ArticlePDF Available




The family is a system whose members are independent, where each member is influenced by the system as a whole, and at the same time affects the health and functioning of the system. Better family functioning is associated with better mental status of respondents. Long-term changes in family structure can affect family function and thus the mental health of family members. The presence of depressive symptoms in parents is one of the main risk factors for the development of depressive symptoms in children in adulthood. Close emotional relationships with parents result in positive psychological outcomes for children, while bad emotional connections lead to negative outcomes. Family conflicts are most strongly associated with depressive symptoms. The family environment has a very significant role and impact on the mental health of the individual in all population groups. It is necessary to implement policies and strategies for the protection of mental health. The timely identification of dysfunctional families, which will be included in mental health promotion programs, and thus prevent further progression of mental illness, is also important. Vol 8, Issue 8, 2021. ISO 9001:2015 Certified Journal
Salihov et al. European Journal of Biomedical and Pharmaceutical Sciences
Amela Salihović1,2*, Jasmina Mahmutović1, Suada Branković1, Ema Pindžo1,2, Almedina Hajrović1,2, Elmedina
1Faculty of Health Studies, University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
2PhD student, Faculty of Health Studies, University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
3Paediatric Clinic, Clinical Centre University of Sarajevo, Sarajevo, Bosnia and Herzegovina
Article Received on 07/06/2021 Article Revised on 28/06/2021 Article Accepted on 19/07/2021
The family is the basic unit of the social community and
in all societies an important institution that occupies a
very high place on the table of life values. The family is
a system whose members are independent, where each
member is influenced by the system as a whole, and at
the same time affects the health and functioning of the
system. Thus the health/illness of an individual affects
the family and vice versa, the family structure affects the
health/illness of the individual.[1] The family can be a
source of health, attitudes about health and a source of
family coherence. As an interconnected group of
individuals, the family is sensitive to changes in its
internal and external environment and is a mediator
between the needs of the individual and society. Family
crises refer to the disturbed psychosocial balance of the
family system and can be developmental and non-
developmental, they are important for development,
because the further development of the individual and
the family as a system depends on the success of
overcoming and resolving.[2]
Long-term changes in the family structure could lead to a
change in the family function, so measures must be taken
to ensure that healthy family functioning continues.
Research shows that better family functioning is
associated with better mental status of respondents. With
irreversible globalization, long-term changes in family
structure can affect family function and thus the mental
health of family members.[3]
FHC- Family Health Climate
The family environment should influence the behaviour
of individuals and individual determinants. One of the
relevant aspects of the family environment may be the
family health climate. Family Health Climate (FHC) is a
degree of family variable that reflects an aspect of a
shared family environment. Because of the interactions
between the shared family environment and individuals
and their interactions, the family health climate should be
associated with cognitive, motivational, and behavioural
variables of individuals, with interactions related to
physical activity or diet in the family, and with family
life habits.[4] The impact of self-perception, family
climate and social support plays a major role in reducing
the incidence of mental disorders.[5]
SJIF Impact Factor 6.044
Review Article
ejbps, 2021, Volume 8, Issue 8, 164-166.
