Depressive Symptoms among Former Spousal Caregivers: Comparing Stressors, Resources, and Circumstances of Caregiving Cessation among Older Husbands and Wives.

Little research focuses on the mental health of caregivers (CGs) who stop providing care to their community-dwelling spouse. We examine depressive symptoms of former primary CG spouses who stopped caregiving over a two-year follow-up period when the care recipient (CR): (1) no longer has functional problems; (2) continues having functional problems; or (3) dies. Using data from the Health and Retirement Study (2000-2014), we located 2,370 couples who were both 50+ at baseline and where one partner provided help with ADL and/or IADL limitations but did not do so two years later. OLS regressions stratified by gender indicated that both male and female former spousal CGs whose CR died had significantly more depressive symptoms than those who ceased caregiving when their spouse did or did not still have functional problems. Former wife CGs who were older and whose husbands had more baseline ADLs had fewer follow-up depressive symptoms; wife CGs whose husbands had a nursing home stay had more depressive symptoms. Former husband CGs who had provided longer monthly hours of care had fewer follow-up symptoms. Findings underscore the importance of targeting mental and physical health services to both former caregiving husbands and wives, especially after spousal death.

The Association of Fathers' Parental Warmth and Parenting Stress to Child Behavior Problems.

This study examines whether fathers' parental warmth and parenting stress were associated with behavior problems when children were approximately 36-months of age, beyond the influence of maternal behaviors. Study participants were 3,342 low-income fathers and mothers who participated in the Building Strong Families (BSF) study. Cross-sectional regression analyses indicated that for unmarried nonresidential families, fathers' parental warmth and parenting stress were associated with child internalizing behavior problems; and fathers' parenting stress only was marginally associated with child externalizing behavior problems. For consistently cohabiting residential fathers, only fathers' parenting stress was marginally associated with child internalizing behavior problems. No associations of fathers' parental warmth and parenting stress on either internalizing or externalizing behavior problems were observed in married families. Overall, study results suggest that fathers' parental warmth and parenting stress may have a modest positive association on the development of child internalizing behavior problems particularly in vulnerable families (e.g., families in which fathers were nonresidential).

Enhancing social connections through an acting and improvisation course for older Americans in low-income housing.

BACKGROUND: Older adults living in subsidized housing may be at increased risk of social isolation. Applied theater, a participatory art program, can facilitate social connections among older adults. METHODS: A professionally-facilitated 12-week acting and improvisation course was held in two federally subsidized buildings in an urban setting. The mixed-method design included thematic analysis of interviews, participant observation, field notes, and statistical analysis of change over time in social isolation, community belonging, and social exclusion. RESULTS: Participants were motivated to meet other building residents, and the course included aspects that encouraged social bonding. CONCLUSIONS: Although recruitment of socially-isolated older adults presented challenges, this study presents lessons on what motivates residents of low-income senior housing to enroll in an acting program and how to design a theater course in this setting that promotes group bonding.

Associations between 11 parental discipline behaviours and child outcomes across 60 countries.

OBJECTIVES: To test associations between 11 caregiver aggressive and non-aggressive discipline behaviours and outcomes (aggression, distraction and prosocial peer relations) of children under 5 years in low-income and middle-income countries (LMICs). PARTICIPANTS: Data came from the fourth (2009-2013) and fifth (2012-2017) rounds of the UNICEF Multiple Indicator Cluster Surveys. Analyses were restricted to households with children under 5 years, leaving a sample of 229 465 respondents across 60 LMICs. Data were analysed using Bayesian multilevel logistic regression. RESULTS: Verbal reasoning (80%) and shouting (66%) were the most common parental discipline behaviours towards young children. Psychological and physical aggression were associated with higher child aggression and distraction. Compared with not using verbal reasoning, verbal reasoning was associated with lower odds of aggression (OR)=0.92, 95% credible interval (CI)=0.86 to 0.99) and higher odds of prosocial peer relations (OR=1.30, 95% CI=1.20 to 1.42). Taking away privileges was associated with higher odds of distraction (OR=1.09, 95% CI=1.03 to 1.15) and lower odds of prosocial peer relations (OR=0.92, 95% CI=0.87 to 0.98). Giving the child something else to do was associated with higher odds of distraction (OR=1.06, 95% CI=1.01 to 1.12). The results indicated country-level variation in the associations between parenting behaviours and child socioemotional outcomes. CONCLUSIONS: Psychological and physical aggression were disadvantageous for children's socioemotional development across countries. Only verbal reasoning was associated with positive child socioemotional development. No form of psychological aggression or physical aggression benefited child socioemotional development in any country. Greater emphasis should be dedicated to reducing parental use of psychological and physical aggression across cultural contexts.

