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Mortality, severe morbidity, and injury in children living with single parents in Sweden: A population-based study
Abstract
Growing up with one parent has become increasingly common, and seems to entail disadvantages in terms of socioeconomic circumstances and health. We aimed to investigate differences in mortality, severe morbidity, and injury between children living in households with one adult and those living in households with two adults.
In this population-based study, we assessed overall and cause-specific mortality between 1991 and 1998 and risk of admission between 1991 and 1999 for 65085 children with single parents and 921257 children with two parents. We estimated relative risks by Poisson regression, adjusted for factors that might be presumed to select people into single parenthood, and for other factors, mainly resulting from single parenthood, that might have affected the relation between type of parenting and risk.
Children with single parents showed increased risks of psychiatric disease, suicide or suicide attempt, injury, and addiction. After adjustment for confounding factors, such as socioeconomic status and parents' addiction or mental disease, children in single-parent households had increased risks compared with those in two-parent households for psychiatric disease in childhood (relative risk for girls 2.1 [95% CI 1.9-2.3] and boys 2.5 [2.3-2.8]), suicide attempt (girls 2.0 [1.9-2.2], boys 2.3 [2.1-2.6]), alcohol-related disease (girls 2.4 [2.2-2.7], boys 2.2 [2.0-2.4]), and narcotics-related disease (girls 3.2 [2.7-3.7], boys 4.0 [3.5-4.5]). Boys in single-parent families were more likely to develop psychiatric disease and narcotics-related disease than were girls, and they also had a raised risk of all-cause mortality.
Growing up in a single-parent family has disadvantages to the health of the child. Lack of household resources plays a major part in increased risks. However, even when a wide range of demographic and socioeconomic circumstances are included in multivariate models, children of single parents still have increased risks of mortality, severe morbidity, and injury.
... Parental substance abuse is strongly related to low education, low household income, singleparent household and mental health problems (Koponen et al., 2020a;Dube et al., 2001;Flannigan et al., 2021;Sarkola et al., 2007), which have been associated with an increased risk of childhood injury (Crandall et al., 2006;Nevriana et al., 2020;Ringbäck Weitoft et al., 2003;Sridharan & Crandall, 2011). Remes et al. (2010) showed that lower parental education was associated with the risk of offspring's death, especially regarding accidental and violent causes of death. ...
... The study included variables reflecting childhood adversities and OHC characteristics considered important for child neurocognitive and emotional development (Miguel et al., 2019;Shonkoff et al., 2009) and associated with injuries and poisoning (e.g., Nevriana et al., 2020;Ringbäck Weitoft et al., 2003). The following official registers were used as sources of information: Population Outcome variable. ...
... Furthermore, the exposed group were placed at younger age, thus decreasing the influence of maternal factors (Koponen et al., 2020a). The results are in line with previous studies among normative samples, which have found a relationship between parental socioeconomic vulnerabilities and children's higher risk of injury (Crandall et al., 2006;Nevriana et al., 2020;Ringbäck Weitoft et al., 2003;Sridharan & Crandall, 2011). In addition, the excess risk of injuries among male individuals found in previous studies (Brehaut et al., 2003;Rivara, 1995;Sridharan & Crandall, 2011) was confirmed among the controls but among the PSE group the difference was not statistically significant. ...
Aim: To investigate whether the youth with prenatal substance exposure (PSE) (aged 15–24 years, n = 615) had been in hospital care more often due to injuries and poisoning in comparison with unexposed matched controls ( n = 1787). Methods: Data from medical records (exposure) and national health and social welfare registers (outcome and confounders) were combined and youths were monitored from birth until either outpatient or inpatient hospital care for injury or poisoning, death or the end of the study period (December 2016). Cox regression models were used in the analyses accounting for associated child and maternal risk factors. Results: Half (50.4%) of the exposed group and 40.6% of controls had been in hospital care due to injury or poisoning during the follow-up ( p < 0.001). The difference between groups was diminished after controlling for postnatal child and maternal risk factors (hazard ratio [HR] = 0.88, 95% confidence interval [CI] 0.72–1.07, p > 0.05). Cumulative adversity, especially out-of-home care in combination with a diagnosed attention or behavioural dysregulation problem, posed the highest risk in both groups (exposed: HR = 1.65, 95% CI 1.24–2.19, p < 0.001; controls: HR = 1.84, 95% CI 1.33–2.56, p < 0.001). Conclusion: Hospital care for injury and poisoning is more common in youth with PSE, but this is largely explained by the related postnatal child and maternal factors. Long-term support to families with maternal substance abuse problems could prevent injury and poisoning among youth with PSE.
... 20 Finally, suicide, accidental death and major psychiatric disorders may share common psychosocial risks, especially childhood maltreatment and adverse early-life experiences. 21,22 The stressdiathesis model may explain the biopsychosocial link between psychosocial adversities and the familial coaggregation of suicide, accidental death and major psychiatric disorders. 21 This diathesis, which exhibits the tendencies to have more suicidal ideation and higher impulsivity, is inherited intergenerationally and evolves into various psychopathologies, such as psychosis, risk-taking, suicidal behaviours and emotion dysregulation, after experiencing childhood maltreatment and other early-life adversities. ...
... 21,22 The stressdiathesis model may explain the biopsychosocial link between psychosocial adversities and the familial coaggregation of suicide, accidental death and major psychiatric disorders. 21 This diathesis, which exhibits the tendencies to have more suicidal ideation and higher impulsivity, is inherited intergenerationally and evolves into various psychopathologies, such as psychosis, risk-taking, suicidal behaviours and emotion dysregulation, after experiencing childhood maltreatment and other early-life adversities. 21,22 The stress-resilience model describes a dynamic developmental process encompassing positive adaptation within the context of severe adversity or trauma (e.g. ...
... 21 This diathesis, which exhibits the tendencies to have more suicidal ideation and higher impulsivity, is inherited intergenerationally and evolves into various psychopathologies, such as psychosis, risk-taking, suicidal behaviours and emotion dysregulation, after experiencing childhood maltreatment and other early-life adversities. 21,22 The stress-resilience model describes a dynamic developmental process encompassing positive adaptation within the context of severe adversity or trauma (e.g. witnessing a suicide), and the model may further explain why so few first-degree relatives of individuals who died by suicide were diagnosed with major psychiatric disorders and died by suicide or accidents in our study. ...
Background:
Evidence suggests a familial coaggregation of major psychiatric disorders, including schizophrenia, bipolar disorder, major depression (MDD), autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD). Those disorders are further related to suicide and accidental death. However, whether death by suicide may coaggregate with accidental death and major psychiatric disorders within families remains unclear.
Aims:
To clarify the familial coaggregation of deaths by suicide with accidental death and five major psychiatric disorders.
Method:
Using a database linked to the entire Taiwanese population, 68 214 first-degree relatives of individuals who died by suicide between 2003 and 2017 and 272 856 age- and gender-matched controls were assessed for the risks of death by suicide, accidental death and major psychiatric disorders.
Results:
A Poisson regression model showed that the first-degree relatives of individuals who died by suicide were more likely to die by suicide (relative risk RR = 4.61, 95% CI 4.02-5.29) or accident (RR = 1.62, 95% CI 1.43-1.84) or to be diagnosed with schizophrenia (RR = 1.53, 95% CI 1.40-1.66), bipolar disorder (RR = 1.99, 95% CI 1.83-2.16), MDD (RR = 1.98, 95% CI 1.89-2.08) or ADHD (RR = 1.34, 95% CI 1.24-1.44).
Conclusions:
Our findings identified a familial coaggregation of death by suicide with accidental death, schizophrenia, major affective disorders and ADHD. Further studies would be required to elucidate the pathological mechanisms underlying this coaggregation.
... This study hypothesizes that single parent family, low birthweight, and severe housing problems could contribute to confirmed cases and death cases of the novel coronavirus disease. Growing up in a singleparent family seems to have disadvantages in terms of socioeconomic circumstances (e.g., McLanahan & Percheski, 2008;Weitoft, Hjern, Haglund, & Rosén, 2003). Children of single parents are vulnerable to economic deprivation, poverty, and lack of resources (e.g., Brady & Burroway, 2012;Eggebeen & Lichter, 1991;McLanahan & Percheski, 2008;Weitoft et al., 2003). ...
... Growing up in a singleparent family seems to have disadvantages in terms of socioeconomic circumstances (e.g., McLanahan & Percheski, 2008;Weitoft, Hjern, Haglund, & Rosén, 2003). Children of single parents are vulnerable to economic deprivation, poverty, and lack of resources (e.g., Brady & Burroway, 2012;Eggebeen & Lichter, 1991;McLanahan & Percheski, 2008;Weitoft et al., 2003). Due to limited household resources, singleparent families have difficulties offering their children sufficient personal protection equipment in this pandemic (Zhang, 2020). ...
... Due to limited household resources, singleparent families have difficulties offering their children sufficient personal protection equipment in this pandemic (Zhang, 2020). Moreover, the absence of parental role in single-parent families could bring their children increased health risks, such as severe morbidity (Weitoft et al., 2003). As such, single-parent families could be accompanied with the higher infection rate among their children in this pandemic. ...
This study intends to reveal the underlying structural inequity in vulnerability to infection of the novel coronavirus disease pandemic among children and youth. Using multi-source data from New York Times novel coronavirus disease tracking project and County Health Rankings & Roadmap Program, this study shows that children and youth in socioeconomically disadvantaged status are faced with disproportionate risk of infection in this pandemic. On the county level, socioeconomic disadvantages (i.e., single parent family, low birthweight, severe housing problems) contribute to the confirmed cases and death cases of the novel coronavirus disease. Policymakers should pay more attention to this vulnerable group to implement more targeted and effective epidemic prevention and control.
... Despite a strong commitment to the health and development of all children, there are still concerns about poor childhood health outcomes determined by issues within the social determinants of health. In recent studies, single-parenthood has been recognized as a risk factor for the development of chronic health conditions among children [6][7][8][9][10][11][12][13]. Children in single-parent households are seen as a socially vulnerable population, as their families tend to have a lower overall income [6], resulting in food insecurity [14] and other physical conditions that impose a heightened risk for maladaptive health outcomes [6,[10][11][12][13]. ...
... In recent studies, single-parenthood has been recognized as a risk factor for the development of chronic health conditions among children [6][7][8][9][10][11][12][13]. Children in single-parent households are seen as a socially vulnerable population, as their families tend to have a lower overall income [6], resulting in food insecurity [14] and other physical conditions that impose a heightened risk for maladaptive health outcomes [6,[10][11][12][13]. Furthermore, these children tend to experience a stronger psychological burden [6,12,15], as they lack instrumental and emotional social support [6,[15][16][17]. ...
... Children in single-parent households are seen as a socially vulnerable population, as their families tend to have a lower overall income [6], resulting in food insecurity [14] and other physical conditions that impose a heightened risk for maladaptive health outcomes [6,[10][11][12][13]. Furthermore, these children tend to experience a stronger psychological burden [6,12,15], as they lack instrumental and emotional social support [6,[15][16][17]. ...
Background
Children’s healthy development is important. While governmental public assistance benefits financially troubled families, it cannot compensate for a lack of social support. Single-parenthood is a health risk factor for children owing to low-income-associated food insecurity and stress. No study has investigated the association between single-parenthood and health status in children from families receiving public assistance. This study aimed to examine the association between single-parent households and children’s health among public assistance recipients in Japan by using linkage data of two municipal public assistance databases and administrative medical assistance data.
