Parental Separation, Adolescent Psychopathology, and Problem Behaviors

Parental Separation, Adolescent Psychopathology, and Problem Behaviors

Parental Separation, Adolescent Psychopathology, and Problem Behaviors DAVID M. FERGUSSON, PH.D., L. JOHN HORWOOD, M.Sc., AND MICHAEL T. LYNSKEY, M...

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Parental Separation, Adolescent Psychopathology, and Problem Behaviors DAVID M. FERGUSSON, PH.D., L. JOHN HORWOOD, M.Sc.,

AND

MICHAEL T. LYNSKEY, M.Sc.

ABSTRACT Objective: This paper examines the effects of parental separation on the occurrence of adolescent psychopathology and problem behaviors at age 15 years. Method: Data collected during the course of a 15-year longitudinal study were used to examine a sample of 935 children with respect to exposure to parental separation during childhood, measures of adolescent psychopathology and problem behaviors at age 15 years, and prospectively collected confounding factors. Results: Children exposed to parental separation during childhood had elevated risks of a range of adolescent problems, including substance abuse or dependence, conduct or oppositional disorders, mood and anxiety disorders, and earlyonset sexual activity. However, adjustment for confounding factors explained a large amount of the increased risks of adolescent disorder, and after adjustment for confounders the odds ratios between exposure to parental separation and adolescent outcomes ranged from 1.07 to 3.32 with a median value of 1.46. The ways in which boys and girls responded to parental separation were similar. Conclusions: While the results suggested that children exposed to parental separation had increased risks of adolescent problems, much of this association appeared to be spurious and arose from confounding social and contextual factors that were present in the child's family before parental separation. However, even after such control, the results suggested that exposure to parental separation during childhood was associated with small but detectable increases in risks of adolescent conduct disorder, mood disorder, and substance abuse disorders. J. Am. Acad. Child Ado/esc. Psychiatry, 1994, 33, 8:1122-1131. Key Words: parental divorce or separation, adolescent problems, gender, longitudinal study.

Over the past four decades there have been marked changes in family structure and family stability in many Western societies. These changes have been characterized by rising rates of divorce, increasing numbers of children reared in single-parent families, increases in the numbers of second or subsequent marriages, and increasing numbers of children reared in step or reconstituted families (Cherlin, 1981; Furstenberg, 1990; Glick and Lin, 1986). In turn, these marked changes in family structure and stability have evoked concerns about the extent to which exposure to family change may have deleterious consequences on the behavioral,

Accepted December 15, 1993. From the Christchurch Healthand Development Study, Christchurch School ofMedicine, Christchurch Hospital Christchurch, New Zealand. This research wasfunded by grants from the Health Research Council of New Zealand and the National Child Health Research Foundation. Reprint requests to Dr. Fergusson, Christchurch Health and Development Study, Christchurch School ofMedicine, Christchurch Hospital, Christchurch, New Zealand. 0890-8567/94/3308-1122$03.00/0©1994 by the American Academy of Child and Adolescenr Psychiatry.

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psychological, and cognitive development of children exposed to family change (for reviews see Amato and Keith, 1991; Brody et al., 1988; Cherlin, 1981; Edwards, 1987; Emery, 1988; Hetherington, 1989; Wallerstein, 1991). Opinions about this matter have varied, with some authors claiming that family changes may often be nonharmful or even beneficial (e.g., Edwards, 1987; Hetherington, 1989), while others have reported more pessimistic views, claiming that family change may have potentially adverse effectson children (Amato and Keith, 1991; Emery, 1988; Wallerstein, 1991). In general, the literature on the effects of family change is consistent with the view that exposure to family change may lead to detectable increases in rates of a wide range of childhood problems. Specifically, in a meta-analysis of the literature on divorce and subsequent child adjustment, Amato and Keith (1991) found that there was evidence to suggest that children exposed to parental divorce tended to have elevated rates of a range of childhood behavioral, psychological, and cognitive problems. However, these differences

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were not large and amounted to differences of between .04 and .23 standard deviations in test scores for studies in which control of confounding factors was included. In this paper we report on the results of a 15-year longitudinal study of the relationship between exposure to parental separation and divorce throughout childhood and a series of measures of adolescent problem behaviors and psychopathology, including early sexual/ activity, substance use and abuse behaviors, conduct and oppositional defiant disorders, mood disorders, and anxiety disorders. The aims of the paper are to address three issues relating to the relationship between exposurets) to parental separation during childhood and outcomes in adolescence: (1) the timing and patterning ofexposure to parental change; (2) confounding factors; and (3) the effects of gender on responses to marital breakdown. Timing and Patterning of Exposure to Parental Change

Parental separations occur throughout childhood as a consequence of patterns of marital dissolution and reformation. As a result, breakdowns may occur at different ages and it is possible that the associations between marital breakdown and adolescent psychopathology may vary with the age at which breakdown occurs. While it has been suggested in the literature that breakdowns occurring during the preschool years are more strongly' associated with risks of problem behaviors than breakdowns occurring after school entry (Allison and Furstenberg, 1989; Emery, 1988), this conclusion was not borne out by Amato and Keith's meta-analysis, which suggested stronger associations between breakdowns occurring after school entry and subsequent child behavior. The first aim of this research will be to document the relationships between breakdowns occurring at different ages and adolescent psychopathology. Confounding Factors

A major problem in the interpretation of associations between family breakdown and measures of child and adolescent outcomes concerns the extent to which the apparent correlations between family change events and measures of adjustment can be explained by confounding social and contextual factors which are associated with increased risks of marital breakdown and which independently contribute to increased risks of