Father-Mother Co-Involvement in Child Maltreatment: Associations of Prior Perpetration, Parental Substance Use, Parental Medical Conditions, Inadequate Housing, and Intimate Partner Violence with Different Maltreatment Types.

The current study applied a family systems approach to examine dyadic parental risk factors linked with mother-father co-involved physical abuse, neglect, sexual abuse, and emotional abuse. Parental substance use, mental health problems, disability and medical conditions, inadequate housing, economic insecurity, intimate partner violence, and prior maltreatment history were investigated as key risk factors at the dyadic parental level. Logistic regression analysis was conducted using national child welfare administrative data from the National Child Abuse and Neglect Data System. The results showed differential associations between risk factors and four child maltreatment types: physical abuse, neglect, emotional abuse, and sexual abuse. Intimate partner violence was associated with higher odds of mother-father co-involved neglect and emotional abuse. Parental substance use, inadequate housing, and prior maltreatment history were all associated with higher odds of mother-father co-involved neglect, but lower odds of physical abuse. Parental disability and medical conditions were associated with higher odds of mother-father co-involved sexual abuse, whereas parental substance use was associated with lower odds of sexual abuse. Implications include more nuanced ways of addressing multiple risk factors within the family to prevent future occurrences of child maltreatment involving both mothers and fathers.

Childcare Subsidy Employment and Copayment Requirements and Child Maltreatment.

Economic support programs for low-income families may play an important role in preventing child abuse and neglect. In the United States, childcare subsidies are provided to low-income families who meet certain requirements to offset the high cost of childcare. States have flexibility in setting many policies related to the provision of childcare subsidies, which results in a great deal of variation in how the programs operate between states. One policy dimension on which states vary is the number of employment hours required to receive childcare subsidies. A small body of work has begun to investigate the ways in which these state policy variations might relate to child maltreatment. Using 11 years of administrative data from the United States, the current study sought to estimate the relationship between two sources of variation in childcare subsidy policies: employment requirements and copayment size; and child neglect, physical abuse, and emotional abuse substantiations. The study found a nuanced relationship between required employment and neglect substantiations. Specifically, requiring some level of work was not associated with neglect substantiations, but requiring 30 hours of employment was associated with higher rates. The study did not find a relationship between copayment size and maltreatment substantiations.

Parental Relationship Status as a Moderator of the Associations Between Mothers' and Fathers' Conflict Behaviors and Early Child Behavior Problems.

This study examines interparental conflict and associations with child behavior problems among a large, diverse sample of families with low income (N = 2,691) using path model analyses of mothers' and fathers' reports of constructive interparental conflict, destructive interparental conflict, and intimate partner violence (IPV) victimization at 15 months and child emotional insecurity and child behavior problems at 36 months. Multigroup models examined whether parental relationship status (i.e., married, cohabiting, and churning) moderated these associations. Fathers' perceptions of interparental conflict behaviors showed few direct associations with child outcomes, whereas mothers' perceptions of interparental conflict showed more robust associations with child outcomes. Specifically, mother-reported destructive conflict was associated with higher levels of child emotional insecurity and child behavior problems across parental relationship status subgroups. Mother-reported constructive conflict had a small negative association with child behavior problems in cohabiting families. Child emotional insecurity mediated the association of maternal destructive conflict on child behavior problems. Although churning families experienced higher levels of moderate and severe interparental conflict, associations linking destructive conflict to child behavior problems were consistent across parental relationship subgroups. There were few direct effects of father-reported constructive and destructive conflict on child well-being. However, the results supported the notion that fathers play an influential role in the family system via maternal reports of IPV victimization. Results of this study suggest that the mechanisms underlying emotional security theory, in which child emotional insecurity mediates the associations between maternal destructive conflict and child behavior problems, apply to a large and racially diverse sample of socioeconomically disadvantaged children.

