Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, 06030, USA.
Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT, USA.
Psychiatr Q. 2021 Sep;92(3):1201-1215. doi: 10.1007/s11126-021-09900-3. Epub 2021 Mar 3.
To examine the prevalence of adverse family experiences (AFEs), their association with poor school engagement and performance, and whether behavioral health conditions mediate the association among US adolescents. We conducted a cross-sectional analysis of data from adolescents aged 12-17 years from the 2016-2018 National Survey of Children's Health (n = 41,648 unweighted). We first estimated the prevalence of AFEs, investigated the association of AFEs with school engagement and performance, and whether behavioral health conditions mediate such relationships, using multivariable-adjusted Poisson regression models. A mediation analysis was used and covariates included socio-demographic characteristics and co-morbid medical conditions. A total of 52.9% of US adolescents (nationally representative of 12.9 million adolescents nationwide) reported experiencing at least one form of AFE, the most common of which included parental divorce/separation (33.1%), economic hardship (22.0%) and living with a person with substance misuse problems (11.5%). Adolescents with ≥4 AFEs had poorer outcomes in school engagement and performance (p < 0.001 each) when compared to those with no AFEs. Behavioral health conditions (e.g., anxiety, depression, and conduct problems) partially mediated these relationships (p < 0.01 each). The indirect effect of behavioral health conditions accounted for 20.4% of the total effect in the association between AFEs and school performance (p < 0.001). AFEs are common among US adolescents, and cumulative AFEs are associated with behavioral health conditions, which may in turn reduce school engagement and performance. While reducing AFEs is important in children and adolescents, addressing potentially resultant behavioral health conditions is equally important in improving school engagement and performance.
为了研究不良家庭经历（AFEs）的流行情况、它们与学业参与度和表现不良的关系，以及行为健康状况是否在青少年中起中介作用，我们对来自 2016-2018 年全国儿童健康调查（n=41648 未加权）的 12-17 岁青少年的数据进行了横断面分析。我们首先使用多变量调整泊松回归模型，估计了 AFEs 的流行率，调查了 AFEs 与学业参与度和表现的关系，以及行为健康状况是否在这些关系中起中介作用。使用了中介分析，协变量包括社会人口统计学特征和合并的医疗状况。共有 52.9%的美国青少年（全国范围内代表全国 1290 万青少年）报告经历过至少一种形式的 AFE，其中最常见的包括父母离婚/分居（33.1%）、经济困难（22.0%）和与滥用药物的人一起生活（11.5%）。与没有 AFE 的青少年相比，经历≥4 种 AFE 的青少年在学业参与度和表现方面的结果更差（p<0.001 ）。行为健康状况（如焦虑、抑郁和行为问题）部分中介了这些关系（p<0.01 ）。行为健康状况的间接效应占 AFE 与学业成绩之间关联的总效应的 20.4%（p<0.001 ）。AFEs 在美国家庭中很常见，累积的 AFE 与行为健康状况相关，而行为健康状况可能会反过来降低学业参与度和表现。虽然减少 AFE 对儿童和青少年很重要，但在提高学业参与度和表现方面，同样重要的是解决可能由此产生的行为健康状况。
