Juan Wang, Yuqian He, Xuemei Li, Ziqian Wei, Xiaopeng, Yinzhe Wang, Tingting Lei, Dan Zhu, Xinyu Zhou

Highlights

- •About 34.56% to 41.56% of parents in unhappy relationships continue their marriage

- •Children and adolescents whose parents had an unhappy relationship but were not divorced experience more depressive and anxiety symptoms, non-suicidal self-injury (NSSI), and suicide risk than other peers, including those whose parents had unhappy-relationship and divorced.

- •The results were robust regardless of whether the interparental relationship was perceived by the students or self-reported by the parents

Abstract

Background

Some couples remain married despite being unhappy, for the sake of their children and adolescents. However, children and adolescents in families with unhappy marriages may be chronically expose to parental conflict, potentially increasing the risk of mental health problems more than divorce itself. Although plausible, this hypothesis has rarely been empirically tested using representative data.

Methods

This large-scale cross-sectional study involved 96,431 parent-child dyads in Chongqing, China. Participants were divided into seven groups based on parental marital status and interparental relationships. Mental health problems, including depressive and anxiety symptoms, non-suicidal self-injury (NSSI) and suicide risk, was evaluated within dyads. Multivariate logistic regression was conducted to compare the risk of mental health problems among different groups.

Results

About 34.56?% to 41.56?% of parents in unhappy relationships continue their marriage. Children and adolescents in the unhappy-relationship-not-divorced parents group had higher odds of depressive and anxiety symptoms, NSSI and suicide risk compared to their peers in other groups, including those with divorced parents across different levels of interparental relationships. These findings were consistent regardless of whether the interparental relationship was reported by children and adolescents or the parents.

Conclusions

Public awareness should be raised that divorce may not be the worst option when parents are in an unhappy relationship, at least when considering the potential association with their child and adolescent mental health.

Introduction

Mental health problems in children and adolescents are major contributors to the global burden of disease (Merry et al., 2020), impacting an estimated 10–20?% of this age group wolrdwide (Fazel et al., 2014). Mental health problems in children and adolescents are associated with various later adverse outcomes, including developing mental disorders in adulthood (Calvete et al., 2019), suicide risk (Fergusson et al., 2005), problems in social functioning (Semkovska et al., 2019), and poor physical and mental health (Jamet et al., 2024). Therefore, identifying risk factors and taking preventive measures to avoid significant disease burdens becomes increasingly important.

Increasing evidence suggests that parents' marriage is an important risk factor for mental health of children and adolescents. Most previous studies have focused on the marital status, like divorce, which may be associated with a high risk of child and adolescent mental health problems, such as depression, anxiety (Tullius et al., 2022), non-suicidal self-injury (NSSI) (F. Wang et al., 2021) and even suicide risk (Dube et al., 2001). However, some researchers have proposed that the poor marital quality of parent may has a more detrimental effect for children and adolescents than divorce (Brand et al., 2019). According to the family system theory, negative feelings from the marital subsystem could “spill over” to the parent-child subsystem and increase the risk of child and adolescent mental health problems (Erel and Burman, 1995; Stroud et al., 2015). Marital quality represents the valence of parental interaction (positive or negative), whereas marital status reflects the duration of the valence (divorce, short term; in marriage, long term). The family climate is usually oppressive and conflictual when parents are in an unhappy relationship (Harold and Sellers, 2018). The longer the child is immersed in such an atmosphere, the greater harm of the ‘spill-over effect’ (Kalmijn, 2015). Therefore, divorce may associate with the mental health problems of children and adolescents from families with positive relationships but it did not harm or even benefit the mental health of children and adolescents from families with negative relationships (Amato et al., 1995; Hanson, 1999).

However, epidemiological studies on the relationships between parents' marriage and the risk of child and adolescent depressive symptoms may not be valid enough to support the theory (Hanson, 1999). Most of studies only focused on one side of the marital status and qualities (O'Hara et al., 2019) and therefore could not directly answer whether divorce or non-divorce was worse for the risk of child and adolescent mental health problems at the same level of unhappy relationships. Second, dependent indicators in previous studies mainly focused on school adjustment and general feelings rather than direct indicators of psychiatric scales. Therefore, it remains unclear whether an unhappy marriage is associated with severe mental health problems, such as NSSI and suicide risk (Boduszek et al., 2021; Racine et al., 2021). Third, interparental relationship quality was usually self-reported by parents, but children's feelings may differ from their parents' perceptions, which may be more closely related to children's own mental health outcomes (Clements et al., 2014). Finally, previous studies were mainly conducted in a Western setting. Unlike individualism in Western countries, Chinese culture stresses sacrificing individual interests for the group benefits (Sun, 1991). Perhaps more Chinese parents would sacrifice their own happiness for the sake of their children. Therefore, clarifying how parental marital status and relationship quality relate to children's mental health problems in China is essential for parents' marriage decisions.

To help answer whether parents should stay in a terrible marriage for the sake of their children, the present study has categorized children into different groups based on their parental marital status (i.e., non-divorce, divorce or separation, remarried) and relationship quality (i.e., happy, so-so, unhappy) reported by the parent and the child, respectively. And then, comparing the risks of mental health problems (i.e., depressive symptoms, anxiety symptoms, NSSI, and suicide risk) in different groups. We hypothesize that children whose parents chose to maintain an unhappy marriage have the highest likelihood of developing mental health problems compared to children in other parental situations.

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Data source and participants

This study was part of a baseline investigation of a large cohort study aimed at assessing the mental health status of children in Chongqing, China. The Ethics Committee of the First Affiliated Hospital of Chongqing Medical University (2020–890) approved this study. Participants were recruited from all students in grades three through twelve in all primary and secondary schools (n?=?262) in Chongqing municipality spanning between September and December 2021. School officials were informed of

Results

Demographic characteristics and grouping results based on parental marital status and relationship quality are summarized in Table 1, Table 2. The educational levels of parents varied widely: 17.55?% of fathers and 22.46?% of mothers had completed primary school or less; 49.52?% of fathers and 45.55?% of mothers had completed middle school; 18.55?% of fathers and 18.01?% of mothers had completed secondary school; 12.93?% of fathers and 13.67?% of mothers held a bachelor's degree; and only

Discussion

To help answer whether children and adolescents whose parents maintained a marriage with an unhappy relationship have a higher risk of developing mental health problems, the current study compared the odds of depressive symptoms, anxiety symptoms, NSSI, and suicide risk of children and adolescents whose parents maintained a marriage with an unhappy relationship and those from other types of families. Results supported our hypotheses. Regardless of whether parental relationship quality was

Conclusions

Using a large-scale sample of parent-child dyad, this study revealed that children and adolescents whose parents maintain a marriage with an unhappy relationship had higher risks of depressive symptoms, anxiety symptoms, NSSI, and suicide risk, than children and adolescents with other parents, including those whose parents divorced and kept unhappy relationships. Such findings may not only challenge the knowledge of parents who endure an unhappy marriage for the sake of loving their offspring https://standingabovethecrowd.com/?p=14856