Supporting Fathers to Prevent Child Maltreatment: How Paid Family Leave and Child Care Subsidies are Part of a Public Health Approach.

There are multiple components of a public health approach for preventing child maltreatment. One of these components is the question of who to intervene with. Fathers are an under-targeted and under-studied group for child maltreatment prevention. In this conceptual article, we describe a public health approach for intervening with fathers. Acknowledging financial stress as a key risk factor for child maltreatment among fathers, we explore two policy interventions that aim to increase economic support for families during the early years of a child's life: paid family leave and child care subsidies. During the weeks following the child's birth, paid family leave can promote child-father bonding and enable fathers to engage in more caregiving during a critical family transition. After paid family leave ends, child care subsidies can make child care affordable for families with low income, thereby promoting parents' employment and earnings. We conclude by highlighting ways in which fathers can take an active role in preventing child maltreatment.

Gender Inequality in Low- and Middle-Income Countries: Associations with Parental Physical Abuse and Moderation by Child Gender.

Gender inequality perpetuates women's economic insecurity and a culture of violence. Parental distress caused by economic pressure may increase violence against children. High levels of gender inequality and interpersonal violence may contribute to higher levels of physical abuse. Using an ecological perspective, this study examines the association of country-level gender inequality and household-level parental physical abuse, and the moderating role of child gender in this association in low- and middle-income countries. We used data on over 420,000 households from the UNICEF Multiple Indicator Cluster Surveys and country-level indicators from the United Nations Development Program Human Development data. We employed multilevel logistic regression to examine the association between gender inequality with the log-odds of physical abuse after accounting for country- and individual-level covariates. In order to more fully explore our results, we calculated predicted probabilities of abuse for several scenarios. The results indicated that higher levels of gender inequality were associated with higher probabilities of physical abuse. This association was stronger for female children than for male children. The probabilities of abuse by child gender were indistinguishable, although rates of physical abuse converged as gender inequality increased, at a statistically marginal level. These findings indicate that macro-level interventions that reduce gender inequality are necessary to prevent and reduce child physical abuse.

The association between spanking and physical abuse of young children in 56 low- and middle-income countries.

BACKGROUND: Nearly one third of children under five in low- and middle-income countries (LMICs) experience spanking. Studies from North America suggest that spanking is associated with heightened risk of physical abuse. However, the link between spanking and physical abuse in the international context remains understudied. OBJECTIVE: To examine the association between caregivers' spanking and physical abuse of young children in LMICs, and to estimate the extent to which physical abuse might be reduced if spanking were eliminated. PARTICIPANTS: We used nationally representative data from 156,166 1- to 4-year-old children in 56 LMICs from the fourth and fifth rounds of UNICEF Multiple Indicator Cluster Surveys. METHODS: A nationally weighted multilevel logistic regression model examined the association between spanking and physical abuse. We calculated predicted probabilities of physical abuse, which we present using natural frequencies. RESULTS: Spanking was associated with higher odds of physical abuse (OR = 5.74, p < .001). The predicted probability of physical abuse decreased by 14% comparing children who were spanked (22%) and who were not spanked (8%). When our estimates were translated to a hypothetical sample of 100 children using a natural frequency approach, 32 children were spanked; of those, seven experienced physical abuse. The elimination of spanking would result in four fewer children who were exposed to physical abuse. In relation to the population of abused children, estimates suggest that physical abuse could reduce by up to 33% if spanking were eliminated. CONCLUSIONS: Results support the UN Sustainable Development Goals Target 16.2 that calls for eliminating all forms of violence against children. Child welfare advocates should discourage caregivers from using spanking, in order to prevent physical abuse.

