Single Parenthood and Adverse Health and Behavioral Outcomes among Children

90 Pages·2015·3.88 MB·English

by  Hrafnhildur Halldórsdóttir

Single Parenthood and Adverse Health and
Behavioral Outcomes among Children
A cross sectional study among children in Iceland 2011
Hrafnhildur Halldórsdóttir
Ritgerð til meistaragráðu
Námsbraut í lýðheilsuvísindum
Heilbrigðisvísindasvið
Læknadeild

Janúar 2015
Heilsufars- og hegðunarvandamál hjá börnum einstæðra foreldra
Þversniðsrannsókn meðal barna á Íslandi árið 2011

Hrafnhildur Halldórsdóttir

Ritgerð til meistaragráðu í lýðheilsuvísindum
Umsjónarkennari: Stefán Hrafn Jónsson
Meistaranámsnefnd: Arna Hauksdóttir og Helga Zoëga
Læknadeild
Námsbraut í lýðheilsuvísindum
Heilbrigðisvísindasvið Háskóla Íslands
January 2015
Single Parenthood and Adverse Health and Behavioral Outcomes
among Children
A cross sectional study among children in Iceland 2011
Hrafnhildur Halldórsdóttir

Thesis for the degree of Master of Public Health Sciences
Supervisor: Stefán Hrafn Jónsson
Masters committee: Arna Hauksdóttir and Helga Zoëga

Faculty of Medicine
Department of Public Health Sciences
School of Health Sciences
January 2015
Ritgerð þessi er til meistaragráðu í lýðheilsuvísindum og er óheimilt að afrita
ritgerðina á nokkurn hátt nema með leyfi rétthafa.
© Hrafnhildur Halldórsdóttir 2015
Prentun: Háskólaprent ehf.
Reykjavík, Ísland 2015
Ágrip
Bakgrunnur: Í þessari rannsókn voru mælikvarðar á velferð og líðan barna sem búa hjá báðum
foreldrum bornir saman við börn einstæðra foreldra.
Markmið: Að kanna tilgátuna hvort börn sem búa hjá einstæðum foreldrum á Íslandi séu líklegri til
að glíma við andleg og líkamleg heilsufarsvandamál en börn sem búa hjá báðum foreldrum.
Aðferðafræði: Rannsóknin nýtti gögn úr íslenska hluta könnunarinnar "Heilbrigði og líðan barna
og unglinga á Norðurlöndum 2011”. Í þessari þversniðsrannsókn voru 3,200 börn á aldrinum 2-17 ára
valin eftir kyni og aldri með slembiúrtaki úr Þjóðskrá. Alls bárust útfylltir spurningalistar fyrir 1,523 börn,
svarhlutfall var 48.9%. Aðhvarfsgreining var notuð við greiningu á sambandinu milli hjúskaparstöðu
foreldra og útkomubreyta; ofvirkni með athyglisbrest, kvíða, ofþyngd ásamt heildarerfiðleikatölu á
SDQ–Ice spurningalistanum. Niðurstöður voru einnig lagskiptar eftir kyni barns.
Niðurstöður : Niðurstöður voru birtar í fimm fjölþáttagreingar líkönum. Leiðrétt var fyrir aldri og kyni
barns, aldri foreldris, heildartekjum fjölskyldunar, menntunarstigi foreldris, ásamt kvíða foreldris. Loka
líkan sýndi marktækan mun á líðan barna eftir því hvort þau bjuggu með einu foreldri eða báðum, börn
einstæðra foreldra voru líklegri til að glíma við kvíða OR= 2,04 95% CI [1,12-3,73], ofvirkni með
athyglisbresti OR= 2,02 95% CI [1,04-3,90], ofþyngd OR= 3,13 95% CI [1,24-7,92], ásamt hærri
heildarerfileikatölu á SDQ-Ice. Niðurstöður sýndu að drengir voru líklegri til að sýna einkenni ofvirkni
með athyglisbrest ásamt hærri heildarerfileikatölu á SDQ-Ice en stúlkur. Drengir einstæðra foreldra
voru líklegri til að vera í yfirþyngd samanborið við drengi sem búa hjá báðum foreldrum OR= 3,87 95%
CL [1,10-13,64]. Stúlkur einstæðra foreldra voru með hærri heildarefiðleikatölu á SDQ-Ice en stúlkur
sem búa hjá báðum foreldrum. Kvíði foreldra hafði sterkt jákvætt forspárgildi í öllum líkönum, nema
hvað varðar yfirþyngd. Ályktanir: Niðurstöður rannsóknarinnar studdu upphaflega tilgátu , þ.e. að börn
sem búa hjá einstæðum foreldrum eru líklegri til að glíma við andleg og líkamleg heilsufarsvandamál
hins vegar má skýra að hluta aukna áhættu á útkomum með kvíða foreldra. Veitendur
heilbrigðisþjónustu mættu bregðast við hugsanlegri áhættu á heilsu barna einstæðra foreldra.
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Abstract
Background. In this study, well being of children living with both parents was compared to that of
children of single parents.
Objectives: To test the hypothesis that children living in single parent households have a higher
risk than children living with both parents for developing adverse health and behavioral outcomes.
Methods: This study utilized data from the survey “Health and well- being of children in the Nordic
countries 2011”, a cross sectional study which randomly selected 3,200 children 2-17 years of age, by
sex and age from the Icelandic Population Registry. The parents of the child answered a questionnaire
on their children’s well being. A total of 1,523 completed questionnaires were returned with a 48.9%
response rate. Logistic and linear regression was used to model relationships between the outcome
variables (anxiety, ADHD, being overweight along SDQ-Ice scores) and the child´s living arrangement.
Results were displayed in five multivariate models, controlling for child age, child sex, parental age,
family income, parental education and parental anxiety. Children were also stratified according to sex.
Results: The results indicated that children being raised by single parents had increased likelihood
of experiencing anxiety OR= 2.04 95% CI [1.12-3.73], ADHD symptoms OR= 2.02 95% CI [1.04-3.90],
overweight OR= 3.13 95% CI [1.24-7.92] and higher scores on total difficulties of the SDQ-Ice scale.
Boys living with single parents were more likely to experience ADHD symptoms and having higher
scores on SDQ-Ice than girls. They were also more likely to be overweight than boys living with both
parents OR= 3.87 95% CI [1.10-13.64]. Girls living with a single parent scored higher on SDQ-Ice total
difficulties than girls living with both parents. Parental anxiety was associated with all outcomes except
for children’s’ overweight.
Conclusions: The results supported the hypothesis, however, adverse outcomes can be explained
to some extent by parental anxiety. Health care providers should acknowledge the potentially
increased risks these results may have for children living with single parents.