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problems of adjustment. There are grounds for believing that some component of the apparent correlation between exposure to family change and problems of adjustment may arise from such factors. In particular, the literature on the family and on child development has identified a range of common variables including socioeconomic status, parental education, parental age, family stresses, and related factors which are associated with both increased risks of marital breakdown (Emery, 1988; Fergusson et al., 1984b; Teachman, 1982) and increased risks of childhood behavioral problems (Brown and Madge, 1982; Fergusson et al., 1990; Rutter and Madge, 1976). Given this evidence, it is reasonable to suggest that the apparent correlations between family breakdown and childhood outcomes may arise from the antecedent effects of common social and family factors on risks of both family breakdown and childhood outcomes. While a number of studies have attempted to control for such confounding factors, the extent of this statistical control has been limited in at least two ways. First, in many studies a limited range of potentially confounding factors has been considered, raising the possibility that these studies may have "undercontrolled" the effects of social and contextual factors, thus leading to inflated estimates of the association between family change experiences and measures of adjustment. Second, few studies have collected prospectively measured confounding factors, and the absence of prospectively collected data makes it difficult to determine whether confounding factors were present before or after family change events. In this study we will use prospectively collected covariate factors to control associations between marital breakdown and adolescent outcomes with these covariate factors being measured before the occurrence of family breakdown. Effects of Gender on Responses to Marital Breakdown

An influential hypothesis in the literature on family breakdown concerns the role of gender as a "modifier" variable which influences the association between exposure to marital breakdown and adolescent outcomes. A number of authors have suggested that exposure to marital breakdown has different effects on boys and girls, with boys being generally more responsive and reactive to marital breakdown (Emery and O'Leary, 1982; Hetherington et al., 1982; Porter and O'Leary, 1980; Wallerstein and Kelly, 1980). Although this

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on questioning of young people at ages 14 and 15 years, and the measurement of sexual behaviors in this cohort has been described previously (Lynskey and Fergusson, 1993). Young people were classified as engaging in early-onset sexual activity if they reported having sexual intercourse before the age of 15 years. To show the statistical properties of the outcome measures, Table 1 reports on the odds ratios (ORs) between each pair of measures. The leading diagonal of the table reports the prevalence (expressed as a percentage) of each outcome. For all statistics 95% confidence intervals (CIs) are quoted .

view is commonly stated in the literature, as Amato and Keith (1991) observed in their meta-analysis of the effects of divorce, the evidence for this hypothesis is by no means strong, and a number of studies have failed to show that gender acts to moderate or influence the associations between exposure to marital breakdown and childhood outcomes. The final aim of this paper will be to determine the extent to which associations between exposure to marital breakdown and adolescent outcomes vary with the child's gender.

Measures of Parental Separation

METHOD The data described in this paper were gathered during the course of the Christchurch Health and Development Study. The Christchurch Health and Development Study is a longitudinal study of a birth cohort of 1,265 Christchurch (New Zealand) born children who have been studied at birth , 4 months , 1 year, and at annual intervals to the age of 15 years using a combination of methods including parental interviews, interviews with the children , data provided by schoolteachers, and information from official records including medical and police records. An overview of the design of this research has been provided in a previous paper (Fergusson et al., 1989). The measures used in the present analysis are described below.

The study incorporated, at each interview period, a family history record which recorded for each 2-month time period (1) the relationships of the child' s parent figures to the child; and (2) the reasons for any change of parent figures during the preceding time period. This recording system was supplemented by a narrative account describing the circumstances and context which lead to family change. To reduce the complexities of the life history record down to manageable dimensions for analysis, a series of exploratory analyses was conducted to examine the relationships between patterns of family change and adolescent outcomes . Thi s analysis suggested that the most useful and robust method of classification was as follows: The longitudinal data were divided into three epochs spanning the periods from birth to 5 years, 5 to 10 years, and 10 to 15 years. For each epoch, whether or not the child had been exposed to parental separation during the epoch was recorded.

Measures of Adolescent Psychopathology and Problem

Covariates

Behaviors at Age 15 Years

A major concern of this analysis was with adjusting associations between exposure to family change during childhood and adolescent outcomes taking into account potential confounding factors that were measured before the onset of both separation and adolescent outcome measures. Since the analysis dealt with a series of age epochs, the availability of covariate factors varied with the period being studied. First, to control associations between separation during the period 0 to 5 years and outcomes at age 15 years, the covariate factors were variables measured at the initial birth interview. These factors included the following: a measure of family social position based on a combination of measures of parental education levels, parent al ethni ciry, family socioeconomic status, and family composition (Fergusson et al., 1984a); parental frequency of church attendance; family size; gender; maternal smoking (cigarettes perday) and alcohol use (drinks per week) during pregnancy; and whether the mother was prescribed seda tives or tranquilizers during pregnancy. Second, to control associations between separation during the period 5 to 10 years and outcomes at 15 years, data collected before the age of 5 years were used as control variables. These data included the birth variables listed above supplemented by a series of measures observed during the interval 0 to 5 years, including a measure of mother-child interaction based on the maternal emotional responsiveness subscale of the Home Ob servation for Measurement of the Environment inventory (Bradley and Caldwell, 1977) measured at 3 years; a measure of family living standards based on an average of interviewer ratings of living standards from 1 to 5 years (Fergusson et al., 1990); and frequency of adverse family life events based on the Holmes and Rahe (1%7) Social Readjustment Rating Scale.

At age 15 years the following aspects of adolescent adjustment were measured: DSM-IJI-R Diagnoses of Adolescent Disorders. At age 15 years subjects were assessed using a series of instruments including the Revised Behavior Problem Checklist (Quay and Peterson, 1987), the Diagnostic Interview Schedule for Children (Costello et al., 1982), and the Self-Report Early Delinquency Scale (Moffitt and Silva, 1988); both maternal and child report were used. From these sources DSM-III-R (American Psychiatric Association, 1987) diagnoses were constructed for the following diagnostic group ings: (1) conduct or oppo sitional defiant disorders; (2) anxiety disorders including overanxious disorder, generalized anxiety disorder , and separation anxiety; (3) mood disorders including major depression and dysthymia; and (4) substance abuse or dependence including nicotine dependence, alcohol abuse, and illicit drug abuse. Diagnostic classifications were constructed using two methods for combining maternal and child report data. These methods were the optimal informant method described by Loeber et al. (1989) and latent class analysis methods . Both methods produced similar prevalence estimates. These estimates were cross-validated by comparing them with estimates from another New Zealand study (McGee et al., 1990) which had developed DSM-JIIdiagnoses using similar instrumentation. There was good agreement between the prevalence estimates from the two studies. A detailed description of the construction of the above measures has been given in a previous paper (Fergusson et al., 1993). Early-Onset Sexual Behavior. Since it has been suggested that exposure to parental separation increases the risk of early-onset sexual behaviors, DSM-JII-R diagnoses were supplemented by a measure of early-onset sexual behaviors. This measure was based