Patterns of caregiver aggressive and nonaggressive discipline toward young children in low- and middle-income countries: A latent class approach.

BACKGROUND: Caregivers use a variety of disciplinary methods to respond to undesired child behavior. Many caregivers use nonaggressive forms of discipline, such as verbal reasoning and redirection. Some caregivers use aggressive forms of discipline, such as spanking and yelling. However, most caregivers use a combination of aggressive and nonaggressive discipline. To date, a disproportionately small number of caregiver discipline studies are conducted in low- and middle-income countries (LMICs), and few studies in low-resource contexts examine aggressive and nonaggressive behaviors simultaneously. OBJECTIVE: This study aims to elucidate caregiver patterns of 11 disciplinary behaviors used in LMICs, and examine how these patterns relate to child outcomes and household characteristics. PARTICIPANTS AND SETTING: Data came from the fourth and fifth rounds of UNICEF Multiple Indicator Cluster Surveys (MICS) distributed between 2009 and 2017 (N = 218,824 respondents across 63 countries). Focal children were 3-4 years old. METHODS: Patterns of disciplinary behaviors were estimated using a multilevel latent class analysis (LCA). Multinomial regression analyses examined associations of disciplinary patterns with caregiver-reported child outcomes and household characteristics. RESULTS: The LCA suggested caregiver discipline fell into three overall patterns: high behavioral control, moderate behavior control, and lower behavioral control. The lower behavioral control class was associated with the most advantageous child outcomes and household socio-demographic characteristics, whereas the high behavioral control class was associated with the most disadvantageous child outcomes and household characteristics. CONCLUSIONS: Efforts should be employed to reduce aggressive behaviors and promote positive parenting among caregivers in LMICs.

Childcare Subsidy Enrollment Income Generosity and Child Maltreatment.

In the United States, childcare subsidies are available to low-income working parents to assist with the cost of childcare. The subsidies are provided as block grants to states, which allows for a great deal of flexibility in the specific policies guiding their distribution. Prior research has found a protective link between childcare subsidies and child maltreatment, but the variations in policies have been much less explored. The current study used longitudinal administrative child welfare data from 10 years (2009-2019) linked with state policies regarding the income eligibility requirements of states to examine the impact of these policies on child abuse and neglect among young children (0-5); early school-age children (6-12), and older children (13-17). Using multiple regression and controlling for state demographic characteristics, the study found that more generous policies surrounding income eligibility were related to lower rates of child abuse and neglect investigations at the state level.

The Associations of Constructive and Destructive Interparental Conflict to Child Well-Being Among Low-Income Families.

Interparental conflict is a well-established precursor to child maladjustment. However, little is understood of the role of different interparental conflict in shaping the developmental outcomes of young children, especially those from socioeconomically disadvantaged backgrounds. This study uses data from a large and racially diverse sample of low-income, unmarried mothers with young children (n = 1,297) to examine the processes linking parental constructive conflict, destructive conflict, intimate partner violence (IPV) to child behavior problems, and child emotional insecurity as a mediator of these processes. Path analyses were conducted to estimate structural paths between (a) conflict constructs and child behavior problems, (b) conflict constructs and child emotional insecurity, and (c) child emotional insecurity and child behavior problems. Results demonstrated that constructive conflict was associated with decreased levels of both child emotional insecurity and child behavior problems, whereas destructive conflict was associated with increased levels of both child outcomes. IPV was associated with increased levels of child emotional insecurity only. Child emotional insecurity mediated the links between all three conflict constructs and child behavior problems. Such findings suggest the need for clinicians to help raise awareness regarding the consequences of children's exposure to different interparental conflict and educate parents about children's sense of emotional security in the family.

