Separation From a Parent Through Age 16 As a Contributing Factor to Severe Mental Health Conditions in a General Population Study in the US: Considerations for Practice, Programming and Research

Background and Purpose: Understanding  the impact of childhood stressors on mental health outcomes is of critical importance to social workers  in the arenas of child welfare and mental health practice, programming and policy.  In this study we examined whether adults who had been separated from a parent during childhood are at increased risk for a range of mental health conditions, specifically Post-Traumatic Stress Disorder (PTSD), Major Depressive Disorder (MDD), Suicidal Ideation (SI),  and Psychotic Experience (PE).

Methods: We  explored the impact of separation from parents through age 16 on mental health outcomes  among participants in the National Comorbidity Survey Replication, a cross-sectional survey conducted in the US between 2001 and 2003 that examines the prevalence and correlates of mental health disorders in the general population. The overall sample included 9282 adults.  Among those responded to the item inquiring whether they experienced childhood separation from one or both parents for more than six months prior to age 16 (n = 6625), we identified four subsamples, including those who had experienced death of a parent (n =  409),   parental separation/divorce (n = 1377), placement in foster care (n = 21), and leaving home (n =  41).  We then calculated the Adjusted Odds Ratios (AOR; controlling for demographics) for PTSD, MDD, SI, and PE for each separation factor.

Results:   Approximately 31% (2055/6625)  had been separated from a parent for a prolonged period during childhood. Such separation  was associated with increased risk for PE, PTSD, and SI. Risk for PE was especially heightened for those ever in foster care (OR=3.93, p < .05) or who had left home (OR=4.04, p < .01). Risk for lifetime SI was likewise elevated for these two specific groups, especially foster care (OR=5.34, p < .01). Risk for lifetime PTSD was greatest for those who had been in foster care (OR=4.44, p < .01) but not for those who had left home for other reasons (OR=1.39). Parental separation or divorce was also a significant risk factor for PTSD (OR=1.42, p < .05) and SI (OR=2.13, p < .001);  parental death was a significant risk factor for PTSD (OR=1.42, p < .05) only. Of note, risk for MDD was not significantly different for individuals who had been separated from a parent (OR=.99). Taken together, these findings suggest that childhood separation from a parent increases risk for severe mental health outcomes, especially if this separation included foster care or otherwise leaving  home prior to age 16.

Conclusions and Implications: The findings support the need for increased attention to the challenges faced by those who have faced separation from a parent during the formative years. Future studies should attempt to replicate these findings by prospectively following youth separated from parents, especially those in foster care. Identifying  needs and building on assets of children and teens who face such traumatic loss through age 16 would help professionals develop family and individually focused interventions, programs and policies that serve to prevent and treat mental health issues as they emerge and before they become entrenched.