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TABLE 1 Prevalences (Leading D iagonal) and Odds Ratios between Measures of Adolescent Problem Behaviors

Sexual activity Substance abuse/dependence Conductloppositional disorders Mood disorders Anxiety disorders

Sexual Activity

Substance Abuse/Dependence

Conduct/ Oppositional Disorders

Mood Disorders

Anxiety Disorders

8.8 (7.0- 10.6) 16.0 (9.3-27.6) 5.1 (3.0-8.5) 2.3 (1.1-4 .7) 1.2 (0.5-2 .8)

7.8 (6. 1-9.5) 10.9 (6.5- 18.4) 4.3 (2.2-8 .3) 2.6 (1.2- 5.3)

10.9 (8.9- 12.9) 3.4 (1.8-6.3) 3.3 (1.8-6.2)

6.3 (4.7-7.9) 5.6 (2.9- 11.0)

6.4 (4.8-8.0)

Note: Values on the diagonal are percent ages; 95% confidence intervals are given in parentheses.

Finally, to cont rol associations between separation durin g the period 10 to 15 years and outcomes at 15 years the data described above were used and were supplemented by furth er measures observed dur ing the interval from 5 to 10 years. These variables included a measure of family living standards over the interval based on an average of interviewer ratings of living standards up to 10 years (Fergusson et al., 1990); frequency of adverse family life events (Holmes and Rahe, 1%7); and a measure of the level of parental conflict based on the frequency of parental arguments, assault by husband, and reponed sexual problems dur ing the interval (Fergusson er al., 1992). In addition, at 15 years the following measure was . obtained: whether there was a history of alcohol or substance abuse among first-degree relatives of the child.

Sample Size Although the original cohort compri sed 1,265 children , the analyses repon ed in this paper were based on a sample of 935 children. This sample represented 73.9% of the original cohort and 83.7% of those cohort members still alive and resident in New Zealand at age 15. T o examine the possible effects of sample attrition on the validity of the conclusions drawn in this paper, two tests were condu cted. In the first test, associations between separation up to the age of 5 years and up to the age of 10 years with sample losses subsequent to these ages were compured. Both analyses revealed that losses to follow-up were uncorrelared with parental separation by the age of 5 years (X2 1 = 0.00; p > .90) or with parental separation by the age of 10 years (X2 ! = 0.04; p > .80). In the second test, associations between the child's behavioral status measured at 8 years and losses to follow-up subsequent to the age of 8 years were computed. These analyses showed that losses to follow-up were uncorrelared with measures of conduct disorder at age 8 years (r = .04; p > .50), attent ion deficit behaviors at age 8 years (r = .01; P > .80), or measures of anxiety or with drawal at age 8 years (r = .01; P > .80). Collectively, these tests provide strong reassurance that the resulrs of the present analysis are unlikely to be adversely affected by sample selection biassince processes ofsample loss were uncorrelated with both the child's history of parental separation and with measures of childhood behaviors.

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RESULTS Bivariate Relationsh ips between Exposure to Parental Separation at Different Ages and Rates of Adolescent Problems at Age 15 Years

Table 2 shows the associations between exposure to parental separation during the intervals 0 to 5, 5 to 10, and 10 to 15 years related to rates of adolescent problem behaviors and psychiatric disorder at age 15 years. Each compar ison is tested for significance using the X2 statistic, and the strength of the associations between exposure to parental separation and outcomes is measured by the OR. The OR measures the increase in the odds of the problem behaviors for children exposed to parental separation relative to the odds of these behaviors for children not exposed to parental separation. Inspection of T able 2 shows that there was a general tendency for children who were exposed to parental separation in childhood to have higher rates of problem behaviors and psychopathology than children not exposed to parental separation. Children who were exposed to separation had odds of problem behaviors and sexual activity that were between 1.11 and 4.00 (median 2.29) times higher than those of children not exposed to separation. . Of the 15 comparisons shown in Table 2, 12 were statistically significant (p < .05), with nonsignificant associations being found between exposure to parental separation during the interval 0 to 5 years and anxiety disorders (p > .20) and between exposure to parental separation during the interval 5 to 10 years and mood disorders (p > .10) and anxiety disorders (p > .50).

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TABLE 2 Rates (Percent) of Problem Behaviors at 15 Years by Parental Separation during the Periods o to 5 Years, 5 to 10 Years, and 10 to 15 Years Period

Sexual Activity

Substance Abuse/Dependence

Conduct/Oppositional Disorders

Mood Disorders

Anxiety Disorders

825 110

7.5 18.2 2.73 (1.58-4.74) <.001

6.9 14.6 2.29 (1.27-4.15) <.003

8.9 26.4 3.69 (2.27-5.99) <.001

5.1 15.5 3.41 (1.87-6.21) <.001

6.1 9.1 1.55 (0.76-3.15) >.20

806 129

7.8 14.7 2.04 (1.18-3.53) <.01

6.7 14.7 2.40 (1.37-4.20) <.003

9.6 19.4 2.28 (1.39-3.73) <.001

5.8 9.3 1.66 (0.85-3.22) >.10

6.3 7.0 1.11 (0.53-2.31) >.50

823 112

7.5 17.9 2.67 (1.54-4.61) <.001

6.1 20.5 4.00 (2.32-6.85) <.001

9.6 20.5 2.43 (1.46-4.07) <.001

5.7 10.7 1.98 (1.02-3.86) <.05

5.7 11.6 2.17 (1.13-4.15) <.05

N

0-5 Years No separation Separation Odds ratio 95% CI

P

5-10 Years No separation Separation Odds ratio 95% CI

P

10-15 Years No separation Separation Odds ratio 95% CI

P Note: CI

=

confidence interval.