Multilevel ecological analysis of the predictors of spanking across 65 countries.

OBJECTIVE: Ending violence against children is critical to promote the health and socioemotional development of children across the globe. To this end, the UNICEF and the WHO have called for the abolishment of spanking, which is the most pervasive form of physical violence against children worldwide. This study used an ecological perspective to examine micro-level and macro-level predictors of parental spanking across 65 countries. PARTICIPANTS: Data came from the fourth and fifth rounds of the UNICEF Multiple Indicator Cluster Surveys, which were administered between 2009 and 2017 (N=613 861 households). We examined the predictors of spanking using multilevel logistic regression analysis. RESULTS: Micro-level factors (ie, those observed at the familial level) were stronger predictors of spanking in comparison to macro-level factors (ie, those observed at the community and country level). Caregiver belief that children need physical punishment in order to be raised properly was the largest risk factor for spanking (OR=2.55, p<0.001). Older child age, the child being female, the head of the household having a secondary education or higher, and higher household wealth were protective factors against spanking, while a higher number of people living in the household was a risk factor for spanking. Living in an urban community was the only macro-level factor associated with spanking. CONCLUSIONS: Intervention at the micro-level and macro-level are important to reduce violence against children across the globe.

Household economic hardship as a moderator of the associations between maternal spanking and child externalizing behavior problems.

BACKGROUND: Spanking is associated with detrimental outcomes for young children. Research shows that spanking is more commonly used in low-income households. OBJECTIVE: To examine whether economic hardship, measured by household income-to-poverty ratio at the time of the child's birth, moderated the longitudinal associations between maternal spanking and child externalizing behavior problems during the first nine years of childhood. PARTICIPANTS AND SETTING: Mother-child pairs (N = 4,149) from a cohort study of urban families in 20 US cities. METHODS: Cross-lagged path models examined associations between maternal spanking and externalizing behavior when children were between the ages of 1 and 9. Multigroup analyses examined whether income-to-poverty ratio moderated these associations. RESULTS: Bivariate analyses showed that income-to-poverty ratio was associated with child externalizing behavior problems at each time point; income-to-poverty ratio was associated with maternal spanking at age 3 only. Longitudinal path model results indicated that, for low- and middle-income groups, maternal spanking at each age had significant associations with child externalizing behavior at each subsequent age. For the high-income group, maternal spanking at age 1 and age 3 had significant associations with child externalizing behavior at each subsequent age; however, spanking at age 5 was not associated with child externalizing behavior at age 9. CONCLUSIONS: Spanking is disadvantageous for children at all income levels, with more persistent effects in low- and middle-income families. For higher-income families, the associations of maternal spanking with child externalizing behavior problems may be attenuated as child age increases. Regardless of income level, parents should be advised against spanking.

Attachment Style and the Association of Spanking and Child Externalizing Behavior.

OBJECTIVE: To examine whether the longitudinal associations between maternal spanking and child externalizing behavior are moderated by attachment style. METHODS: This study used data from the Fragile Families and Child Wellbeing Study (n = 2211), a large cohort sample of low-income urban families. Multiple-group autoregressive cross-lagged models examined the associations between maternal spanking and child externalizing behavior when children were ages 1, 3, and 5. Moderation by attachment style was examined using structural invariance testing. RESULTS: For children with an insecure mother-child attachment style, spanking at age 1 was associated with externalizing behavior at age 3. However, for children with a secure mother-child attachment style, the association between maternal spanking at age 1 and child externalizing behavior at age 3 was absent. Attachment style did not moderate the association between maternal spanking at age 3 and externalizing behavior at age 5, suggesting that spanking at age 3 is associated with deleterious outcomes at age 5, regardless of attachment style. CONCLUSIONS: Results suggest that even in the context of a secure attachment style, spanking is associated with adverse outcomes in early childhood. Findings support the American Academy of Pediatrics 2018 policy statement, which encourages parents to avoid spanking when disciplining children. Results suggest that children, regardless of attachment style, may benefit from policies and services that promote non-violent forms of discipline.

