Abstract
Poor school-functioning can be indicative of parent and adolescent mental health and adolescent behavior problems. This study examined 472 adolescents enrolled in the World Trade Center (WTC) Health Registry, with a two-step path analysis, using regression-based models, to unravel the relationships between parent and adolescent mental health, adolescent behavior problems, and adolescent unmet healthcare need (UHCN) on the outcome school-functioning. WTC exposure was associated with UHCN and parental mental health was a significant mediator. There was no evidence that family WTC exposure was associated with UHCN independent of its effect on parental mental health. For the second path, after accounting for the effects of adolescent mental health, behavioral problems, and UHCN, there remained a significant association between parental mental health and school-functioning. Interventions for poor school-functioning should have multiple components which address UHCN, mental health, and behavioral problems, as efforts to address any of these alone may not be sufficient.
Highlights
The terrorist attack on the World Trade Center (WTC) in New York City on September 11, 2001 (9/11) has had long-term mental and physical health consequences[1,2,3,4]
Studies of adult survivors enrolled in the World Trade Center Health Registry (Registry) showed that 9/11 exposure was associated with unmet healthcare need (UHCN) [5, 8], but corresponding studies of unmet healthcare needs among 9/11-exposed children are limited
There was no evidence that family WTC exposure was associated with adolescent UHCN independent of its effect on parental non-specific psychological distress (NPD) (c’ = 0.05, SE = 0.03, p = 0.17)
Summary
The terrorist attack on the World Trade Center (WTC) in New York City on September 11, 2001 (9/11) has had long-term mental and physical health consequences[1,2,3,4]. Studies of adult survivors enrolled in the World Trade Center Health Registry (Registry) showed that 9/11 exposure was associated with unmet healthcare need (UHCN) [5, 8], but corresponding studies of unmet healthcare needs among 9/11-exposed children are limited. Parental 9/11-related psychopathology was associated with child behavior problems. Parental psychopathology, including depression and anxiety, has been shown to be a predictor of UHCN in children [11, 12, suggesting a potential relationship between 9/11 exposure, parental mental health, and adolescent unmet healthcare needs. If emotional and behavioral problems of adolescents are left untreated, they may result in ongoing and lifelong psychological, social, and economic problems for the adolescent, families, and society [13]
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