European Journal of Biomedical
AND Pharmaceutical sciences
ISSN 2349-8870
Volume: 8
Issue: 8
Year: 2021
*Corresponding Author: Amela Salihović
Faculty of Health Studies, University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
Salihović et al. European Journal of Biomedical and Pharmaceutical Sciences Vol 8, Issue 8, 2021. ISO 9001:2015 Certified Journal
Emotional security theory
Emotional security theory emphasizes the role of parent-
child relationships in shaping children’s psychological
outcome. Relationships with parents are among the most
important social relationships, especially in the early
stages of life. Close emotional relationships with parents
result in positive psychological outcomes for children,
while bad emotional connections lead to negative
outcomes. A large number of empirical studies in
Western countries have shown that high-quality marital
and parental relationships improve adolescent mental
health. Adolescents who have good relationships with
their mothers and fathers have lower depression scores.[6]
Family environment and mental health
Most studies that study the relationship between a
parent's personality and the quality of parenting focus on
the links between psychological functioning disorders
and parental behaviour. Depressed mothers create a
destructive and repulsive environment that adversely
affects the child's functioning and psychological
adaptation of the child, are less responsible and less
adaptable to children's needs, show more anger and
sadness, and less positive emotions than non-depressed
The perinatal period can be a time of psychological
adjustment for both parents. Perinatal anxiety and
depression in a male family member or father are
significant concerns due to the impact on the spouses and
their families. Although the mental illnesses of mothers
and fathers are correlated, depression in the husband or
father exists even after the suppression of the mother's
depression. Research shows that children of such fathers
face an increased risk of adverse behavioural and
emotional outcomes.[8]
Research states that a negative family environment is
associated with depressive symptoms in offspring, and
that a less supportive and more conflicting family
environment is associated with current and future
symptoms of depression in children.[9]
The presence of depressive symptoms in parents is one
of the main risk factors for the development of
depressive symptoms in children in adulthood, especially
for female respondents. This effect was found in cases of
both biological parents and adoptive parents.[10]
Children whose families are characterized as functional
report fewer psychological problems compared to
children from families with poor family functioning.
Research shows that more than one-third (38%) of
mentally ill parents describe their families as
dysfunctional.[11] This is confirmed by other studies
whose results show that depression is significantly
negatively correlated with family functioning.[12]
The most important predictor of mental health is the
relationship with parents, followed by parental
upbringing, and pressure from parents. The results of
many studies suggest that parents are one of the key
factors contributing to the mental health of adolescents
and as such are of great value and importance for
planning the prevention and promotion of adolescent
mental health.[13]
The family structure became smaller with increased
industrialization and urbanization, and caring for older
individuals within the family structure became more
difficult. [14]
The results of the t-test show that there is a statistically
significant difference (p <0.05) in the severity of
depression in third-aged respondents living in
institutional accommodation compared to respondents
living at home with their families.[15]
Protective factors that affect mental health
The group of protective factors includes: positive and
warm family relationships, support, clearly defined roles
in the family, positive parental marriage, family
harmony, acceptance of change, effective
communication aimed at solving problems, time spent
together, family traditions, finances (satisfactory
economic status), spirituality of the family, health of
family members, support.[13]
Risk factors affecting mental health
The group of risk factors includes: conflicts in the
family, domestic violence, frequent stressful situations,
inconsistent discipline, unrealistic expectations of
parents, high-risk behaviours of parents and lack of
social support and social isolation of the family. Family
conflicts are most strongly associated with depressive
symptoms.[13] Given that the support of friends and
intimate partners usually replaces or at least
complements parental support when adolescents become
adults, it is interesting to discover that family
relationships in adolescents have such lasting effects
until middle age.[16]
Based on a review of scientific publications that have
studied the family and mental health from different
aspects, we can conclude that the family environment has
a very significant role and impact on the mental health of
the individual in all population groups. It is necessary to
implement policies and strategies for the protection of
mental health. The timely identification of dysfunctional
families, which will be included in mental health
promotion programs, and thus prevent further
progression of mental illness, is also important.
1. Đurasov L. Uloga obitelji za ozdravljenje bolesnog
člana. Varaždin. Sveučilište sjever. 2017. Završni
rad/The role of the family in the healing of member
with illness. Varaždin. University North, 2017. Final
Salihović et al. European Journal of Biomedical and Pharmaceutical Sciences Vol 8, Issue 8, 2021. ISO 9001:2015 Certified Journal
2. Minić LJ. J. Osjećaj porodične koherentnosti kod
adolescenata. Niš.Univerzitet u Nišu Filozofski
fakultet.2016. Doktorska disertacija/Sense of family
coherence in adolescents. Niš. University of Niš,
Faculty of Philosophy, 2016. Doctoral thesis.
3. Cheng Y. Zhang L. Wang F. Zhang P. Ye B. Liang
Y. The effects of family structure and function on
mental health during China’s transition: a cross-
sectional analysis. BMC Family Practice, 2017;
18(59): 2-8.
4. Niermann C.Y.N. Kremers S.P.J. Renner B. Woll A.
Family Health Climate and Adolescents’ Physical
Activity and Healthy Eating: A Cross-Sectional
Study with Mother-Father Adolescent Triads. PLoS
ONE., 2015; 10(11): 1.
