Rates of Mental Health Problems Among U.S. Children Based on Relational and Social Risks

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Rates of Mental Health Problems Among U.S. Children Based on Relational and Social Risks

Jim Windell

             Children who face relational and social risk factors are more likely to have mental, emotional and behavioral health problems. But the extent of the negative impact of these problems on resilience, self-regulation and school engagement can be mitigated by certain protective factors.

            The protective factors which help offset problems for kids include a strong parent-child connection and family resilience.

            So says a new study led by researchers at Johns Hopkins Bloomberg School of Public Health. The findings of the study appear in Child and Adolescent Psychiatric Clinics of North America and come about as the U.S. struggles with a crisis in children’s mental health exacerbated by the pandemic.     

           Study leader Christina Bethell, Ph.D., MPH, MBA, professor in the Department of Population, Family and Reproductive Health and director of the Child and Adolescent Health Measurement Initiative at the Bloomberg School, and her team gathered data from the National Survey of Children’s Health, an annual survey led by the U.S. Health Resources and Services Administration’s Maternal and Child Health Bureau in collaboration with the U.S. Bureau of the Census. The survey, administered to thousands of parents and caregivers each year, covered nearly 132,000 children ages 3 to 17, and the intent was to examine the complex interplay between common mental health problems among children, social and relational health risks, and protective factors. 

           Bethell and her colleagues found that children who were facing relational risks only, such as substance abuse among family members, were more likely to have mental, emotional, or behavioral concerns than those who were only facing social risks, such as economic hardship.

           Previous research suggests that both social and relational health risks contribute to mental, emotional, and behavioral health problems in children. However, much of the prior research has focused on individual social and relational health risks. This new study investigated both the individual and combined effects of these factors on U.S. children.

           The study found that over two-thirds of children with mental health conditions experienced at least one of the eight evidence-based social or relational health risk factors examined in the analysis compared to about half of children without mental health conditions. Those social and relational health risk factors included economic hardship, food insecurity, unsafe neighborhood, racial discrimination, multiple Adverse Childhood Experiences (ACEs) like substance abuse or domestic violence, poor caregiver mental health, and low levels of caregiver coping or high aggravation with their child.

           As it turned out, relational—versus social health risks—were both more prevalent among children with mental health problems and had a stronger association with these conditions. Nearly one-third of children with mental health problems experienced both types of risks.

           The research found that the chances a child was engaged in school were 77 percent less if they lacked self-regulation. Offering hope, the chances a child with mental health problems demonstrated good self-regulation—a key component of resilience—were 5.73 times greater when children also experienced stronger parent-child connection. These odds were over 2.25 times greater when their family reported staying hopeful and could identify strengths to draw on during difficult times. Findings were consistent across all levels of social and relational health risks.

           Bethell notes that both parent-child connection and family resilience are learned behaviors that can be strengthened through supports to families and skills building. She pointed out that the American Academy of Pediatrics recommend promoting these factors during routine well-child check-ups, through schools, in mental health treatment, and in the community at large. According to study co-author Tamar Mendelson, Ph.D., M.A., a Bloomberg Professor of American Health in the Bloomberg School’s Department of Mental Health, “There is a mental, emotional, and behavioral health crisis for children in our country, but most children with these conditions have risk factors that we can identify and do something about. Ultimately, we need to address the structural and systemic issues that threaten young people’s well-being; at the same time, there is a lot we can be doing to decrease risk factors for families.”

           And Bethell adds, “If we treat children with mental, emotional, and behavioral problems without individually and collectively addressing social and relational health risks, or even assessing them, which is often the case, we are missing some of the biggest factors driving the mental and emotional suffering of our children.”

           Find and read the original article with this reference:

Bethell, C. D., Garner, A. S., Gombojav, N., Blackwell, C., Heller, L., & Mendelson, T. (2022). Social and Relational Health Risks and Common Mental Health Problems Among US Children: The Mitigating Role of Family Resilience and Connection to Promote Positive Socioemotional and School-Related Outcomes. Child and adolescent psychiatric clinics of North America, 31(1), 45–70. https://doi.org/10.1016/j.chc.2021.08.001

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