For low-income children, relationship with parent key to health

Educators, health care providers and researchers have known for some time that low socioeconomic status is connected to poor health, including in children, but a new study led by a UCSF psychologist has shed light on what can be done to protect young people from negative outcomes.

The keys? A more positive parent-child relationship as well as the child’s own ability to manage his or her response to stressful situations, according to research published last month in the journal Psychosomatic Medicine.

“In pediatricians’ offices or in school nurses’ offices, people often talk about what things in the environment can mitigate negative physical health impacts, and here we find that there are actually aspects of parenting that can be protective,” said Melissa Hagan, PhD, lead author and an assistant adjunct professor with the UCSF Department of Psychiatry's Division of Infant, Child and Adolescent Psychiatry at Zuckerberg San Francisco General Hospital and Trauma Center. She is also an assistant professor of psychology at San Francisco State University.

The results have implications not just for parents but for health-care providers and educators, who often play key roles in the well-being of young children.

Melissa Hagan, PhD, in her office

A new study from UCSF researchers, including Melissa Hagan, PhD (above), suggests that a more positive parent-child relationship as well as the child’s own ability to manage his or her response to stressful situations may help prevent negative health impacts associated with low socioeconomic status.  [Photo courtesy San Francisco State University]

Hagan and her colleagues surveyed the general health of 338 kindergarteners from diverse backgrounds throughout the San Francisco Bay Area at both the beginning and end of the school year. They found that those from low socioeconomic households generally had poorer health in the spring than classmates from higher-income households.

Discovering that it took less than a year for such health disparities to manifest was dramatic in itself, but the research also provided some clues as to how they could be avoided. The researchers also asked parents to describe their relationship with their child, and found that the absence of a “negative” parent-child relationship — for example, the parent describing the child as disappointing or reporting a lot of conflict with their child — helped reduce negative health outcomes in children from low socioeconomic backgrounds.

They also tested how well the children managed their emotional and physiological response to stressful situations, and found that those better able to self-regulate their responses were also protected from health impacts. That ability could be connected to the parent-child relationship, but Hagan cautioned that the study looked at each factor individually and that just one of the two factors was enough to make a difference.

“Children see the world through the eyes of their parents, so the way that children interpret things and deal with things is that they look to their parents to make sense of the world,” Hagan said. “Parents who are able to make sense of the world in a sufficient way are going to do a lot to help their children in terms of physical and mental health.”

For health-care professionals, Hagan said, the research suggests that, in addition to the usual typical checkup, pediatricians should also ask parents how they are feeling about their relationship with their child and educate them on ways they can help their child better respond to stress.

“It’s important to help parents make the child’s environment as predictable and consistent as possible, since increased structure can go a long way toward helping children regulate themselves,” she said. “That said, you do not want so much structure that they’re not exposed to anything, because it’s through being exposed to some level of moderate stress that we learn to deal with it.”

Hagan and her fellow researchers are now looking at how the health of a low socioeconomic household can be impacted by the surrounding neighborhood, taking into account factors such as the availability of parks and health-care facilities or the number of home foreclosures.

Co-authors on the study were Nancy E. Adler, PhD, and Nicole R. Bush, PhD, of the UCSF Department of Psychiatry; Danielle S. Roubinov, PhD, of the UCSF Department of Pediatrics; and W. Thomas Boyce, MD, of the UCSF Departments of Pediatrics and Psychiatry.

The study was supported by grants from the National Institute of Mental Health, the MacArthur Foundation Research Network on Psychopathology and Development, and the Canadian Institute for Advanced Research.

About UCSF Psychiatry

The UCSF Department of Psychiatry and the Langley Porter Psychiatric Institute are among the nation's foremost resources in the fields of child, adolescent, adult, and geriatric mental health. Together they constitute one of the largest departments in the UCSF School of Medicine and the UCSF Weill Institute for Neurosciences, with a mission focused on research (basic, translational, clinical), teaching, patient care, and public service.

UCSF Psychiatry conducts its clinical, educational, and research efforts at a variety of locations in Northern California, including UCSF campuses at Parnassus Heights, Mission Bay, and Laurel Heights, the UCSF Medical Center at Mt. Zion, Zuckerberg San Francisco General Hospital and Trauma Center, the San Francisco VA Health Care System, and UCSF Fresno.

About the UCSF Weill Institute for Neurosciences

The UCSF Weill Institute for Neurosciences, established by the extraordinary generosity of Joan and Sanford I. "Sandy" Weill, brings together world-class researchers with top-ranked physicians to solve some of the most complex challenges in the human brain.

The UCSF Weill Institute leverages UCSF’s unrivaled bench-to-bedside excellence in the neurosciences. It unites three UCSF departments—Neurology, Psychiatry, and Neurological Surgery—that are highly esteemed for both patient care and research, as well as the Neuroscience Graduate Program, a cross-disciplinary alliance of nearly 100 UCSF faculty members from 15 basic-science departments, as well as the UCSF Institute for Neurodegenerative Diseases, a multidisciplinary research center focused on finding effective treatments for Alzheimer’s disease, frontotemporal dementia, Parkinson’s disease, and other neurodegenerative disorders.

About UCSF

UC San Francisco (UCSF) is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes top-ranked graduate schools of dentistry, medicine, nursing and pharmacy; a graduate division with nationally renowned programs in basic, biomedical, translational and population sciences; and a preeminent biomedical research enterprise. It also includes UCSF Health, which comprises two top-ranked hospitals, UCSF Medical Center and UCSF Benioff Children’s Hospital San Francisco, and other partner and affiliated hospitals and healthcare providers throughout the Bay Area.