Parental Aggravation Research Articles

Predicting Emotional Well-Being in Caregivers of Children with More Complex Special Healthcare Needs

ObjectiveIdentify factors associated with reduced emotional well-being (EWB) among family caregivers of children with more complex special health care needs (SHCN). MethodsWe applied gradient boosted trees (GBTs) to the 2016-2021 National Survey of Children’s Health to identify factors associated with questions assessing (1) global mental health, (2) parental coping, and (3) parental aggravation among family caregivers of children with more complex SHCN. We then conducted adjusted logistic regression and post-hoc margins analyses to describe the relationships between GBT-identified factors and caregiver EWB outcomes. ResultsOur GBT models’ area under the curve (AUC) scores ranged from 0.69-0.77. Among our sample, (1) caregiver reported lack of emotional support, (2) increased levels of frustration and effort in getting their child needed health services, and (3) the presence of child emotional and behavioral conditions were factors associated with reduced caregiver EWB. In margins analyses of adjusted regression models, GBT-identified factors were associated with significantly higher likelihoods of adverse caregiver EWB outcomes. For example, compared to caregivers who reported a source of emotional support, the predicted probabilities of experiencing poor/fair mental health (13.7% vs. 7.8%), reduced parental coping (8.0% vs. 2.1%), and frequently feeling bothered by (9.9% vs. 5.4%) and angry with (3.5% vs. 1.5%) their child were higher among caregivers who lacked emotional support. ConclusionIn addition to enhanced care coordination support, future efforts aiming to improve well-being among family caregivers of children with more complex SHCN could consider targeting caregiver emotional support and/or treatment of child emotional and behavioral conditions.

Parental Aggravation, Parenting Behaviors, Child Self-Control and Externalizing Problems in Singapore: Evidence from a Nationally Representative Sample

Parental Aggravation, Parenting Behaviors, Child Self-Control and Externalizing Problems in Singapore: Evidence from a Nationally Representative Sample

Family Functioning and Unmet Mental Health Needs among School-Aged Youth

Background: Unmet mental health needs can lead to worsening outcomes in youth. Given that youth depend on family for access to mental health services, and positive family functioning is associated with improved health outcomes, understanding the association between family-level factors and youth’s unmet mental health needs is essential to inform inclusive solutions. Objective: This study aimed to examine the association between family functioning (parental aggravation, parent-child communication, family resilience) and unmet mental health needs among school-aged youth. Methods: A cross-sectional analysis of the combined 2019-2020 National Survey on Children’s Health (NSDH) dataset was performed (n=9,204). Bivariate and multivariate logistic regression models were used to examine the association between unmet mental health needs (primary outcome) and family functioning using three explanatory variables, parental aggravation, parent-child communication, and family resilience. We also examined age-related differences in these associations between children aged 6-11 and adolescents aged 12-17. Results: The weighted proportion of youth with reported unmet mental health needs was 18%. Weighted unadjusted analyses showed that low family resilience was associated with 60% higher odds of unmet mental health needs, while parental aggravation and poor parentchild communication were not associated with unmet mental health needs. After adjusting for potential confounders, low family resilience was associated with 50% higher odds of unmet mental health needs among school-aged youth (AOR=1.54, 95% CI: 1.15-2.07). Being Black (AOR=2.28, 95% CI: 1.41-3.69), younger (AOR=0.95, 95% CI: 0.91-0.99), lacking consistent health insurance (AOR=2.64, 95% CI: 1.59-4.38), and having a mother with poor maternal health (AOR=1.82, 95% CI: 1.36-2.46), were also associated with unmet mental health needs. Among children aged 6-11 years, low family resilience, being Black, lacking consistent insurance, and having a mother with poor maternal health were associated with unmet mental health needs (all p’s<0.05). Similarly, among adolescents aged 12-17 years, low family resilience, being Black, lacking consistent insurance, and having a mother with poor maternal health were associated with unmet mental health needs (all p<0.05). Having a parent with a college education was associated with lower odds of unmet mental health needs among children (6-11 years), but not adolescents (12-17 years). Conclusion: Our findings have suggested an association between low family resilience and unmet mental health needs among school-aged youth. Since families are an integral part of meeting youth’s needs, applying approaches to addressing unmet mental health needs that consider family resilience and parental well-being is imperative. Identifying and addressing factors contributing to unmet health needs barriers may help address existing racial disparities.

