The Relationship between Family Cohesion and Child Behavioral Challenges Among School-Going Children in Southwestern Uganda

Background: Approximately one in seven children in sub Saharan Africa struggle with mental illness. In Uganda, one in five children experience mental health challenges. Specifically, in a recent study among school going children in Uganda, 6% of the participants scored positive on oppositional defiant disorder (ODD) and 2% scored positive on conduct disorder (CD). Untreated impairments in childhood behaviors may lead to detrimental outcomes including substance use, delinquency, incarceration, increased HIV risk, and premature death. Most of the child behavior research is based in the US and suggests an association between family cohesion and child disruptive behaviors. However, there is little research about the relationship between family cohesion and disruptive behavioral challenges in SSA, and specifically for Ugandan youth. Against this backdrop, this study examines the association between family cohesion and disruptive behavior disorders among Ugandan youth.

Methods: This study utilized data from the SMART Africa study, a scale up study in Southwestern Uganda, funded by National Institute for Mental Health (U19MH110001). We utilized baseline data (N=2108) from caregivers of children ages 8-13, across 30 public primary schools. In this study, we measured Oppositional Defiant Disorder (ODD) and conduct disorder (CD) using the Disruptive Behavioral Disorder scale. We conducted ordinary least squares (OLS) regression analyses to assess family level factors associated with DBDs.

Results: After adjusting for socio-demographic factors, family cohesion and number of children (under 18 years) were significant independent predictors of DBD symptomology among school going children between the ages 8 and 13. Specifically, family cohesion was associated with less likelihood of screening positive for DBDs (ß=-0.21, 95% CI: -0.27, -0.15). In addition, increase in the number of children (under 18 years) in the household was associated with an increase in the likelihood of screening positive for DBDs (ß=0.99, 95% CI: 0.91, 1.09).

Implications and conclusion: Family cohesion was associated with a less likelihood of screening positive for DBDs among school-going children (ages 8 to 13) youth in Uganda. Moreover, children in larger households with more children under 18 years of age were at higher risk for behavior challenges. The study findings demonstrate that a supportive family environment may protect youth from the stressors that make them susceptible to DBDs. Therefore, engaging families and strengthening supportive relationships between youth and their caregivers, especially in households with high number of children, may be effective in preventing/addressing child behavioral challenges.