The purpose of this study was to identify which domains of family functioning were associated with odds of internalizing versus externalizing mental health disorder, past-year health professional consultations, hospitalizations, and length of hospital stay in a sample of children with a mental health disorder. One hundred children aged 6–17 years who received mental health services (inpatient or outpatient) and their parents at a large clinical paediatric tertiary care centre in Ontario were recruited in this cross-sectional study. The final recruited and analyzed sample was children aged 8–17 years. Family functioning was measured using the McMaster Family Assessment Device (FAD), child mental health disorder using the Mini International Neuropsychiatric Interview, and mental health service use using items from the 2012 Canadian Community Health Survey (Mental Health). Higher scores on affective involvement and problem solving were associated with greater odds of major depressive disorder [OR = 2.12 (1.01, 4.43)] and social phobia [OR = 1.80 (1.09, 2.98)]. Reports of better communication were correlated with lower odds of generalized anxiety disorder [OR = 0.55 (0.35, 0.84)] and shorter length of stay in hospital [OR = 0.93 (0.89, 0.97)]. Higher scores on behaviour control were associated with lower odds of social phobia and oppositional defiant disorder [OR = 0.48 (0.27, 0.86) and OR = 0.52 (0.32, 0.84)], respectively. Future research should aim to gain an understanding of strategies that ameliorate family functioning to limit the impact and severity of childhood mental health conditions.
Affective involvement is correlated with major depressive disorder and social phobia.
Better communication is associated with shorter lengths of stay in hospital.
Family-based interventions that consider child mental health need to be examined.
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Aarthun, A., Øymar, K. A., & Akerjordet, K. (2019). Parental involvement in decision—making about their child’ s health care at the hospital. Nursing Open, 6(1), 50–58. https://doi.org/10.1002/nop2.180.
Babtisch, B., Gohl, D., & Von Lengerke, T. (2012). Re-revisiting andersen’s behavioural model of health services use: a systematic review of studies from 1998-2011. GMS Psycho-Social-Medicine, 9, 1–15. https://doi.org/10.1016/0005-2795(75)90146-4.
Boat, T., & Wu, T. (2015). Clinical characteristics of oppositional defiant disorder and conduct disorder. Washington: National Academies Press.
Bögels, S. M., & Brechman-toussaint, M. L. (2006). Family issues in child anxiety: attachment, family functioning, parental rearing and beliefs. Clinical Psychology Review, 26(7), 834–856. https://doi.org/10.1016/j.cpr.2005.08.001.
Branje, S. J. T., Iii, W. W. H., Frijns, T., & Meeus, W. H. J. (2010). Longitudinal associations between perceived parent-child relationship quality and depressive symptoms in adolescence. Journal of Abnormal Child Psychology, 38, 751–763. https://doi.org/10.1007/s10802-010-9401-6.
Brière, F. N., Archambault, K., & Janosz, M. (2013). Reciprocal prospective associations between depressive symptoms and perceived relationship with parents in early adolescence. Canadian Journal of Psychiatry, 58(3), 169–176. https://doi.org/10.1177/070674371305800307.
Buie, V. C., Owings, M. F., DeFrances, C. J., & Golosinskiy, A. (2010). National hospital discharge survey: 2006 annual summary. Vital Health Statistics, 168, 1–79.
Byles, J., Byrne, C., Boyle, M. H., & Offord, D. R. (1988). Ontario child health study: reliability and validity of the general functioning subscale of the mcmaster family assessment device. Family Process, 27(1), 97–104. https://doi.org/10.1111/j.1545-5300.1988.00097.x.
Canadian Mental Health Association. (2014). Child and youth—access to mental health promotion and mental health care. https://cmha.ca/documents/child-youth-accessmental-%0Dhealth-promotion-mental-health-care.
Clark, N. M., Gong, M., Schork, M. A., Kaciroti, N., Evans, D., Roloff, D., Hurwitz, M., Maiman, L. A., & Mellins, R. B. (2000). Long-term effects of asthma education for physicians on patient satisfaction and use of health services. European Respiratory Journal, 16, 15–21. https://doi.org/10.1034/j.1399-3003.2000.16a04.x.