However, because the table reports multiple significance tests, it is clear that the interpretation of the p values is complex since the probability of observing at least one significant result will vary with the number of tests conducted. One means of addressing this problem is to adjust significancelevelsusing the Benferroni correction. This correction takes into account the effects of multiple significance tests by setting an adjusted significance level based on the number of tests conducted. This adjusted level is given by al n, where a is the level of significance adopted and n the number of tests. The Bonferroni adjusted significance level for Table 2 and a = .05 is .0033. Using this level, 9 of the 15 comparisons reached statistical significance.

years may have been exposed to separation at later ages as a result of parental remarriage and the dissolution of a second union. To address the issueof the dependencies between exposure to separation during childhood, the results were analyzed using a series of logistic models. In these models, the log odds of each of the five outcomes was regressed upon the child's history of exposure to parental separation up to a given age taking into account his or her history of separation at preVIOUS ages. To estimate the association between separation at age 0 to 5 years and outcomes, the model fitted was: Logit Pr( Ii

=

/30

+

/31 X;

where Logit Pr( Ii = 1) was the log odds of the ith outcome measure and X; was the measure of separation during the interval 0 to 5 years. The coefficient /31 measures the shift in the log odds of the outcome for children exposed to separation during their first 5 years. To estimate the effects of separation at age 5 to 10 years on outcomes, the model fitted was:

Relationships between History of Exposure to Separation at Different Ages and Outcomes at Age 15 Years

The results in Table 2 suggest general tendencies for children who were exposed to separation at different periods of childhood to have generally increased rates of disorder and early sexual activity. However, these results do not fully represent the relationships between the child's history of exposure to separation during childhood and outcomes, since some children who were exposed to separation during the period 0 to 5

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1)

=

Logit Pr( Ii

=

1)

=

/30

+

/31 X;

+

/32

~

where ~ was the measure of separation at age 5 to 10 years. The parameter /32 estimates the shift in the

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log odds of the ith outcome measure for children whose parents separated in the interval 5 to 10 years when the effects.of separation during the interval 0 to 5 is taken into account. Similarly, the model for separation during the interval 10 to 15 years was: Logit PrO~ = 1) = ~o + ~l X; + ~2

.x;

+ ~3

A3

where A3 was the measure of separation during the interval 10 to 15 years. The parameter ~3 measures the effects of separation during the interval 10 to 15 years on the outcome after the effects of the separations during the previous period (0 to 5 years; 5 to 10 years) are taken into account. The results of this analysis are shown in Table 3, which gives estimates of the ORs linking parental separation at each age interval to each outcome after adjustment for previous history of separation. The table shows that parental separation during the interval 0 to 5 years was associated with significant (p < .003) increases of early sexual activity, substance abuse or dependence, conduct or oppositional disorders, and mood disorders. In all cases these associations are significant using conventional and Bonferroni corrected significance levels and suggest that children whose parents separated during the interval from 0 to 5 years had odds of 2.3 to 3.4 of displaying early-onset sexual activity, substance abuse or dependence, conduct or oppositional behaviors, and mood disorders. However, anxiety disorders were unrel~ted to parental separation.

Table 3 also shows that during the interval from 5 to 10 years there were significant (p < .05) associations between parental separation and early sexual activity, substance abuse or dependence, and conduct or oppositional disorders. However, none of these associations reached the Bonferroni corrected significance level (p < .0033). Finally, the results for 10 to 15 years show that exposure to parental separation during the interval was associated with significant (p < .05) increases in the risks of all outcomes. However, only three of these comparisons (sexual activity, substance abuse, conduct or oppositional disorders) reached significance using Bonferroni corrected values (p < .0033). Adjustment for Covariate Factors

The results thus far suggest that when allowance is made for the associations between separation at various ages, exposure to parental separation was associated with increases in risks of adolescent problems. These associations were most marked for separations occurring either during the preschool (0 to 5 years) period or after the age of 10 years. It is possible, however, that the apparent associations between parental separation and adolescent outcomes reflect the presence of third or confounding factors that were associated with increased risks of both parental separation and adolescent problems. To address this issue the results were further analyzed using logistic regression models in which the associations between separation at a given age and a

TABLE 3 Odds Ratios (95% Confidence Intervals) between Adolescent Outcomes and Parental Separation Adjusted for Preceding History of Parental Separation Sexual Activiry

Substance Abuse/Dependence

Conduct/Oppositional Disorders

Mood Disorders

Anxiety Disorders

JI'

2.73 (1.58-4.74) <.001

2.29 (1.27-4.15) <.003

3.69 (2.27-5.99) <.001

3.41 (1.87-6.21) <.001

1.55 (0.76-3.15) >.20

r

1.77 (1.01-3.11) <.05

2.17 (1.22-3.84) <.005

1.90 (1.14-3.18) <.01

1.36 (0.68-2.69) >.15

1.04 (0.49-2.19) >.40

2.39 (1.35-4.22) <.003

3.53 (2.02-6.17) <.001

2.13 (1.24-3.66) <.003

1.81 (0.91-3.63) <.05

2.18 (1.12-4.24) <.05

Timing of Parental Separation 0-5 Years Odds ratio

5-10 Years Odds ratio

10-15 Years Odds ratio

• One-tailed test.

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given adolescent outcome were adjusted for (1) the child's history of separation before the age studied and (2) confounding social and contextual factors. The logistic model fitted was: Logit Pr( 1';"

=

1)

= ~o + ~1

X

+

L

~j

correlated effects of a range ofsocial and familial factors that were correlated with both parental separation and adolescent outcomes. These factors include family social and economic circumstances, parental substance use behaviors, parental religiosity, and parental conflict.