Key words: Single-Parent Family/psychology; Risk factors; SDQ; Anxiety; ADHD; Overweight
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Acknowledgements
This thesis is a 60 ECTS - credit final project toward a Master´s degree in Public Health Science at
The University of Iceland, my supervisor was Stefán Hrafn Jónsson, Phd. associate professor, at The
University of Iceland Faculty of Social and Human Sciences. I want to thank him for his patience
throughout this project. His moral support, guidance and advice were an inspiration to me during it´s
construction. I would also like to thank my masters commitee members Arna Hauksdóttir Ph.d and
Helga Zoéga Ph.d, associate professors, at The University of Iceland department of Public Health, for
their enlightment and advice in scientific writing along with encouragement and guidence. Thor
Asepund, and Birgir Hrafnkelsson, associate professors, at The University of Iceland, for instruction
and lectures with videos in Biostatisics. Jóhanna Eyrún Torfadóttir and Sigrún Helga Lund, research
counselors, at The University of Iceland for their statisitcal guidance. I would also like to thank the
Directorate of Health in Iceland for providing the data for this study.
I would also like to thank my employer, Heilsugæsla höfuðborgarsvæðis, Primary Health Care of
the Capital Area , for their support and for providing me with a study sabaticle so that I could continue
my studies in Public Health. Along with that comes a special thanks to my coworkers at Heilsugaeslan
in Mosfellsumdæmi, who often had to be flexible and tolerant of my absences to attend school and
write this thesis. I would also like to thank the Icelandic Nurses Association (Fíh) for the grant this
research received.
A very special thanks to my husband, Benedikt Gröndal who helped me with technical assistance
along with moral support and advice in working with SAS and statistics. Finally I want to thank my
oldest children Ragnar Þór, Brynjar and Elsa Margrét, for their patience and endurance while they
were children being raised by single parents. I am endlessly proud of the success you are making with
your lives. To my youngest son Sigurður Andri, I look forward to spending more quality time together
now that this thesis is finished.
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Table of contents
Ágrip ....................................................................................................................................................... 5 
Abstract .................................................................................................................................................. 6 
Acknowledgements ............................................................................................................................... 7 
Table of contents ................................................................................................................................... 8 
Figures ................................................................................................................................................. 10 
Tables ................................................................................................................................................... 10 
List of abbreviations ........................................................................................................................... 11 
1  Introduction .................................................................................................................................... 12 
1.1.1  Single parent- studies in Iceland .................................................................................. 12 
1.1.2  Single parents-literature review .................................................................................... 13 
1.1.3  Single parents- mental health status of the parents ..................................................... 14 
1.1.4  The present study ......................................................................................................... 14 
1.2  Anxiety ..................................................................................................................................... 14 
1.2.1  Declaration of WHO ...................................................................................................... 14 
1.2.2  Definition ....................................................................................................................... 15 
1.2.3  Prevalence studies of anxiety in adults ........................................................................ 15 
1.2.4  Anxiety in Icelandic children ......................................................................................... 15 
1.3  ADHD symptoms ...................................................................................................................... 16 
1.3.1  ADHD- definition ........................................................................................................... 16 
1.3.2  ADHD- studies .............................................................................................................. 17 
1.3.3  ADHD- treatment and impact on health ........................................................................ 17 
1.3.4  ADHD in Icelandic children ........................................................................................... 18 
1.3.5  Parental anxiety and ADHD diagnosis in children ........................................................ 18 
1.4  Overweight ............................................................................................................................... 19 
1.4.1  Overweight- definition according to WHO .................................................................... 19 
1.4.2  Single parents and overweight status among their children ......................................... 19 
1.4.3  Overweight among Icelandic children ........................................................................... 20 
1.5  SDQ-Ice (Total difficulties) ....................................................................................................... 20 
1.5.1  SDQ translation and Nordic studies ............................................................................. 21 
1.5.2  SDQ- total difficulties .................................................................................................... 21 
2  Specific aims .................................................................................................................................. 22 
