Abstract
BackgroundMental health problems are an important issue among institutionalized children. Although positive communication with parents is essential for children’s well-being, it has not been sufficiently verified how interactions with parents affect mental health among institutionalized children, who have experienced childhood adversity and likely lack secure attachment formation with their parents. The objectives of this study were to investigate the association between parental visitation and depressive symptoms among institutionalized children in Japan, and to explore whether the established security of attachment interacts with that association.MethodsA cross-sectional data from 399 institutionalized children aged 9 to 18 in Japan was used for the analysis. A mixed effects regression analysis was conducted to investigate the associations.ResultsInstitutionalized children who had parental visitation showed higher depressive symptoms than those who did not. In particular, father’s visitations were significantly associated with higher depressive symptoms. There was a significant interaction with score of secure attachment; children with low scores on secure attachment showed higher levels of depression with their father’s visitation, whereas children with high scores on secure attachment did not.ConclusionsFindings suggested that parental visitation and the frequency of visitation were not actually associated with better psychological status, but that instead, father’s visitations were associated with higher depressive symptoms among institutionalized children. It should be noted that our cross-sectional results cannot infer any causal relationship and do not emphasize that parental visitation should be avoided. However, it may be important to conduct careful assessment before starting parental visitation, especially when children seem to have problems with attachment formation.
Highlights
Mental health problems are an important issue among institutionalized children
Yazawa et al BMC Psychiatry (2019) 19:129 In Japan, nearly 30,000 children were living in alternative care because their parents were either unable or unwilling to care for them properly as of 2015; nearly 60% of these children had a history of maltreatment [13], and over 80% of them were placed in institutions while the rest received care from foster parents, which is higher compared to other developed countries such as the U.S (8%) [14, 15]
Since institutionalization is still common in the Japanese child welfare system, where nearly 50 children may live in the same facility [16], Japan has received recommendations to enhance alternative care, such as foster parents and family reunification, from the United Nations Committee on the Rights of the Child [17]
Summary
Mental health problems are an important issue among institutionalized children. positive communication with parents is essential for children’s well-being, it has not been sufficiently verified how interactions with parents affect mental health among institutionalized children, who have experienced childhood adversity and likely lack secure attachment formation with their parents. Research has shown that mental health problems, such as social problems, internalizing and externalizing problems, and depression [1,2,3,4,5,6], are more frequently observed among children in out-of-home care, especially in child care institutions, than children in typical home care. This could be because most of them experienced stressful events in their original household, such as Yazawa et al BMC Psychiatry (2019) 19:129. It was shown that 56% of adolescents in foster care recognized that contact with their parents was unhelpful for them [28], and children who established good relationships with both biological parents and foster parents were more likely to have loyalty conflicts [29]
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