Zj

where X was the measure of separation of interest and Zj was a set of covariate factors summarizing the individual's prior history of exposure to separation and measures of family and social contextual factors observed before the separation of interest. The parameter ~l estimates the increase in the log odds of the outcome after the main effects of the covariate factors on the outcome have been taken into account. The results of this analysis are summarized in Table 4, which shows estimates of the ORs between measures of parental separation and each outcome adjusted for the covariate factors, tests of the significance of the OR based on the ratio of the estimated model parameter (~l) to its standard error, the covariate factors entered into each equation, and the significant covariate factors in the equation. Comparison of the results in Table 4 with those in Tables 2 and 3 show that the consequence of controlling associations between parental separation and covariate factors was to reduce the associations between parental separation and childhood outcomes quite substantially. For the interval 0 to 5 years, only two associations remained significant after covariate adjustment. These were between early parental separation and conduct or oppositional disorders (OR = 2.03; 95% CI = 1.19, 3.45) and mood disorders (OR = 3.33; 95% CI = 1.79,6.16). Using the Bonferroni corrected significance level of .0033, only the comparison for mood disorders remains significant. For the interval 5 to 10 years, none of the associations between parental separation and adolescent outcomes remained statistically significant (p > .10), suggesting adjustment for covariate factors was sufficient to explain any association between parental separation at this age and adolescent outcomes. For the period 10 to 15 years, one OR remained statistically significant. This was between parental separation during the interval 10 to 15 years and substance abuse behaviors (OR = 2.75; 95% CI = 1.52, 4.95). Inspection of the covariate factors suggests that the associations between parental separation and the outcome measures arose largely from the common and

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Effects of Gender as a Modifier Variable

The analysisabove reports on the association between parental separation and adolescent outcomes for the total sample. It has, however, been proposed that the effects of separation may be modified by the child's gender, with boys being more responsive to this event than girls. It was possible to test this hypothesis by stratifying the sample by gender and fitting nested logistic models which permit estimation of the extent to which the associations between separation and outcomes vary with the child's gender. An account of the method of fitting nested models to stratified data may be found in the SAS manual (SAS Institute Inc., 1985, pp. 171-195). Using this method, it was possible to construct log likelihood X2 tests of the extent to which the regression parameters relating parental separation to adolescent outcomes differed for males and females. This analysis failed to produce any evidence of consistent gender differences in the models linking parental separation to adolescent outcomes. Of the 15 comparisons made, only 1 showed the presence of a small significant (p < .05) difference in the model parameters for boys and girls, and it is likely that this result could reflect chance variation due to repeated significance testing.

DISCUSSION

In this paper we have used 15-year longitudinal data to examine the relationship between exposure to parental separation and divorce during childhood and a range of adolescent outcomes including early-onset sexual activity, substance abuse or dependence, conduct or oppositional disorders, mood disorders, and anxiery disorders. An important feature of this design was that it was possible to examine the relationships between exposure to separation and adolescent behaviors taking into account family and socialfactors that were observed before the occurrence of parental separation. The major findings and conclusions of the study are described below.

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TABLE 4 Odds Ratios (95% Confidence Intervals) between Adolescent Outcomes and Parental Separation Adjusted for Covariates and Preceding History of Parental Separation Sexual Activity

Substance Abuse/Dependence

Conduct/Oppositional Disorders

Mood Disorders

Anxiety Disorders

JI'

1.46 (0.81-2.64) >.10 1-7 1,7

1.37 (0.72-2.59) >.15 1-7 1,3,4

2.03 (I.I9-3.45) <.006 1-7 1-3,6

3.33 (1.79-6. 16) <.001 1-7 5,7

1.42 (0.67-2.99) >.15 1-7 3,6,7

JI'

I.I7 (0.65-2.13) >.25 1,7-10 1,7

1.46 (0.80-2.66) >.10 1,3,4,8-10 1,3,4

1.40 (0.82-2.39) >.10 1-3,6,8-10 1-3,6

1.24 (0.61-2.51) >.25 5,7,8-10 5,7

1.07 (0.50-2.32) >.40 3,6,7-10 3,6,7

JI'

1.58 (0.87-2.89) >.05 1,7,9-12 1,7,11,12

2.75 (1.52-4.95) <.001 1,3,4,9-12 1,3,4,11

1.23 (0.69-2.18) >.20 1-3,6,9-12 3,9,11,12

1.55 (0.75-3.19) >.10 5,7,9-12 5,7,9

1.77 (0.88-3.53) >.05 3,6,7,9-12 7,12

Timing of Parental Separation

0-5 Years Odds ratio

Covariates entered" Significant covariates 5-10 Years Odds ratio

Covariates entered" Significant covariates 10-15 Years Odds ratio

Covariates entered" Significant covariates

One-tailed test. 1 = family social position; 2 = family size; 3 = frequency of church attendance; 4 = maternal alcohol use during pregnancy; 5 = maternal use of sedativesltranquilizers during pregnancy; 6 = maternal smoking during pregnancy; 7 = gender; 8 = mother-child interaction; 9 = family living standards; 10 = family life events; 11 = family history of alcohol/substance abuse; 12 = parental conflict. a

b Covariates:

First, the results confirmed the findings of many previous studies that have reported that exposure to family change and parental separation during childhood is associated with increased risks of adolescent problem behaviors. In this study children exposed to parental separation at various ages had increased odds of adolescent psychiatric disorder or early sexual activity that were between 1.11 and 4.00 (median 2.29) times higher than those of children without such exposure. On the basis of this evidence, it is quite clear that parental separation during childhood is a correlate of psychiatric disorders and problems of adjustment during adolescence. However, while children exposed to parental separation during childhood had increased risks of later adolescent problems, further analysis suggested that most of this association did not reflect a cause and effect association between exposure to parental separation and childhood outcomes. The analysis identified a series of factors that were correlated with both increased risks of parental separation and increased risks of adolescent psychopathology and problems. These factors include measures of family social and economic circumstances, parental substance use behaviors, parental religiosity,

