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Mental Health of Parents and Primary Caregivers by Sex and Associated Child Health Indicators


Poor mental health among parents or primary caregivers is associated with poor mental and physical health in children; however, research often excludes the mental health of male caregivers including fathers. This analysis examines associations between caregiver mental health by caregiver sex and child health indicators (i.e., child’s general health; child’s history of diagnosed mental, behavioral, or developmental disorders (MBDDs)). Using parent-reported data on 97,728 US children aged 0–17 years from the National Survey of Children’s Health (2016–2018), we estimated nationally representative, weighted proportions of children with parents or primary caregivers with poor mental health by caregiver sex, prevalence ratios (PR), and 95% confidence intervals (CI) for child health indicators by caregiver mental health and sex. Nationally, 7.2% of children had at least one caregiver with poor mental health; 2.8% had any male caregiver; and 5.1% had any female caregiver with poor mental health. Compared to children with all male caregivers with good mental health, children with any male caregiver with poor mental health were more likely to have poor general health (PR: 4.9, CI: 3.0–8.0) and have ≥1 diagnosed MBDDs (PR: 1.9, CI: 1.7–2.1); this remained significant when controlling for caregiver and household characteristics. Findings were similar when comparing children with any female caregiver with poor mental health to children with all female caregivers with good mental health. Our findings support previously published recommendations that promoting mental health among all types of caregivers by addressing gaps in research on fathers and male caregivers may further promote child health and wellness.

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Availability of Data and Material

Data is publicly available at US Census Bureau’s National Survey of Children’s Health (NSCH)

Code Availability

We conducted weighted analyses in SAS-callable SUDAAN® version 9.4 (RTI International; Cary, NC). Please contact Sara Beth Wolicki (, lead analyst, with any questions.


This research was supported in part by an appointment to the Research Participation Program at the Centers for Disease Control and Prevention administered by the Oak Ridge Institute for Science and Education through an interagency agreement between the US Department of Energy and CDC.

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Authors and Affiliations



Sara Beth Wolicki, MPH, CPH: Conceptualization, methodology, formal analysis, writing—original draft and review/editing, visualization, project administration

Rebecca H. Bitsko, PhD: Conceptualization, methodology, writing—original draft and review/editing, supervision

Robyn A. Cree, PhD: Conceptualization, methodology, writing—original draft and review/editing, validation

Melissa L. Danielson, MSPH: Conceptualization, methodology, writing—review/editing, validation

Jean Y. Ko, PhD: Writing—review/editing

Lee Warner, PhD: Writing—review/editing

Lara R. Robinson, PhD, MPH: Conceptualization, methodology, writing—review/editing, supervision

Corresponding author

Correspondence to Sara Beth Wolicki.

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Conflict of Interest

The authors declare no competing interests.


The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

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Wolicki, S.B., Bitsko, R.H., Cree, R.A. et al. Mental Health of Parents and Primary Caregivers by Sex and Associated Child Health Indicators. ADV RES SCI 2, 125–139 (2021).

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  • Child mental disorders
  • Family health
  • Fathers
  • Men’s health
  • Parent-child relations
  • Women’s health