Methods
We performed a retrospective cohort study. Public assistance for households below the poverty line ensures income security and medical care. The study population included all children aged 15 or younger availing public assistance in January 2016. We extracted recipients’ sociodemographic factors from January 2016 and identified the incidence of childhood diseases’ diagnosis until December 2016 as the outcome, including 1) acute upper respiratory infections; 2) influenza and pneumonia; 3) injuries, including fractures; 4) intestinal infectious diseases; 5) conjunctivitis; 6) asthma; 7) allergic rhinitis; 8) dermatitis and eczema, including atopic dermatitis; and 9) diseases of the oral cavities, salivary glands, and jaws, such as tooth decay or dental caries.
Results
Among the 573 children, 383 (66.8%) lived in single-parent households. A multivariable Poisson regression, with a robust standard error estimator, showed that single-parenthood is associated with a higher prevalence of asthma (incidence ratio [IR] = 1.62; 95% confidence interval [CI], 1.16–2.26), allergic rhinitis (IR = 1.41; 95% CI, 1.07–1.86), dermatitis and eczema (IR = 1.81; 95% CI, 1.21–2.70), and dental diseases (IR = 1.79; 95% CI, 1.33–2.42) compared to non-single parent households, whereas little association was found between single-parenthood and children’s acute health conditions.
Conclusions
Among public assistance recipients, living in single-parent households may be a risk factor for children’s chronic diseases. The Japanese public assistance system should provide additional social care for single-parent households. Further investigations are necessary using more detailed longitudinal data, including environmental factors, the severity of children’s health conditions, contents of medical treatments, and broader socioeconomic factors.
... Findings from a cohort study conducted at Cincinnati Children's Hospital Medical Center reported that asthma-related emergency readmissions were 44% higher among children living with single parents [56]. The overall health of the children living with a single parent could be mediated via household financial resources and residential conditions [57]. Namely, Weitoft et al. found significant associations between health insurance and female asthma exacerbation-related emergency visits [57]. ...
... The overall health of the children living with a single parent could be mediated via household financial resources and residential conditions [57]. Namely, Weitoft et al. found significant associations between health insurance and female asthma exacerbation-related emergency visits [57]. Uninsured children with asthma are 1.4-2.4 ...
Background
Attributes defining the Social Determinants of Health (SDoH) are associated with disproportionate exposures to environmental hazards and differential health outcomes among communities. The dynamics between SDoH, disproportionate environmental exposures, and differential health outcomes are often specific to micro-geographic areas.
Methods
This study focused on children less than 20 years of age who lived in Douglas County, Nebraska, during 2016–2019. To assess the role of SDoH in differential exposures, we evaluated the association between SDoH metrics and criteria pollutant concentrations and the association between SDoH and pediatric asthma exacerbations to quantify the role of SDoH in differential pediatric asthma outcomes. The Bayesian Poisson regression model with spatial random effects was used to evaluate associations.
Results
We identified significant positive associations between the annual mean concentration of criteria pollutants (carbon monoxide, particulate matter 2.5 , nitrogen dioxide, sulfur dioxide) with race (Non-Hispanic Black and Hispanic/Latino), financial stability, and literacy. Additionally, there were significant positive associations between higher rates of pediatric asthma emergency department visits and neighborhoods with more Non-Hispanic Black children, children without health insurance coverage, and households without access to a vehicle.
Conclusions
Non-Hispanic Black and Hispanic/Latino children living in Douglas County, NE experience disproportionately higher exposure to criteria pollutant concentrations. Additionally, higher rates of asthma exacerbations among Non-Hispanic Black children could be due to reduced access to respiratory care that is potentially the result of financial instability and vehicle access. These results could inform city planners and health care providers to mitigate respiratory risks among these higher at-risk populations.
... If a student had ever had at least one drink of alcohol (except during ancestral rites or religious ceremonies), he or she was classified as an ever drinker. Also, a binary variable was created to determine whether students were living with both biological parents or not, as this can influence health outcomes (Weitoft et al., 2003). ...
... We hypothesized that this is because parents who undergo divorce early in their marriage will have done so before they have time to have a second child. Children whose parents have divorced experience significant increases in morbidity and mortality, which can be explained by stress from family conflict, inconsistent parental oversight, and economic distress (Weitoft et al., 2003). Thus, we believe that living with both biological parents could confound the association between only-child status and outcomes or behaviors, and adjusted for this in all of our six models. ...
The proportion of children who are the only child in the family are increasing. Several associations between only-child status and health outcomes or risky behaviors have been identified, but no study has explored associations across a wide range of outcomes in a single study. We used the 2019 Korea Youth Risk Behavior Survey, a nationwide cross-sectional survey of 57,303 middle and high school students, to perform an outcome-wide analysis on six health outcomes and risky behaviors, i.e. alcohol use, asthma, body mass index, sexual activity, smoking, and suicide attempt. Individual multivariable logistic regression models examined associations between single-child status and each outcome or behavior. Of the eligible 38,211 students, 5,334 students (14.0%) were the only child in their family, while 32,877 students (86.0%) had siblings. Of the six selected outcomes and behaviors, alcohol use (aOR 0.88, 95% CI 0.82-0.94), asthma (aOR 1.22, 95% CI 1.10-1.35) and sexual activity (aOR 1.16, 95% CI 1.02-1.31) were significantly associated with only-child status. Thus, being the only child among South Korean adolescents is both a potential protective factor and risk factor for different health outcomes and behaviors. Future research is warranted to corroborate these findings and identify mechanisms, which could provide evidence for reducing adverse outcomes and behaviors in adolescents.
... La Estrategia de salud sexual del Sistema Nacional de Salud (SNS) español (2019) 82 se orienta a poner en marcha medidas como: ...
... Esta propuesta complementa y concreta las recomendaciones y medidas formuladas en la Primera Estrategia de salud sexual y reproductiva (2011) 82 , que ponía el mayor énfasis en la salud reproductiva. En todo caso, ambas propuestas están sólidamente fundamentadas en las recomendaciones de organizaciones internacionales y en legislaciones y normativas internacionales y nacionales que han cambiado de forma notable en nuestro país. ...
... Findings from a cohort study conducted at Cincinnati Children's Hospital Medical Center reported that asthma-related emergency readmissions were 44% higher among children living with single parents (48). The overall health of the children living with a single parent could be mediated via household nancial resources and residential conditions (49). Namely, Weitoft et al. found signi cant associations between health insurance and female asthma exacerbation-related emergency visits (49). ...
... The overall health of the children living with a single parent could be mediated via household nancial resources and residential conditions (49). Namely, Weitoft et al. found signi cant associations between health insurance and female asthma exacerbation-related emergency visits (49). Uninsured children with asthma are 1.4-2.4 ...
Background: Attributes defining the Social Determinants of Health (SDoH) are associated with disproportionate exposures to environmental hazards and differential health outcomes among communities. The dynamics between SDoH, disproportionate environmental exposures, and differential health outcomes are often specific to micro-geographic areas.
Methods: This study focused on children less than 20 years of age who lived in Douglas County, Nebraska, during 2016-2019. To assess the role of SDoH in differential exposures, we evaluated the association between SDoH metrics and criteria pollutant concentrations and the association between SDoH and pediatric asthma exacerbations to quantify the role of SDoH in differential pediatric asthma outcomes. The Bayesian Poisson regression model with spatial random effects.
Results: We identified significant positive associations between the annual mean concentration of criteria pollutants (carbon monoxide, particulate matter 2.5, nitrogen dioxide, sulfur dioxide) with race (Non-Hispanic Black and Hispanic/Latino), financial stability, and literacy. Additionally, there were significant positive associations between higher rates of pediatric asthma emergency department visits and neighborhoods with more Non-Hispanic Black children, children without health insurance coverage, and households without access to a vehicle.
Conclusions: Non-Hispanic Black and Hispanic/Latino children living in Douglas County, NE experience disproportionately higher exposure to criteria pollutant concentrations. Additionally, higher rates of asthma exacerbations among Non-Hispanic Black children could be due to reduced access to respiratory care that is potentially the result of financial instability and vehicle access. These results could inform city planners and health care providers to mitigate respiratory risks among these higher at-risk populations.
... Other potential mechanisms linking single parenthood to a higher risk of adverse child outcomes include parental stress (Fang et al. 2022), social exclusion (e.g. lack of social networks and support; McArthur & Winkworth, 2017), and social stigma which can influence parental mental health and effective parenting (Cairney et al. 2003;Weitoft et al. 2003) but were not investigated in this study. ...
... Singlemother families often face structural disadvantages due to having lower income and less time together with their children [36]. In a Swedish study, children of single-parent households (90% women) were found to be at increased risk for childhood psychopathology, suicide attempts, and drug addiction [37]. Single mothers may face not only the non-shared care of a child but also economic problems resulting from discriminatory wage levels and the absence of a second income from a partner [38]. ...
Background: COVID-19 has led to a global health crisis that is defining for our times and one of the greatest challenges to emerge since World War II. The potential impact of the pandemic on mental health should not be overlooked, especially among vulnerable populations such as women who gave birth during the COVID-19 pandemic. Materials and Methods: The study is a cross-sectional survey conducted from 1 March 2020 to 1 March 2023, during the period of the SARS-CoV-2 (COVID-19) pandemic, based on a retrospective evaluation of 860 postpartum women. The screening tool used to assess symptoms of postpartum depression was the Edinburgh Postnatal Depression Rating Scale (EPDS) questionnaire. The questionnaire was completed both in the Obstetrics and Gynaecology Clinical Sections I and II of the “Pius Brînzeu” County Emergency Hospital in Timisoara, Romania, and online using Google Forms. Results: The highest severity of postpartum depression symptoms was observed during the COVID-19 pandemic. The results of the study conducted during the period of the SARS-CoV-2 pandemic (COVID-19) showed that the prevalence of major postpartum depressive disorder (EPDS ≥ 13) was 54.2% (466 patients), while 15.6% (134) had minor depressive disorder (10 < EPDS ≤ 12) in the first year after delivery. Comparing these results with those obtained in research conducted before the onset of the pandemic period showed an alarming increase in the prevalence of postpartum depression. The risk factors associated with postpartum depression included the type of delivery, level of education, socio-economic conditions, health status, age, background, and personal obstetric history (number of abortions on demand, parity). Conclusions: The effects of the pandemic on mental health are of particular concern for women in the first year after childbirth. Observing these challenges and developing effective measures to prepare our health system early can be of great help for similar situations in the future. This will help and facilitate effective mental health screening for postpartum women, promoting maternal and child health.
... For example, according to the parental-care hypothesis, pair-bonding in humans is adaptive because it allows fathers to play a greater role in caring for and defending their offspring Fraley & Shaver, 2000). Indeed, paternal care has a positive association with birthweight and infant survival rates (Collins, Dunkel-Schetter, Lobel, & Scrimshaw, 1993;Padilla, 2001), as well as psychiatric health in infancy (Weitoft, Hjern, Haglund, & Rosén, 2003) and early adolescence (Zvizdnic & Butollo, 2001). Therefore, intimate partner violence represents a kind of futile aggression because the actor does not attain a larger territory, resources, or reproductive opportunities. ...
Many teachers continue to respond aggressively to students who misbehave. A small handful of studies have investigated the causal events that lead to teacher aggression, but none have investigated the broader causal process of teacher aggression. The present thesis investigated the causal process of teacher aggression using two metatheories of human aggression, which included I3 theory and the General Aggression Model (GAM). Study 1 (N = 249), an ex post facto study, revealed that the causal process of teacher aggression does not follow I3 theory, but instead follows the GAM. Study 1 showed that insecure caregiving indirectly leads to teacher aggression via two mediators (misbehaviour provocation and trait self-control), which function both sequentially and in parallel. Study 2 (N = 110), an experimental study, found that ego depletion does not moderate the indirect relationship between insecure caregiving and teacher aggression when it is mediated by misbehaviour provocation. Finally, Study 3 (N = 2) was a phenomenological interview, which included two participants from Study 1 who recorded relatively unresponsive caregiving styles, high misbehaviour provocation, low trait self-control, and high levels of teacher aggression. Study 3 found that insecure caregiving influences the causal process of teacher aggression through three distinct sub-pathways, including perceiving student misbehaviour as a caregiving rejection, perceiving student misbehaviour as a personal attack, and the fear of losing control of the classroom. The general discussion focuses on the importance of teacher personal history in the causal process of teacher aggression, and considers the possibility that teachers experience a form of countertransference (“teacher countertransference”) in much the same way as psychoanalysts, psychotherapists, and practitioners in related professions.
