Individual and family factors associated with child mental health and wellbeing
Melissa Willoughby and Joanna Schwarzman, Australian Institute of Family Studies, Australia, December 2024
Resource Summary
This short article summarises the research evidence on individual and family factors associated with child mental health and wellbeing. It also provides insights for practitioners and services about how knowledge of these factors can be useful for promoting child mental health.
Who is this resource for?
This resource is for non-specialist practitioners and services who work with or encounter children and their families, including generalist services with no experience providing mental health services.
Introduction
Child mental health encompasses a child’s emotional, social and psychological wellbeing (Emerging Minds, n.d.)1. Understanding what factors are associated with child mental health challenges or promote wellbeing is important for practitioners and services who work with children and families2. This understanding can help practitioners to identify children in need of more support by indicating who may be at higher risk of developing mental health challenges or how best to respond to existing mental health challenges (Eriksson, Ghazinour, & Hammarström, 2018). It can also provide opportunities to intervene early to prevent challenges arising (Eriksson et al., 2018). For example, programs and policies can be designed for children or their families that target these factors and consequently promote child mental health.
Children’s mental health and wellbeing can be influenced by a range of factors relating to the characteristics of the individual child, their family and relationships, and the community and society that they live in (Eriksson et al., 2018). This resource summarises the evidence on the individual and family factors that research reviews have found are associated with child mental health outcomes and outlines related implications for practice. These are the factors that services working with children and families are most likely to influence and are also those that have been most extensively researched.
This article does not provide an exhaustive list of all factors associated with child mental health but instead focuses on those that are the most well researched and where the recent evidence is strongest. Some emerging factors, or previously established factors that have not been included in recent reviews of the evidence, may not be covered in this article.
Individual factors associated with child mental health
The term ‘individual factors’ refers to the characteristics of an individual child such as their age, biological sex, personality or behaviour. Table 1 outlines the individual factors examined in research reviews of the evidence on child mental health. It shows the impact of each factor on different child mental health outcomes.
Of the several individual factors associated with child mental health, self-regulation3 – which refers to a child’s ability to understand and manage their emotions and behaviours (Raising Children Network, 2024) – is one that has most consistently been associated with a reduction in child mental health challenges. The evidence is strongest for improved self-regulation having a relationship to reduced externalising and internalising behaviour (Table 1). Self-regulation may therefore be a good factor to target for programs addressing child wellbeing because it is associated with a reduction in the likelihood of a child experiencing multiple mental health challenges.
Table 1. The association between individual factors and child mental health outcomes
*Note: Unless otherwise stated, definitions of individual factors are adapted from the cited reviews.
1. Definition adapted from Miguel-Aliaga, I. (2022). Let’s talk about (biological) sex. Nature Reviews Molecular Cell Biology, 23(4), 227–228.
Family factors associated with child mental health
The term ‘family factors’ refers to the characteristics of the child’s caregiver4, such as their parenting skills, behaviour and health, as well as the family’s functioning. This can also include the parent–child relationship and family conflict.
Table 2 shows family factors that have been identified in previous evidence reviews and their association with different child mental health outcomes. Parenting skills, child maltreatment and childhood exposure to intimate partner violence are examples of factors that were associated with a range of child mental health outcomes in multiple evidence reviews. As a result, there appears to be stronger evidence for these associations. More details about these factors are described below.
Parenting skills5 – a term which refers to caregiver knowledge, behaviours and abilities that enable them to care for their child (Hurley et al., 2014) – were found to improve child mental wellbeing and reduce mental health challenges in multiple research reviews. Parenting skills were associated with an increase in adaptive behaviours and social functioning in children (Table 2). They were also associated with a decrease in children’s externalising and internalising behaviours, behavioural difficulties, emotional difficulties and anxiety symptoms. The evidence for the impact of parenting skills was strongest for the reduction of externalising, internalising and behavioural difficulties. Parenting skills may therefore be a useful factor to target in interventions that aim to reduce these child mental health challenges.
Multiple evidence reviews also found that child maltreatment and childhood exposure to intimate partner violence6 between caregivers, which is sometimes considered a type of child maltreatment, both have a negative impact on child mental health (Table 2). Child maltreatment was associated with an increase in anxiety, depression, externalising behaviour, internalising behaviour and post-traumatic stress disorder. Childhood exposure to caregiver intimate partner violence was also associated with decreased emotional regulation, self-regulation and social competence. Children with these experiences are likely to require additional follow-up and supports to screen for mental health challenges. Including child maltreatment and exposure to caregiver intimate partner violence in general screening may also help with early identification of potential challenges and support opportunities.
Table 2. The association between family factors and child mental health outcomes
*Note: Unless otherwise stated, definitions of family factors are adapted from cited reviews.
1. Reviews of this factor included young people up to the age of 18 years.
2. Definition adapted from National Collaborating Centre for Mental Health (UK). (2015). Children’s attachment: Attachment in children and young people who are adopted from care, in care or at high risk of going into care. National Institute for Health and Care Excellence.
3. Definition adapted from Hurley, K. D., Huscroft-D’Angelo, J., Trout, A., Griffith, A., & Epstein, M. (2014). Assessing parenting skills and attitudes: A review of the psychometrics of parenting measures. Journal of Child and Family Studies, 23, 812–823. DOI: 10.1007/s10826-013-9733-2.
