Poverty, social exclusion, and mental health: the role of the family context in children aged 7–11 years INMA mother-and-child cohort study

Abstract

Mental health problems are common in childhood and tend to be more frequent in populations at risk of poverty or social exclusion (AROPE). The family environment can play a role in reducing the impact of economic hardship on these problems. The aim of this study was to assess the effect of multidimensional poverty on the mental health of children aged 7–11 years and the role of the family environment in two areas of Spain. Participants were 395 and 382 children aged 7 and 11 from Gipuzkoa and Valencia, respectively. Internalizing and externalizing problem scales of the child behaviour checklist (CBCL) were used. AROPE indicators were obtained by questionnaire, and three dimensions of the family context (Organization of the Physical Environment and Social Context, Parental Stress and Conflict, and Parental Profile Fostering Development) were measured through subscales 3, 4 and 5 of the Haezi-Etxadi family assessment scale (7–11) (HEFAS 7–11), respectively. Data were analysed using negative binomial regression and Structural Equation Modelling. AROPE prevalence was 7.1 and 34.5% in Gipuzkoa and Valencia, respectively. In both cohorts, there was a significant increase in internalizing and externalizing problems among participants with a higher AROPE score. However, AROPE did not affect internalizing problems in children from families living in a better physical environment and with social support (Subscale 3). The AROPE effect was jointly mediated by subscales 4 and 5 in 42 and 62% of internalizing and externalizing problems, respectively. Preventing economic inequities by economic compensation policies, improving the neighbourhood and immediate environment around the school, and promoting positive parenting programmes can improve mental health in childhood.

Rare Diseases: Needs and Impact for Patients and Families: A Cross-Sectional Study in the Valencian Region, Spain

“…The training of health professionals in the field of RDs, which is generally insufficient, should, therefore, include not only the clinical aspects, which can obviously be specific to each condition, but also these socio-health aspects, which would be very effective because they can be applied to all those affected. It is, therefore, a matter of achieving comprehensive training that will enable professionals to make the existing resources available to their patients and to help them while the healthcare systems adapt [ 8 , 11 , 42 ]. This would be especially important for primary care professionals, who are often the first point of contact, to whom the chronic follow-up of patients is sometimes delegated, and who could coordinate resources, provided they are aware of the needs of families with RDs [ 43 , 44 ].…”

“…Primary care professionals, although they generally see a small number of patients with RDs, may be confronted with a wide variety of conditions [ 10 ]. Moreover, due to the nature of their care, they often have to respond not only to clinical needs but also to social and other healthcare needs [ 11 ]. For all these reasons, in this study, we chose to begin with those patients and families seen in the primary care with a confirmed or suspected diagnosis of RD in order to understand their needs and better grasp the impact the disease has on their lives.…”

Socioeconomic position, family context, and child cognitive development

“…The political agenda of the European Union (EU) has provided the At Risk of Poverty or Social Exclusion (AROPE) rate [6], a useful multidimensional tool to compare cohort samples consisting of the general population of European countries. However, the AROPE indicator includes self-reported family income, which could lead to biased responses [7]. Family income is not easy to measure, and the total income of a family should be considered only after tax deductions and social transfers standardised by household size and composition (total disposable income) [8].…”

“…In previous works, we explored SEP indicators (parental social class, education, and employment) and their relation to child cognitive development at ve years of age [30], and also the effect of AROPE and family context on children's mental health [7]…”

Addressing the complexity of child psychiatry practice in the current landscape

“…A good proportion of the articles in this number of the journal analyse the relationship between social factors, family dynamics and psychiatric disorders in children and adolescents. González et al assessed the effect of multidimensional poverty and the role of the family environment on the mental health of children aged 7–11 years in two areas of Spain [ 3 ]. They found a significant increase in both internalising and externalising problems in children with a higher family risk of poverty and social exclusion and with lower quality in the family context.…”