... Fiduciary theories could explain the value of having a co-parent if, empirically, co-parents are able to secure the rights of their child more reliably or completely than solo-parents. Many studies suggest that the children of single-parents stand at a higher risk of ills such as psychological problems and poor educational outcomes, even after controlling for financial disadvantage (Lipman et al. 2002;Weitoft et al. 2003). Plausibly, some of these outcomes are violations of the child's rights or are empirically associated with violations. ...
The paper offers an account of co-parenthood according to which co-parents are parent and child to one another. The paper begins by reviewing extant theories of the value of being a parent, to see whether the value of co-parenthood is reducible to this. Finding that it is not, I briefly elaborate a theory of parenthood on which parents are those who create persons. Using Aristotle’s four causes as a helpful prism, I outline how parents are the cause of their child, and how in causing a child together co-parents become parent and child to one another. For instance, since parents create children by offering themselves as models to be copied, co-parents should enjoy the best type of friendship with one another, each treating the other’s flourishing as a human person as their end. I suggest that co-parenthood contains parenthood virtually, that the co-parents’ love of their child is a manifestation of their love for one another, that the teleological fulfilled state of the friendship between parent and child exists in the friendship of co-parents.
... According to Kayes et al. (2000) and Ringsback-Weitoft et al. (2003), children having single mothers or single fathers are more prone to experience emotional and behavioral issues (8 percent compared to 4 percent for children having both parental figures). ...
Although divorce is the most despicable act in Islam, Pakistan, an Islamic country, has a growing tendency in its divorce rate. Divorce and separation of a couple effects negatively on children, families, financial conditions even society at large. Although children seems to have higher negative exposure after divorce / parental separation that those baggage can last into adulthood. The actual goal of the study is to understand the reasons contributing in divorce and the impact of divorce of children’s life on whole analyzing its social, occupational, financial, physical and psychological consequences. The current study is entirely grounded in secondary data analysis based on previously released research studies by newspapers or other organizations, such as the Gilani research institution. Additionally, as the main goal of this analysis was to provide a clear picture of the factors leading to the divorce rate in the case of Pakistan, we also consulted the individual/independent research articles. In order to find all relevant articles and studies, we conducted a web search utilizing a variety of keywords.
... Many studies were conducted among single parents regarding their psychological, social, and emotional aspects and well-being (Walker & Hennig, 1997;Hetherington, 2003;Weitoft, Hjern, Haglund & Rosén, 2003;Bradshaw, Keung, Chzhen, Nieuwenhuis, & Maldonado, 2018;Rani, 2006;Pujar, Chanda & Hittalamani, 2018;Chavan, 2018;Swain & Pillai, 2005;Mishra, Thamminaina & Mishra, 2021;Daniel, 2021) but there is an urgent need for extending these concerns to the children who live with a single parent because the factors that they are struggling with have a potential to lead them to many adverse life circumstances and psychological consequences. ...
The current study investigated the role of resilience in the relationship between single-parent adolescents' social competence (SC) and psychological well-being (PWB). A total of 385 single-parent adolescents from Kerala (179 boys and 206 girls, Mean age=15.03, SD = 1.45) were selected using a convenient sampling method. 185 participants (48.1%) were from single-parent families due to the death of one parent, and the other 200 participants (51.9%) were from single-parent families due to divorce or separation. Data were collected using self-reported measures for social competence, resilience, and psychological well-being. Analysis of the data was performed using IBM SPSS and AMOS version 24. The results indicated that social competence and resilience are significantly correlated with the psychological well-being of single-parent adolescents. According to the findings, resilience completely mediates the linkage between SC and PWB. When compared to adolescents who experienced parental divorce or separation, those who lost one parent due to death reported higher levels of social competence, resilience, and psychological well-being. Except for antisocial behavior, one of the dimensions of social competence, adolescents from divorced or separated family backgrounds scored low on all other scales. No gender difference is identified in any of the variables in the present study. Adolescents living with grandparents and those who have siblings significantly differ from others. The findings have clinical as well as educational implications.
... Lower socioeconomic status [10,12,13], living with a single parent [13,14], parental drug and alcohol problems [10], having been the subject of a report to child protective services [15], bullying [16,17] and child-and adolescent attributes such as hyperactivity [18,19] are all factors known to be associated with child maltreatment and unintentional injuries in children. Nevertheless, scant research has focused on the association between child maltreatment and unintentional injuries, although previous national surveys among Swedish school children have highlighted the issue [20]. ...
Injuries constitute a large share of childhood morbidity and mortality. This study examines whether adolescents with self-reported experiences of different types of child maltreatment more frequently reported unintentional injury events requiring health- or dental care during the last year and/or hospitalization at any time during childhood. Cross-sectional data from a Swedish national representative school survey (2016) including 4741 adolescents were used (78.5% response rate). Data were analyzed with univariate tests and multiple logistic regression. Statistically significant associations between reported experiences of physical, psychological and sexual abuse, neglect, and witnessing partner violence during childhood and reported unintentional injuries requiring health- or dental care during the last year were found (aOR:s between 1.39–1.77). The corresponding association for poly-victimization was aOR 1.91 (95% CI 1.39–2.62). Furthermore, a linear-by-linear association was seen for degree of victimization and number of episodes of unintentional injuries that required care in the last year (p = 0.000), as well as lifetime hospitalizations (p = 0.000). This study shows significant associations between child maltreatment and unintentional injuries requiring health- and/or dental care and hospitalization. To improve both injury and child maltreatment prevention, healthcare professionals need to pay particular attention to children and adolescents who repeatedly seek healthcare services due to injurious events.
... The cultural disadvantage, the lack of valid emotional references, the economic, housing, health problems (Ringback, Weitoft, Hjern et al., 2003) and the related risk to physical and mental health, the probability of being subjected to abuse and neglect, school difficulties, etc. are very critical factors, able to accumulate with each other. The children are predisposed to many disconforts and further potential risks (Botting, Rosato & Wood, 1998). ...
... In the current study, the mortality rate was higher among preterm babies born of single mothers as compared to those born of married mothers. In line with this finding, several studies in the Western countries reported that the mortality rate was higher among babies born of single mothers relative to those born in two-parent households [25] [26] [27]. This relationship can be explained by the fact that single mothers might not have adequate capacity to provide an ideal environment both during pregnancy and after delivery due to a lack of psycho-social support systems and pregnancy-related stress [28]. ...
... Finally, we restricted our study sample to cases in which both the mother and father were present; therefore, children from single-parent families who are considered the most vulnerable were excluded from this study. Future studies should consider children with such disadvantaged parents because they may suggest different aspects of social inequalities (Weitoft et al., 2003). In particular, although the epidemiological perspective is important, a follow-up study from a sociological perspective is needed to investigate the point where the social status of Korean women and the socioeconomic inequality of child mortality intersect and the social structure that affects it. ...
Background
Inequalities in child mortality occur via interactions between socio-environmental factors and their constituents. Through childhood developmental stages, we can observe changing patterns of mortality. By investigating these patterns and social inequalities by cause and developmental stage, we aim to gain insights into health policies to reduce and equalize childhood mortality.
Methods
Using vital statistics, we examined the Korean birth cohort of 2012, including all children born in 2012 up to five years of age (N = 466,636). The dependent variables were all-cause and cause-specific mortality by developmental stage (i.e., neonatal, post-neonatal, and childhood). A Cox proportional hazard regression model was built to compare child mortality according to maternal education. The distribution of inequalities in cause-specific mortality by child age was calculated using the slope index of inequality (SII).
Results
Inequalities in child mortality due to maternal education occur during the neonatal period and increase over time. After adjusting for covariates, the Cox proportional hazard models showed that “injury and external causes” (HR = 2.178; 95% CI = [1.283–3.697]) and “unknown causes” (HR = 2.299; 95% CI = [1.572–3.363]) in the post-neonatal period, and “injury and external causes” (HR = 2.153; 95% CI = [1.347–3.440]) in the childhood period significantly contributed to socioeconomic inequalities in child mortality. For each period, the leading causes of inequality were identified as follows: “congenital” (96.7%) for the neonatal period, “unknown causes” (58.2%) and “injury and external causes” (28.4%) for the post-neonatal period, and “injury and external causes” (56.5%) for the childhood period.
Conclusion
We confirmed that the main causes of death in mortality inequality vary according to child age, in accordance with the distinctive context of child development. Strengthening the health system and multisectoral efforts that consider families' and children's needs according to spatial contexts (e.g., home, community) may be necessary to address the social inequalities in child health.
... Future research should also include PSP mental health status, since children who have parents with mental disorders are more likely to have developmental problems or their own mental disorder diagnosis [41][42][43]. Additionally, it is important to include other important sociodemographic variables in our models to examine the impact of marital status, parent education, and geographic region, which are important predictors of PSP mental health symptom endorsement [20]. ...
Public safety personnel (PSP) often experience stress due to their occupational demands that affect the family environment (e.g., work-family conflict, marital breakdown, disruption to home routines, and holidays). A substantial base of research has focused on the impact of PSP work on the marital relationship, but fewer studies have focused specifically on children’s functioning within PSP families. The current study investigated mental health, well-being, and functioning among children of PSP in Canada, as reported by PSP. Data were collected between 2016 and 2017 as part of a large pan-Canadian study of PSP. Participants (n = 2092; 72.5% women) were PSP parents who responded to questions about their 4- to 17-year-old children. Overall, a substantial proportion of PSP parents reported their children have at least some difficulties with sadness (15.4%), worries and fear (22.0%), disobedience or anger (22.0%), attention (21.0%), and friendships (11.4%). Firefighters reported the fewest problems among their children compared to other PSP groups. Almost 40% of participants indicated that their child’s problems were related to their work as a PSP. The results highlight the need to find ways to identify children that are struggling and provide support to those families. Organizations and PSP leadership should develop and prioritize efforts to support families of PSP members, with the likely outcome of enhancing PSP member well-being.
... Children in socioeconomically disadvantaged families have higher rates of injuries. The risk factors include low family income, low parental education, single parenting, maternal age, older siblings, and area of residence [16][17][18][19][20][21][22][23]. Moreover, children whose parents were recurrent drinkers or had mental illness were at a higher risk of injury than other children [24]. ...
Although past studies have identified predictors related to child injuries with developmental disorders, national-level research in Asia is limited. The objective of this study was to explore the risk factors for child injuries with developmental disorders in Taiwan using a national-level integrated database for the period between 2004–2015 (The Maternal and Child Health Database, National Health Insurance Research Database, Census Registry, and Indigenous Household Registration). Children younger than 12 years old who had records of visiting the ER or being hospitalized due to injury or without injury were included in this study. A 1:1 nested case-control study (injury vs. noninjury) to examine the risk factors for child injury with developmental disorder was performed. A total of 2,167,930 children were enrolled. The risk factors were associated with repeated ER visits or hospitalization: being indigenous (adjusted odds ratio [AOR]: 1.51; CI: 1.45–1.57); having a developmental disorder (AOR: 1.74; CI: 1.70–1.78); and having parents with illicit drug use (AOR: 1.48; CI: 1.32–1.66), alcohol abuse (AOR: 1.21; CI: 1.07–1.37), or a history of mental illness (AOR: 1.43; CI: 1.41–1.46). Being indigenous, having developmental disorders, and having parents with history of illicit drug use, alcohol abuse, or mental illness were predictors related to injuries in children.
