Skip to main content

Advertisement

SpringerLink
Log in

Association of Adverse Family Experiences with School Engagement and Performance in US Adolescents: Do Behavioral Health Conditions Mediate the Relationship?

  • Original Paper
  • Published:
Psychiatric Quarterly Aims and scope Submit manuscript

Abstract

To examine the prevalence of adverse family experiences (AFEs), their association with poor school engagement and performance, and whether behavioral health conditions mediate the association among US adolescents. We conducted a cross-sectional analysis of data from adolescents aged 12–17 years from the 2016–2018 National Survey of Children’s Health (n = 41,648 unweighted). We first estimated the prevalence of AFEs, investigated the association of AFEs with school engagement and performance, and whether behavioral health conditions mediate such relationships, using multivariable-adjusted Poisson regression models. A mediation analysis was used and covariates included socio-demographic characteristics and co-morbid medical conditions. A total of 52.9% of US adolescents (nationally representative of 12.9 million adolescents nationwide) reported experiencing at least one form of AFE, the most common of which included parental divorce/separation (33.1%), economic hardship (22.0%) and living with a person with substance misuse problems (11.5%). Adolescents with ≥4 AFEs had poorer outcomes in school engagement and performance (p < 0.001 each) when compared to those with no AFEs. Behavioral health conditions (e.g., anxiety, depression, and conduct problems) partially mediated these relationships (p < 0.01 each). The indirect effect of behavioral health conditions accounted for 20.4% of the total effect in the association between AFEs and school performance (p < 0.001). AFEs are common among US adolescents, and cumulative AFEs are associated with behavioral health conditions, which may in turn reduce school engagement and performance. While reducing AFEs is important in children and adolescents, addressing potentially resultant behavioral health conditions is equally important in improving school engagement and performance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Garrido EF, Weiler LM, Taussig HN. Adverse Childhood Experiences and Health-Risk Behaviors in Vulnerable Early Adolescents. J Early Adolesc. 2017;38(5):661–80. https://doi.org/10.1177/0272431616687671.

    Article  PubMed  PubMed Central  Google Scholar 

  2. World Health Organization. Adolescent mental health. World Health Organization Web site. Published October 23, 2019. Updated 2019. https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health. Accessed 10 September 2020.

  3. Centers for Disease Control and Prevention. Adverse Childhood Experiences (ACEs): Preventing early trauma to improve adult health. Vital Signs. 2019:1–2.

  4. Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the adverse childhood experiences (ACE) study. Am J Prev Med. 1998;14(4):245–58. https://doi.org/10.1016/S0749-3797(98)00017-8.

    Article  CAS  PubMed  Google Scholar 

  5. Bellis MA, Hughes K, Leckenby N, Jones L, Baban A, Kachaeva M, et al. Adverse childhood experiences and associations with health-harming behaviours in young adults: surveys in eight eastern European countries. Bull World Health Organ. 2014;92(9):641–55. https://doi.org/10.2471/blt.13.129247.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Campbell JA, Walker RJ, Egede LE. Associations Between Adverse Childhood Experiences, High-Risk Behaviors, and Morbidity in Adulthood. Am J Prev Med. 2016;50(3):344–52. https://doi.org/10.1016/j.amepre.2015.07.022.

    Article  PubMed  Google Scholar 

  7. U.S. Department of Health and Human Services, Health Resources and Services Administration. Children with Special Health Care Needs in Context: A Portrait of States and the Nation 2007. U.S. Department of Health and Human Services Web site. Published September, 2011 https://mchb.hrsa.gov/nsch/07cshcn/national/3csc/1sfc/pages/01sea.html. Accessed 5 September 2020.

  8. Crouch E, Radcliff E, Hung P, Bennett K. Challenges to school success and the role of adverse childhood experiences. Acad Pediatr. 2019;19(8):899–907. https://doi.org/10.1016/j.acap.2019.08.006.

    Article  PubMed  Google Scholar 

  9. Duke NN. Adolescent adversity, school attendance and academic achievement: school connection and the potential for mitigating risk. J Sch Health. 2020;90(8):618–29. https://doi.org/10.1111/josh.12910.

    Article  PubMed  Google Scholar 

  10. Bellis MA, Hughes K, Ford K, Hardcastle KA, Sharp CA, Wood S, et al. Adverse childhood experiences and sources of childhood resilience: a retrospective study of their combined relationships with child health and educational attendance. BMC Public Health. 2018;18(1):792–12. https://doi.org/10.1186/s12889-018-5699-8.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Fornander MJ, Kearney CA. Internalizing Symptoms as Predictors of School Absenteeism Severity at Multiple Levels: Ensemble and Classification and Regression Tree Analysis. Front Psychol. 2020;10:3079. https://doi.org/10.3389/fpsyg.2019.03079.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Pedersen ML, Holen S, Lydersen S, Martinsen K, Neumer SP, Adolfsen F, et al. School functioning and internalizing problems in young schoolchildren. BMC Psychol. 2019;7:88. https://doi.org/10.1186/s40359-019-0365-1.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Schulte-Körne G. Mental health problems in a school setting in children and adolescents. Dtsch Arztebl Int. 2016;113(11):183–90. https://doi.org/10.3238/arztebl.2016.0183.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Fava NM, Trucco EM, Martz ME, et al. Childhood adversity, externalizing behavior, and substance use in adolescence: Mediating effects of anterior cingulate cortex activation during inhibitory errors. Dev Psychopathol. 2019;31(4):1439–50. https://doi.org/10.1017/S0954579418001025.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Hughes K, Bellis MA, Sethi D, Andrew R, Yon Y, Wood S, et al. Adverse childhood experiences, childhood relationships and associated substance use and mental health in young Europeans. Eur J Pub Health. 2019;29(4):741–7. https://doi.org/10.1093/eurpub/ckz037.