]. AM. ACAD. CHILD ADOLESC. PSYCHIATRY. 33:8. OCTOBER 1994

and parental conflict. When due allowance was made for these social and contextual factors associated with parental separation, most of the associations between parental separation and adolescent outcomes were explained. Nonetheless, three associations persisted after such control. In particular, children exposed to parental separation before school entry showed increased risks of later conduct or oppositional disorders and mood disorders. These results suggest that exposure to parental separation during early childhood may, by various processes, increase later vulnerability to disruptive behavior problems and mood disorders. In addition, children exposed to parental separation after the age of 10 showed increased risks of substance abuse behaviors in adolescence, with these children having odds of substance abuse behavior that were approximately 2.75 times higher than those of children not exposed to separation at this time. This result may suggest that parental separation in early adolescence is a risk factor for adolescent substance use. What perhaps emerges most clearly from this analysis is that despite long-standing concerns about the role of parental separation, divorce, and processes of family change as risk factors for adolescent and adult psychiat-

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FERGUSSON ET AL.

ric illness, the associations between these measures and later ourcomesare generally very modest and much of the apparent associations between exposure to parental separation during childhood and later outcomes is likely to be explained by social and contextual factors that are associated with both increased risks of parental separation and adolescent outcomes. Furthermore, it is possible that the present results may overestimate the associations between adolescent outcomes and parental separation. In particular, while this study has controlled a number of prospectively measured covariate factors, it is clear that this control could have excluded some influential covariates that may explain any remaining association between parental separation and childhood outcomes. One such omission is the absence of any measure of child abuse or neglect. It seems likely that such a measure could act asa further source of confounding, since it is well documented that experiences of neglect and abuse during childhood are associated with increased risksof later psychopathology (e.g., Brown and Anderson, 1991; Finkelhor and Brown, 1988) and it is likely that families in which such events occur may be characterized by higher rates of parental separation. These considerations all lead to the general conclusion that parental separation, in the absence ofother social and contextual factors, is unlikely to play a major role in the development of adolescent psychopathology. An influential hypothesis in this area has been that the child's gender modifies responses to parental separation, with boys being more responsive to this event than girls (Emery and O'Leary, 1982; Hetherington et al., 1982; Porter and O'Leary, 1980; Wallerstein and Kelly, 1980). In a review of the evidence for this hypothesis, Amato and Keith (1991) note that the evidence in support of this view is not strong and the popularity of the hypothesis appears to reflect the frequent citation of a small number of influential studies. In the present study no evidence was found to support the hypothesis that boys generally react to separation in a way that differs from the response of girls, and this evidence is consistent with the findings of more recent studies that have failed to find any evidence to suggest that gender acts to modify responses to parental separation (Allisonand Furstenberg, 1989). The major clinical implications of these findings are clearly that parental separation in the absence of other social and contextual factors is unlikely to be an event

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J.

that increases risks of adolescent psychopathology markedly. However, children subject to early separation may be at an increased risk of disruptive behavior problems and mood disorders, and adolescents exposed to separation may show increased use of substances. These considerations suggest that there may be considerable value in reducing the emphasis on parental separation as a cause of adolescent psychopathology and replacing this emphasis with a more general perspective involving social and contextual factors including family social background, parental substance use, parental values, and parental conflicts that may give rise to increased risks of psychopathology in adolescents. From a theoretical standpoint, the results of this study are generally consistent with emerging trends in research into processes of family change. Coleman and Ganong (1990) have noted that the earlier emphasis of research in this area upon family change as a cause of psychiatric problems is gradually being replaced by an alternative approach that examines family changes as a process of adaptation and examines the factors that lead to successful and unsuccessful responses to these circumstances. The present study is generally consistent with this emerging theme to the extent that the findings suggest that exposure to parental separation during childhood is unlikely to play a major role in the development of adolescent psychopathology. Rather, the results of the present analysis suggest that separation during childhood is one of a large number of disadvantageous experiences in childhood that individually have only small effects on risks of psychopathology but that collectivelymay result in large increases in vulnerability to psychiatric illness.

REFERENCES Allison PE, Furstenberg FF jr (1989), How marital dissolution affects children: variations by age and sex. DevelopmentalPsychology 25:540-549 Amato PR, Keith B (1991), Parental divorce and the well-being of children: a meta-analysis. Psychol Bull 110:26-46 American Psychiatric Association (1987), Diagnostic and Statistical Manual ofMentalDisorders, 3rd edition-revised (DSM-IlI-R). Washington, DC: American Psychiatric Association Bradley RH, Caldwell BM (1977), Home Observation for Measurement of the Environment: a validation study of screening efficiency. Am J

Ment Deficiency 81:417-424 Brody GH, Neubaum E, Forehand R (1988), Serial marriage: a heuristic analysis of an emerging family form. Psychol Bull 103:211-222 Brown GR, Anderson B (1991), Psychiatric morbidity in adult inpatients with childhood histories of sexual and physical abuse. Am J Psychiatry 148:55-61

AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 33:8, OCTOBER 1994

SEPARATION AND ADOLESCENT PROBLEMS

Brown M, Madge N (1982), Despite the Welfare State: A Report on

the SSRCIDHSS Programme of Research into Transmitted Deprivation. London: Heinemann CheriinAJ (1981), Marriage, Divorce, Remarriage. Cambridge, MA: Harvard University Press Coleman M, Ganong LH (1990), Remarriage and stepfamily research in the 1980's: increased interest in an old family form. Journal ofMarriage and the Family 52:925-940 Costello A, Edelbrock C, Kalas R, KesslerM, K1aric SA (1982), Diagnostic Interview Schedule for Children (DISC). Contract No. RFP-BD-810027. Bethesda, MD: National Institute of Mental Health Edwards IN (1987), Changing family structure and youthful wellbeing: assessing the future. Journal ofFamily Issues 8:355-372 Emery RE (1988), Marriage, Divorce, and Children's Adjustment. Newbury 1 Park, CA: Sage Emery RE, O'Leary KD (1982), Children's perceptions of mariral discord and behavior problems of boys and girls. J Abnorm Child Psychol 10:11-24 Fergusson DM, Dimond ME, Horwood LJ, Shannon FT (1984a), The utilisation of preschool health and education services. Soc Sci Med 19:1173-1180 FergussonDM, Horwood LJ, LawtonJM (1990), Vulnerability to childhood problems and family social background. J Child Psychol Psychiatry 31:1145-1160 Fergusson DM, Horwood LJ, LynskeyMT (1992), Family change, parental discord and early offending. J Child Psychol Psychiatry 33:1059-1075 Fergusson DM, Horwood LJ, LynskeyMT (1993), Prevalenceand cornorbidity of DSM-III-R diagnoses in a birth cohort of 15 year olds. JAm Acad ChildAdolesc Psychiatry 32:1127-1134 Fergusson DM, Horwood LJ, Shannon FT (1984b), A proportional hazards model of family breakdown. Journal of Marriage and the Family 46:539-549 Fergusson DM, Horwood LJ, Shannon FT, Lawton JM (1989), The Christchurch Child Development Study: a review of epidemiological findings. Paediatr Perinat Epidemiol 3:302-325 Finkelhor D, Brown A (1988), Assessing rhe long term impact of child sexual abuse. In: Family Abuseand Its Consequences, Horalling RGT,

Finkelhor D, Kirkparrick JT, Srrauss MA, eds. London: Sage, pp 270-284 Furstenberg FF Jr (1990), Divorce and the American family. Annual Review of Sociology 16:379-403 Glick PC, Lin S (1986), Recent changes in divorce and remarriage. Journal of Marriage and the Family 48:737-747 Hetherington EM (1989), Coping with family transitions: winners, losers and survivors. Child Dev 60:1-14 Hetherington EM, Cox M, Cox R (1982), Effects of divorce on parents and children. In: Nontraditional Families, Lamb M, ed, Hillsdale, NJ: Erlbaum, pp 233-288 Holmes TH, Rahe RH (1967), The Social Readjustment Rating Scale. J Psychosom Res 11:213-217 Loeber R, Green SM, Lahey BB, Stouthamer-Loeber M (1989), Optimal informants on child disruptive behaviors. Development and Psychopathology 1:317-337 Lynskey MT, Fergusson DM (1993), Sexual activity and contraceptive use amongst teenagers under the age of 15 years. N Z Med ] 106:511-514 McGee R, Feehan M, Williams S, Partridge F, Silva PA, Kelly J (1990), DSM-III disorders in a large sample of adolescents. JAm Acad Child Adolesc Psychiatry 29:611-619 Moffitt TE, Silva PA (1988), Self-reported delinquency: results from an insrrument for New Zealand. Australian and New ZealandJournal of Criminology 21:227-240 Porter B, O'Leary KD (1980), Marital discord and childhood behavior problems. J Abnorm Child Psychol 8:287-295 Quay HC, Peterson DR (1987), Manualfor the Revised Behavior Problem Checklist. Miami: HC Quay and DR Pererson Rutter M, Madge N (1976), Cycles of Disadvantage: A Review ofResearch. London: Heinemann SAS Institute Inc (1985), SAS User's Guide: Statistics, version 5 edition. Cary, NC: SAS Institute Inc Teachman JD (1982), Methodological issues in the analysis of family formation and dissolution. Journal of Marriage and the Family 44:1037-1053 Wallerstein JS (1991), The long-term effects of divorce on children: a review. JAm Acad ChildAdolesc Psychiatry 30:349-360 Wallerstein JS, Kelly JB (1980), Surviving the Breakup: How Children and Parents Cope with Divorce. London: Grant McIntyre

DISCUSSION OF:

"Parental Separation, Adolescent Psychopathology, and Problem Behaviors" j~

ANDRE P. DERDEYN, M.D.

Paralleling the Virginia Slims cigarette advertising theme, over the last several decades the child development and therapy field has come a long way from considering father absence as the key to developmental

Accepted May 20, 1994. Dr. Derdeyn is WOHDAN Professor and Chief, Division of Pediatric Psychiatry, University ofArkansas for Medical Sciences, Arkamas Children's Hospital, Little Rock. Correspondence to Dr. Derdeyn, Chief, Division of Pediatric Psychiatry, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, 800 Marshall Street, Little Rock, AR 72202. 0890-8567/94/3308-1131$03.00/0©1994 by rhe American Academy of Child and Adolescent Psychiatry.

J. AM.

ACAD. CHILD ADOLESC. PSYCHIATRY, 33:8, OCTOBER 1994

disruption in children after the separation· and divorce of their parents. In 1960 the number of young children living with divorced mothers and with widowed mothers was equal (Glick, 1979), and the research focus of the time was on "broken homes" and "father absence." Being raised in a broken home was found to be associated with an increased risk for delinquency in boys (Anderson, 1968; Douglas, 1970). Divorce or separation, however, was the most closely associated: loss of a parent by death was followed by only a slight increase in delinquency over that of the control group in boys, while divorce or separation. was followed by almost a doubling of the delinquency rate (Douglas

