Family factors and psychiatric disorders among Puerto Rican children and youth in two different socio-cultural contexts
- Autores: Olga Santesteban Echarri
- Directores de la Tesis: Adela Masana (dir. tes.), Ana Milena Gaviria (codir. tes.), Cristian Alonso Duarte Carreño (codir. tes.)
- Lectura: En la Universitat Rovira i Virgili ( España ) en 2017
- Idioma: español
- Tribunal Calificador de la Tesis: Gisela Sugranyes Ernest (presid.), Susana Ochoa Güerre (secret.), Stefanie Schmidt (voc.)
- Programa de doctorado: Programa de Doctorado en Salud, Psicología y Psiquiatría por la Universidad de Almería y la Universidad Rovira i Virgili
- Materias:
- Enlaces
- Tesis en acceso abierto en: hdl.handle.net TDX
- Resumen
ABSTRACT Introduction / Background:
Puerto Rican families seem to be at elevated risk compared with other Hispanic groups for future development of psychopathology. Parental warmth (PW) has a strong influence on child development and may precede the onset of psychiatric disorders in children and youth including substance use problems. PW is interconnected with other family processes (e.g., coercive discipline, family structure) that may also influence the development of psychiatric disorders in children. However, during periods of family instability effective parenting practices (e.g., warmth, monitoring) may decrease and as a consequence, youth internalizing and externalizing symptoms may increase.
Objectives:
- (Study 1) To address whether parental warmth (PW) is associated with specific psychiatric disorders (i.e., anxiety, major depressive disorder (MDD), ADHD, and disruptive behavior disorder (DBD)) in Puerto Rican children and its changes over time. To explore whether: (1) PW would be associated with lower odds of youth psychiatric disorders over time; (2) PW would be related to youth psychiatric disorders independently of other parent and family factors (parental coercive discipline, parental monitoring, parental psychopathology, familism, and social support), and (3) there would be differences in the association between PW and different youth psychiatric disorders across sociocultural contexts (study site), child gender and age.
- (Study 2) To prospectively examine (1) the unique relationship of PW and youth alcohol use, non-alcohol substance use (SU) (drugs, tobacco and marijuana), and any SU over three years among Puerto Rican youth; (2) whether youth from families with higher levels of PW, independently of other parental factors, would present lower levels of non- alcohol SU and any SU over the course of three years; (3) due to the lack of previous research regarding PW and alcohol and high rates of consumption of alcohol among this population, and we cast doubt about the role of PW over alcohol.
- (Study 3) To examine the influence of family structure and transitions on child psychiatric disorders in this population. We examined: (1) the influence of family structure (including cohabitation unions) on child psychiatric disorders, to verify, among Puerto Rican youth, if two-parent family structures would have a more beneficial impact on the development of psychiatric disorders compared with the single-parent family structure; (2) Whether Puerto Rican children whose families had experienced a family transition would have a higher risk of psychiatric disorders compared with those children living in a stable two-parent family (regardless of their marital status); (3) Whether other parental factors might have better explained possible effects of family structure or transitions towards child psychiatric disorders.
Methods:
- (Study 1) Boricua Youth Study participants, Puerto Rican children 5 to 13 years of age at Wave 1 living in the South Bronx (New York) (SB) and San Juan and Canguas Metropolitan Area (Puerto Rico) (PR) (n = 2,491), were followed for three consecutive years. Measures: PW was assessed through parental responses to the Hudson's Index of Parental Attitudes, and The Diagnostic Interview Schedule for Children-IV (DISC-IV) measured youth psychiatric disorders. Data analysis: Generalized Linear Mixed models tested the association between PW (Wave 1) and psychiatric disorders in the next two years adjusting for demographic characteristics and family processes.
- (Study 2) Participants from the Boricua Youth Study, Puerto Rican children 5-13 years of age at Wave 1 living in the South Bronx (New York) (SB) and San Juan and Canguas Metropolitan Area (Puerto Rico) (PR), were consecutively followed over three years. Youth, who were 10 years old or older at Wave 1 and participated in all three waves, were included in this analysis (n=1,271). Measures: PW was assessed through parental responses to the Hudson's Index of Parental Attitudes, and youth SU was measured using questions from the past year SU section of the Diagnostic Interview Schedule for Children-IV (DISC-IV). Data analysis: Generalized Linear Mixed Models were used to test the association between PW (Wave 1) and SU over the three waves controlling for demographics and family factors.
- (Study 3) The study used longitudinal data (three waves) from the Boricua Youth Study, which included probability samples of children in the South Bronx (New York) (SB) and San Juan and Canguas Metropolitan Area (Puerto Rico) (PR) (n= 2,142). We examined factors that may explain how family structure and transitions may be related to child psychiatric disorders. Measures: Family structure: (a) two married bio-parents; (b) two cohabiting bio-parents (c) cohabiting with at least one step-parent; (d) married with at least one step-parent; (e) one single-parent; Family transitions: (a) stable two-parent family; (b) stable single-parent family; (c) 1 transition from single- to two-parent family; (d) 1 transition from a two- to single-parent family; (e) 2 transitions. Child internalizing and externalizing disorders were assessed with The Diagnostic Interview Schedule for Children-IV (DISC-IV). Data analysis: two sets of logistic regression analyses stratified by site (SB and PR) were conducted.
Results:
- (Study 1) Higher levels of PW were related to lower odds of child anxiety and major depressive disorder over time (AOR = 0.69, 95% CI: [0.60; 0.79]; AOR = 0.49, 95% CI: [0.41; 0.58], respectively). The strength of the association between PW and ADHD and disruptive behavior disorder declined over time, although it was still significant in the last assessment (AOR = 0.44, 95% CI: [0.37; 0.52]; AOR = 0.46, 95% CI: [0.39; 0.54], respectively). PW had a unique influence on psychiatric disorders beyond the influence of other parenting and family processes. Stronger associations were observed among girls for depression and ADHD.
- (Study 2) Higher levels of PW were related to lower odds of using non-alcoholic substances and any SU over time after adjusting for demographics, parent and individual factors (AOR=0.77, 95% CI: [0.62, 0.96]; AOR=0.81, 95% CI: [0.67, 0.99] respectively).
- (Study 3) Our results showed that for both internalizing and externalizing disorders there were no significant differences between children of cohabiting (biological or step) parents or of single parents compared to children of married biological parents. In Puerto Rico only, transitioning once from a two-parent family to a single-parent family was related to child internalizing disorders after adjusting for demographic, parental and child psychiatric disorders at Wave 1 (AOR=4.43; 95% CI [1.54, 12.68]). Family transitions were not associated with externalizing disorders at either site.
Conclusions:
- (Study 1) Incorporating PW behaviors such as acceptance, support, and comforting into interventions focused on parenting skills may help prevent child psychiatric disorders.
- (Study 2) PW had an individual influence on SU problems beyond the influence of other parenting factors. Promoting interventions focused on parenting skills involving behaviors such as acceptance and support may prevent youth SU.
- (Study 3) Context may be an important factor shaping the risk that family dissolution is followed by an internalizing disorder among children.