... The random-forest model was built with a minimum of 1000 trees and 30 observations to attempt splits. 81 To gauge predictive performance, we computed receiver operating characteristic (ROC) curves and the area under the ROC curve (AUC). We used Delong's method to compute 95% CIs for the AUC. ...
Background
Electronic health records (EHRs) of mothers and children provide an opportunity to identify adverse childhood experiences (ACEs) during crucial periods of childhood development, yet well developed indicators of ACEs remain scarce. We aimed to develop clinically relevant indicators of ACEs for linked EHRs of mothers and children using a multistage prediction model of child maltreatment and maternal intimate partner violence (IPV).
Methods
In this multistage development and validation study, we developed a representative population-based birth cohort of mothers and children in England, followed from up to 2 years before birth to up to 5 years after birth across the Clinical Practice Research Datalink (CPRD) GOLD (primary care), Hospital Episode Statistics (secondary care), and the Office for National Statistics mortality register. We included livebirths in England between July 1, 2004, and June 30, 2016, to mothers aged 16–55 years, who had registered with a general practitioner (GP) that met CPRD quality standards before 21 weeks of gestation. The primary outcome (reference standard) was any child maltreatment or maternal IPV in either the mother's or child's record from 2 years before birth (maternal IPV only) to 5 years after birth. We used seven prediction models, combined with expert ratings, to systematically develop indicators. We validated the final indicators by integrating results from machine learning models, survival analyses, and clustering analyses in the validation cohort.
Findings
We included data collected between July 1, 2002, and June 27, 2018. Of 376 006 eligible births, we included 211 393 mother–child pairs (422 786 patients) from 400 practices, of whom 126 837 mother–child pairs (60·0%; 240 practices) were randomly assigned to a derivation cohort and 84 556 pairs (40·0%; 160 practices) to a validation cohort. We included 63 indicators in six ACE domains: maternal mental health problems, maternal substance misuse, adverse family environments, child maltreatment, maternal IPV, and high-risk presentations of child maltreatment. Excluding the seven indicators in the reference standard, 56 indicators showed high discriminative validity for the reference standard of any child maltreatment or maternal IPV between 2 years before and 5 years after birth (validation cohort, area under the receiver operating characteristic curve 0·85 [95% CI 0·84–0·86]). During the 2 years before birth and 5 years after birth, the overall period prevalence of maternal IPV and child maltreatment (reference standard) was 2·3% (2876 of 126 837 pairs) in the derivation cohort and 2·3% (1916 of 84 556 pairs) in the validation cohort. During the 2 years before and after birth, the period prevalence was 39·1% (95% CI 38·7–39·5; 34 773 pairs) for any of the 63 ACE indicators, 22·2% (21·8–22·5%; 20 122 pairs) for maternal mental health problems, 15·7% (15·4–16·0%; 14 549 pairs) for adverse family environments, 8·1% (7·8–8·3%; 6808 pairs) for high-risk presentations of child maltreatment, 6·9% (6·7–7·2%; 7856 pairs) for maternal substance misuse, and 3·0% (2·9–3·2%; 2540 pairs) for any child maltreatment (2·4% [2·3–5·6%; 2051 pairs]) and maternal IPV (1·0% [0·8–1·0%; 875 pairs]). 62·6% (21 785 of 34 773 pairs) of ACEs were recorded in primary care only, and 72·3% (25 140 cases) were recorded in the maternal record only.
Interpretation
We developed clinically relevant indicators for identifying ACEs using the EHRs of mothers and children presenting to general practices and hospital admissions. Over 70% of ACEs were identified via maternal records and were recorded in primary care by GPs within 2 years of birth, reinforcing the importance of reviewing parental and carer records to inform clinical responses to children. ACE indicators can contribute to longitudinal surveillance informing public health policy and resource allocation. Further evaluation is required to determine how ACE indicators can be used in clinical practice.
Funding
None.
... In African countries, Azuka-Obieke (2013) and Mikeal (2018) showed that children growing up in single-parent families scored lower on assessments of psychological well-being, such as happiness and selfesteem, than children from dual-parent households. These children faced psychological disorders such as depression (Ntumi et al., 2016), suicide, and substance abuse at higher rates (Weitoft et al., 2003). In India, children from single-parent households, especially those headed by a single father, had a higher intensity of externalizing and internalizing problem behaviors (Ganesha & Ventakesan, 2012). ...
Even though the number of single-parent households has been increasing in recent decades, they
still face many challenges, including finances, health, and social stigma. This is a global literature
review that aims to understand the experiences and difficulties faced by single-parent families and
how cultural and social factors shape these challenges. This review shows that single parents have
more negative experiences than coupled parents in most cultures worldwide. Certain difficulties
like economic challenges are found globally, while others such as relational difficulties are found
more in collectivistic cultures (Mudau et al., 2018). There are also differences in the types of
challenges experienced by single mothers versus single fathers, with mothers facing more economic
challenges and fathers facing more caregiving difficulties (D'Mello et al., 2016). In more feministic
cultures, like Swedish, there is a smaller discrepancy between genders as the state creates equal
support and opportunities for both single mothers and fathers (Barber, 2003). Furthermore, single
parenthood can significantly impact children’s health during and after birth, academic
performance, and psychosocial development (Amato & Patterson, 2017; Sinha & Ram, 2018;
Wang, 2015). This review asserts that most problems faced by single parents are not due to
inherent limitations, but rather discrimination and stigma rooted in their respective communities.
The paper also discusses the need for further cross-cultural studies on single parents’ experiences
and their impact on children while also considering important factors in developing interventions
for single-parent families to help manage psychological distress and provide economic support.
... These include whether the index person's mother or father had died before age 50, the index person's marital status at age 50 (never married, married, divorced, widowed), their own educational attainment (same categories as used for the educational attainment of parents), their own socio-economic status (taken from the 1990 Census), and the number of children that they had by age 50 (0, 1, … 6+). All these variables have been shown to covary with family size as well as with health outcomes (Cherlin et al. 1998;Weitoft et al. 2003;Torssander and Erikson 2010;Rostila and Saarela 2011;Myrskylä et al. 2014; Barclay, Keenan, et al. 2016). ...
Only children (with no full biological siblings) are a growing subgroup in many high-income settings. Previous studies have largely focused on the short-term developmental outcomes of only children, but there is limited evidence on their health outcomes. Using Swedish population register data for cohorts born 1940-75, we compare the health of only children with that of children from multi-child sibling groups, taking into account birth order, family size, and presence of half-siblings. Only children showed lower height and fitness scores, were more likely to be overweight/obese in late adolescence, and experienced higher later-life mortality than those with one or two siblings. However, only children without half-siblings were consistently healthier than those with half-siblings, suggesting that parental disruption confers additional disadvantages. The health disadvantage was attenuated but not fully explained by adjustment for parental characteristics and after using within-family maternal cousin comparison designs.
... 99 Previous studies found that children raised in single-parent households had a more inferior mental health status and had increased suicide attempts and drug addiction risk. 100 Parents with a higher education level showed more concerns and were better informed about their children's mental health problems. On the other hand, a psychologically controlling parental style may increase children's academic and sport-related burnout. ...
Objectives: We assessed the relationship between physical activity (PA) and mental health among Chinese adolescents. Methods: We conducted a cross-sectional survey in 4 Chinese cities – Beijing, Shanghai, Nanchang, and Urumchi. We randomly selected 25 schools from these cities in both urban and suburban areas. A total of 9269 adolescents completed the survey. We conducted multilevel logistic regressions to examine the relationship between PA engagement and mental health, adjusting for various sample characteristics. Results: Compared to those with low levels of daily PA, adolescents with moderate and high levels of daily PA had lower odds of having learning anxiety (23% for moderate and 37% for high), solitude tendency (52% for moderate and 41% for high), self-accusation (13% for moderate and 15% for high), experiencing sensitivity (15% for moderate and 13% for high), physical symptoms (20% for moderate and 21% for high), and a general mental health problem (total score of all the domains: 41% and 34%). Conclusions: An increase in PA participation holds the potential to improve multiple mental health domains among Chinese adolescents. Future longitudinal or experimental research is warranted to confirm findings from this study.
... We identified several potential mediators of interest to explore in these analyses. First, Nonwhite or minority group membership is commonly associated with socioeconomic indicators, like educational attainment (Brown and Moran 1997;Cairney et al. 2003;Weitoft et al. 2003). Additionally, injury prevention researchers have posited that children's injury risk results from interactions among child, caregiver, and contextual/environmental factors. ...
Objective
While there are clear racial/ethnic disparities in child restraint system (CRS) use, to date no studies have identified mediators that quantitatively explain the relationship between race and CRS use. Therefore, the objective of this study was to provide an example of how a proportion-eliminated approach to mediation may be particularly useful in understanding the complex relationship between race and CRS use.
Methods
Sixty-two mothers with a child between 4-8 years old completed a survey and had their CRS use assessed by a Child Passenger Safety Technician using a structured assessment based on the 2018 American Academy of Pediatrics’ Best Practice guidelines. Recruitment and data collection occurred in Birmingham, Alabama between June 2018 and January 2019. We used chi-squared tests, logistic regressions, and a proportion-eliminated approach to mediation to compare our variables of interest and to estimate the amount of the association between racial group membership and errors in restraint use that may be explained by sociodemographic, psychosocial, and parenting variables.
Results
Before mediation, Nonwhite mothers in this sample had a 7.38 greater odds of having an error in CRS use than White mothers. Mediation analyses indicated that being married and self-reported seatbelt use explained 47% and 35% of the effect of race on CRS use errors, respectively.
Conclusion
A proportion-eliminated approach to mediation may be particularly useful in child passenger safety research aiming to inform the development of interventions tailored for racial minority populations.
... Children who are raised in families with their own biological mother and father are advantaged socially, emotionally, psychologically, and financially over children raised in other contexts. Children raised in single parent homes, for example, are more likely to be impoverished, to engage in delinquency as adolescents and criminality as adults, to fail to finish school, to become pregnant as a teenager, as well as to experience poor emotional and psychological health (Defoe 2003;Norval et al. 2002;Weitoft et al., 2003). Even as adults, they are more likely to "… get fewer years of education and enjoy less stable marriages and lower occupational statuses than children whose parents got and stayed married" (Gallagher and Waite 2000, p. 125). ...
LANGUAGE NOTE | Document text in English; abstract also in Chinese.本文探討關於婚姻與家庭生活的不同觀念的社會及文化意義，比較對於婚姻與家庭生活的兩種不同的理解。傳統的理解是契合於具體的宗教與文化之中的，而當代西方俗世的自由主義理解則尋求將婚姻重塑為自主個人之間的一種平等主義的社會契約。前者把家庭視為社會存在的一種規範形式，是圍繞著一夫一妻制婚姻以及他們的生物學子女（甚或收養子女）而形成的；而後者則把家庭看作符合於當代西方流行的社會公正及性別中立原則而合法構成的機構。This paper explores the social and cultural implications of different conceptions of marriage and family life. It compares traditional understandings of marriage and family, set within particular religions and cultures, to a Western secular liberal understanding, which seeks to recast marriage as a sort of egalitarian social contract between autonomous individuals. Rather than appreciating the family as a normative form of social being constituted around the monogamous marriage of husband and wife and their own biological (and perhaps adopted) children, here the family is to be appreciated as an institution legally to be molded more closely in line with currently popular Western principles of social justice and gender neutrality. Claims regarding individual autonomy, gender neutrality, and rights to sexual freedom have come to possess a commanding place within the West’s recasting of the family.DOWNLOAD HISTORY | This article has been downloaded 120 times in Digital Commons before migrating into this platform.