    Article  Google Scholar 

  16. Child and Adolescent Health Measurement Initiative. National Survey of Children’s Health. Data Resource Center for Child and Adolescent Health, supported by Cooperative Agreement U59MC27866 from the U.S. Department of Health and Human Services, Health Resources and Services Administration’s Maternal and Child Health Bureau (HRSA MCHB). Web site. Updated 2019 www.childhealthdata.org. Accessed October 5, 2020.

  17. Health Resources and Services Administration. National Survey of Children's Health. U.S. Department of Health and Human Services Web site. Updated 2020 https://mchb.hrsa.gov/data/national-surveys. Accessed 5 October 2020.

  18. Bethell C. Methods to Assess Adverse Childhood Experiences of Children and Families: Towards Resilience and Well-Being Based Approaches in Policy and Practice. Child and Adolescent Health Measurement Initiative Web site. Updated 2015 https://www.cahmi.org/wp-content/uploads/2015/01/ACEs-Measurement-paper-Technical-Appendix.pdf. Accessed 5 October 2020.

  19. Bethell CD, Carle A, Hudziak J, Gombojav N, Powers K, Wade R, et al. Methods to assess adverse childhood experiences of children and families: toward approaches to promote child well-being in policy and practice. Acad Pediatr. 2017;17(7S):S51–69. https://doi.org/10.1016/j.acap.2017.04.161.

    Article  PubMed  PubMed Central  Google Scholar 

  20. United States Census Bureau. National Survey of Children's Health (NSCH): codebooks, variable lists, and frequencies. United States Census Bureau Web site https://www.census.gov/programs-surveys/nsch/technical-documentation/codebooks.html. Accessed 5 October 2020.

  21. Bethell CD, Newacheck P, Hawes E, Halfon N. Adverse childhood experiences: assessing the impact on health and school engagement and the mitigating role of resilience. Health Aff. 2014;33(12):2106–15.

    Article  Google Scholar 

  22. Hicks R, Tingley D. Causal mediation analysis. The Stata J. 2011;11(4):605–19.

    Article  Google Scholar 

  23. Imai K, Keele L, Tingley D. A general approach to causal mediation analysis. Psychol Methods. 2010;15:309–34.

    Article  PubMed  Google Scholar 

  24. Imai K, Keele L, Tingley D, Yamamoto T. Unpacking the black box of causality: learning about causal mechanisms from experimental and observational studies. Am Polit Sci Rev. 2011;105(4):765–89.

    Article  Google Scholar 

  25. Imai K, Keele L, Tingley D, Yamamoto T. Identification, inference, and sensitivity analysis for causal mediation effects. Stat Sci. 2010;25(1):51–71.

    Article  Google Scholar 

  26. Heerman WJ, Krishnaswami S, Barkin SL, McPheeters M. Adverse family experiences during childhood and adolescent obesity. Obesity (Silver Spring). 2016;24(3):696–702. https://doi.org/10.1002/oby.21413.

    Article  Google Scholar 

  27. Bethell C. Issue Brief: Adverse Childhood Experiences Among US Children. Child and Adolescent Health Measurement Initiative, Johns Hopkins Bloomberg School of Public Health Web site. Published October 01 2017 https://www.cahmi.org/wpcontent/uploads/2018/05/aces_fact_sheet.pdf. Accessed 26 September 2020.

  28. Kasehagen L, Omland L, Bailey M, Biss C, Holmes B, Kelso PT. Relationship of adverse family experiences to resilience and school engagement among Vermont youth. Matern Child Health J. 2018;22(3):298–307. https://doi.org/10.1007/s10995-017-2367-z.

    Article  PubMed  Google Scholar 

  29. Neppl TK, Senia JM, Donnellan MB. Effects of economic hardship: testing the family stress model over time. J Fam Psychol. 2016;30(1):12–21. https://doi.org/10.1037/fam0000168.

    Article  PubMed  Google Scholar 

  30. Agnafors S, Barmark M, Sydsjö G. Mental health and academic performance: a study on selection and causation effects from childhood to early adulthood. Soc Psychiatry Psychiatr Epidemiol. 2020. https://doi.org/10.1007/s00127-020-01934-5.

Download references

Author information

Authors and Affiliations

  1. Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, 06030, USA

    Adekemi O. Suleiman, Amy A. Hunter & Taeho Greg Rhee

  2. Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT, USA

    Damion J. Grasso

  3. Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA

    Robert A. Rosenheck & Taeho Greg Rhee

  4. VA New England Mental Illness, Research, Education and Clinical Center (MIRECC), VA Connecticut Healthcare System, West Haven, CT, USA

    Robert A. Rosenheck & Taeho Greg Rhee

Authors
  1. Adekemi O. Suleiman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Damion J. Grasso
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Amy A. Hunter
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Robert A. Rosenheck
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Taeho Greg Rhee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Taeho Greg Rhee.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendix

Appendix

Table 5 Validated measures of adverse family experiences (AFEs)
Full size table

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Suleiman, A.O., Grasso, D.J., Hunter, A.A. et al. Association of Adverse Family Experiences with School Engagement and Performance in US Adolescents: Do Behavioral Health Conditions Mediate the Relationship?. Psychiatr Q 92, 1201–1215 (2021). https://doi.org/10.1007/s11126-021-09900-3

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11126-021-09900-3

Keywords

Search

Navigation