5. Triana R. Keliat B.A. Wardani Y.I. Sulistiowati
D.M. Veronika A.M. Understanding the protective
factors (self-esteem, family relationships, social
support) and adolescents’ mental health in Jakarta.
Enferm Clin., 2019; 29: 629-633.
6. Liu Y. Ge T. Jiang Q. Changing family relationships
and mental health of Chinese adolescents: the role of
living arrangements. / Public Health, 2020; 110-115.
7. Čavčić D. Podaci o postojanju psihičkih poremećaja
u užoj ili široj obitelji kod mladih u tretmanu na
zavodu za dječju i adolescentnu psihijatriju. Osjek.
Sveučilište Josipa Jurja Strossmayera u Osjeku.
Medicinski fakultet. 2016. Završni rad/Data on the
existence of mental disorders in the immediate or
extended family of young people in treatment at the
Department of Child and Adolescent Psychiatry.
Osijek. Josip Juraj Strossmayer University of Osijek.
Faculty of Medicine, 2016. Final paper.
8. Darwin Z. Galdas P. Hinchlif S. Littlewood E.
McMillan D. McGowan L. Gilbody S. Fathers’
views and experiences of their own mental health
during pregnancy and the first postnatal year: a
qualitative interview study of men participating in
the UK Born and Bred in Yorkshire (BaBY) cohort.
BMC Pregnancy and Childbirth, 2017; 17(45): 2-15.
9. Daches S. Vine V. Layendecker M.K.George C.
Kovacs M. Family Functioning as Perceived by
Parents and Young Offspring at High and Low Risk
for Depression. J Affect Disord, 2018; 15(226):
10. Villatte A. Marcotte D. Potvin A. Correlates of
Depression in First-Year College Students. CSSHE
SCÉES, 2017; 47(1): 114136
11. Grefe-Wiegand S. Sell M. Filter B. Plass-Christl A.
Family Functioning and Psychological Health of
Children with Mentally Ill Parents. Int. J. Environ.
Res. Public Health, 2019; 16: 2-12.
12. Shao R. He P. Ling B. Tan L. Xu L. Hou Y. et all.
Prevalence of depression and anxiety and
correlations between depression, anxiety, family
functioning, social support and coping styles among
Chinese medical students. BMC Psychology, 2020;
8(38): 2-19.
13. Strle A. Povezanost obiteljske dinamike i mentalnog
zdravlja adolescenata. Sveučilište u Zagrebu,
Hrvatski studiji. Zagreb. 2018. Diplomski
rad/Relationship between family dynamics and
adolescent mental health. University of Zagreb,
Croatian Studies. Zagreb. 2018. Graduation thesis.
14. Choulagai P.S. Sharma C.K. Choulagai B.P.
Prevalence and Associated Factors of Depression
among Elderly Population Living in Geriatric
Homes in Kathmandu Valley. Journal of Institute of
Medicine, 2013; 35: 39-44.
15. Babazadeh T. Sarkhoshi R. Bahadori F. Moradi F.
Shariat F. Sherizadeh Y. Prevalence of depression,
anxiety and stress disorders in elderly people
residing in Khoy, Iran (2014-2015). J Anal Res Clin
Med., 2016; 4: 122-126.
16. Berg N. Kiviruusu O. Karvonen S. Rahkonen O.
Huurre T. Pathways from problems in adolescent
family relationships to midlife mental health via
early adulthood disadvantages a 26-year
longitudinal study. PLoS ONE, 2017; 12(5): 1-16.
ResearchGate has not been able to resolve any citations for this publication.