Comeau, J., & Georgiades, K. (2019). Changes in the prevalence of child and youth mental disorders and perceived need for professional help between 1983 and 2014: evidence from the ontario child health study. The Canadian Journal of Psychiatry (La Revue Canadienne de Psychiatrie), 64(4), 256–264. https://doi.org/10.1177/0706743719830035.
Cumella, S., & Bellerby, T. (2001). Mental health problems and social supports among homeless mothers and children victims of domestic and community violence. International Journal of Social Psychiatry, 47(4), 30–40. https://doi.org/10.1177/002076400104700403.
Danforth, J. S. (2016). A flow chart of behavior management strategies for families of children with co-occurring attention-deficit hyperactivity disorder and conduct problem behavior. Behavioural Analysis Practice, 9, 64–76. https://doi.org/10.1007/s40617-016-0103-6.
DeLambo, K. E., Ievers-Landis, C. E., Drotar, D., & Quittner, A. L. (2004). Association of observed family relationship quality and problem-solving skills with treatment adherence in older children and adolescents with cystic fibrosis. Journal of Pediatric Psychology, 29(5), 343–353. https://doi.org/10.1093/jpepsy/jsh038.
Denboba, D., Mcpherson, M. G., Kenney, M. K., Strickland, B., & Newacheck, P. W. (2006). Achieving family and provider partnerships for children with special health care needs. Pediatrics, 118(4), 1607–1615. https://doi.org/10.1542/peds.2006-0383.
DiMatteo, M. R. (2004). Social support and patient adherence to medical treatment: a meta-analysis. Health Psychology, 23(2), 207–218. https://doi.org/10.1037/0278-622.214.171.124.
Dittman, C., Keown, L. J., Sanders, M., Rose, D., Farruggia, S. P., & Sofronoff, K. (2011). An epidemiological examination of parenting and family correlates of emotional problems in young children. American Journal of Orthopsychiatry, 81(3), 360–371. https://doi.org/10.1111/j.1939-0025.2011.01104.x.
Dmitrieva, J., Chen, C., Greenberger, E., & Gil-rivas, V. (2004). Family relationships and adolescent psychosocial outcomes: converging findings from eastern and western cultures. Journal of Research on Adolescence, 14(4), 425–447. https://doi.org/10.1111/j.1532-7795.2004.00081.x.
Douzenis, A., Seretis, D., Nika, S., Nikolaidou, P., Papadopoulou, A., Rizos, E. N., Christodoulou, C., Tsopelas, C., Mitchell, D., & Lykouras, L. (2012). Factors affecting hospital stay in psychiatric patients: the role of active comorbidity. BMC Health Services Research, 12(1), 1. https://doi.org/10.1186/1472-6963-12-166.
Duncan, L., Georgiades, K., Wang, L., Lieshout, R. J., Van, Macmillan, H. L., Ferro, M. A., Lipman, E. L., Szatmari, P., Bennett, K., Kata, A., Janus, M., Boyle, M. H., Lieshout, V., Psychometric, D., Duncan, L., Georgiades, K., Wang, L., Lieshout, R. J., Van, Macmillan, H. L., & Boyle, M. H. (2018). Psychometric evaluation of the mini international neuropsychiatric interview for children and adolescents (MINI-KID). Psychological Assessment, 30(7), 916–928. https://doi.org/10.1037/pas0000541.
Ferro, M. A., Lipman, E. L., Boyle, M. H., Gorter, J. W., MacMillan, H. L., Gonzalez, A., & Georgiades, K. (2019). Mental—physical multimorbidity in youth: associations with individual, family, and health service use outcomes. Child Psychiatry & Human Development, 50(3), 400–410. https://doi.org/10.1007/s10578-018-0848-y.
Flink, I. J. E., Beirens, T. M. J., Butte, D., & Raat, H. (2013). The role of maternal perceptions and ethnic background in the mental health help-seeking pathway of adolescent girls. Journal of Immigrant Minority Health, 15, 292–299. https://doi.org/10.1007/s10903-012-9621-7.
