Children with problem drinking parents in Sweden: Prevalence and risk of adverse consequences in a national cohort born in 2001
Original paper
Abstract
Introduction
To estimate the prevalence of children of households with alcohol problems (CoHAP) in Sweden and the extent to which they have an elevated risk of poor health, social relationships and school situation in comparison with other children.
Methods
Survey with a nationally representative sample of Swedish youth aged 15–16 years (n = 5576) was conducted in 2017. A short version of The Children of Alcoholics Screening Test (CAST-6) was used to identify CoHAP. Health status, social relations and school situation were measured by well-established measures. Overall prevalences for girls and boys were presented as well as relative risks (RR) of harm for children of households with alcohol problems compared with other children.
Results
A total of 13.1% of the sample had at least one parent with alcohol use problems during adolescence according to CAST-6 – a higher proportion of girls (15.4%) than boys (10.8%).
This group had an elevated risk of poor general health as well psychosomatic problems compared with other children. They were also more likely to use medication for depression, sleeping difficulties and anxiety.
Their social relations were also worse especially with their father and they had more problems at school.
Discussion and Conclusions
The risk of problems related to parental alcohol use goes beyond the most severe cases where parents have been in treatment for their alcohol problem. This is important knowledge since the majority of people with alcohol use problems never seek treatment and the major part of parental alcohol use problems is found in population samples.
Why the study matters
The overall aim of this paper is to extend knowledge in the area of CoHAP by using a nationally representative sample of Swedish youth born in 2001 to estimate the prevalence of children of households with alcohol use problems and the risk of adverse consequences for the affected children. The paper also examines to what extent alcohol use problems in parents in a population sample are different with respect to parenting practices compared to parents without alcohol use problems.
The more specific research questions for the paper are:
- How many children in the Swedish population live in a household with alcohol use problems during adolescence and is there a difference between girls and boys?
- To what extent have children from a household with alcohol use problems a higher risk of adverse consequences in terms of poor health, social relations and school situation and to what extent is the risk different between girls and boys?
- To what extent are parenting practices among parents with alcohol use problems different than among parents whose alcohol use is not perceived as problematic by their children?
Proportion of children of households with alcohol use problems during adolescence
It was estimated that 13.1% of 15- to 16-year olds in Sweden had an experience of at least one parent with alcohol use problems during adolescence, that is they answered yes to at least three of the six statements of parental alcohol use problems included in CAST-6.
It was most common to have experienced that a parent consumed too much alcohol (19.9%), followed by having a wish that they stopped consumed alcohol (14.9%) and to have encouraged them to stop consuming alcohol (13.4%).
Experiences of arguments or fights related to parental alcohol use were reported by 12% of the respondents and 7.5% had ever felt like hiding or emptying a parent’s bottle of liquor.
Significant gender difference in experience of parental alcohol use problems
A higher proportion of girls reported experiences of parental alcohol use problems (15.4%) compared with boys (10.8%).
The risk was 42% higher among girls.
A significant gender difference was found across all problem linked to parental alcohol use problems with the relative risks ranging from 1.33 to 1.65.
Risk of adverse consequences among children of households with alcohol use problems
Children of households with alcohol use problems (CoHAP) are more likely to have poor health status according to all studied health indicators, that is poor general health and experiences of psychosomatic problems such as stomachache, headache, sleeping problems and stress at least once a week.
The difference was most pronounced for general health which was poor among 35.3% of CoHAP compared with 18.7% among others. The corresponding rates for stomachache were 42% versus 25%, for headaches 53.1% versus 36.9% and for sleeping problems 60.4% versus 44.1%. The smallest difference was found for stress which was reported by 78.2% among CoHAP and 65.6% in the other group.
A higher risk of having received medication from a doctor for depression, sleeping difficulties and anxiety was also found among CoHAP. The prevalence of having received medication for depression was 4.5% compared to 1.9% among others and corresponding rates for anxiety were 6.6% versus 2.5% and for sleeping problems 7.6% versus 3.5%.
CoHAP also had poorer relationships with both friends and parents. A poor relationship with the father was especially common, with 34% reporting that they were not happy with the relationship compared with 11% for others. Fully 15% were not happy with their relationship with their mother compared with 7% in the other group. Finally, 13% were not happy with their relationships with friends compared with 7% among others (RR 1.8).
It was also more common among CoHAP to report problems in school. The largest difference was found with respect to experiences of being bullied at least once which were reported by 19.3% of CoHAP compared with 7.6% among other children. Corresponding estimates for not enjoying school were 31.1% versus 19.3% and to have skipped school at least once, 35.1% versus 24.3%.
Discussion
On the basis of data from a national cohort of 15- to 16-year olds (born in 2001) and the screening instrument CAST-6, researchers estimated that 13.1% of these adolescents had experienced at least one parent with alcohol use problems. This estimate was lower than in a Swedish study published in 2013 where 20% of adolescents aged 16 to 19 years reported to have lived in a household with alcohol use problems, according to CAST-6. This study was however not based on a nationally representative youth sample but a web panel with uncertain representativeness and a dropout rate of 75%.
Therefore, the researchers believe that the new estimates are more accurate.
The present estimate of 13.1% falls within the broad range of estimates found in a recent review of population studies of the prevalence of CoHAP, showing a range between 2% and 20%. Thus, although 13.1% should not be regarded as a precise estimate, it seems reasonable in relation to previous research.
Summary
Almost one in eight children in Sweden experience problems due to their parents’ alcohol use. These children have an elevated risk of poor health, social relations and in school. Girls are more attentive and vulnerable to parental alcohol use problems than boys but no gender difference in risk of harm was found among those perceiving their parents’ alcohol use as problematic. A possible explanation is that these children have more difficulty to get emotional support from their parents.
The results emphasize the understanding that the risk of problems related to parental alcohol use goes beyond the most severe cases where parents have been in treatment for their alcohol use disorder. This is important knowledge since the majority of people with alcohol use problems never seek treatment and since the major part of parental alcohol use problems is found in population samples.