Associations between Family Resilience and Health Outcomes Among Kinship Caregivers and Their Children

Background: Research documents the prevalence of health and mental health problems among kinship families. Kinship families face health-compromising ecological stressors including disproportionate poverty, food insecurity, and unemployment. Additionally, child health and mental health may suffer following traumatic circumstances that may precede kinship care. This dynamic is particularly acute for informal kinship families who cannot access many social services. Therefore, understanding how kinship families address health-compromising stressors is critical to improving kinship services.

Family resilience is the capacity for families to weather and grow through adverse circumstances via transactional, intrafamilial processes that promote mutual support and problem solving. Despite their well-documented hardships, few studies examine associations between family resilience and kinship family health outcomes.

Methods: The current study analyzes cross-sectional associations between family resilience and health outcomes among 2,635 kinship caregiver-child dyads who completed the National Survey of Children’s Health, an annual survey conducted by the U.S. Census Bureau. The majority of caregivers (M_age= 55.25 years; 75.68% women) were grandparents (73.53%). Children (51.01% girls; M_age=8.57 years) were mostly white (51.01%) or Black (33.10%), and 22.83% were Latinx. Approximately 62.83% of families lived below 200% of the federal poverty threshold. The survey did not ask whether families were child welfare-involved. Associations were tested using weighted multiple linear and logistic regression.

Independent variable. Family resilience was measured using a four-item scale assessing the frequency with which kinship caregivers engage in family resilience processes when confronted with challenges (⍺= .90). Higher scores indicate higher family resilience.

Caregiver outcomes. Caregiver health and mental health were each assessed using single items asking caregivers to rate their overall health or mental health on a five-point scale. Higher scores indicated greater health. Parenting stress was measured using a three-item scale assessing emotional distress related to caregiving (⍺=.80). Higher scores indicated greater parenting stress.

Child outcomes. Child health was measured using a single item asking caregivers to rate their child’s health on a five-point scale. Higher scores indicated greater health. Child internalizing disorders were measured using a dichotomous variable indicating whether the child had been diagnosed with anxiety or depression. Child behavioral problems were measured using a dichotomous variable indicating whether a medical provider/educator had ever reported the child having behavioral problems.

Covariates. Caregiver-level covariates included age, sex, marital status, education, relationship to the child, number of children, family size, and income. Child-level covariates included ACEs, age, sex, race, and ethnicity.

Results: Family resilience was positively associated with caregiver health (β= .12, p= .001), caregiver mental health (β= .26, p< .001), and child health (β= .07, p= .04). Family resilience was negatively associated with parenting stress (β= -.15, p< .001). Family resilience was associated with decreased odds of child behavioral problems (adjusted OR= .91, p= .02) but not child internalizing disorders (adjusted OR= .94, p= .13).

Conclusions/Implications: Findings highlight kinship families’ resilience and their ability to promote multigenerational health outcomes despite hardship. Kinship families may benefit from interventions that target entire families rather than individuals. A resilience-based approach may also better acknowledge kinship families’ ingenious responses to adversity.