Full-text available
Background: Medical students experience depression and anxiety at a higher rate than the general population or students from other specialties. While there is a growing literature on the high prevalence of depression and anxiety symptoms and about potential risk factors to the prevalence of depression and anxiety symptoms among medical students, there is a paucity of evidence focused on the prevalence of depression and anxiety symptoms and associations with family function, social support and coping styles in Chinese vocational medicine students. This study aims to investigate the prevalence of depression and anxiety symptoms among Chinese medical students and assess the correlation between depression/anxiety symptoms and family function, social support and coping styles. Methods: A sample of 2057 medical students from Chongqing Medical and Pharmaceutical College in China was investigated with a self-report questionnaire, which included demographic information, Zung self-rating depression scale, Zung Self-Rating Anxiety Scale, Family APGAR Index, Social Support Rating Scale and Trait Coping Style Questionnaire. Results: The prevalence of depression and anxiety symptoms among the medical students was 57.5 and 30.8%, respectively. Older students(≥20 years) experienced higher levels of depression and anxiety. More depression and anxiety symptoms were exhibited among students with big financial burden, big study-induced stress and poor sleep quality. Students with large employment pressure showed more anxiety symptoms. Students who live alone or had bad relationship with their lovers or classmates or friends showed higher depression and anxiety scores. Depression and anxiety symptoms had highly significant correlations with family functioning, social support and coping style. Conclusions: Academic staffs should take measures to reduce depression and anxiety among medical students and to provide educational counseling and psychological support for students to cope with these problems.
Full-text available
Objective: Mental health problems may occur in teenage years, thus it is important for adolescents to understand how to maintain mental health. Method: This was a correlative descriptive study to examine mental health and adolescent protective factors (self esteem, family relationships, and social support). There were 452 eighth grade students under 15 years old at junior high schools who participated in this study. The respondents were selected with purposive sampling technique. Respondents filled a questionnaire about self esteem, family relationships, social support, and youth mental health. Results: The results show the majority of respondents have moderate self esteem, good family relationships, and adequate social support from parents, teachers, classmates, and peers, but they obtain lack social support from school (such as school administrator and anyone, except teachers and their friends). Conclusions: Promotion of adolescent mental health is recommended for schools. Adolescent protective factors could be improved to achieve optimal adolescent mental health.
Full-text available
Parental mental illness can be linked to reduced family functioning, which is associated with more conflicts, less adaptability and cohesion as well as a disorganized pattern of everyday planning. Concurrently, family functioning is an important moderator for the influence of parental mental disorders on the development of the children. Consequently, the current study addresses the correlation of family functioning in families with mentally ill parents and the psychological health of the children. The sample consists of 67 mentally ill parents. Both parents and therapists completed questionnaires related to family functioning and the psychological health of the children. Family functioning was rated as dysfunctional in 38% of the families. The psychological health of the children was classified as clinical or subclinical in 43% of the cases. 52% of the children were rated to have no psychological problems. In families with good family functioning, children were assessed to have less psychological problems than in families with poor functioning. Children outside the clinical range lived in families with good family functioning and vice versa. Significant positive correlations were found between the FB-A scales, the CBCL/4-18 syndrome scales and the CBCL/4–18 total score. Results indicate that family functioning and psychological health of children in families with mentally ill parents correlate closely and represent potential targets for future family interventions.
Full-text available
Poor childhood family conditions have a long-term effect on adult mental health, but the mechanisms behind this association are unclear. Our aim was to study the pathways from problematic family relationships in adolescence to midlife psychological distress via disadvantages in early adulthood. Participants of a Finnish cohort study at the age of 16 years old in 1983 were followed up at ages 22, 32 and 42 years old (N = 1334). Problems in family relationships were measured with poor relationship with mother and father, lack of parental support in adolescent’s individuation process and poor home atmosphere, and mental health was assessed using Kessler’s Psychological Distress Scale (K10). We analyzed the indirect effects of adolescent family relations on mental health at age 42 years old via various disadvantages (somatic and psychological symptoms, relationship/marital status, low education/unemployment and heavy drinking) at ages 22 and 32 years old. Problematic adolescent family relationships were associated with midlife psychological distress in women (0.19; 95% CI 0.11, 0.26) and men (0.13; 95% CI 0.04, 0.21). However, after adjustment for adolescent psychological symptoms, the association was only significant for women (0.12; 95% CI 0.04, 0.20). Poor family relationships were associated with various disadvantages in early adulthood. The association from poor family relationships (16 years old) to psychological distress (42 years old) was in part mediated via psychological symptoms in women (0.03; 95% CI 0.01, 0.04) and men (0.02; 95% CI 0.00, 0.04) and in women also via heavy drinking in early adulthood (0.02; 95% CI 0.00, 0.03). Adolescent family relationships have a role in determining adult mental health. Targeted support addressing psychological well-being and hazardous drinking for adolescents with problematic family relationships might prevent disadvantages in early adulthood, and further prevent poor midlife mental health.
