAUMAS The traditional family must be approached taking into account the socio-cultural and moral context, which are different throughout history and in different communities. The current types of families are: nuclear family, recomposed family, single parent family, extended family. Some families are functional – they favor the development of each member, allowing autonomy and providing support to each other; the dysfunctional family – they cannot overcome the conflicts of interests of the members being rigid, with chaotic organization [12]. A nuclear family can become dysfunctional when family members find no solution to the problems they face. The factors contributing to the traditional family transformation are: the scientific progress that led to the possibility of planning the birth and the number of births, increasing the average life expectancy, economic and social changes, access to school education and women’s professional ability, modifying the relationship between the sexes, being complemented by Caille (2003) with: population migration to the city, instability of professional and social relations, the option of women to have a professional career, mistrust in politics, disinterest in religion with the disappearance of traditionalism, media and publicity [13]. The disruption of the family structure can lead to several events that affect the mental health of the children and the parents, this interruption most often does not meet the psychological, biological and even physical needs of the child, the interruption at an early age leading to an uncertain attachment, anxiousavoiding, the quality of attachment being preserved throughout the life. The mother-infant interaction is a bidirectional process, in which the newborn is subjected to the influences of the mother or both parents, which are related to the pre-existing qualities of the conception and to the new skills, triggered by the presence and behavior of the newborn, facilitating interaction and attachment. A family with an increased psychopathological burden may determine symptoms during the child’s development period, these symptoms indicating the health status of the whole family [13]. More emotional and behavioral problems occur in families disturbed by divorce compared to other types of disturbances, such as, for example, the death of a parent. The early age, depression, substance abuse, poverty and history of mothers separated by their own mothers during childhood serve as risk factors. Some risk factors have also been identified in children themselves, such as low birth weight, physical, mental disabilities, aggression and hyperactivity. Parents exposed to childhood abuse or family violence were also more likely to act aggressively toward their own children [2]. However, the studies failed to decipher and document in detail the different forms of abuse experienced by children from different 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 compared to children of parents who do not have any affective illness. Further, studies have also indicated that the course of depression in these children may be more chronic with increased rates of relapse. It also appears that mother’s affective state has a more profound effect on the child than father’s illness and the difference being statistically significant. As mentioned previously, parental marital impairments also affect child’s risk for psychopathology and probably intertwine with parental psychopathology further leading to marital discord [9].
FAMILY STRUCTURE AND HOSPITALIZATION The connection between the social network, the psychosocial and the family structure is not sufficiently studied, as their effects on the state of health are not studied either which could impact on early intervention strategies aimed at reducing mortality and morbidity. 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] found that more than 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 main aim of this study was to look at any association between family structure and hospitalizations as this has never been done before. Several other factors were also studied with hospitalization being the dependent variable. We were interested in finding any link between these factors and if a certain type of family structure was predictive of higher rates of hospitalization, trauma, or specific diagnoses. The following conclusions could be reached in the study: – Significant differences in family structure have been demonstrated in studies in children with hospitalization indicated. – Only 11% of them lived in intact families from a biological point of view. Significant differences were also noted between Caucasians and nonCaucasians within the mixed and residential groups. – The presence of traumas and family psychiatric history predicted higher readmission rates in the hospital. – Hyperkinetic disorder, mood disorders and physical trauma also predicted higher relapse rates. Children from biological families are less likely to be exposed to trauma.