Gamble, K. L. M. W. C., & Taylor, A. R. (2007). Family emotional climate and sibling relationship quality: influences on behavioral problems and adaptation in preschool-aged children. Journal of Child and Family Studies, 16(1), 59–71. https://doi.org/10.1007/s10826-006-9068-3.
Georgiades, K., Duncan, L., Wang, L., Comeau, J., Boyle, M. H., & Child, O. (2019). Six-month prevalence of mental disorders and service contacts among children and youth in ontario: evidence from the 2014 ontario child health study. The Canadian Journal of Psychiatry (La Revue Canadienne de Psychiatrie), 64(4), 246–255. https://doi.org/10.1177/0706743719830024.
Glick, I. D., Stekoll, A. H., & Hays, S. (2011). The role of the family and improvement in treatment maintenance, adherence, and outcome for schizophrenia. Journal of Clinical Psychopharmacology, 31(1), 82–85. https://doi.org/10.1097/JCP.0b013e31820597fa.
Gronholm, P. C., Ford, T., Roberts, R. E., & Thornicroft, G. (2015). Mental health service use by young people: the role of caregiver characteristics. PLoS ONE, 10(3), 1–16. https://doi.org/10.1371/journal.pone.0120004.
Gruenberg, B. D. A., Shelton, W., Rose, S. L., & Rutter, A. E. (2006). Factors influencing length of stay in the intensive care unit. American Journal of Critical Care, 15(5), 502–509.
Hamilton, E., & Carr, A. (2016). Systematic review of self-report family assessment measures. Family Process, 55(1), 16–30. https://doi.org/10.1111/famp.12200.
Hutch, K. (1999). Family-centred care: a concept analysis. Journal of Advanced Nursing, 29(5), 1178–1187. https://doi.org/10.1046/j.1365-2648.1999.00987.x.
Jacobs, R., Gutacker, N., Mason, A., Goddard, M., Gravelle, H., Kendrick, T., & Gilbody, S. (2015). Determinants of hospital length of stay for people with serious mental illness in England and implications for payment systems: a regression analysis. BMC Health Services Research, 15(439), 1–16. https://doi.org/10.1186/s12913-015-1107-6.
Jona, C. M. H., Labuschagne, I., Mercieca, E. C., Fisher, F., Gluyas, C., Stout, J. C., & Andrews, S. C. (2017). Families affected by huntington’s disease report difficulties in communication, emotional Involvement, and problem solving. Journal of Huntington’s Disease, 6(3), 169–177. https://doi.org/10.3233/JHD-170250.
Kennedy, S. H. (2008). Core symptoms of major depressive disorder: relevance to diagnosis and treatment. Dialogues in Clinical Neuroscience, 10(3), 271–277.
Kim, H. H. K., Viner-brown, S. I., & Garcia, J. (2007). Children’s mental health and family functioning in rhode island. Pediatrics, 119, 22–28. https://doi.org/10.1542/peds.2006-2089E.
Kluczniok, D., Sc, M., Boedeker, K., Ph, D., Fuchs, A., Sc, M., Attar, C. H., Ph, D., Fydrich, T., Ph, D., Fuehrer, D., Sc, M., Dittrich, K., Sc, M., Reck, C., Ph, D., Winter, S., Heinz, A., Herpertz, S. C., & Bermpohl, F. (2015). Emotional availability in mother-child interaction: the effects of maternal depression in remission and additional history of childhood abuse. Depression and Anxiety, 10(November), 1–10. https://doi.org/10.1002/da.22462.
Koopmans, G. T., Sc, M., Donker, M. C. H., Ph, D., Rutten, F. H. H., & Ph, D. (2005). Length of hospital stay and health services use of medical inpatients with comorbid noncognitive mental disorders: a review of the literature. General Hospital Psychiatry, 27, 44–56. https://doi.org/10.1016/j.genhosppsych.2004.09.008.