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DISCUSSION

et al., 1966; Gibson, 1969). Rutter (1971) suggested that the association between broken homes and delinquency may be due to the marital discord and distortion of relationships that preceded divorce rather than to the divorce itself. Parental discord before and after the divorce has been found to influence children's adjustment more powerfully than does the separation or divorce itself (Amato and Keith, 1991; Emery, 1982; Forehand et al., 1991; Johnston et al., 1987; Patterson and Stouthamer-Loeber, 1984; Shaw and Emery, 1987). Parental conflict is a key issuewith which boys' behavior problems are associated, whether or not the families are intact or separated (Emery and O'leary, 1982; Lupenitz, 1979; McCord et al., 1962; Porter and O'leary, 1980; Rosen, 1979; Rutter, 1981). Parental disagreement has also been found to predict both behavior problems in boys and divorce of parents. The boys of subsequently divorcing families exhibited undercontrol of impulses, aggression, and excessive energy as much as 11 years before the divorce of their parents (Block et al., 1986, 1988). A longitudinal survey has found that for girls, as well, consideration of preexisting conditions reduced the apparent effect ofdivorce (Cherlin et al., 1991). The separation process, however, contributes some disruptions of its own: two major longitudinal studies report a period of impaired adjustment in children in the postseparation period (Hetherington et al., 1982; Wallerstein and Kelly, 1980). The study "Parental Separation, Adolescent Psychopathology, and Problem Behaviors" found most of the association between parental separation and increased risk of adolescent problems to arise from confounding social and contextual factors; separation itself contributed a relatively small amount. These factors were correlated with increased risk of both parental separation and of adolescent psychopathology and other problems. Exposure to parental separation during the interval from 0 to 5 years predicted odds of between 2.3 and 3.4 of displaying early-onset sexual activity, substance abuse or dependence, conduct or oppositional behaviors, and mood disorders. Separation during the interval from 5 to 10 years was associated with early sexual activity, substance abuse or dependence, and conduct or oppositional disorders. Exposure to parental separation during the 10- to 15-year interval was associated with

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significant increases in the risk for all the outcomes including anxiety disorders. However, controlling the associations between parental separation and the covariate factors reduced the association between parental separation and childhood outcome quite substantially. The social and contextual factors which the authors found to be associated with parental separation and adolescent psychopathology are harmful for children whether their parents divorce or not. The finding that parental separation during childhood is unlikely to play a major role in the development of adolescent psychopathology parallels the older work discussed previously. As the authors cogently state, "separation during childhood is one of a large number of disadvantageous experiences in childhood . . . that collectively may result in large increasesin vulnerability to psychiatric illness." It is striking how the worlds of divorce research and therapeutic or forensic work differ. The research is "cool" and finds no overwhelming effect of parental separation; one's child and adolescent patients are overwhelmed by emotion and are not at all cool. Those of us who conduct psychotherapy continue to hear the anger, pain, and longing associated with separation and divorce of parents. Our patients focus on the separation, long for parental contact and caring, and often consider the divorce as the major event of their childhoods. Their subjective experience is, I think, a major factor in why the research findings in this area have not been accepted among clinicians. The research has come a long way from assuming that it was a devastating loss when the Big Guy departed, to currently finding that his leaving is just another adverse event of many.'

REFERENCES Amato PR, Keith B (1991), Parental divorce and the well-being of children: a meta-analysis. J Psychol Bull 110:26-46 Anderson RE (1968), Where's dad? Parental deprivation and delinquency.

Arch Gen Psychiatry 18:641-649 Block JH, Block], Gjerde PF (1986), The personality of children prior to divorce: a prospective study. Child Deu 57:827-840 Block], Block ]H, Gjerde PF (1988), Parental functioning and the home environment in families of divorce: prospective and concurrent analyses.

JAm Acad ChildAdolesc Psychiatry 27:207-213 Cherlin AJ, Furstenberg FF, Chase-Lansdale L (1991), Longitudinal studies of effects of divorce on children in Great Britain and the United States.

. Science 252:1386-1389 Douglas]WB (1970), Broken families and child behavior. J R ColiPhysicians

Lond 4:203-210 Douglas ]WB, Ross ]M, Hammond WA et al, (1966), Delinquency and social class. British Journal of Criminology 6:294-302

]. AM. ACAD. CHILD ADOLESC. PSY<;:HIATRY, 33:8, OCTOBER 1994

SEPARATION AND ADOLESCENT PROBLEMS Emery RE (1982), Interparental conflict and the children of discord and divorce. Psychol Bull 92:310-330 Emery RE, O'Leary KD (1982), Children's perceptions of marital discord and behavior problems of boys and girls. 1 Abnorm Child Psychol 10:11-24 Forehand R, Wierson M, Thomas AM et al. (1991), A short-term longitudinal examination of young adolescent functioning following divorce. J

McCordJ, McCord W , Thurber E (1962), Some effectsof paternal absence on male children. J Abnorm Soc PsychoI64:361-369 Parterson GR, Southamer-Loeber M (1984), The correlation of family management practices and delinquency. Child Deu 55:1299-1307 Porter B, O'Leary KD (1980), Marital discord and childhood behavior problems. J Abnorm Child Psychol8:287-295 Rosen R (1979), Some crucial issuesconcerning children of divorce. Journal ofDivorce 3:19- 25 Rutter M (l971), Parent-child separation. J Child Psychol Psychiatry 12:233-260 Rutter M (1981), Stress, coping and development. J ChildPsychol Psychia-

Abnorm Child PsychoI19:97-111 Gibson HB (1969) , Early delinquency in relation to broken homes. J Child

Psychol Psychiatry 10:195-204 Glick PC (1979), Children of divorced parents in demographic perspective.

Journal ofSocial Issues 35:170-182

try 22:323-356

Hetherington EM, Cox M, Cox R (1982), Effects of divorce on parents and children. In: Nontraditional Families, Lamb M, ed. Hillsdale, NJ: Erlbaum Johnston JR, Gonzalez R, Campbell LE (1987), Ongoing posrdivorce conflict and child disturbance. J Abnorm ChildPsychoI15:493-509 Lupenitz DA (1979), Which aspects of divorce affect children? Family

Shaw DS, Emery RE (1987), Parental conflict and other correlates of the adjustment of school-age children whose parents have separated. J

Abnorm Child PsychoI15:269-281 Wallerstein JS, Kelly JB (1980), Surviving the Breakup. New York: Basic Books

Coordinator 28:79-85

Coming in November/December: Somatization in Children and Adolescents John V Campo and Sandra L. Fritsch



Are Adolescents Changed by an Episode of Major Depression? PaulRohde et al.



Learning Disabilities in School-Refusing Adolescents Michael W Naylor et at.



7-Year Follow-up of Speech-Impaired Children Joseph H Beitchman et at.

J. AM. ACAD . CHILD ADOLESC. PSYCHIATRY, 33 :8, OCTOBER 1994

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