THE INFLUENCE OF THE FAMILY CLIMATE IN THE SCHOOL ADAPTATION OF THE CHILD The role of the family in school adaptation is a major one. Through its psychological and social characteristics, the family can favor or, on the contrary, can block the school adaptation of the child. In this context, the psychological value of the family (the family affective climate, the stability of the family group, the mental health of the family) and the socio-economic and socio-cultural status of the family (socio-professional environment and intellectual development of the child, socioeconomic status and school success) become major factors in school adaptation. The child needs a safe and stable family climate, created by a united family couple. Parents, bound by a satisfying marital relationship, can use their authority to educate respect for rules. Children raised in such an atmosphere usually attend a smooth schooling. Generally, school learning becomes meaningful for the child insofar as it is ensured by the approval and interest of the parents towards his work. There is ample evidence in the literature that, regardless of the professional level of the parents, the results obtained at school are better when the father and mother are satisfied with their own work, they maintain warm and open family relationships towards the outside world, they are interested in the free time of children and their work, which becomes the subject of discussions, an opportunity for exchanging opinions and a source of shared pleasure. Certain parental attitudes are recognized as detrimental to school adaptation: z the attitude of abandonment (it causes the feeling of inferiority, distracts an important part of the mental energy that the child should normally invest in school learning); z paternal and maternal anxiety (diminishes the child’s safety, inhibits it); z parental overprotection, more often the maternal one (condemns the child to an affective immaturity that makes his adaptation difficult); z parental cold (it generates attention disorders, instability, closure itself or refuge in the imaginary). The family environment, through the action it exerts on the psycho-affective development of the
child, on the motivation of the learning, has a decisive influence on schooling. This environment is the decisive element that influences the schooling. Disorders caused by disturbances in the family environment (affective insecurity, fear of abandonment, sadness, feeling of guilt, anxiety, anger) and behaviors that can provoke (instability, impulsivity, passivity, escape from reality, attitude of dependence) have negative repercussions on of the child’s school activity. According to some studies, these behaviors may be at the origin of the intelligence coefficient , wich is lower than the children from two-parent families. Due to an increased responsibility, the affective availability of the mother in the single-parent family decreases, leading to a cognitive stimulation that harms the child, especially the preschooler (R. Perron, 1993). The family influences majorly – positively or negatively – students whose intelligence coefficient is within the norm area (90-110). The socioprofessional status, the composition of the family, the agglomeration of the house, the quality and continuity of the care given to the child will play a decisive role for these students. The existence of a negative correlation between the average level of intelligence and the number of family members. The average intellectual level of the students decreases with the numerical growth of the family. In general, students from families which have more than 3 children have a higher percentage to repeat the school year. The considerable influence of the economic conditions on the schooling of the child is added to the predominant influence of the unanimously recognized family socio-cultural status. In the middle areas, but especially in the disadvantaged ones, a climate of concern reigns almost permanently. Parents are too often concerned about material problems, sometimes serious, and are not available to their children. Poverty of affective relationships reinforces the effects of family cultural poverty. In addition, the crowds, the crowding of the house, which is likely to cause certain tensions, and further darken the family atmosphere. And finally, chronic quantitative and/or qualitative malnutrition, insufficient or disturbed sleep due to poor material conditions are detrimental to the child’s mental balance, his physical development and, consequently, his schooling.THE INFLUENCE OF A CHILD WITH A PSYCHIATRIC DISORDER IN THE FAMILY The existence of a child with a severe disability in the family causes trauma that affects all members of the family. Many times, the parents of these children mention that the other children in the family are sometimes affected by their brother’s illness, being either worried or even disturbed by the behavior of the sick child. Studies in children with chronic disabilities as well as personal clinical experience show that the presence of a child in the family such as Autism or Hyperkinetic Disorder can cause severe stress on all family members. Parental stress influences how they will get involved in caring for both, the sick child and healthy, identifying behavioral and / or emotional problems, parental stressors, and family functioning issues by helping us the proper psychotherapeutic approach of the whole family. The correlation between family structure and the onset of emotional and language disorders has been widely studied over time. Because the development of the child is so closely linked to the quality of care and education received, correcting some shortcomings or mistakes in education and care is often seen as an integral part of the psychopathological recovery process of the child or adolescent. The family is the reference group whose values, norms and practices the child adopts and refers to them in the evaluation of behaviors. The structure of the interactions within the family becomes a part of the individual personality. The child adopts the values, norms and practices of the family as his own. The family is the child’s first reference group, with which all subsequent experiences are compared. The family members give the child the first ideas regarding the roles within the society.
It is necessary to develop strategies to prevent the psychiatric disorders in children and adolescents oriented to the family, in order to prevent psychiatric disorders in children and adolescents, but also to increase the quality of life of each member of the family. Also, the support network is very important for the prevention of psychopathology. The health and social assistance systems must recognize the family risk factors, make bio-psycho-social intervention focused on primary, secondary and tertiary prevention. In the case of a psychopathology, the family is the first line of support for the affected person, thus the family interventions include psychoeducation and psychological support that helps to understand the problem, the evolution, the consequences, the reaction mode and the prevention of relapses. In most cases, family therapy is complementary to drug therapy. A positive predictor of evolution is the commitment of informing, motivating and fulfilling the family regarding the intervention. The therapeutic relationship with the child or adolescent and with the family members is essential. CONCLUSIONS The family represents an important educational and socio-cultural model, which influence the conceptions about life, the moral and social norms of the child, with the role of structuring the value system and affective stabilization, being the main support of character and personality formation. At the moment, there is a great diversity of family structures with direct influence in development, but the most important elements remain the quality of the family relationships and the education, essential for the prevention of a psychiatric disorder appearance.

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