Koutra, K., Triliva, S., Roumeliotaki, T., Basta, M., Simos, P., Lionis, C., & Vgontzas, A. N. (2015). Impaired family functioning in psychosis and its relevance to relapse: a two-year follow-up study. Comprehensive Psychiatry, 62, 1–12. https://doi.org/10.1016/j.comppsych.2015.06.006.
Lalayants, M., Kim, M., & Prince, J. D. (2017). Psychiatric hospitalization among adolescents. Journal of Behavioral Health Services and Research, 1–7. https://doi.org/10.1007/s11414-017-9567-6.
Lee, D., & Mclanahan, S. (2016). Family structure transitions and child development: instability, selection, and population heterogeneity. American Sociological Review, 80(4), 738–763. https://doi.org/10.1177/0003122415592129.Family.
Lemanek, K. L., Kamps, J., & Chung, N. B. (2001). Empirically supported treatments in pediatric psychology: regimen adherence. Journal of Pediatric Psychology, 26(5), 253–275. https://doi.org/10.1093/jpepsy/26.5.253.
Leucht, S., & Heres, S. (2006). Epidemiology, clinical consequences, and psychosocial treatment of nonadherence in schizophrenia. Journal of Clinical Psychiatry, 67(5), 3–8.
Liu, H., & Li, M. (2018). Factors influencing the willingness to participate in medical research: a nationwide survey in Taiwan. PeerJ, 6, 1–12. https://doi.org/10.7717/peerj.4874.
Marom, S., Munitz, H., & Jones, P. B. (2005). Expressed emotion: relevance to rehospitalization in schizophrenia over 7 years. Schizophrenia Bulletin, 31(3), 751–758. https://doi.org/10.1093/schbul/sbi016.
Mcbride, K. E., Solomon, M. J., Young, J. M., Steffens, D., Lambert, T. J., Glozier, N., & Bannon, P. G. (2018). Impact of serious mental illness on surgical patient outcomes. ANZ Journal of Surgery, 88, 673–677. https://doi.org/10.1111/ans.14508.
Miklowitz, D. J., Goldstein, M. J., Nuechterlein, K. H., Snyder, K. S., & Mintz, J. (1988). Family factors and the course of bipolar affective disorder. Archives of General Psychiatry, 45(3), 225. https://doi.org/10.1001/archpsyc.1988.01800270033004.
Moffitt, T. E., Caspi, A., Harrington, H., Milne, B. J., Goldberg, D., & Poulton, R. (2007). Generalized anxiety disorder and depression: childhood risk factors in a birth cohort followed to age 32. Psychological Medicine, 37(3), 441–452. https://doi.org/10.1017/S0033291706009640.
Moos, R., Schaefer, J., & Andrassy, J. (2001). Outpatient mental health care, self-help groups, and patients’ one-year treatment outcomes. Journal of Clinical Psychology, 57(152), 273–287. https://doi.org/10.1002/jclp.1011.
Murphy, Y. E., & Flessner, C. A. (2015). Family functioning in paediatric obsessive compulsive and related disorders. British Journal of Clinical Psychology, 54(4), 414–434. https://doi.org/10.1111/bjc.12088.
Owens, J. S., Beilstein, E. A., Murphy, C. E., & Vancouver, J. B. (2005). School-based mental health programming for children with inattentive and disruptive behavior problems: first-year treatment outcome. Journal of Attention Disorders, 9(1), 261–274. https://doi.org/10.1177/1087054705279299.
Peleg-popko, O., & Klingman, A. (2002). Family environment, discrepancies between perceived actual and desirable environment, and children’ s test and trait anxiety. British Journal of Guidance & Counselling, 30(4), 37–41. https://doi.org/10.1080/0306988021000025646.
Peris, T. (2015). Parental expressed emotion and youth psychopathology: new directions for an old construct. Child Psychiatry & Human Development, 46(6), 863–873. https://doi.org/10.1007/s10578-014-0526-7.Parental.
Pour, E. M., & Kasaei, F. (2013). Family functioning in children with attention-deficit/hyperactivity disorder. Procedia - Social and Behavioral Sciences, 84, 1864–1865. https://doi.org/10.1016/j.sbspro.2013.07.049.