... The reasons behind the link between divorce rates and victimization are difficult to ascertain at this aggregated level but may be related to other factors beyond economic hardship as suggested by Fröjd, Marttunen, Pelkonen, von der Pahlen, and Kaltiala-Heino (2006) and Weitoft, Hjern, Haglund, and Rosén (2003). An alternative interpretation for the effect of divorce on crime is through the parent-child relationship. ...
Chapter 5 starts showing the changing rates and geography of a selected group
of offenses by municipalities in Sweden. Police records are used as the main
source of the analysis but reference is also made as much as possible to the
National Crime Victim Surveys. This chapter aims at improving the knowledge
base regarding the rates and spatial distribution of crimes in Sweden. Focus is
given to shifts in geography between rural (remote and accessible) and to urban
municipalities (especially Stockholm, Gothenburg, and Malmö), and vice versa.
Geographical information systems (GIS) and spatial statistics techniques are
used to assess concentration of thefts and violence. There is an inequality in victimization
that is worth highlighting as trends in crime may impress different
geographies in space. Which are the main factors behind the geography of crime in Sweden? Are
these factors in urban areas different from the ones found in rural municipalities?
Following the main strand of theories in environmental criminology, the second
section of this chapter searches for factors that can explain the spatial arrangement
of crime. Crime rates are modeled cross-sectionally as a function of the
municipalities’ structural indicators, such as demography, socioeconomic conditions,
and lifestyles. Note that this chapter is based on previous work published
by the author with the criminologist Lars Dolmén in 20111 but it makes an effort
to take distance from the previous study by expanding the analysis, including
detailed analysis of property crime and updating the violence section with new
statistics. The chapter ends with a discussion of unanswered questions about the
geography of crime in Sweden and the methodological challenges of analysing
the regional distribution of crime using police recorded data at municipal level.
Finally, a relevant issue that is also discussed in the final section of this chapter
is the adequacy of current criminological theory in supporting the analysis of
crime dynamics that go beyond the urban and/or neighborhood contexts.
... 4 6 7 Multiple studies have concluded that children who grow up with continuously married parents have better outcomes than children who grow up with single parents or children whose parents separate during childhood. [8][9][10] This is consistent for key health and development outcomes including physical health, 11 psychological well-being 12 and educational attainment. 13 A systematic review of maternal marital status and birth outcomes from 2010 has summarised the current literature on risks of an infant being born with low birth weight (<2500 g), preterm birth (<37 weeks' gestational age) or small for gestational age (below the 10th percentile for babies of the same gestational age) among married and unmarried women. ...
Introduction
Up to a quarter of all children globally live in single-parent households. Studies have concluded that children who grow up with continuously married parents have better health outcomes than children who grow up with single or separated parents. This is consistent for key health and development outcomes including physical health, psychological well-being and educational attainment. Possible explanations include higher poverty and time limitations of parental engagement within single-parent families, but these only represent a narrow range of mechanisms. We aim to identify and synthesise the evidence on how being born into and/or living in a single-parent household compared with living in a two-parent household as a child impacts health and development outcomes, healthcare use and factors that may be driving differences.
Methods and analysis
We will search PubMed, Scopus and ERIC and adapt our search terms for search engines and grey literature sites to include relevant conference abstracts and grey literature. We will restrict results to English language publications from 2000 to 2020 and screen against inclusion criteria. We will categorise main outcomes into five groups of outcomes: birth outcomes, mortality, physical health, mental health and development, and healthcare use. We will use the Newcastle-Ottawa Scale to assess the methodological quality of studies. Narrative synthesis will form the primary analysis in the review. Synthesis of effect estimates without meta-analysis will follow the Synthesis Without Meta-analysis guidelines.
Ethics and dissemination
All documents used are publicly accessible. We will submit results to a peer-reviewed journal and international social science conferences. We will communicate results with single-parent groups and relevant charitable organisations. This review will also be included in IL’s PhD thesis.
PROSPERO registration number
CRD42020197890.
... The reasons behind the link between divorce rates and victimization are difficult to ascertain at this aggregated level but may be related to other factors beyond economic hardship as suggested by Fröjd, Marttunen, Pelkonen, von der Pahlen, and Kaltiala-Heino (2006) and Weitoft, Hjern, Haglund, and Rosén (2003). An alternative interpretation for the effect of divorce on crime is through the parent-child relationship. ...
... The result of the present study supports the hypothesis (see Table 14). Research evidence supports the notion that parental loss negatively effects psychological well-being and resilience of children (Weitoft, et al., 2003). ...
... Ability to establish a stable and loving relationship with the child Doctors' responsibility for the wellbeing of children born from treatment concerns the prevention of both medical and psychosocial harm (Pennings, 1999;Bredenoord et al., 2008). Empirical research identified numerous factors that are potentially harmful to children: a short life expectancy, history of substance abuse or child abuse, serious physical disability, psychiatric disorders, poverty, an unstable relationship and single parenthood (Weitoft et al., 2003;Arnow, 2004;Bolt et al., 2004;Steinhausen et al., 2007;Jenkins et al., 2018). Risk factors can, however, be mitigated by the presence of a stable relationship between parent(s) and the child, supportive relatives, and a good socialeconomic status (Aalbers-van Leeuwen and van Hees, 2002;Bolt et al., 2004;Golombok, 2015). ...
A growing number of people desire ART with cryopreserved donor oocytes. The allocation of these oocytes to couples and mothers to be is a 2-fold process. The first step is to select a pool of recipients. The second step is to decide who should be treated first. Prioritizing recipients is critical in settings where demand outstrips supply. So far, the issue of how to fairly allocate cryopreserved donor oocytes has been poorly addressed. Our ethical analysis aims to support clinics involved in allocation decisions by formulating criteria for recipient selection irrespective of supply (Part I) and recipient prioritization in case supply is limited (Part II). Relevant criteria for recipient selection are: a need for treatment to experience parenthood; a reasonable chance for successful treatment; the ability to safely undergo an oocyte donation pregnancy; and the ability to establish a stable and loving relationship with the child. Recipients eligible for priority include those who: have limited time left for treatment; have not yet experienced parenthood; did not undergo previous treatment with cryopreserved donor oocytes; and contributed to the supply of donor oocytes by bringing a donor to the bank. While selection criteria function as a threshold principle, we argue that the different prioritization criteria should be carefully balanced. Since specifying and balancing the allocation criteria undoubtedly raises a moral dispute, a fair and legitimate allocation process is warranted (Part III). We argue that allocation decisions should be made by a multidisciplinary committee, staffed by relevant experts with a variety of perspectives. Furthermore, the committees’ reasoning behind decisions should be transparent and accessible to those affected: clinicians, donors, recipients and children born from treatment. Insight into the reasons that underpin allocation decisions allows these stakeholders to understand, review and challenge decisions, which is also known as accountability for reasonableness.
... This change could allow mothers and daughters to bond in relation to household production activities while mothers focus less on the adolescent and pre-teen boys, but it could also create conflict between mothers and daughters. Gender-specific effects of welfare reform on parental investments and parent-child relationships are important to study given past research suggesting that boys are more sensitive than girls to changes in time and monetary investments during childhood (Autor et al., 2019;Bertrand & Pan, 2013;Conti, Heckman & Pinto, 2015;Fan, Fang & Markussen, 2015;Kling, Ludwig & Katz, 2005;Lei & Lundberg, 2020;Weitoft et al., 2003). ...
... Following Smith's idea (Smith et al., 2009) we strongly believe that there is a problem in most Polish families, which often struggle with lack of time and fi nancial issues. Furthermore, this economic and usually social issues force them to undertake generally accessible and low-cost activities (Weitoft et al., 2003), which seem to be essential to make a more valuable contribution to family life (Freeman & Zabriskie, 2003). Also, Shaw and Dawson (2001) have revealed that the parents' appreciation to spend time (here selecting core leisure activities) together with their foster children enhances their foster family cohesion. ...
... Despite a strong commitment to the health and development of all children, there are still concerns about poor childhood health outcomes due to issues within the social determinants of health. In recent studies, single-parenthood is recognised as a risk factor for the development of chronic health conditions among children [6][7][8][9][10][11][12][13]. Children in single-parent households are seen as a socially vulnerable population, as their families tend to have a lower overall income, resulting in food insecurity and other physical conditions that impose a heightened risk for maladaptive health outcomes. ...
Background: Single-parenthood is recognised as a risk factor for chronic childhood health conditions due to lower family income, resulting in food insecurity and an increased psychological burden. Governmental social assistance may address the risk by ensuring minimum-income protection and financial healthcare access. However, no study has investigated the association between single-parenthood and health statuses among children in families receiving social assistance benefits. This study aimed to examine the association between single-parent households and children’s health among public assistance recipients in Japan by—for the first time ever—using linkage data of two municipal public assistance databases and medical assistance claim data.
Methods: We performed a cross-sectional study. Public assistance for households below poverty line ensures their income security and medical care. We extracted individual factors of children aged 15 years or younger in January 2016 and observed until December 2016. We identified one-year prevalence of childhood diseases by using International Classification of Disease, Tenth Edition (ICD-10) codes.
Results: Among the 573 participants, 383 (66.8%) lived in single-parent households. A multivariable Poisson regression showed that single-parenthood is associated with a higher prevalence of asthma (prevalence ratio [PR] = 1.62; 95% confidence interval [CI], 1.16-2.26), allergic rhinitis (PR = 1.41; 95% CI, 1.07-1.86), dermatitis and eczema (PR = 1.81; 95% CI, 1.21-2.70), and dental diseases (PR = 1.79; 95% CI, 1.33-2.42), as compared to other households. No association was found between single-parenthood and acute children’s diseases such as respiratory infections, injuries, and intestinal infections.
Conclusions: Living in single-parent households is a risk factor for children’s chronic diseases, despite them receiving public assistance benefits. These results may be explained by the increased psychosocial stress, suggesting that the present public assistance system in Japan should provide additional social support. Ameliorating health conditions of children among single-parent households on public assistance can be achieved by closer monitoring of the community. Further investigations are necessary using more detailed information such as environmental factors, the severity of children’s health conditions, the contents of any received treatments, and broader socioeconomic factors.
While there are negative stereotypes against children who have been through divorce, research indicates that there are a wide range of potential outcomes children can experience after their parents’ divorce. Research indicates that there are at least four protective factors that lead to positive mental health and social outcomes for children of divorce: (a) external social support, (b) self-reliance and grit, (c) positive relationships with parents, and (d) resilience and self-compassion. These protective factors are then illustrated through a narrative therapy framework, which focuses on multiple possible realities, meaning making, perception of the client as the expert of their own experience, and the role of dominant discourses in the client's life and clinical intervention. A clinical vignette is then presented, depicting a teenage girl whose parents have divorced after an especially turbulent marriage. Narrative therapy's strength is that it helps the client develop cognitive distance between their sense of self and the problems they are experiencing. However, some limitations to this presentation are that it is highly theoretical and requires further quantitative research to explore the effects of narrative therapy on clients whose parents are divorced. Further research is required to explore the wide spectrum of outcomes children can experience after divorce and how clinicians can help children reach more positive outcomes.
Limited research exists on the association between cumulative risk factors and the psychosocial well‐being of adolescents in low‐income, culturally distinct settings. This study aimed to fill this gap by examining the impact of cumulative risk exposure on Ghanaian adolescents' psychosocial problems and exploring the mediating role of parenting. The study involved 212 adolescents (61% girls; average age = 13.38) who completed measures on cumulative risk, maternal and paternal warmth, behavioral control, anxiety, depression, overt aggression, and relational aggression. The results indicated that cumulative risk indirectly influenced adolescents' depression and overt aggression through paternal warmth. Furthermore, paternal behavioral control mediated the relationship between cumulative risk and adolescents' overt aggression. Findings highlight the importance of fathers' parenting in mediating cumulative risk effects.
