Pathways From Family Disadvantage via Abusive Parenting and Caregiver Mental Health to Adolescent Health Risks in South Africa

• Published in: Journal of adolescent health 2017-01, Vol.60 (1), p.57-64
• Main Authors: Meinck, Franziska, D.Phil, Cluver, Lucie Dale, D.Phil, Orkin, Frederick Mark, Ph.D, Kuo, Caroline, D.Phil, Sharma, Amogh Dhar, M.Sc, Hensels, Imca Sifra, M.Sc, Sherr, Lorraine, Ph.D
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adolescent; Adolescent abuse; Adolescent behavior; Adolescent health; Adolescent Health - statistics & numerical data; Adolescents; AIDS; Caregivers; Caregivers - psychology; Child; Child abuse & neglect; Child Abuse - psychology; Child Abuse - statistics & numerical data; Childrens health; Clinical outcomes; Confirmatory factor analysis; Cross-Sectional Studies; Deprivation; Families & family life; Family - psychology; Female; Health behavior; Health care access; Health risks; Health Status; Humans; Illnesses; Indirect effects; Low income groups; Male; Measurement; Mental Disorders - epidemiology; Mental Disorders - psychology; Mental health; Mental health care; Mental health services; Parenting; Parenting - psychology; Parents & parenting; Pediatrics; Physical symptoms; Poverty; Psychological distress; Psychological problems; Random sampling; Risk; Risk factors; Socioeconomic Factors; South Africa; Structural equation modeling; Structural models; Violence
• ISSN: 1054-139X; 1879-1972
• DOI: 10.1016/j.jadohealth.2016.08.016

Abstract Purpose Adolescent health is a major concern in low- and middle-income countries, but little is known about its predictors. Family disadvantage and abusive parenting may be important factors associated with adolescent psychological, behavioral, and physical health outcomes. This study, based in South Africa, aimed to develop an empirically based theoretical model of relationships between family factors such as deprivation, illness, parenting, and adolescent health outcomes. Methods Cross-sectional data were collected in 2009–2010 from 2,477 adolescents (aged 10–17) and their caregivers using stratified random sampling in KwaZulu-Natal, South Africa. Participants reported on sociodemographics, psychological symptoms, parenting, and physical health. Multivariate regressions were conducted, confirmatory factor analysis employed to identify measurement models, and a structural equation model developed. Results The final model demonstrated that family disadvantage (caregiver AIDS illness and poverty) was associated with increased abusive parenting. Abusive parenting was in turn associated with higher adolescent health risks. Additionally, family disadvantage was directly associated with caregiver mental health distress which increased adolescent health risks. There was no direct effect of family disadvantage on adolescent health risks but indirect effects through caregiver mental health distress and abusive parenting were found. Conclusions Reducing family disadvantage and abusive parenting is essential in improving adolescent health in South Africa. Combination interventions could include poverty and violence reduction, access to health care, mental health services for caregivers and adolescents, and positive parenting support. Such combination packages can improve caregiver and child outcomes by reducing disadvantage and mitigating negative pathways from disadvantage among highly vulnerable families.