Rao, P. A., & Beidel, D. C. (2009). The impact of children with high-functioning autism on parental stress, sibling adjustment, and family functioning. Behaviour Modification, 33(4), 437–451. https://doi.org/10.1177/0145445509336427.
Restifo, K., & Bögels, S. (2009). Family processes in the development of youth depression: translating the evidence to treatment. Clinical Psychology Review, 29(4), 294–316. https://doi.org/10.1016/j.cpr.2009.02.005.
Riper, M. V.(1999). Maternal perceptions of family—provider relationships and well-being in families of children with down syndrome. Research in Nursing & Health, 22, 357–368. https://doi.org/10.1002/(sici)1098-240x(199910)22:53.0.co;2-q.
Roman, N. V., Schenck, C., Ryan, J., Brey, F., Henderson, N., Lukelelo, N., Minnaar-McDonald, M., & Saville, V. (2016). Relational aspects of family functioning and family satisfaction with a sample of families in the Western Cape. Social Work (Maatskaplike Werk), 52(3), 303–312. https://doi.org/10.15270/52-2-511.
Sander, J. B., & McCarty, C. A. (2005). Youth depression in the family context: familial risk factors and models of treatment. Clinical Child and Family Psychology Review, 8(3), 203–219. https://doi.org/10.1007/s10567-005-6666-3.
Schroeder, V. M., & Kelley, M. L. (2009). Associations between family environment, parenting practices, and executive functioning of children with and without ADHD. Journal of Child and Family Studies, 18(2), 227–235. https://doi.org/10.1007/s10826-008-9223-0.
Sheehan, D. V., Sheehan, K. H., Shytle, R. D., Janavs, J., Bannon, Y., Rogers, J. E., Milo, K. M., Stock, S. L., & Wilkinson, B. (2010). Reliability and validity of the mini international neuropsychiatric interview for children and adolescents (MINI-KID). Journal of Clinical Psychiatry, 71(3), 313–326. https://doi.org/10.4088/JCP.09m05305whi.
Siegel, R., Hoeppner, B., Yen, S., & Stout, R. (2016). Longitudinal associations between interpersonal relationship functioning and mood episode severity in youth with bipolar disorder. Journal of Nervous and Mental Disease, 203(3), 194–204. https://doi.org/10.1097/NMD.0000000000000261.Longitudinal.
Staccini, L., Tomba, E., Grandi, S., & Keitner, G. I. (2015). The evaluation of family functioning by the family assessment device: a systematic review of studies in adult clinical populations. Family Process, 54(1), 94–115. https://doi.org/10.1111/famp.12098.
Stewart, S. L., Kam, C., & Baiden, P. (2014). Predicting length of stay and readmission for psychiatric inpatient youth admitted to adult mental health beds in Ontario, Canada. Child and Adolescent Mental Health, 19(2), 115–121. https://doi.org/10.1111/camh.12022.
Sullivan, A., Judd, C., Axelson, D., & Miklowitz, D. (2013). Family functioning and the course of adolescent bipolar disorder. Journal of Behavioural Therapy, 43(4), 837–847. https://doi.org/10.1016/j.beth.2012.04.005.Family.
Swahn, M. H., & Hayat, M. J. (2018). Association between neighborhood conditions and mental disorders among children in the US: evidence from the national survey of children’s health 2011/12. Psychiatry Journal, 1–9. https://doi.org/10.1155/2018/5914315.
Taddeo, D., Egedy, M., & Frappier, J. (2008). Adherence to treatment in adolescents. Paediatrics and Child Health, 13(1), 19–24.
Taylor, S. E., Lerner, J. S., Sage, R. M., Lehman, B. J., & Seeman, T. E. (2004). Early environment, emotions, responses to stress, and health. Journal of Personality, 72(6), 1366–1394. https://doi.org/10.1111/j.1467-6494.2004.00300.x.
