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Child Mental Illness and Mental Health Service Use: Role of Family Functioning (Family Functioning and Child Mental Health)

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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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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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I.I.O.: conducted the data analysis and wrote the initial manuscript. C.P. and S.M.: provided guidance on analyses and edited the paper for intellectual content. M.A.F.: designed and executed the study, collaborated in the writing of the paper, and edited the paper for intellectual content.

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Correspondence to Irina I. Oltean.

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The authors declare that they have no conflict of interest.

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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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Informed consent was obtained from all individual participants included in the study.

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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).

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