Disentangling the impact of poverty threshold and material hardship on child maltreatment: a mediating role of parenting aggravation

ABSTRACT To examine the role of subjective and objective poverty in relation to child maltreatment through parenting aggravation, the current study selected the biological mothers in wave 5 of the Future of Families & Child Wellbeing Study. The results showed that material hardship was consistently associated with all the child maltreatment outcomes through parenting aggravation, while only certain poverty threshold categories were related to physical abuse, neglect, and ever CPS involvement. Caregivers whose income is above 200% but experiencing more material hardship and those whose income is below 200% and experiencing more material hardship, showed a higher likelihood of child maltreatment.

Parenting Stress, Community Support, and Unmet Health Care Needs of Children in the US.

In 2018, approximately 2.3million children in the United States had unmet healthcare needs (UHCN). To date, studies examining associations between UHCN and parent stress and support have had limited generalizability. This study aimed to investigate the relationship between children's UHCN and parenting stress and support using a nationally representative sample. Additionally, this study aimed to assess associations between unmet mental health needs and these parental well-being measures. Households with children ages 0-17 and complete data on UHCN in the combined 2016, 2017, 2018, and 2019 cohorts of the National Survey of Children's Health (NSCH) met inclusion criteria. Logistic regressions were used to evaluate associations between overall UHCN and outcome measures of parental coping, aggravation, emotional support, and neighborhood support. Associations between mental UHCN and these outcome measures were analyzed in a subset limited to children with mental health conditions. Regressions were adjusted for potential confounders, including demographics, household income, medical home status, and health insurance (adequacy/type). In our sample of 131,299 children, overall UHCN were associated with poorer parental coping (aOR = 5.35, 95% CI: [3.60, 7.95]), greater parental aggravation (aOR = 3.35, 95% CI: [2.73, 4.12]), and non-supportive neighborhood (aOR = 2.22, 95% CI: [1.86, 2.65]). Mental UHCN were similarly associated with parental coping and aggravation and neighborhood support in the mental health subset. Healthcare professionals must address the needs of children with UHCN and collaborate with community organizations and child advocates to promote coordinated and comprehensive care and adequately support caregivers.

The role of parental aggravation in the intergenerational transmission of depression across different family structures

AbstractThis study examined the role of parental aggravation in the pathway from maternal depression to child depression in different family structures. While studies have extensively examined the transmission of maternal depressive symptoms to children, there is still a limited emphasis on potential contributors, such as parental aggravation. Meanwhile, cohabiting and single‐parent families are more vulnerable to multiple risk factors than married families. Using a large national longitudinal dataset, this study examined the indirect effect of parental aggravation on the association between maternal depression and child depression among married, cohabiting and single‐mother families. Secondary data analysis was performed using multigroup mediation analysis on three waves from the Future of Families and Child Wellbeing Studies (n = 3 117). The study results show that only in cohabiting households did maternal depression have a direct association with child depression. Furthermore, in married, cohabiting and single‐mother families, parental aggravation had indirect effects on the association between maternal depression and child depression. Implications for social work professionals to address the mental health of parents and children from non‐traditional families are discussed.

Mediation of Parental Aggravation in the Association Between ADHD Severity and Electronic Media Use: A National Survey of Children’s Health Study

Objective: To determine whether the association between ADHD severity and electronic media use was mediated by parental aggravation. Methods: This was a retrospective analysis from the 2016 to 2017 National Survey of Children’s Health (NSCH) involving children ages of 3 to 17 years with parent-reported ADHD (n = 5,930). Path analyses were used to model the relationships between ADHD severity with parental aggravation (PA) as a mediator, and electronic device (ED) and television (TV) use as outcomes, controlling for covariates. Results: Parental aggravation mediated the relationship between ADHD severity and ED use and TV use (indirect effects: β = .02, p < .001; β = .01, p = .004). When stratified by age, the mediation effect between ADHD and ED use remained significant for adolescents and school-age children, and mediation between ADHD and TV use remained significant only for adolescents. Conclusion: These findings suggest a need to develop targeted interventions to address PA and manage excessive electronic media use in children with moderate/severe ADHD.