Tully, L. A., Piotrowska, P. J., Collins, D. A. J., Mairet, K. S., Hawes, D. J., Kimonis, E. R., Lenroot, R. K., Moul, C., Anderson, V., Frick, P. J., & Dadds, M. R. (2017). Study protocol: evaluation of an online, father-inclusive, universal parenting intervention to reduce child externalising behaviours and improve parenting practices. BMC Psychology, 5(1), 1–11. https://doi.org/10.1186/s40359-017-0188-x.
Villatoro, A., & Aneshensel, C. (2015). Family influences on the use of mental health services among african americans. Journal of Health and Social Behavior, 55(2), 161–180. https://doi.org/10.1177/0022146514533348.Family.
Wang, X., Chen, Q., & Yang, M. (2017). Effect of caregivers’ expressed emotion on the care burden and rehospitalization rate of schizophrenia. Patient Preference and Adherence, 11, 1505–1511. https://doi.org/10.2147/PPA.S143873.
Waring, J., Marshall, F., Bishop, S., Sahota, O., Walker, M., Currie, G., Fisher, R., & Avery, T. (2014). An ethnographic study of knowledge sharing across the boundaries between care processes, services and organisations: the contributions to “safe” hospital discharge. Health Services and Delivery Research, 2(29), 5–14. https://doi.org/10.3310/hsdr02290.
Weiden, P. J., Kozma, C., Grogg, A., & Locklear, J. (2004). Partial compliance and risk of rehospitalization among california medicaid patients with schizophrenia. Psychiatric Services, 55(8), 886–891. https://doi.org/10.1176/appi.ps.55.8.886.
Woo, S. M., Goldstein, M. J., & Nuechterlein, K. H. (2004). Relatives’ affective style and the expression of subclinical psychopathology in patients with schizophrenia. Family Process, 43(2), 233–247. https://doi.org/10.1111/j.1545-5300.2004.04302008.x.
Woodall, A., Morgan, C., Sloan, C., & Howard, L. (2010). Barriers to participation in mental health research: are there specific gender, ethnicity and age related barriers? BMC Psychiatry, 10(1), 103. https://doi.org/10.1186/1471-244X-10-103.
Ygge, B. M., & Arnetz, J. E. (2004). A study of parental involvement in pediatric hospital care: implications for clinical practice. Journal of Pediatric Nursing, 19(3), 217–223. https://doi.org/10.1016/j.pedn.2004.02.005.
Yu, Y., Yang, X., Yang, Y., Chen, L., Qiu, X., Qiao, Z., Zhou, J., Pan, H., Ban, B., Zhu, X., He, J., Ding, Y., & Bai, B. (2015). The role of family environment in depressive symptoms among university students: a large sample survey in china. PLoS ONE, 10(12), 1–13. https://doi.org/10.1371/journal.pone.0143612.
Zhang, J., Harvey, C., & Andrew, C. (2011). Factors associated with length of stay and the risk of readmission in an acute psychiatric inpatient facility: a retrospective study. Australian & New Zealand Journal of Psychiatry, 45, 578–585. https://doi.org/10.3109/00048674.2011.585452.
Zimmerman, M., Morgan, T. A., & Stanton, K. (2018). The severity of psychiatric disorders. World Psychiatry, 17, 258–275. https://doi.org/10.1002/wps.20569.
The authors gratefully acknowledge the children, parents and health professionals and their staff without whose participation this study would not have been possible. We especially thank Jessica Zelman for coordinating the study.
This research was supported by Hamilton Health Sciences (Grant No. NIF-14363). I.I.O. is supported by funds from the Early Researcher Award from the Ministry of Research, Innovation and Science awarded to M.A.F. M.A.F. holds the Canada Research Chair in Youth Mental Health.
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The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Oltean, I.I., Perlman, C., Meyer, S. et al. Child Mental Illness and Mental Health Service Use: Role of Family Functioning (Family Functioning and Child Mental Health). J Child Fam Stud 29, 2602–2613 (2020). https://doi.org/10.1007/s10826-020-01784-4
- Child mental health disorder
- Mental health service use
- Mental health service access
- Family-centred care
- Family functioning