Pathways from family disadvantage via harsh parenting and caregiver mental health to adolescent health risks - Findings from South Africa

Objective: Parenting is an important determinant of adolescent health outcomes. But within low and middle income countries very little is known about predictors of harsh or abusive parenting, and how these and parenting... [ view full abstract ]

Objective: Parenting is an important determinant of adolescent health outcomes. But within low and middle income countries very little is known about predictors of harsh or abusive parenting, and how these and parenting behaviors are associated with adolescent psychological, behavioral and physical health outcomes. This study, based in South Africa, aimed to develop an empirically-based theoretical model of relationships between harsh parenting, its predictors, and adolescent health outcomes.

Methods: Cross-sectional data were collected in 2009-2010 from 2477 adolescents (aged 10-17) and their caregivers using stratified random sampling in KwaZulu-Natal, South Africa. Participants reported on socio-demographics, psychological symptoms, parenting and physical health. Multivariate regressions were conducted, confirmatory factor analysis employed to identify measurement models and a structural equation model developed.

Results: The final model demonstrated that family disadvantage was associated with harsh parenting. Harsh parenting was in turn strongly associated with poor adolescent health. Additionally, family disadvantage was directly associated with caregiver mental health distress which increased adolescent health risks. There was no direct effect of family disadvantage on adolescent health risks but indirect effects through caregiver mental health distress and harsh parenting were found.

Conclusions: Reducing harsh parenting is essential in improving adolescent health in South Africa. Combination interventions could include mental health support for caregivers and adolescents, supporting positive parenting, and reducing violence and disadvantage. Mitigating these negative pathways from disadvantage that are experienced by highly vulnerable families has the potential to improve both caregiver and child health outcomes.