Extracurricular Activities, Child and Caregiver Mental Health, and Parental Aggravation-A National Cross-Sectional Study.

Expanding access to extracurricular activities (EA) may help address the growing mental health needs of children and caregivers. Evidence supports that EA may benefit child mental health, but few studies explore whether this association is influenced by child and EA factors. Further, the impact of EA on caregivers remains unknown. We conducted a secondary analysis of the 2019 National Survey of Children's Health (NSCH), a nationally representative sample of children and their caregivers. We used responses from caregivers of children aged 6 to 17. Weighted logistic regressions tested associations between EA and 1) child anxiety and/or depression diagnosis, 2) caregiver mental health, and 3) parental aggravation, controlling for child, family, and neighborhood-level covariates. Interaction terms tested whether associations were moderated by child age, sex, and presence of physical, developmental, or behavioral condition. Subanalyses explored whether results varied by EA number and type. Weighted sample included 21,259 children. There were disparities in which children were engaged in EA. EA participation was associated with lower odds of a 1) child being diagnosed with anxiety and/or depression; 2) caregiver reporting "fair/poor" mental health, and 3) caregiver reporting "usually/always" experiencing parental aggravation. Child age, sex, EA number and type, but not health condition, influenced the relationship between EA and child anxiety and/or depression diagnosis. Access to EA is associated with child mental health and family functioning. Further studies should assess causality and specific mechanisms of action.

The Impact of Temporary Assistance for Needy Families Benefit Requirements and Sanctions on Maternal Material Hardship, Mental Health, and Parental Aggravation.

Temporary Assistance for Needy Families requirements can be stress-inducing, difficult for families to complete, and may be detrimental during early life. We assessed the impact of TANF requirements on primary caregiving mothers' experiences of material hardship, anxiety, depression, and parental aggravation in the first year of a child's life. Survey responses were selected from mothers in the Future of Families and Childhood Wellbeing Study, who received TANF in the first year of their child's life (N = 1085). Survey-weighted regression models showed associations between: presence of any requirements and increased material hardship, work requirements and increased material hardship, requirement to name the father of their child and increased depression, benefit cuts and increased parental aggravation, and benefit cuts and increased material hardship. Federal and state policies should revise requirement programs to increase program accessibility and support the mental health and financial stability of mothers applying for TANF to facilitate sustainable movement into employment.

Association Between Maternal Health Status and Family Resilience: Results from a National Survey

The relationship between maternal health and health outcome of offspring has been studied extensively. However, measures such as family resilience in the context of maternal health are not well understood. The objective of this study was to determine if overall maternal health status is associated with family resilience. Using the 2016 National Survey of Children's Health, a nationally representative survey of parents/guardians of children ages 0-17, we evaluated the association of overall maternal health status with measures of family resilience. The analysis was performed using descriptive and multivariable analyses. The study adjusted for current health insurance status, family structure of child's household, income level, highest education of adult in household, child race, primary household language, children with special health care needs, emotional support, neighborhood support, parental aggravation, and adverse childhood experiences. Compared to mothers who reported their physical health to be good, mothers who had a very good/excellent physical health status reported significantly higher adjusted rates for family resilience measures [Adjusted Odds Ratio (AOR) 0.741, 95% Confidence Interval (CI) (0.640, 0.859); p < 0.001]. Results suggested also that mothers whose mental health was very good/excellent were more likely to exhibit greater family resilience as compared to those that were good [(AOR) 0.452, 95% (CI) (0.390, 0.525); p < 0.001] or poor/fair [(AOR) 0.283, 95% (CI) (0.223, 0.360); p < 0.001]. Our findings suggest that maternal mental and physical health may contribute to how families respond to adversity. Our findings highlight the importance of evaluating interventions that target both physical and mental aspects of maternal health status to better the resilience of the family unit. In the healthcare setting, maternal health services should ensure early detection and prevention of chronic conditions beyond obstetric care and detection and treatment of mental health.