This chapter explores the experiential reality of the family and its role in securing human well-being. I argue that the family is an epistemic category as well as an ontological category: it reveals the being of the phenomenological life-world in ways that are necessary for adequately appreciating the embodiment of human health and well-being. Without the family, there are significant areas of human flourishing about which one can neither know nor experience. The family uncovers categories of moral duties and virtues central to the creation and maintenance of core areas of human well-being. Familial interactions, for example, routinely demonstrate significant forms of altruistic behavior and other-directed personal costs at levels that are atypical of nonfamilial relationships. Moreover, significant cross-cultural sociobiological data support the conclusion that family life provides social, emotional, adaptive, and financial advantages, as well as the development of affective autonomy, increased longevity, improved physical and psychological health. Conversely, traumatic changes to family life, such as the death of a spouse, are well-documented as negatively impacting personal stability, life-expectancy, and overall well-being. In short, to focus unduly on the individual in isolation from the family is to diminish this rich and significant category of human good and well-being.
Parental divorce is the second most prevalent adverse childhood event. Although most children from divorced families do not experience significant adjustment problems, compared to youth in two-parent families, those from divorced families exhibit higher levels significant problems (e.g., mental health problems; school dropout). Analysis of the problems that children face once parents get divorced are presented, and related prevention programs – either child-focused or family-focused – are described. Based on the notion that high-quality parenting mitigated the negative effect of divorce-related stressors on mental health problems, the New Beginnings Program (NBP) is further presented and discussed. The NBP is a theory-based preventive intervention that combines elements from a person-environment transactional framework and a risk and protective factor model. Evaluations of the NBP indicate its wide range of positive outcomes for families and prove that it is also cost-effective.KeywordsMarriageFamilyParental divorceMental health problemsNew Beginnings Program (NBP)Person-environment transactionalRisk factorsProtective factorsPositive outcomesCost-effective
Objectives: About 20 % of children in Germany grow up with a single mother - this is often associated with multiple strain for the mothers and may have adverse effects on the child-parent relationship. Methods: In two retrospective internet surveys (wave 1 born in 1960s, wave 2 born in 1990s) perceived maternal love and role reversal were assessed in children of single mothers and children grown up in two parent families. Results: In both waves high values of maternal love were reported. For children raised by single mothers, strong effects for age and occupational status were observed. Contrary to literature, no gender specific effects on role reversal were observed in this sample. Discussion: High occupational strain in a single mother was associated with less perceived love in the child.Multiple strain in singlemothers should findmore social and political attention. Regarding role reversal support should address daughters and sons similarly.
The institution of marriage is at a crossroads. Across most of the industrialized world, unmarried cohabitation and nonmarital births have skyrocketed while marriage rates are at record lows. These trends mask a new, idealized vision of marriage as a marker of success as well as a growing class divide in childbearing behavior: the children of better educated, wealthier individuals continue to be born into relatively stable marital unions while the children of less educated, poorer individuals are increasingly born and raised in more fragile, nonmarital households. The interdisciplinary approach offered by this edited volume provides tools to inform the debate and to assist policy makers in resolving questions about marriage at a critical juncture. Drawing on the expertise of social scientists and legal scholars, the book will be a key text for anyone who seeks to understand marriage as a social institution and to evaluate proposals for marriage reform.
The institution of marriage is at a crossroads. Across most of the industrialized world, unmarried cohabitation and nonmarital births have skyrocketed while marriage rates are at record lows. These trends mask a new, idealized vision of marriage as a marker of success as well as a growing class divide in childbearing behavior: the children of better educated, wealthier individuals continue to be born into relatively stable marital unions while the children of less educated, poorer individuals are increasingly born and raised in more fragile, nonmarital households. The interdisciplinary approach offered by this edited volume provides tools to inform the debate and to assist policy makers in resolving questions about marriage at a critical juncture. Drawing on the expertise of social scientists and legal scholars, the book will be a key text for anyone who seeks to understand marriage as a social institution and to evaluate proposals for marriage reform.
Background
Few studies have examined the association between reproductive history and the multidimensional health of older adults with more diverse reproductive histories and poorer health status in rural China. The purpose of this study is to explore the effect of parity, sex ratio of children and late childbearing on multidimensional health and its gender differences.
Methods
The analytical sample consisted of 3,377 older adults in rural China who participated in the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2018. Linear regression models were applied to estimate the relationship between reproductive history and multidimensional health, with separate models for each indicator of health outcomes.
Results
Older adults in rural areas with greater parity were more likely to have better cognitive function (β = 0.409, 95% CI: 0.255–0.563), fewer Activities of Daily Living (ADL) limitations (β = −0.085, 95% CI: −0.137 to −0.034) and symptoms of depression (β = −0.396, 95% CI: −0.577 to −0.216). The social mechanism of intergenerational support from children later in life partly explained the positive effect of parity. Late childbearing had negative effects on cognitive function (β = −1.220, 95% CI: −1.895 to −0.545), ADL (β = 0.253, 95% CI: 0.028–0.478) and symptoms of depression (β = 1.025, 95% CI: 0.237–1.812). Women were more likely to be influenced by the positive effect of parity; the association between late childbearing and health was only significant in the male group.
Conclusions
Parity and late childbearing are associated with cognitive function, activities of daily living, and symptoms of depression in the older adults in rural China. Older adults with more children might be in better health, and this finding is especially significant in women. However, late childbearing had a negative effect on multidimensional health, especially for men. The social mechanism and gender differences between reproductive history and health need to be further explored.
The review of literature analyzes the publications which cover the peculiar features of the schoolchildren’s lifestyle in Gomel and studies the incidence rate of the main classes of diseases among them.
This volume brings together a set of conceptual, moral, and cultural concerns carefully to assess a significant public policy issue: the development and proliferation of sex robots. Critics argue, for example, that sex robots present a clear risk to real persons as well as a degradation of society. They claim that the prevalence of sex robots will increase sexual violence, immorally objectify women, encourage pedophilia, reinforce negative body image stereotypes, increase forms of sexual dysfunction, and pass on sexually transmitted disease. Proponents judge robotic sexual companionship as just another step in the exploration of human erotic desire. Sex robots, and similar technology, such as virtual reality pornography and other forms of “digi-sexuality,” are appreciated as providing autonomy affirming companionship, sexual release for the lonely, and a relatively harmless outlet for sexual fantasies that avoids the use of human prostitutes and thus reduces sexual victimization. As these chapters explore, to secure normative claims about sexual activity with artificial humanoids, one will need first to understand what the meaning of the morality of sexual activity can be as well as the significance of various practices with robotic partners on such cardinal social institutions as the family and the relationship between the sexes. One will also need to consider in terms of which ranking of human goods, right-making conditions, social outcomes, or personal virtues we ought to evaluate the significance of sexual relations with robots that look like women, men and children. Without such analysis, it will be unclear whether sex robots ought to be appreciated as a social evil that will further degrade moral culture, a positive technological innovation that will help preserve human dignity, or a more or less harmless pastime.
This is the first in Poland and fourth in the world report devoted to present the costs of family breakdown for the state and society.
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.
Background
There is growing evidence that higher childhood cognitive ability predicts lower all-cause mortality risk across the life course. Whereas this association does not appear to be mediated by childhood socioeconomic circumstances, it is unclear whether socioeconomic circumstances moderate this association.
Methods
The moderating role of childhood socioeconomic circumstances was assessed in 5318 members of the 36-day sample of the Scottish Mental Survey 1947. Univariate, sex-adjusted and age-adjusted, and mutually adjusted Cox models predicting all-cause mortality risk up to age 79 years were created using childhood IQ scores and childhood social class as predictors. Moderation was assessed by adding an interaction term between IQ scores and social class and comparing model fit.
Results
An SD advantage in childhood IQ scores (HR=0.83, 95% CI 0.79 to 0.86, p<0.001) and a single-class advantage in childhood social class (HR=0.92, 95% CI 0.88 to 0.97, p<0.001) independently predicted lower mortality risk. Adding the IQ–social class interaction effect did not improve model fit (χ ² Δ=1.36, p=0.24), and the interaction effect did not predict mortality risk (HR=1.03, 95% CI 0.98 to 1.07, p=0.25).
Conclusions
The present study demonstrated that the association between higher childhood cognitive ability and lower all-cause mortality risk is not conditional on childhood social class. Whereas other measures of socioeconomic circumstances may play a moderating role, these findings suggest that the benefits of higher childhood cognitive ability for longevity apply regardless of the material socioeconomic circumstances experienced in childhood.
Objective
Electronic health records (EHRs) are routinely used to identify family violence, yet reliable evidence of their validity remains limited. We conducted a systematic review and meta-analysis to evaluate the positive predictive values (PPVs) of coded indicators in EHRs for identifying intimate partner violence (IPV) and child maltreatment (CM), including prenatal neglect.
Methods
We searched 18 electronic databases between January 1980 and May 2020 for studies comparing any coded indicator of IPV or CM including prenatal neglect defined as neonatal abstinence syndrome (NAS) or fetal alcohol syndrome (FAS), against an independent reference standard. We pooled PPVs for each indicator using random effects meta-analyses.
Results
We included 88 studies (3 875 183 individuals) involving 15 indicators for identifying CM in the prenatal period and childhood (0–18 years) and five indicators for IPV among women of reproductive age (12–50 years). Based on the International Classification of Disease system, the pooled PPV was over 80% for NAS (16 studies) but lower for FAS (<40%; seven studies). For young children, primary diagnoses of CM, specific injury presentations (eg, rib fractures and retinal haemorrhages) and assaults showed a high PPV for CM (pooled PPVs: 55.9%–87.8%). Indicators of IPV in women had a high PPV, with primary diagnoses correctly identifying IPV in >85% of cases.
Conclusions
Coded indicators in EHRs have a high likelihood of correctly classifying types of CM and IPV across the life course, providing a useful tool for assessment, support and monitoring of high-risk groups in health services and research.
Importance
Injury is a leading cause of childhood morbidity and mortality worldwide. Serious mental illness (SMI) is a major contributor to the global burden of disease.
Objective
To compare injury event rates in children from birth to 5 years of age among Taiwanese children with and without parents with SMI, including schizophrenia, bipolar disorder, and major depressive disorder.
Design, Setting, and Participants
This population-based, retrospective cohort study of an 11-year Taiwanese birth cohort used data from the Taiwan National Health Insurance Research Database (covering 99% of Taiwanese citizens), the Maternal and Child Health Database, and birth and death certificate databases. The study included 1 999 322 singletons with Taiwanese citizenship born from January 1, 2004, to December 31, 2014, and followed up from birth to their fifth birthday, December 31, 2014, or the date of death, yielding a total of 7 741 026 person-years. Data analysis was performed from April 20, 2017, to September 24, 2019.
Exposures
Physician-diagnosed parental SMI defined using outpatient and inpatient records from 6 years before the child’s birth to 5 years after delivery.
Main Outcome and Measures
Rates of medically attended injury events, injury hospitalization, and injury death retrieved from outpatient records, inpatient records, and death certificates. Generalized estimating equation for log-linear models estimated injury incidence rate ratios (IRRs) comparing parental SMI-exposed children and unexposed children.
Results
The study cohort included 1 999 322 singletons (52.1% males without parental SMI and 52.2% males with parental SMI). Incidence rates of child injury-related outcomes were higher among children exposed to parental SMI (294.8 injury events per 1000 person-years) compared with children who were unexposed (256.1 injury events per 1000 person-years). After adjustment for sociodemographic factors, children with parental SMI had higher rates of injury events (IRR, 1.14; 95% CI, 1.13-1.15), injury hospitalization (IRR, 1.49; 95% CI, 1.42-1.57), and injury death (IRR, 1.82; 95% CI, 1.38-2.39) compared with unexposed children. The results were confirmed in sensitivity analyses. Appendicitis, a negative control outcome, was not associated with parental SMI (IRR, 1.10; 95% CI, 0.94-1.28). In addition, children with and without parental SMI had similar patterns of preventive health care. The mean (SD) number of prenatal visits was 8.09 (2.50) for children with parental SMI and 8.17 (2.47) among unaffected children. The mean (SD) number of well-child visits was 5.70 (2.24) for children with parental SMI and 5.80 (2.21) among unaffected children.
