Association Adolescent Mental Disorder With Family Environment, Upbringing Style And Personality

Objective: To investigate family environment, family upbringing style,personality traits, and psychological symptoms of adolescents with mental disorders,relation family environment, upbringing style and personality traits with mental health, and risk factors and protective factors for internalizing disorders and externalizing disorders.Methods: Using case-control study method, 228 normal adolescents were recruited through middle schools and colleges(control group), and 235 adolescents with mental disorders were collected from mental health specialized hospital and psychological consulting clinic(case group), including 137 internalizing disorders, 63 externalizing disorders and 35 schizophrenia. The participants were tested with general data questionnaire, Family Environment Scale, Family Upbringing Style Questionnaire, the Big Five Personality Questionnaire and Psychological Symptom Inventory-100. Group comparison was investigated characteristics of the family environment, family upbringing style, personality traits and psychological symptoms of adolescents with mental disorders. The related factors of mental disorders were explored by stepwise regression analysis and path analysis, and risk factors of internalizing disorders and externalizing disorders with logistic regression analysis.Results:1. The comparison between mental disorders group and control group showed:(1) There were no significant differences in age, gender, ranking and housing condition between the two groups(P>0.05), significant differences in the nation,education, academic and professional situation, previous physical health, previous mental health, family type, father’s education and mother’s education(P<0.01).(2)The total score of symptoms and ten dimensional scores of Psychological Symptom Inventory-100 were significantly higher in the adolescents with mental disorders than control group on(P<0.001). Except mother’s expectations-demanding, the other dimension scores of family upbringing style were significantly higher in the control group than mental disorders group(P<0.01).(3) The scores mental disorders group were significantly lower than of control group on the cohesion expressiveness,achievement orientation, active recreational orientation, moral-religious emphasis,organization(P<0.05), but significantly higher than the control group on the conflict(P<0.001).(4) The mental disorders group were significantly lower than the control group on the agreeableness, conscientiousness and extraversion, however higher than the control group on the neuroticism(P<0.001).2. The comparison analysis of internalizing disorder group, externalizing disorder group and schizophrenia group: There were no significant differences in the nation,ranking, academic career, previous physical health, family type, father’s education and housing conditions(P>0.05). There were significant differences in depressive symptom, anxiety symptom, obsessive-compulsive symptom, somatic symptom,attention problem, sensitive nerve, diet and sleep, impulse control and total score of symptoms among the three groups(P<0.05). Father’s acceptance-rejection, mother’s acceptance-rejection, father’s catholicity-permissive, father’s inspirit-punishment,mother’s inspirit-punishment and mother’s expectation-demanding for the three groups showed significant differences(P<0.05). The score of cohesion,expressiveness, conflict, active-recreational orientation among the three groups had significant differences(P<0.05). The three groups on the extraversion and neuroticism had significant differences(P<0.001). There were no significant differences in the other variables of family environment, family parenting style and personality traits among the three groups(P>0.05).3. The regression analysis and path analysis showed:(1) The impact of social demographic data on mental health had statistically significance(P<0.01), for instance that the total score of symptoms was affected by previous mental health(β=0.344), previous physical health(β=0.171), education attitude(β=0.130) and father education(β=0.087).(2) The impact of family upbringing style on mental health showed statistically significance(P<0.01), and the total score of symptoms was affected by mother’s warmth-wildness(β=-0.232), mother’s supervision-control(β=0.214), father’s understand-blame(β=-0.198) and mother’s acceptance-rejection(β=0.163).(3) The impact of family environment on mental health had statistically significance(P<0.01), such as the total score of symptoms affected by conflict(β=0.320), organization(β=-0.150) and expressiveness(β=-0.102).(4) The impact of the big five personality traits on mental health showed statistically significance(P<0.01), such as total score affected by neuroticism(β=0.429), agreeableness(β=-0.202) and conscientiousness(β=-0.202).(5) The combined action of social demographic data, family environment, family upbringing style and personality traits on mental health was greater than the impact of a single factor on mental health. The total score of symptoms was affected by neuroticism(β=0.348), previous mental health(β=0.150), agreeableness(β=-0.153), conscientiousness(β=-0.159), father’s education(β=0.115), previous physical health(β=0.125) and mother’s warmth-wildness(β=-0.119), which could explained 50.6% of total score.(6) There were interactive actions among family environment, family upbringing style and personality traits. Family environment and personality characteristics affected mental health directly, family upbringing style affected mental health indirectly through personality traits or family environment. The fit index( such as χ2/df=2.160,RMSEA=0.052, GFI=0.88, AGFI=0.84, PGFI=0.67, NFI=0.91, RFI=0.89, IFI=0.95,TLI=0.94, and CFI=0.95) basically reached the standard of model.4. The risk factors analysis showed:(1) The fit index test for internalizing disorders on the whole model( χ2=113.948, P= 0.000) and Hosmer-Lemeshow test( χ2=3.748, P=0.808) indicated that regression model was very ideal; there was moderate correlation between independent variables and dependent variables(Cox-Snell R2=0.268, Nagelkerke R2=0.365); lower achievement orientation, father’s acceptance and lower extraversion were risk factors of internalizing disorders(P<0.05), lower conflict, father’s supervision, higher extraversion and lower neuroticism being protective factors of internalizing disorders(P<0.05).(2) The fit index test for externalizing disorder on the whole model(χ2=25.545, P=0.000),Hosmer-Lemeshow test(χ2=0.424,P=0.980) suggested that regression model was basically fit; there was mild correlation between independent variable and dependent variable(Cox-Snell R2=0.084, Nagelkerke R2=0.130); Father’s catholicity was protective factor of externalizing disorder(P<0.01), father’s demanding was risk factor of externalizing disorder(P<0.01).Conclusion: 1. Adolescents with mental disorders report that six low and one high feature in the family environment; more negative parenting style such as rejection, demanding or permissive; and three low and one high feature in the personality traits. 2. Compared with externalizing disorders, adolescents with internalizing disorders appeared that more depressive, anxiety, compulsive, somatic and neurotic symptoms; lower extraversion, higher neuroticism and higher openness;higher blame and higher expectations; lower cohesion, lower active-recreational orientation and higher conflict in their family. 3. There were interactive actions among family environment, family upbringing style and personality traits; family upbringing style affect mental health indirectly through personality traits and family environment; family environment could influence on the mental health directly and also indirectly affected mental health through personality traits; personality traitswere the most important variables affecting mental health; Combined effect of family environment, parenting style and personality traits contributed rate of 60.8% to mental health. 4. Lower Achievement Orientation, father’s acceptance and lower extraversion were risk factors of internalizing disorders, lower conflict, father’s supervision, higher extraversion and lower neuroticism were protective factors of internalizing disorders; father’s catholicity was protective factor of externalizing disorder, father’s demanding was risk factor of externalizing disorder.