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Children's mental health and family functioning in Rhode Island.

Article Excerpt
AT LEAST 1 in 5 children in the United States has a mental health disorder, and 1 in 10 has a serious emotional disturbance. (1) These problems are a source of stress for the child, as well as the family, school, community, and larger society. (1-3)

It is important to understand the burden of children's mental health problems and their impact on family functioning to assess the needs and gaps in mental health services for children and their parents. (4,5) Previous research has shown that parents of children with mental or behavioral health problems experience higher levels of stress in their parenting roles. (6-9) Parents of these children have higher rates of mental health problems, as well as higher marital, employment, and financial problems. (10-15) In addition, parents of these children are less likely to be involved or have a close relationship with their children because of stressful life circumstances. (15)

In Rhode Island, studies have indicated that there are inadequate resources (eg, child psychiatrists) and fragmented systems of care in mental health services for children and their families. (16,17) However, there have been no population-based studies in the state that estimate the burden of children's mental health problems and its relationship with family functioning.

Our objectives were to (a) estimate the prevalence of children's mental health problems, (b) assess the level of family functioning, and (c) investigate the relationship between children's mental health and family functioning in Rhode Island. We hypothesized that parents of children with mental health problems would be more likely to have high stress levels and less likely to be involved with their children.

METHODS

Data

The 2003 National Survey of Children's Health's (NSCH) Rhode Island data were used for the analyses. The NSCH is a random-digit-dial telephone survey of a sample of parents with children <18 years of age from each of the 50 states and the District of Columbia, using a state-specific sampling frame. In Rhode Island, a total of 2019 interviews were completed, with the weighted overall response rate of 57.1%. Among them, children 6 to 17 years of age (N = 1326) were used for this study, because the measures of mental health status and family functioning for children <6 years of age were less reliable. Human subjects review was not required for this study. The survey design is described briefly in the article by Kogan and Newacheck in this issue (18); more in-depth information can be found elsewhere. (19)

Dependent Variables

Two aspects of family functioning were assessed: parental stress and parental involvement with their child.

Parental stress was measured by using the Aggravation in Parenting Scale (APS), which was derived from the Parenting Stress Index. (20) The APS is an index of stress in the parenting role measured by administering a 4-item sequence of questions that have been used in many other studies. (21-23) In accordance with previous studies, we used those 4 questions to measure the level of parental stress. The 4 questions were: "During the past month, how often have you felt [sample child] is much harder to care for than most children [his/her] age?"; "During the past month, how often have you felt [he/ she] does things that really bother you a lot?"; "During the past month, how often have you felt you are giving up more of your life to meet [sample child]'s needs than you ever expected?"; and "During the past month, how often have you felt angry with [him/her]?" Respondents were asked to choose 1 answer among 4 categories: never, sometimes, usually, or always. Following previous research, we summed respondents' answers to create scores ranging from 4 to 16: a score of [less than or equal to] 11 was defined as high parental stress. (21-23)

Parental involvement was measured by using 2 questions: "Is your relationship with [sample child] very dose, somewhat dose, not very dose, not close at all?"; and "How well can you and [sample child] share ideas or talk about things that really matter? Would you say very well, somewhat well, not very well, or not well at all?" Parents who reported "very dose" and "very well" to both questions were defined as having high parental involvement.

The...