The Impact of Family Functioning on Child Mental Health Service Use and Access
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In Canada, the prevalence of mental illness is high among young people with 13% of Canadian youth aged 15-24 years affected. This striking mental health burden warranted further investigation of the contextual (i.e., family-level) determinants of mental illness early in life, and the extent to which these family factors influenced access and use of mental health services. Previous evidence shows that indicators of less supportive family environments, and family dysfunction are robust factors predicting the onset of internalizing and externalizing mental illness in children. Family dysfunction has also been associated with decreased medical adherence, which can lead to a subsequent increase in “crisis” mental health care (e.g., hospitalizations). However, less is known about the extent to which the family environment is associated with mental health service use in children. In an attempt to address this gap, this research examined the interrelationships of family functioning, child mental illness, and mental health service use and access. Understanding the role of the family in accessing and using child mental health services is knowledge needed to improve the provision of health services to children and families, particularly through the adoption of family-centred care strategies in inpatient, outpatient, and community settings. The aims of this research project were to: 1—Examine associations between family functioning and internalizing versus externalizing mental illness. Better family functioning will be associated with lower odds of internalizing (depression, anxiety) and externalizing (attention deficit hyperactivity, oppositional defiant, conduct) illnesses. 2—Examine associations between family functioning and odds of past-year health professional consults, hospitalizations, and length of hospital stay. Better family functioning will be associated with lower odds of past-year health professional consults, hospitalizations, and length of hospital stay. 3—Identify which domains of family functioning are associated with odds of internalizing versus externalizing mental illness, past-year health professional consults, hospitalizations, and length of hospital stay. Problem solving, communication, and behaviour control will be the most relevant aspects of family functioning in predicting mental illness and service use and access. Data came from a cross-sectional study, which recruited 100 youth aged 4-17 years currently receiving mental health services (inpatient or outpatient) and their parents at a large paediatric tertiary care centre in Ontario. Family functioning was measured using the McMaster Family Assessment Device (FAD), youth mental illness using the Mini International Neuropsychiatric Interview, and mental health service use and access using items from the 2012 Canadian Community Health Survey (Mental Health). Controlling for relevant covariates, associations between family functioning and child mental illness and use of mental health services were examined using regression modelling (binary logistic and Poisson regression). The associations between parent FAD scores and major depressive disorder (MDD) [OR=0.88 (0.81, 0.97)], separation anxiety disorder (SAD) [OR=0.91 (0.83, 1.00)], and oppositional defiant disorder (ODD) [OR=0.91 (0.84, 0.99)] were similar in magnitude. There were no statistically significant associations between parent FAD total or domain scores and being hospitalized, accessing any health professional, and number of hospitalizations. Higher scores on affective involvement were associated with greater odds of MDD [OR=2.34 (1.09, 5.01)], generalized anxiety [OR= 2.34 (1.09, 5.01)], and greater stay in hospital [OR= 2.04 (1.76, 2.36)]. Higher scores on problem solving were only associated with greater stay in hospital [OR= 1.41 (1.24, 1.61)]. Higher reports of behaviour control were correlated with lower odds of SAD [OR= 0.60 (0.38, 0.96)], any type of social phobia [OR= 0.50 (0.28, 0.88)], ODD [OR= 0.53 (0.33, 0.85)], and less stay in hospital [OR= 0.83 (0.76, 0.91)]. Higher scores on affective responsiveness and roles were associated with less stay in hospital [OR=0.76 (0.69, 0.84); OR= 0.70 (0.63, 0.78)]. Findings have implications for the provision of clinically based, family-centred mental health services for children and youth. Family-centred care strategies are an effective approach to promoting positive mental health among children by encouraging family members to be actively involved in the mental health care of their child. While facilitating family-centred care strategies, primary care providers could prioritize screening for indicators of family functioning. Mental health professionals can also facilitate family-centred interventions that foster better family functioning by targeting specific domains that require improvement unique to each family. Tailored family-centred care strategies could cultivate better family functioning solutions. These strategies could potentially reduce strain on the health care system. Saved funds could be diverted to other clinical priorities, with the hopes of improving health system efficiency.
Cite this version of the work
Irina Oltean (2019). The Impact of Family Functioning on Child Mental Health Service Use and Access. UWSpace. http://hdl.handle.net/10012/14737