Individual, family, and social correlates of flourishing outcomes among youth: Findings from the 2016–2017 National Survey of Children's Health

BackgroundFlourishing is considered an optimal state of well-being and is associated with positive psychological outcomes. Although, individual, family, and social factors may either facilitate or impede flourishing, their unique influence on flourishing outcomes is not well-understood among youth. ObjectiveUsing data from the 2016–2017 National Survey of Children's Health (NSCH), this study investigated cross-sectional associations among adverse family experiences (AFE), community safety, family resilience, parental aggravation, and flourishing among youth. Participants and settingData from the 2016–2017 NSCH (N = 51,156) were analyzed. Participants included males (n = 26,124) and females (n = 25,032) whose ages ranged from 6 to 17 years old (M = 12.14, SD = 3.45). MethodsAfter controlling for relevant demographics, adjusted odds ratios (AORs) using a single-block logistic regression determined the relative likelihood of flourishing. ResultsYouth who experienced zero to one AFE (AOR = 2.10; 95% CI [1.95, 2.26]) and two to three AFEs (1.32 [1.20, 1.45]) were more likely to flourish than youth with four or more AFEs. Youth whose parents endorsed low parental aggravation (6.80 [6.41, 7.22]) and moderate parental aggravation (3.70 [3.51, 3.89]) were more likely to be flourishing than youth whose parents endorsed high parental aggravation. ConclusionsFindings suggest that high parental aggravation is related to poorer flourishing outcomes, after considering community safety, family adversity, family resilience, and demographic characteristics. Providers should consider interventions to support the emotional regulation of parental systems as a means of maximizing developmental outcomes among youth.

Child Maltreatment in Asian American and Pacific Islander Families: The Roles of Economic Hardship and Parental Aggravation

Parents face various stressors in their daily lives, and their child discipline practices are likely to be affected by the stressors. Existing research suggests that parental stress is a significant contributor to child maltreatment, but more research is needed, particularly among Asian American and Pacific Islander (AAPI) families. This study examined the relationship between economic hardship and aggravation in parenting and three types of child maltreatment (i.e., psychological aggression, physical assault, and neglect) in AAPI families through secondary data analysis of a longitudinal de-identified data set. This study analyzed a sample size of 146 AAPI children, with mothers as the primary caregiver. Economic hardship was positively associated with psychological aggression (β = 3.104, p < .01) and physical assault (β = 1.803, p < .05). Aggravation in parenting was positively associated with neglect (β = 0.884, p < .05). The findings suggest that AAPI parents are more likely to use certain child maltreatment methods when they experience specific stressors. Researchers and practitioners should consider the various stressors that AAPI families face and how other social or economic challenges can compound these stressors.

Gun Violence Exposure and Experiences of Depression Among Mothers.

Gun violence is a uniquely prevalent issue in the USA that disproportionately affects disadvantaged families already at risk of health disparities. Despite the traumatic nature of witnessing gun violence, we have little knowledge of whether exposure to local gun violence is associated with higher risks of depression among mothers, whose symptoms of depression are likely to have spillover effects for kin. We examined the association between exposure to gun violence in mothers’ neighborhoods and their experiences of depression using longitudinal Fragile Families and Child Wellbeing Study data (n = 4587) in tandem with lagged outcome and fixed effect models. We find that mothers who witness at least one shooting in their neighborhoods or local communities exhibit more symptoms of depression and are 32–60% more likely to meet criteria for depression than mothers who do not witness a shooting. We also find that witnessing a shooting is associated with increases in parental aggravation, which is partially mediated by maternal depression. Given this and other previously documented spillover effects of mothers’ mental health on children and family members, these findings have important implications for mothers’ wellbeing and their kin. Further, we observe substantial racial and socioeconomic disparities in exposure to gun violence, suggesting that gun violence may heighten health disparities and drawing attention to the importance of providing mental health resources in communities that are most affected by gun violence.

A comparison study: caregiver functioning and family resilience among families of children with cystic fibrosis, asthma, and healthy controls

ABSTRACT Caregivers of children with cystic fibrosis (CF) are at risk for psychosocial difficulties, which has been related to poorer child well-being and medical adherence. The present study utilized the National Survey of Children’s Health (NSCH) to examine self-reported differences in caregiver functioning among a matched sample of caregivers of youth with CF, asthma, and healthy controls (N = 114). CF caregivers reported poorer mental health and more parenting aggravation. Among CF caregivers, poorer caregiver mental health predicted less family resilience, which in turn, predicted more parenting aggravation. Findings have implications for prevention screening and brief interventions within pulmonary medicine.

