The association between single-parent family background and physical morbidity, mortality, and criminal behaviour in adulthood

Anu Sauvola

Department of Psychiatry, University of Oulu, and Department of Public Health Science and General Practice, University of Oulu, P.O.Box 5000, FIN-90014 University of Oulu, Finland

Abstract

The proportion of single-parent families has increased in the last few decades world-wide, mostly due to high divorce rates. Also in Finland growing numbers of children spend part of their childhood in single-parent families. The aim of this study was to investigate in a longitudinal perspective, the possible long-term effects of the childhood family structure on psychological, physical and criminal outcomes of an offspring during adulthood.

A large, prospectively collected general population birth cohort (n= 11 017), the Northern Finland 1966 Birth Cohort, was used as a study population. This database provided the information on childhood family structure of cohort members with additional information of sociodemographic factors of the family and of the child. Information concerning physical and psychiatric illnesses were gathered from the Finnish Hospital Discharge Register (FHDR). Death certificates and the information from national crime register were also obtained.

Females with a single-parent family background were more commonly hospital-treated (61.3 % vs. 56.7 %) for any physical condition than females with a two-parent family background. For males such difference in overall physical illness was not found. Both females and males from single-parent families had more commonly been hospital-treated for some diagnoses in the ICD-category of "injury and poisoning" than had other cohort members. Furthermore, females from single-parent families had also more commonly been treated due to pregnancy-related conditions such as induced abortions. During the follow-up time (16 to 28 years of age) 117 (90 males, 27 females) cohort members had died. Males with single-parent family background exhibited an increased mortality risk, especially due to suicides (OR=2.5, 95% CI 1.1-5.8, adjusted for psychiatric hospital diagnosis, parental social class).

Criminality was more common among both males and females from single-parent families compared with other cohort members. The results showed that the risk of violent offending and recidivism was increased up to 8-fold if the cohort male member had been born and raised in a single-mother family over most of his childhood. Parental divorce also doubled the risk for both violent and recidivistic offending. Non-violent offences among males were associated only with parental death and divorce. Furthermore, drunk driving was more common among both males and females with single-parent background. Males who were born into single-mother families were at the highest risk of drunk driving offences in adulthood (OR=2.4, 95% CI 1.4-4.2, adjusted for maternal age, psychiatric hospital diagnosis, parental social class).

In this study it was shown that young adults with single-parent families in childhood experienced a more stressful pathway from late adolescence to adulthood. However, most of the offspring of single-parent families did well during the follow-up time. Strategies to promote the well-being of children and adolescents in single-parent families are of prime importance for preventive health care.

Table of Contents
Acknowledgements
Abbreviations
List of original papers
1. Introduction
2. Review of the literature
2.1. Definition of family
2.1.1. The single-parent family
2.1.2. The step-parent family
2.1.3. Concept of parental loss and separation
2.2. Characteristics of divorce
2.3. Predictors of a child’s post-divorce adjustment
2.4. Mental health problems among offspring of single-parent families
2.4.1. Mental health problems in childhood and in adolescence
2.4.2. Mental health problems in adulthood
2.5. The association of single-parent family background and physical illness
2.5.1. Physical illness in childhood and in adolescence
2.5.2. Physical illness in adulthood
2.6. Mortality in relation to single-parent family in childhood
2.7. Criminal behaviour of the offspring of single-parent families
2.7.1. Juvenile delinquency
2.7.2. Criminality in adulthood
2.8. Single-parent family in childhood and alcohol-related problems in adulthood
2.8.1. Alcohol use in adolescence
2.8.2. Alcohol use in adulthood
2.9. Summary of the reviewed literature
3. Aims of the present study
4. Material and methods
4.1. Study design: the Northern Finland 1966 Birth Cohort
4.1.1. The follow-ups
4.2. Study variables
4.2.1. Childhood family type (I-V)
4.2.2. Physical illness (I)
4.2.3. Mortality (II)
4.2.4. Criminal offending (III, IV)
4.2.5. Drunk driving (V)
4.3. Confounding variables
4.3.1. Psychological variables
4.3.2. Biological variables
4.3.3. Social variables
4.4. Statistical methods
4.5. Ethical considerations
5. Results
5.1. Physical illness of the cohort members with single-parent family background (I)
5.1.1. Physical illness among males
5.1.2. Physical illness among females
5.2. Association between childhood single-parent family and later mortality (II)
5.2.1. Mortality among males
5.2.2. Mortality among females
5.3. Childhood single-parent family in relation to criminality in adulthood (III, IV)
5.3.1. Criminality among males
5.3.2. Criminality among females
5.4. Childhood family background in relation to drunk driving in adulthood (V)
5.4.1. Drunk driving among males
5.4.2. Drunk driving among females
6. Discussion
6.1. Discussion of the results
6.1.1. Physical illness of adults with single-parent family background (I)
6.1.2. Mortality of adult offspring of single-parent families (II)
6.1.3. Childhood single-parent family in relation to impulsive behaviour in adulthood (III-V)
6.2. General discussion
6.2.1. Strengths of the study
6.2.2. Limitations of the study
7. Conclusions
7.1. Main findings
7.2. Practical implications
7.3. Implications for further study
References
List of Tables
1. Hypotheses explaining long-term effects of parental divorce on child development (Kalter et al. 1989).
2. The diagnostic codes of the causes of deaths among deceased cohort members between the age of 16 to 28 years of age.
3. Confounding variables and their categorisation as used in the original papers.
4. The diagnostic categories with DSM-III-R codes of hospital-treated psychiatric disorders in the Northern Finland 1966 Birth Cohort.
5. The names of the response and confounding variables used to examine the effect of the family background in logistic regression analyses in original papers I-V.
6. Frequencies of hospital-treated injuries and poisoning among males with single- and two-parent family backgrounds (I: Table 1).
7. Frequencies of pregnancy related hospital admissions among females with single- and two-parent family backgrounds (I: Table 1).
8. Distribution of causes of deaths in the Northern Finland 1966 Birth Cohort (1982-1994) by gender.
9. Number of the males by cause of death in single-parent family subgroups.
10. Frequency and percentage distributions of some sociodemographic and clinical variablesamong male cohort members according to criminality*.
11. Frequency and percentage distributions of some sociodemographic and clinical variables among female cohort members according to criminality*
List of Figures
1. The number of divorces per year in Finland (1963-1998) (Statistics Finland 1977, 1988, 1999a).
2. A transactional model of the predictors of the children’s adjustment following divorce and remarriage (Hetherington et al. 1998).
3. The collection of data during the years 1966-1998, the Northern Finland 1966 Birth Cohort
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