Full-text available
Background Social change, intensified by industrialization and globalization, has not only changed people’s work lives but also their personal lives, especially in developing countries. The aim of this study was to provide evidence and recommendations regarding family structure, function, and mental health to actively respond to rapid social change. Methods A cross-sectional survey was conducted face-to-face and door-to-door from July 2011 to September 2012 in Hubei Province, central China. Family structure comprised alone, couple, nuclear family, and extended family; family function was measured using the family APGAR (Adaptation, Partnership, Growth, Affection, and Resolve) scale, and mental health was measured using the Chinese version of the 12-item General Health Questionnaire (GHQ-12). Results The urban-vs-rural difference of family structure among alone, couple, nuclear family, and extended family was statistically significant (5.21% vs 4.62%; 27.36% vs 13.14%; 33.22% vs 27.74%; 34.20% vs 54.50%, respectively; p < 0.0001); and those difference of family function was not statistically significant (8.11 ± 2.13 vs 8.09 ± 2.27, p = 0.9372). The general linear regression showed that the effect of family structure on mental health, whether urban or rural, was not significant, however, the effect of family function was significant, especially regarding better family functioning with better mental health. Conclusions Combined the effects of family structure and function on mental health, the external form of family (family structure) may not be important; while the internal quality of role (family function) might be key. Improving the residents’ family function would be a priority strategy for family practice with their mental health.
Full-text available
Background The prevalence of fathers’ depression and anxiety in the perinatal period (i.e. from conception to 1 year after birth) is approximately 5–10%, and 5–15%, respectively; their children face increased risk of adverse emotional and behavioural outcomes, independent of maternal mental health. Critically, fathers can be protective against the development of maternal perinatal mental health problems and their effects on child outcomes. Preventing and treating paternal mental health problems and promoting paternal psychological wellbeing may therefore benefit the family as a whole. This study examined fathers’ views and direct experiences of paternal perinatal mental health. Methods Men in the Born and Bred in Yorkshire (BaBY) epidemiological prospective cohort who met eligibility criteria (baby born <12 months; completed Mental Health and Wellbeing [MHWB] questionnaires) were invited to participate. Those expressing interest (n = 42) were purposively sampled to ensure diversity of MHWB scores. In-depth interviews were conducted at 5–10 months postpartum with 19 men aged 25–44 years. The majority were first-time fathers and UK born; all lived with their partner. Data were analysed using thematic analysis. ResultsFour themes were identified: ‘legitimacy of paternal stress and entitlement to health professionals’ support’, ‘protecting the partnership’, ‘navigating fatherhood’, and, ‘diversity of men’s support networks’. Men largely described their ‘stress’ with reference to exhaustion, poor concentration and irritability. Despite feeling excluded by maternity services, fathers questioned their entitlement to support, noting that services are pressured and ‘should’ be focused on mothers. Men emphasised the need to support their partner and protect their partnership as central to the successfully navigation of fatherhood; they used existing support networks where available but noted the paucity of tailored support for fathers. Conclusions Fathers experience psychological distress in the perinatal period but question the legitimacy of their experiences. Men may thus be reluctant to express their support needs or seek help amid concerns that to do so would detract from their partner’s needs. Resources are needed that are tailored to men, framed around fatherhood, rather than mental health or mental illness, and align men’s self-care with their role as supporter and protector. Further research is needed to inform how best to identify and manage both parents’ mental health needs and promote their psychological wellbeing, in the context of achievable models of service delivery.