Family resilience and flourishment: Well-being among children with mental, emotional, and behavioral disorders.

Approximately 20% of children and adolescents in the United States are affected by mental, emotional, and behavioral (MEB) disorders. Child flourishment and family resilience contribute to healthy family development, including the promotion of child MEB wellbeing. Identifying factors that promote child flourishment and family resilience are critical. This study aimed to determine the prevalence and parenting factors associated with family resilience and child flourishment among children aged 6-17 years with MEB disorders. This was a secondary analysis of the 2016-2017 National Survey of Children's Health. The sample consisted of parents and their children (n = 1,900, weighted n = 5,375,670). Data were weighted to be representative of the US population and analyzed using descriptive statistics and linear regression. We found that only 6.3% of children aged 6-17 with an MEB were optimally flourishing. Parental aggravation was negatively associated with child flourishment, and parental coping was positively associated with child flourishment. In total, 66.5% of families with children exhibited resilience. Parental coping and availability of parental emotional support were positively associated with family resilience. Potential interventions that leverage study findings include parent training to increase parental emotional regulation (e.g., increase frustration tolerance, coping skills) and family navigation services to increase parental support (e.g., emotional support, coping skills) through the child's treatment trajectory. Overall, this study provides evidence of a disparity in flourishment in America's youth with MEB disorders, and despite this adversity, families are resilient.

Healthcare access and adverse family impact among U.S. children ages 0\u20135\u2009years by prematurity status

BackgroundMany children and their families are affected by premature birth. Yet, little is known about their healthcare access and adverse family impact during early childhood. This study aimed to (1) examine differences in healthcare access and adverse family impact among young children by prematurity status and (2) determine associations of healthcare access with adverse family impact among young children born prematurely.MethodsThis was a secondary analysis of cross-sectional 2016 and 2017 National Survey of Children’s Health data. The sample included 19,482 U.S. children ages 0–5 years including 242 very low birthweight (VLBW) and 2205 low birthweight and/or preterm (LBW/PTB) children. Prematurity status was defined by VLBW (i.e., < 1500 g at birth) and LBW/PTB (i.e., 1500–2499 g at birth and/or born at < 37 weeks with or without LBW). Healthcare access measures were adequate health insurance, access to medical home, and developmental screening receipt. Adverse family impact measures were ≥ $1000 in annual out-of-pocket medical costs, having a parent cut-back or stop work, parental aggravation, maternal health not excellent, and paternal health not excellent. The relative risk of each healthcare access and adverse family impact measure was computed by prematurity status. Propensity weighted models were fit to estimate the average treatment effect of each healthcare access measure on each adverse family impact measure among children born prematurely (i.e., VLBW or LBW/PTB).ResultsBivariate analysis results showed that VLBW and/or LBW/PTB children generally fared worse than other children in terms of medical home, having a parent cut-back or stop working, parental aggravation, and paternal health. Multivariable analysis results only showed, however, that VLBW children had a significantly higher risk than other children of having a parent cut-back or stop work. Adequate health insurance and medical home were each associated with reduced adjusted relative risk of ≥$1000 in annual out-of-pocket costs, having a parent cut-back or stop work, and parental aggravation among children born prematurely.ConclusionsThis study’s findings demonstrate better healthcare access is associated with reduced adverse family impact among U.S. children ages 0–5 years born prematurely. Population health initiatives should target children born prematurely and their families.

Parental aggravation may tell more about a child’s mental/behavioral health than Adverse Childhood Experiences: Using the 2016 National Survey of Children’s Health

