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Single-parent Children At Increased Risk Of Suicide, Psychiatric Disease, And Substance Abuse (pp 271, 289)

January 23, 2003

Authors of a Swedish population study in this week's issue of THE LANCET provide strong evidence that children brought up in single-parent households are more likely to suffer health problems--especially relating to mental illness and suicide risk--than children brought up with both parents in the same household.

Research on the psychological and health effects of parental separation provides conflicting results; early studies suggest that divorce or separation has only short-term effects on the well-being of children, while more recent reports suggest that the negative effects of parental break-up may be long-term. Gunilla Ringb'¤ck Weitoft from Sweden's National Board for Health and Welfare, Stockholm, and colleagues proposed that low socioeconomic status would be one of the main causes behind poorer health outcomes for children growing up in single-parent households.

The investigators compared death statistics and the risk of hospital admission during the 1990s for around 65,000 children living with single parents with around 920,000 children brought up in two-parent households. Children with single parents showed increased risks of psychiatric disease, suicide or suicide attempt, injury, and addiction. After adjustment for confounding factors such as socioeconomic status and parents' addiction or mental disease, children in single-parent households were twice as likely to have psychiatric disease compared with those in two-parent households; relative risks of suicide attempt and for alcohol-related disease were also doubled. The risk of childhood narcotic abuse was increased threefold among girls and fourfold among boys living in single-parent households.

Gunilla Ringb'¤ck Weitoft comments: "Growing up in a single-parent family is associated with increased risks of a variety of severe health outcomes. Among the variables available in our study, lack of household resources plays a major part in increased risks. Even when a wide range of demographic and socioeconomic circumstances are included in multivariate models, children of lone parents still have increased risks of mortality, severe morbidity, and injury. However, interpretations need to be done with care, since these severe and negative outcomes are relatively rare. To describe the distribution of health disorder and social adjustment further studies with less severe outcomes are needed."

An accompanying Commentary (p 271) by Margaret Whitehead and Paula Holland from the University of Liverpool, UK, emphasises how it is difficult to generalise these findings because of differing prevailing sociological environments in different countries. They conclude: "What such studies highlight more generally is the need for a deeper understanding of the policy context in the various societies under study, and the need to question the meaning of what is being measured. Part of the issue may be that the necessarily crude indicators used to measure complex sociological processes may have different meanings in different places. Whilst in the UK and USA, receipt of welfare benefits is often taken as a marker of poverty, what is this variable capturing in Sweden in Ringb'¤ck Weitoft and colleagues' study?Future studies need to take these lines of investigation forward, to increase understanding of the subtleties of the multiple pathways to health disadvantage in specific societies. Such work is imperative to find effective policies, matched to prevailing circumstances, to address these inequalities."

Lancet