Spanking and young children's socioemotional development in low- and middle-income countries.

Spanking is one of the most common forms of child discipline used by parents around the world. Research on children in high-income countries has shown that parental spanking is associated with adverse child outcomes, yet less is known about how spanking is related to child well-being in low- and middle-income countries. This study uses data from 215,885 children in 62 countries from the fourth and fifth rounds of UNICEF's Multiple Indicator Cluster Surveys (MICS) to examine the relationship between spanking and child well-being. In this large international sample which includes data from nearly one-third of the world's countries, 43% of children were spanked, or resided in a household where another child was spanked, in the past month. Results from multilevel models show that reports of spanking of children in the household were associated with lower scores on a 3-item socioemotional development index among 3- and 4-year-old children. Country-level results from the multilevel model showed 59 countries (95%) had a negative relationship between spanking and socioemotional development and 3 countries (5%) had a null relationship. Spanking was not associated with higher socioemotional development for children in any country. While the cross-sectional association between spanking and socioemotional development is small, findings suggest that spanking may be harmful for children on a more global scale than was previously known.

Punishment and Inequality at an Early Age: Exclusionary Discipline in Elementary School.

We advance current knowledge of school punishment by examining (1) the prevalence of exclusionary discipline in elementary school, (2) racial disparities in exclusionary discipline in elementary school, and (3) the association between exclusionary discipline and aggressive behavior in elementary school. Using child and parent reports from the Fragile Families Study, we estimate that more than 1 in 10 children born 1998-2000 in large US cities were suspended or expelled by age nine, when most were in third grade. We also find extreme racial disparity; about 40% of non-Hispanic black boys were suspended or expelled, compared to 8% of non-Hispanic white or other-race boys. Disparities are largely due to differences in children's school and home environments rather than to behavior problems. Next, consistent with social stress and strain theories, we find suspension or expulsion associated with increased aggressive behavior in elementary school. This association does not vary by race but is robust to a rich set of covariates, individual fixed-effects, and matching methods. In conjunction with what we find for racial disparities, our results imply that school discipline policies relying heavily on exclusionary punishment may be fostering childhood inequality.

Stepfather Involvement and Stepfather-Child Relationship Quality: Race and Parental Marital Status as Moderators.

Stepparent-child relationship quality is linked to stepfamily stability and children's well-being. Yet, the literature offers an incomplete understanding of factors that promote high-quality stepparent-child relationships, especially among socio-demographically diverse stepfamilies. In this study, we explore the association between stepfather involvement and stepfather-child relationship quality among a racially diverse and predominately low-income sample of stepfamilies with preadolescent children. Using a subsample of 467 mother-stepfather families from year 9 of the Fragile Families and Child Wellbeing Study, results indicate that stepfather involvement is positively associated with stepfather-child relationship quality. This association is statistically indistinguishable across racial groups, although the association is stronger among children in cohabiting stepfamilies compared to children in married stepfamilies.

Gender differences in depression across parental roles.

Prior research has focused on the relationship between parenthood and psychological well-being, with mixed results. Some studies have also addressed potential gender differences in this relationship, again yielding varied findings. One reason may be methodological choices pursued in these studies, including the lack of focus on combined parental roles (for example, biological parent and stepparent). The authors used data from the National Longitudinal Survey of Youth, 1979 (N = 6,276) and multinomial treatment models to address how combined roles influence depressive symptoms in mothers and fathers. Further, they explored potential gender differences. Their results indicated that having multiple parental roles is negatively associated with psychological well-being for both men and women, whereas childlessness is more negative for women, and specific parental role combinations affect mothers and fathers differently. Within the context of changing family structure in the United States, these results have important implications for social workers and other mental health professionals-particularly with regard to screening for depression among parents, who are less likely to seek mental health counseling than childless adults.