Full-text available
Introduction: Psychiatric disorders such as depression, stress, and anxiety are factors that affect the quality of life, suicide and many physical problems, and socioeconomic in elders. Considering the importance of the issue and increasing the number of elderly people in this County, researchers decided to investigate the levels of stress, anxiety, and depression in the elderly health centers of Khoy, Iran. Methods: This cross-sectional study was done on 383 elderly people referred to health centers in Khoy County. A random cluster sampling was used in this study where each health care is considered as a cluster. The Depression, Anxiety, Stress Scale 21 (DASS-21) standard questionnaire was used for data collection. The SPSS software was used for all computations. Data were analyzed using descriptive statistic, t-test, and one-way ANOVA. P < 0.050 was determined to be significant. Results: The results of this study showed that 1.3% of the elderly people suffer from very severe stress, 1.3% from severe depression, and 3.1% from severe anxiety. Likewise, the comparison between anxiety, stress, and depression disorders with demographic variables showed that there is a significant association between these disorders and sex, education, marital status, medical condition, as well as their housing conditions (P < 0.050). Conclusion: The results of this study indicated anxiety disorders, depression, and stress prevail among the elderly. In addition, some factors such as education, housing, medical condition, and marital status had significant effects on anxiety disorders, depression, and stress. Therefore, more attention is deserved in these aspects. Moreover, appropriate measures need to be taken to improve the mental health of elderly people.
This study aimed to identify and rank the personal, family-related, social, and academic correlates of depressive symptoms in first-year college students. A questionnaire that included the Beck Depression Inventory-II (BDI-II) was administered to 389 first-year college students (mean age = 18.9; SD = 3.38; 59.4% female). Eight variables contributed uniquely to the variance of depressive symptoms and were, in decreasing order of importance: (1) the absence of personal goals, (2) a high level of anxiety and (3) of dysfunctional thoughts regarding success, (4) a lack of emotional adjustment to college, (5) being female, (6) receiving little warmth and encouragement of autonomy from one’s mother and (7) from one’s father, and (8) being attracted to members of the opposite or both sexes. These results suggest that a multimodal intervention is required to support students’ mental health.
Objective This study examined the association between changing family relationships (marital relationships and parent-child relationships) and adolescents' mental health in transitional China. It further explored the potential moderating role of living arrangements in the abovementioned associations. Study design The study design used in the study is a longitudinal study. Methods Data were derived from wave 1 (academic year: 2013–2014, grade 7) and wave 2 (academic year: 2014–2015, grade 8) of the China Education Panel Survey (CEPS). We used fixed-effects models in the longitudinal data analysis (N = 7237). Results Descriptive analysis indicated significant changes in both adolescents' mental health and self-reported family relationships during the transition from grade 7 to grade 8. The fixed-effects models showed that high marital quality and close parent-child relationships improved the mental health of adolescents. Interaction analysis suggested that paternal living arrangements significantly moderated the association between the father-child relationships and adolescents' mental health: effects of the father-child relationships were weaker among those living away from their biological fathers than among those living with their biological fathers. Conclusions Family relationships play an important role in shaping Chinese adolescents' psychological status. However, the effect of the father-child relationships varies based on the paternal living arrangements. This finding highlights the importance of considering the context in examining the effects of family relationships on adolescents' well-being.
Background: Family dysfunction has been proposed as one of the environmental mechanisms whereby risk of depression is transmitted from mothers to their children. Using our sample of offspring at high and low familial risk for depression, we hypothesized that: a) high-risk offspring (n = 79) and their mothers will report more extensive family dysfunction than low-risk offspring (n = 82) and their mothers, b) family dysfunction will predict the extent of offspring's depressive symptoms, and c) family dysfunction will mediate the impact of mother's depression on offspring's depressive symptoms. Methods: The study enrolled 161 offspring of parents who, in a previous study, were ascertained to have either childhood onset mood disorder or no history of a major psychiatric disorder. Parents completed questionnaires and a clinical interview about themselves, their offspring, and the family, while offspring also completed questionnaires about themselves and the family. Results: We found support for all three hypotheses. The significant indirect effect between maternal depression and offspring depressive symptoms was driven primarily by offspring's, but not mothers', reports of family dysfunction. Limitations: Although our assessment of mother's early history of depression was done in a previous study, it is important to note that our results do not inform about causality because of the present study's cross-sectional nature. Conclusions: The results highlight the importance of detecting and treating family dysfunction, particularly via offspring report, as one way to lower the risk of depression transmission from mothers to their children.