Implications for practice and services
Given the strong evidence for the influence of individual and family factors, the following considerations may be useful for practitioners and services in supporting child mental health.
- Recognise that a child’s mental health can be influenced by factors related to their characteristics, personality and behaviour, and the behaviour, skills and functioning of their caregivers and family. The whole child and their relationships should be taken into consideration when working with children and their families.
- Factors that can influence child mental health, and that can potentially be modified, may be useful targets for interventions aiming to improve child wellbeing and reduce mental health challenges. These include the child’s ability to self-regulate, level of behavioural inhibition and resilience, and their quality of sleep. They can also include caregivers’ parenting skills, mental health (e.g. via support for parents), and prescription or illicit substance use.
- Factors that can influence child mental health but cannot be readily modified via support from practitioners (e.g. past experiences of child maltreatment, previous exposure to caregiver intimate partner violence, very low birth weight), may be indicators that can help practitioners and services identify children and families that may need additional mental health support. Practitioners should be mindful that the presence of these factors doesn’t mean that a child will always experience mental health challenges.
- Where possible, practitioners can also consider their role in primary prevention of individual and family factors that contribute to mental health challenges (i.e. prevention of factors before they occur). For example, this could include providing expectant parents with adequate mental health support or teaching children self-regulation skills from a developmentally appropriate early age.
Conclusion
This resource summarised the evidence on individual and family factors that are the most well researched and where the evidence is strongest for their association with child mental health. These factors may be useful targets for interventions aiming to reduce child mental health challenges and improve mental wellbeing. They could also help practitioners and services identify which children and families may need additional support. In addition to the factors explored in this article, there are likely other factors that are less well-researched but may influence child mental health.
Notes
1. In this article, ‘child’ refers to young people aged 0–18 years.
2. The presence of one or more of the factors mentioned in this resource doesn’t guarantee that a child will or won’t experience mental health challenges. Rather, these factors have been found to be common among children who have mental health challenges or positive mental wellbeing (in the case of factors that improve mental health).
3. This can include regulating strong emotions such as frustration or anger, calming down after being excited, and being able to focus on a task (Raising Children Network, 2024). Self-regulation can be measured using survey instruments such as the Early Years Toolbox created by Early Start Discovery Space, University of Wollongong. This is a brief, game-like assessment that measures children’s cognitive, self-regulatory, language, numeracy and social development.
4. In this article, the term ‘caregiver’ encompasses biological, adoptive, foster and kinship carers.
5. For example, skills related to building and maintaining relationships, behaviour management, and being warm and responsive (Hurley, Huscroft-D’Angelo, Trout, Griffith, & Epstein, 2014). Parenting skills can be measured through survey instruments such as the Keys to Interactive Parenting Scale. This tool measures parenting behaviours relating to building relationships, promoting learning and supporting confidence.
6. Reviews of the association between child maltreatment or exposure to caregiver intimate partner violence and child mental health included young people up to the age of 18 years.
How was this resource developed?
This resource is based on a review conducted by the Australian Institute of Family Studies (AIFS) for Emerging Minds. As part of the review, a search was conducted to identify systematic reviews and meta-analyses on factors associated with child mental health. The search was conducted in April 2021 in the Australian Family & Society Abstracts database, the Campbell Systematic Reviews and the Cochrane Database of Systematic Reviews. Terms related to ‘child’, ‘mental health’ and ‘review’ were searched for in these databases. Included reviews were 1) published in a peer reviewed journal from 2011–2021, 2) written in English, and 3) focused on children aged 0–12 years.
Although the original search conducted for the AIFS review was comprehensive, it lacked the sensitivity to identify reviews on the association between child mental health and some of the identified factors of interest (i.e. domestic and family violence, child maltreatment and adverse childhood experiences). As such, a specific search for reviews on these factors was conducted in Google Scholar on 30 July 2024 using terms related to ‘violence’ in addition to ‘child’, ‘mental health’ and ‘review’. The inclusion criteria for reviews of these factors were also expanded to include children up to the age of 18 years (as opposed to 12 years for the original search).
Grey literature was not included. As only reviews of the evidence were included (i.e. not original research studies), some emerging evidence on individual and family factors associated with child mental health may not be included.
Acknowledgements
The authors would like to thank the team who contributed to the original AIFS review that this resource is based on: Dr Kristel Alla, Dr Nikola Balvin, Dr Trina Hinkley, Anagha Joshi, Dr Nerida Joss, Dr Judy McInnes and Cat Strawa.
Further reading and related resources
- What works to improve young children’s social, emotional and behavioural wellbeing? (policy and practice paper) outlines the evidence on programs that are effective at improving the social, emotional and behavioural health of children under five.
- What is infant and child mental health (and why is it important)? (short article) explores what child mental health is and how children experience mental health.
- In focus: Understanding children’s mental health (resource) aims to help parents and caregivers understand what child mental health is and what positive child mental health looks like.
- Exploring parents’ concerns about children’s mental health and wellbeing (webinar) discusses working with parents who have concerns about their child’s mental health and wellbeing.
- What is infant mental health, why is it important, and how can it be supported? (short article) explores factors that are important to infant mental health.
- Understanding and supporting infant mental health (webinar) discusses signs of infant mental health and how to have conversations with parents and caregivers.
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