Conclusions and Relevance
In this study, children with parental SMI had increased risk of injury, particularly serious injury. Excess risk may be reduced by providing effective mental health treatment, parenting support, and home safety education to parents with SMI who are raising young children.
This two-part review documents inconsistencies in the empirical basis for the hypothesis that boys are more negatively affected than are girls by parental divorce. An attempt is made to move beyond a global hypothesis to one specifying circumstances for the pattern. Part 1 asks whether methodological adequacy or postdivorce family forms in the studies help explain the discrepancy across studies that examine sex differences in children's response to parental divorce. Part 2, reviewing other possible sources for the discrepancy, will appear in a forthcoming issue of this Journal.
This meta-analysis involved 92 studies that compared children living in divorced single-parent families with children living in continuously intact families on measures of well-being. Children of divorce scored lower than children in intact families across a variety of outcomes, with the median effect size being .14 of a standard deviation. For some outcomes, methodologically sophisticated studies yielded weaker effect sizes than did other studies. In addition, for some outcomes, more recent studies yielded weaker effect sizes than did studies carried out during earlier decades. Some support was found for theoretical perspectives emphasizing parental absence and economic disadvantage, but the most consistent support was found for a family conflict perspective.
Children living in single-parent families or stepfamilies were found to be more likely to suffer accidental injuries in their first five years of life than children living with two natural parents. Frequent household moves, low maternal age, and perceived poor behaviour in the child were all more strongly associated with overall accident rates than family type, and these disadvantages were more common in atypical families. Family type appeared to be the most important influence on hospital admission after accidents. Overall, there was a close similarity in accident rates between children of single-parent families and stepfamilies, and both groups were more at risk than children living with both natural parents.
To show that the exclusion from conventional class based analyses of child mortality of children whose parents are classified as "unoccupied" produces a misleading picture of health inequalities.
Reanalysis of data published in the childhood supplement of the registrar general's decennial supplement on occupational mortality in England and Wales, which compares numerator data for registrations of deaths in children over the age of 1 but below their 16th birthday in 1979, 1980, 1982, and 1983 with data about children aged 1-15 who were enumerated at the 1981 census.
Parents who are classified as "unoccupied" largely consist of economically inactive single mothers. Their children are estimated to represent 89% of the 614,000 aged 1-15 classified as "unoccupied" in the childhood supplement. They have the worst mortality record of all social groups--an age specific death rate of 68.8/100,000 a year, 42% worse than in social class V (48.4/100,000) and worse than that of social class I (22.8) by a factor of 3. At older ages (10-15 years) these children have a relative risk of death of 4.14 relative to classes I and II; the risk is 2.58 in children 0-4 and 2.56 in those 5-9. Relative risks of child mortality in social classes I and II in comparison to classes IV and V suggests a progressive shallowing from 2.08 at ages 1-4 to 1.37 at ages 10-15. When unoccupied parents were combined with classes IV and V and compared with classes I and II, however, inequalities seemed to be pervasive throughout childhood; the relative risks were 2.21 for those aged 1-4 and 1.98 for those aged 10-15.
Children classified as unoccupied are almost certainly living in poverty as well as experiencing relatively high risks of mortality. Class based analyses which exclude them therefore produce a misleading picture of inequalities in child health. The implications for health policy are profound. Strategies to promote the nation's health should acknowledge the importance of material and social deprivation more explicitly.
To examine mortality differences by parental social class and cause of death from age 5 to age 34.
Register-based follow up study based on census records for 1985 and 1990 linked with death records for the period 1987-95.
The study covers all males and females in non-manual and manual classes in Finland aged 5-34 years in 1987-95 (8135 deaths). Parental social class is defined on the basis of the occupation of the head of household at the time the child was 0-14 years.
All cause mortality, mortality from diseases, mortality from accidents and violence, and alcohol related mortality during the period 1987-95.
At ages 5-14 there is no systematic gradient in mortality by parental social class. Both absolute and relative differences increase with age. The relative rate of male all cause mortality among manual class descendants at ages 25-29 compared with that of upper non-manual class descendants is 1.60 (95% CI 1.37, 1.86). At ages 30-34 the relative rate among males is 1.95 (95 % CI 1.58, 2.42) and among females 1.47 (95% CI 1. 03, 2.10). Among males alcohol related causes of death account for 70% of the excess mortality of sons of manual class parents compared with sons of upper non-manual class parents at ages 25-34. At ages 25-34, both among females and males, the contribution of diseases to the mortality difference increases.
Parental social class has an impact on mortality after childhood mainly through health related behaviours and lifestyles up to age 34.
The relationship between family background and mortality of offspring was studied by using a prospectively collected, general population, birth cohort database (n = 11,017), that is the Northern Finland 1966 birth cohort which is linked with the national death register.
A logistic regression analysis was performed in order to examine the association between family background and death of offspring (between ages 16 and 28 years).
It was revealed that 117 subjects (90 males and 27 females) from the original birth cohort had died. The majority of the deaths were due to unnatural causes in both sexes (79%). After adjusting for confounders (psychiatric diagnosis and parental social class), the results indicated that the general mortality risk for males with a single-parent family background was significantly increased compared with males from a two-parent family background (odds ratio 1.8 and 95% confidence interval: 1.1-2.9). The risk of committing suicide was significantly increased among young adult males with a single-parent family background (OR 2.5 and 95% CI: 1.1-5.8).
Our finding calls for health care professionals to provide more preventative mental health support for children and adolescents living in broken homes.
Research reviewed in this essay documents a complex process in which macroeconomic and family demographic factors are associated with economic distress among individuals and families. Four components of economic distress—employment instability, employment uncertainty, economic deprivation, and economic strain—are shown to be negatively related to individual adjustment and family relations. Several individual and family coping resources and behaviors mediate relationships between economic distress and individual adjustment and family relations. The review closes with suggestions for future research and theory development.
The low psychological well-being of the divorced and separated could be due to the hardships of the divorce process, more general problems of unmarried living, or differential selection for divorce. Using combined questionnaire and register data on 39,000 Norwegian men and women, it is shown that psychological well-being is a strong predictor of subsequent marital dissolution over a 2-to 4-year period. The strength of the relationship is particularly strong in the short run, but remains significant throughout the period of observation. The strong short-term relationship is most probably due to hardships associated with the divorce process. The somewhat weaker long-term relationship could be due to selection effects, but the possibility that low well-being many years before the separation may be due to persistent marital problems cannot be ruled out.
The vanishing nuclear family constitutes one of the most significant demographic and social transformations in recent history. A voluminous body of theoretical and empirical literature in family studies, proceeding on the assumption that the nuclear family is the optimum child-rearing structure, suggests this change will have dire consequences for the well-being of future generations. The present essay challenges that conclusion, pointing out various methodological and conceptual problems with the extant research on which this prediction is based.
Discusses the emotional impact of divorce on children and adolescents and, after reviewing the literature and findings from a five-year longitudinal study, describes the implications of the spiraling divorce rate for practice, research, and social policy. (Author)
Background:
An increasing number of lone mothers are experiencing financial and health disadvantages. Our aim was to assess mortality among lone mothers compared with mothers with partners.
Methods:
In this population-based study, overall and cause-specific mortality, between 1991 and 1995, was estimated for 90,111 lone mothers and 622,368 mothers with partners from data collected in the Swedish Population and Housing Census 1990. We estimated relative risks by Poisson regression, adjusted for socioeconomic status, and, to handle health-selection effects, we adjusted for previous inpatient history from 1987 to 1990.
Findings:
Lone mothers showed an almost 70% higher premature risk of death than mothers with partners. The excess risk remained significantly increased (relative risk 1.2 [95% CI 1.1-1.4]) after adjustments for socioeconomic status and previous severe somatic and psychiatric inpatient history. Increased mortality was especially pronounced for suicides (2.2 [1.5-3.1]), violence (3.0 [0.9-10.6]), and alcohol-related mortality (2.4 [1.4-4.1]) among mothers who were without a partner in 1985 and in 1990.
Interpretation:
The increase of lone mothers in society shows financial, social, and health disadvantages. Nevertheless, the increased mortality risk of lone mothers seems to be partly independent of socioeconomic status and health selection into lone motherhood. For long-term lone mothers the risks may be underestimated when adjusting for selection bias by taking hospital discharge history into account, since these events may be part of the consequences of the stress of lone motherhood.
The aim was to explore the relationships between indicators of economic and social problems in childhood on the one hand and illness and mortality in adulthood on the other. In 1968 a representative sample of the Swedish population born 1906-1951 were interviewed about their childhood living conditions, among other things. Four indicators of adverse childhood living conditions were included. Two of these reflect economic circumstances (economic hardship; a large family, defined as four or more siblings), and two reflect social conditions (broken family; conflicts in the family). In 1981, 13 years later, this sample was re-interviewed. This allows for illness in 1981 to be related to reports of childhood conditions given in 1968. A follow-up of mortality for the period 1981-1984 was also conducted. When one controls for age, sex and father's social class, those exposed to economic as well as social problems during childhood are found to have a considerably higher risk of being ill as adults. Of the four factors analysed, conflicts in the family during upbringing is that most strongly related to illness later in life, as well as with mortality. Having a broken family, and, to some extent, economic hardship during childhood, are also clearly associated with illness later in life. These results also hold true when all four factors are included simultaneously in the model, and remain relatively unchanged when controlling for mental illness in 1968.(ABSTRACT TRUNCATED AT 250 WORDS)
In the last couple of decades there has been a considerable amount of research, mainly in the U.S.A., on the effects of family position on health. This paper reviews material on (a) the impact of family of origin on health and (b) adult family position and health. Parental divorce is shown to be related to a range of adverse outcomes in childhood, adolescence and adulthood. Marriage and parenthood are associated with longevity and good mental and physical health. This paper argues for more research in other cultural settings, for panel studies, for more direct measures of the roles and processes often inferred from structural variables, and for the use of measures of physical development and functioning.
Includes bibliographical references. Thesis (doctoral)-Stockholm University, 1998.
Background: We investigated the association between parental divorce, adolescent well-being and later mental health and mortality in young men. Methods: A national cohort of 47, 033 conscripts was followed up using registers for a period of 18 years. Baseline data were obtained from questionnaires at conscription, including data on social background, well-being, health and the use of alcohol and drugs. These data were matched with the national register of psychiatric care and with the national cause of death register. Results: Parental divorce was more common where less favourable social, behavioural and psychological characteristics were reported. For example, in families where the father frequently consumed alcohol, the odds ratio for parental divorce was 5.6 [95% confidence interval (CI): 5.0–6.2), compared with those families where the father never or rarely consumed any alcohol. In the long-term follow-up the relative risk (RR) of hospitalisation for psychiatric disorders was 1.8 (95% CI: 1.6–2.1) for young men who had divorced parents. The RR was 2.3 (95% CI: 2.0–2.8) for a diagnosis of alcoholism, 1.3 (95% CI: 0.9–1.8) for a diagnosis of schizophrenia and 1.3 (95% CI: 1.1–1.6) for mortality. Conclusions: Several indicators of low levels of well-being at conscription and mental illness, including alcoholism, later in life were found amongst young men with divorced parents. Although the results were adjusted for antecedents and covariate factors in multivariate analyses, some degree of confounding of long-term health effects from factors contributing to divorce cannot be ruled out.