BackgroundAdverse childhood experiences (ACEs) are associated with a number of health problems and early mortality. Developmental studies have also shown strong links between parents’ contemporaneous negative feelings toward their children and the children’s maladjustment. ObjectivesThe relative, unique contributions of ACEs and parents’ feelings of aggravation were examined in predicting to the presence of children’s internalizing and externalizing problems, perseverance and emotional regulation. Also tested was the potential moderating roles of personal support and external emotional resources for parents. Participants and settingData from the 2016 National Survey of Children’s Health were used. A random, nationally representative sample of 35,718 adult caregivers in the United States (US) with children ages 6–17 were included. MethodsHierarchical multiple regression analyses were performed to explore the patterns of results in predicting to children’s maladjustment and adjustment, separately by child sex. ResultsParental aggravation consistently had larger effects on children’s maladjustment and adjustment than ACEs (1.47–1.82 timesamong males; 1.31–1.83 time among females, with one exception, i.e. internalizing problems). Personal support for parenting attenuated the relations of both ACEs and parental aggravation with children’s outcomes. In the presence of external resources for parenting, children’s maladjustments tended to be even more pronounced, suggesting that parents seek external resources when problem behaviors become significant in their children. ConclusionFor children at risk, future interventions should consider the value of refocusing attention from the occurrence ACEs per se, to critical, proximal indices – parents’ negative feelings around parenting – that can have stronger links with children’s maladjustment and that are more amenable to change.

Parenting While Food Insecure: Links Between Adult Food Insecurity, Parenting Aggravation, and Children’s Behaviors

Parents who experience food insecurity face not only uncertainty in obtaining food, but an invisible emotional burden, one that can potentially influence both their parenting behaviors and ultimately, their children. In our study, we investigated adult food insecurity’s link to parents’ aggravation and whether that aggravation influenced their children’s behaviors. Results, based on data from the Early Childhood Longitudinal Survey, Kindergarten Class of 2010-2011 using first-difference regression, showed that parents ( N = 7,820) of first graders who became food insecure experienced heightened parenting aggravation (0.525; p &lt; .01). Our mediation analysis on a matched sample of food secure ( n = 1,600) and insecure parents ( n = 470) revealed that adult food insecurity was not directly associated with children’s behaviors; rather, it was indirectly related to lowered attentional focus (−0.062; p &lt; .05) and inhibitory control (−0.093; p &lt; .001) via parenting aggravation. Our findings underscore the importance of parenting aggravation in transmitting the effects of food insecurity on children’s behaviors.

Epidemiology and Impact of Health Care Provider-Diagnosed Anxiety and Depression Among US Children.

This study documents the prevalence and impact of anxiety and depression in US children based on the parent report of health care provider diagnosis. National Survey of Children's Health data from 2003, 2007, and 2011-2012 were analyzed to estimate the prevalence of anxiety or depression among children aged 6 to 17 years. Estimates were based on the parent report of being told by a health care provider that their child had the specified condition. Sociodemographic characteristics, co-occurrence of other conditions, health care use, school measures, and parenting aggravation were estimated using 2011-2012 data. Based on the parent report, lifetime diagnosis of anxiety or depression among children aged 6 to 17 years increased from 5.4% in 2003 to 8.4% in 2011-2012. Current anxiety or depression increased from 4.7% in 2007 to 5.3% in 2011-2012; current anxiety increased significantly, whereas current depression did not change. Anxiety and depression were associated with increased risk of co-occurring conditions, health care use, school problems, and having parents with high parenting aggravation. Children with anxiety or depression with effective care coordination or a medical home were less likely to have unmet health care needs or parents with high parenting aggravation. By parent report, more than 1 in 20 US children had current anxiety or depression in 2011-2012. Both were associated with significant comorbidity and impact on children and families. These findings may inform efforts to improve the health and well-being of children with internalizing disorders. Future research is needed to determine why child anxiety diagnoses seem to have increased from 2007 to 2012.

Benefits of Family Meals for Children With Special Therapeutic and Behavioral Needs.

Frequency of family meals (FMs) is associated with favorable child outcomes; however, no study to date has examined the relationship between frequency of FMs and outcomes for children with disabilities. Data from the 2007 National Survey of Children's Health for children with disabilities (N = 4,336) were used. Logistic regression for each dependent variable was completed using frequency of FMs and covariates of age, gender, race, family structure, and poverty level. Each day per week increase in the frequency of FMs increased the likelihood for positive social skills (odds ratio [OR] = 1.09, 95% confidence interval [CI] [1.01, 1.19]) and engagement in school (OR = 1.09, 95% CI [1.02, 1.16]). Frequency of FMs was not associated with problematic social behaviors or parental aggravation with child. Our findings suggest that children with disabilities whose families participate in frequent FMs have a greater likelihood of positive social and family health outcomes.