3  Material and Methods .................................................................................................................... 23 
3.1  Study design ............................................................................................................................ 23 
3.2  Study population ...................................................................................................................... 23 
3.3  Explanatory variable ................................................................................................................. 24 
3.3.1  Children living with single parent vs. both parents ....................................................... 24 
3.3.2  Exclusion criteria .......................................................................................................... 24 
3.4  Potential confounding and intermediating variables ................................................................. 24 
3.4.1  Education ...................................................................................................................... 24 
3.4.2  Parents’ reported anxiety .............................................................................................. 24 
3.4.3  Family income .............................................................................................................. 24 
3.5  Outcome variables ................................................................................................................... 25 
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3.5.1  ADHD symptoms, anxiety symptoms, being overweight .............................................. 25 
3.5.2  SDQ-Ice (Total difficulties scores) ................................................................................ 25 
3.6  Data analysis ............................................................................................................................ 26 
3.6.1  Logistic regression ........................................................................................................ 27 
3.6.2  Linear regression .......................................................................................................... 27 
3.7  Ethics ....................................................................................................................................... 28 
4  Results ............................................................................................................................................ 29 
4.1  Baseline characteristics ........................................................................................................... 29 
4.2  Outcome variable - child‘s anxiety symptoms .......................................................................... 31 
4.3  Outcome variable- child‘s ADHD symptoms ............................................................................ 34 
4.4  Outcome variable – child´s overweight .................................................................................... 37 
4.5  Outcome variable-SDQ-Ice (Total difficulties) .......................................................................... 40 
5  Discussion ...................................................................................................................................... 43 
5.1  Anxiety ..................................................................................................................................... 43 
5.2  ADHD symptoms ...................................................................................................................... 44 
5.3  Being overweight ...................................................................................................................... 44 
5.4  SDQ-Ice (Total difficulties) ....................................................................................................... 45 
5.5  Strengths and limitations .......................................................................................................... 46 
6  Conclusions .................................................................................................................................... 47 
References ........................................................................................................................................... 48 
Appendix 1. Approval of The National Bioethics committee ......................................................... 56 
Appendix 2. Introduction letter .......................................................................................................... 57 
Appendix 3. Questionnaire ................................................................................................................ 58 

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Figures
Figure 1. Hypothetical Causal Diagram .......................................................................................... 26 

Tables
Table 1. SDQ- behavior-screening scores according to Goodman, 1997 ............................................ 26 
Table 2. Socio-demographic characteristics of single and couple parent households ......................... 30 
Table 3. Multivariate logistic regression models for parent- reported anxiety symptoms in the child ... 32 
Table 4. Multivariate logistic regression models for parent reported anxiety symptoms in the child
stratified by sex ......................................................................................................................... 33 
Table 5. Multivariate logistic regression models for parent reported ADHD symptoms in the child ..... 35 
Table 6. Multivariate logistic regression models for parent reported ADHD symptoms in the child
stratified by sex ......................................................................................................................... 36 
Table 7. Multivariate logistic regression models for parent reported child being overweight ................ 38 
Table 8. Multivariate logistic regression models for parent reported child being overweight stratified by
sex ............................................................................................................................................ 39 
Table 9. Multiple linear regression models for parent reported child SDQ-Ice Total difficulties scores 41 
Table 10. Linear regression models for parent reported child SDQ-Ice Total difficulties stratified by sex
.................................................................................................................................................. 42 

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