The Impact of Family Functioning on Child Mental Health Service Use and Access
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Date
2019-05-31
Authors
Oltean, Irina
Journal Title
Journal ISSN
Volume Title
Publisher
University of Waterloo
Abstract
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.
Description
Keywords
mental health, epidemiology, mental health service use, mental health service access, family functioning, family environment