Previous studies have shown parental divorce to be associated with poor functioning of children and adolescents. Almost all of the studies attempting to delineate these effects, and to shed light on the differences between boys and girls, have limited data collection to postdivorce. This practice has left a void in the picture of divorce--specifically in the area of predivorce effects. The purpose of the present study was to examine academic functioning of young adolescents with respect to both pre- and postdivorce effects. Fifty-eight young adolescents (29 from families which subsequently divorced and 29 from families which remained intact) were studied. Results indicated that boys from subsequently divorcing homes had significantly poorer academic functioning prior to their parents' divorce than did boys whose families remained intact and girls whose parents divorced. Differentially, girls from subsequently divorcing families showed a decline in academic functioning which began prior to divorce and continued beyond the time of divorce. Possible explanations for these gender differences are explored, and the importance of examining predivorce effects is addressed.
A comprehensive review of research from several disciplines regarding long-term effects of divorce on children yields a growing consensus that significant numbers of children suffer for many years from psychological and social difficulties associated with continuing and/or new stresses within the postdivorce family and experience heightened anxiety in forming enduring attachments at later developmental stages including young adulthood. Different conceptual models in the field are explicated. Major lacunae in research, particularly around issues of public policy, are identified. The critical importance of expanding clinical research to enhance understanding of the child's perspective and experience is proposed.
Data from the Ontario Child Health Study were used to examine the association between single-parent family status and child psychiatric disorder and poor school performance. Bivariate results indicate that children of single-parent families are at a small hut statistically significant increased risk for poor outcome. These same families, however, experience severe economic and social hardship. When variables indicative of hardship, such as poverty and family dysfunction, are controlled for in a multivariate analysis, the relationship between single-parent family status and childhood psychiatric disorder and poor school performance becomes statistically nonsignificant. The implications of these findings are discussed.
Explanations for social inequalities in health are often explored but remain largely unresolved. To elucidate the origins of health inequalties, we investigated the extent to which adult-disease risk factors vary systematically according to social position over three decades of early life.
We used the 1958 birth cohort (all children born in England, Scotland, and Wales on March 3-9, 1958) with data up to age 33 years from parents, teachers, doctors, and cohort members (n = 11,407 for age 33 interview).
Social class of origin was associated with physical risk factors (birthweight, height, and adult body-mass index); economic circumstances, including household overcrowding, basic amenities, and low income; health behaviour of parents (breastfeeding and smoking) and of participants (smoking and diet); social and family functioning and structure, such as divorce or separation of participants or their parents, emotional adjustment in adolescence, social support in early adulthood; and educational achievement and working career, in particular no qualifications, unemployment, job strain, and insecurity. With few exceptions, there were strong significant trends of increasing risk from classes I and II to classes IV and V. Self-perceived health status and symptoms were worse in participants with lower class origins.
An individual's chance of encountering multiple adverse health risks throughout life is influenced powerfully by social position. Social trends in adult-disease risk factors do not emerge exclusively in mid-life, but accumulate over decades. Investment in educational and emotional development is needed in all social groups to strengthen prevention strategies relating to health behaviour, work-place environment, and income inequality.
To identify and consider differences in morbidity in children in households with one adult presenting to general practitioners compared with children in households with more than one adult.
Observational study; data analysed with logistic regression controlling for age, sex, and practice.
93 356 children aged 0-15 years included in the fourth national study of morbidity in general practice and for whom data about household structure were available. Among them 10 983 (11.8%) were living in households with a sole adult.
Morbidity data were recorded from each consultation as the assessment diagnosis made by the general practitioner.
Number of consultations and consultations per person for any illness, infections, acute respiratory infections, asthma, and accidents; number presenting and mean consultations per person for immunisation; number receiving home visits and home visits per person visited; average annual frequency of consultation among those consulting.
Compared with children in other households, a higher proportion of children in households with one adult consulted for infections and accidents. The proportion consulting for immunisation was lower and the proportion receiving home visits greater. Mean numbers of consultations per person consulting were also generally higher for all conditions. For infections, accidents, and home visits, the differences were evident in all age groups.
The study confirms the importance of single parent families as an indicator of deprivation. Children in such families should be targeted for immunisation and accident prevention.
A number of studies have shown that lone parents have poorer health status than the general population. However, what is missing from the existing literature is any systematic assessment of the contribution that lone parents' relatively poor socioeconomic circumstances make to their relative health disadvantage. This paper aims to fill this gap. It employs a large national dataset based on three consecutive years of the British General Household Survey (1992/1993 to 1994/1995) to assess the relative health status of lone parents in comparison to couple parents, and to evaluate the importance of different explanations for their health differences. The results confirm that lone parents, particularly lone mothers, have poor health status relative to parents living as couples. The observed health differences mirror variations in socioeconomic circumstances. However, even when a wide range of demographic and socioeconomic circumstances are included in multivariate models, lone mothers still have significantly poorer health than couple mothers for four out of five health variables. The paper concludes by discussing alternative explanations for the health differences between lone and couple parents--such as the absence of an intimate/confiding relationship, the stress and stigma associated with becoming a lone parent and health selection--and by highlighting future options for policy and research in this area.
This study investigates the relationship between the family type (two-parent and 4 different single-parent types, mainly divorced) during childhood up to 14 years of age and adult hospital-treated psychiatric disorders in a sample from the unselected, general population Northern Finland 1966 Birth Cohort (N = 11,017). Up to the end of 1994, a total of 387 individuals (3.5%) had a hospital-treated psychiatric disorder, with 3.1% in two-parent families and 5.4% in single-parent families (p < .001). The single-parent family was not associated with the child's schizophrenia or other psychotic disorders. The adjusted odds ratios (OR) for personality disorders were highest among individuals without a father before the age of 14 years (OR 4.8), or at birth only (OR 4.0), or with a history of parental divorce (OR 2.8). Parental divorce was also associated with alcoholism (OR 3.7) and parental death with depressive disorders (OR 3.4). In conclusion, we found an elevated risk of hospital-treated nonpsychotic disorder among individuals from a single-parent family background. It is likely that a combination of the single-parent family and psychosocial and/or genetic risk may influence the development of these disorders.
Lone mothers have been shown to have higher levels of psychological distress than married mothers, but it is not clear how this difference arises. Using data from the 1958 British birth cohort followed to age 33, we investigated alternative explanations for the excess distress of lone mothers. Logistic regression models were used to estimate odds ratios for distress (measured using the Malaise Inventory) in lone vs married mothers. Odds ratios were adjusted to assess the contribution of explanatory factors. At age 33, psychological distress was greater among lone than married mothers (OR 2.59, 95% CI 1.97, 3.41). The odds ratio decreased to 1.43 (95% CI 1.02, 2.01) after adjustment for all explanatory factors (prior psychological distress, age of youngest child and number of children in the household, and contemporary measures of financial hardship, employment, and social support). Attenuation of the odds ratio was most marked after taking account of financial hardship. Psychological distress was greater among divorced mothers than never married mothers, though not significantly (OR = 1.70, 95% CI 0.88, 3.28). This difference was not explained by the factors examined, and was not due to the immediate distress associated with a recent divorce. Elevated psychological distress of lone mothers appears to be related to financial hardship, while other explanations, including social support and selection, have a more modest impact. Not all of the elevated psychological distress among lone mothers was accounted for, particularly among divorced lone mothers.
The aim of this study is to contribute to the emerging field of health inequalities impact assessment. It develops further a conceptual framework that encompasses the policy context as well as the pathways leading from social position to inequalities in health. It then uses this framework for a comparative analysis of social policies and their points of potential impact on the pathways leading from lone motherhood to ill health in Britain and Sweden. The British General Household Survey and the Swedish Survey of Living Conditions are analysed for the 17 years from 1979 to 1995/96. First, the results show that the health of lone mothers is poor in Sweden as well as in Britain and, most notably, that the magnitude of the differential between lone and couple mothers is of a similar order in Sweden as in Britain. This is despite the more favourable social policies in Sweden, which our results indicate have protected lone mothers from poverty and insecurity in the labour market to a much greater degree than the equivalent British policies over the 1980s and 1990s. Second, the pathways leading to the observed health disadvantage of lone mothers appear to be very different in the two countries in relation to the identified policy entry points. Overall, in Britain, around 50% of the health disadvantage of lone mothers is accounted for by the mediating factors of poverty and joblessness, whereas in Sweden these factors only account for between 3% and 13% of the health gap. The final section discusses the implications of the findings for future policy intervention and research in the two countries.
Children from single-mother families are at increased risk of psychosocial morbidity. This article examines the strength of association between single-mother family status and child outcome, both alone and controlling for other sociodemographic and personal (maternal/family) variables.
Data from the Canadian National Longitudinal Survey of Children and Youth Cycle 1 (1994-1995) were used. Children aged 6 to 11 years in single-mother and two-parent families were included (n = 9,398). Child functioning measures included social impairment, psychiatric problems, and math score.
Single-mother family status on its own is a significant predictor of all child difficulties, but the explained variance is limited and the effect size decreases when other variables known to influence child functioning are included. Household income, a sociodemographic variable, is inversely associated with social impairment and positively associated with math score. Hostile parenting and maternal depression are the personal variables most strongly associated with social impairment and psychiatric problems. Children in single-mother families where there is hostile parenting are at significantly increased risk of psychiatric problems.
The results suggest that children from single-mother families develop difficulties for the same reasons as children from two-parent families. Specific interventions for single-mother families may be warranted in the areas of parenting and other areas of concentrated risk.
Being a lone mother often implies disadvantage in terms of both socioeconomic circumstances and health. Our aim was to examine differences in mortality, severe morbidity and injury between lone mothers and mothers living with partners, on the assumption that the disadvantaged socioeconomic circumstances contribute to poor health.
The odds for receipt of hospital care or death between 1991 and 1994 were estimated for 26 619 lone mothers and 379 855 partnered mothers from data collected for the Swedish Population and Housing Census of 1990. We computed odds ratios by means of logistic regression, adjusting for confounders, mediators, and factors with an indeterminate position in various models. To control for health-selection effects, we only considered initially healthy women, as measured by non-hospitalization 4 years prior to follow-up. To reduce the impact of distress following divorce on health, we only included mothers who had been either lone or partnered for a period of > or =5 years.
Lone mothers showed increased risks of total mortality, lung cancer, suicide/ suicide attempt, inflicted violence, traffic injury and other accident, psychiatric disease, and addiction. The main explanation for increased risks seems for most outcomes to lie in deficient household resources, as indicated here by receipt of social-welfare benefit and housing situation. For all the initially elevated outcomes, except for total mortality, significant risk increases remained unaccounted for even in the full model. Relationships varied according to subgroup. Lone motherhood was not related to accident, suicide and addiction among medium- and high-grade non-manual workers. Although lone mothers in general showed no increased risk of ischaemic heart disease, those receiving social benefit were exposed to a significantly increased risk.
Our findings suggest that lone motherhood entails health disadvantages. Lack of household resources seems to play a major role in accounting for increased risks, but the risks are partly independent of socioeconomic circumstances, selection factors, and distress following divorce.
PIP
The declining prevalence of the nuclear family in the United States is examined, and the consequences for the healthy development of children are considered. Attention is given first to research supporting the claim that nuclear families provide the optimum environment for child rearing and then to studies presenting differing results. Methodological and conceptual issues concerning studies in family structure are discussed. The author concludes that family structure in and of itself has little effect on child development and that an alternative theory, de-emphasizing structural inputs, is needed.
Mortality of young adults in relation to single-parent family background
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An economic analysis of lone motherhood in Sweden
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Children and their families 1999: demographic reports
- Barn Och Deras Familjer
Barn och deras familjer 1999. Children and their families 1999:
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Social structure and children's life chances: an analysis of child mortality in Sweden Stockholm: Swedish Institute for Social Research
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- Hetherington