Perceived parental support in childhood and adolescence as a tool for mental health screening in students: A longitudinal study in the i-Share cohort

Highlights

• Perceived parental support was strongly associated with the one-year incidence of mental health problems among college students.

• Lower levels of perceived parental support were dose-dependently associated with higher incidences of suicidal behavior, major depression, and severe generalized anxiety disorder.

• Health professionals can readily assess this marker to improve mental health risk assessment, and it could be considered as an additional screening tool.

Abstract

Background

Negative events in childhood are associated with increased risk of mental health problems, and evaluation could help identify students at high risk of mental health disorder. However, childhood adversity measures are difficult to implement in routine care. Perceived parental support in childhood and adolescence may be more easily assessed, as it is a rather neutral and non-intrusive question.

Methods

We retrieved students’ health data collected from the French i-Share cohort, in a longitudinal population-based study including 4463 students of 18–24 years of age. Students in this cohort completed a self-reported questionnaire about major psychiatric problems at one-year follow-up.

Results

Among 4463 participants, 26% reported a major mental health problem—including suicidal behavior (17%), major depression (7%), and severe generalized anxiety disorder (15%). Adjusted logistic regression revealed that a lower level of perceived parental support was significantly associated with higher risk of any mental health problem. Compared to students who reported extremely strong perceived parental support, students who perceived no support had a nearly 4-fold higher risk of mental health problems (aOR 3.80, CI 2.81–5.13). Lower levels of perceived parental support were dose-dependently associated with higher incidences of suicidal behavior, major depression, and severe generalized anxiety disorder.

Limitations

Study limitations included a moderate follow-up response rate, and retrospective self-report questionnaires.

Conclusion

Perceived parental support was strongly associated with the incidence of mental health problems among college students. If validated, these results suggest that health professionals should consider using this simple marker to improve mental health risk assessment and screening.

Introduction

College students exhibit a high prevalence of mental health problems (Blanco et al., 2008; Wilcox et al., 2010; Auerbach et al., 2016; Auerbach et al., 2018) with many youths experiencing severe depression, anxiety, or suicidal behaviors. In a large study including 13 984 students at 19 universities worldwide, about one-third of the population reported 12-month DSM-IV mental disorders—predominantly major depression episode (18.5%), generalized anxiety disorder (16.7%), or suicidal behavior (8.4% suicidal ideation and 1.0% suicide attempt) (Bruffaerts et al., 2019). Depression and generalized anxiety disorders are often comorbid with suicidal behaviors (Eisenberg et al., 2007). Although a substantial proportion of students suffering from mental problems require psychosocial support, several studies suggest that most do not receive appropriate care and treatment (Eisenberg et al., 2007; Wilcox et al., 2010; Bruffaerts et al., 2019).

Avoiding aggravation of mental disorders requires early detection, and rapid intervention and care (Garlow et al., 2008; Auerbach et al., 2019; Duffy et al., 2019). However, it is difficult to identify young people who suffer from these problems (Weist et al., 2007; Moore et al., 2015). Determining which students are in need of support or treatment is particularly challenging due to the limited on-campus mental health resources on campus, and because students may be reluctant to disclose information about their mental health.

Familial factors, including life events and intra-familial environment, play a central role in the aetiology of mental health problems, due to both psychosocial and genetic reasons (Turecki and Brent, 2016). Many studies describe an association between psychiatric disorders and childhood adversity (Kessler et al., 2010; Green et al., 2010; Bruwer et al., 2014; Björkenstam et al., 2017; Easterlin et al., 2019), such as abuse or maltreatment (Gilbert et al., 2009; Zhu et al., 2019), parental death (Guldin et al., 2015), parental divorce (Lindström and Rosvall, 2015), or parental history of mental health problems (King et al., 2010).

Many studies show that chaotic family environments are associated with low levels of parental support (Levin and Currie, 2010; Bagner and Graziano., 2013; Hugues et al., 2019; Schaan et al., 2019). This relationship can be direct, eg, related to neglect behaviors (Shan et al., 2019) or indirect, eg, when parental mental health problems lead to less effective parenting practices (Taraban et al., 2017; Simpson-Adkins and Daiches, 2018). For example, parental depression is linked to reduced parenting quality (Lovejoy et al., 2000; Wilson and Durbin, 2010).

Family assessment measures are heterogeneous (Falissard et al., 2015) and can be difficult to implement. There remains a need for screening tools that provide rapid and non-intrusive assessment of a person's risk of mental health problems that may require further evaluation and treatment. In contrast, perceived parental support in childhood and adolescence can be easily assessed since it is a rather neutral question. In a previous cross-sectional study of the association between perceived parental support and suicidal thoughts, we found that low levels of perceived parental support were associated with higher risk of suicidal ideation (Macalli et al., 2018). However, this result was limited by the cross-sectional nature of the study.

In the present study, we tested the strength of the association between a one-item assessment of perceived parental support during childhood and adolescence and the one-year risk of major mental health problems within a large sample of college students. Our secondary objective was to compare the relative strength of association between self-reported parental support and objective indicators of childhood adversity.