A recent Swedish study based on a survey of almost 150,000 6th and 9th-grade students revealed that children who live equally with both parents after parental separation suffered from fewer psychosomatic problems than those living mostly or only with one parent. As might be expected, children of separated parents generally reported more psychosomatic problems than those in intact “nuclear” families.
A group of Swedish university and government child experts published their results online April 28, 2015 in the Journal of Epidemiology & Community Health in the article, Fifty moves a year: is there an association between joint physical custody and psychosomatic problems in children?
Using responses along the range of “never,” “ seldom,” “sometimes,” “often” and “always,” the survey investigated correlations between parenting arrangements and “psychosomatic” problems including difficulties in (1) concentration and (2) sleeping; suffering from (3) headaches and (4) stomach aches; feeling (5) tense, (6) sad and (7) dizzy and (8) loss of appetite. The students were asked to respond to the survey questions with
The authors noted that during the past 20 years, it has become more common for children in the Western world to live alternatively and equally with both parents after a parental separation. In Sweden, this practice of joint physical custody is particularly frequent and has risen from about 1–2% in the mid-1980s to between 30% and 40% of the children with separated parents in 2010.
Over the same period, however, there has been an increase in self-reported pediatric psychosomatic symptoms. Already, stressful circumstances such as bullying, economic stress in the family, peer and teacher relationships, schoolwork pressure and lack of emotional support from the parents have been shown to be related to psychosomatic symptoms in Swedish adolescents.
The higher frequency of psychosomatic symptoms, as a sign of increased stress in children’s lives and could hypothetically also be related to stressors imposed by joint physical custody. Concerns have been raised about children’s potential feelings of alienation from living in two separate worlds, increased exposure to parental conflict and other stressors that shared physical custody may impose on a child. Additional stressors may be long distances to school, friends and leisure activities, lack of stability in parenting and home environment and the need to adjust to the demands of two different family lives. The logistics of traveling between their homes and keeping in contact with friends has been thought to be a drawback of shared physical custody. Older adolescents, in particular, indicated that they preferred to be in one place.
Several studies over a long period of time had established that children with separated parents showed higher risks for emotional problems and social maladjustment than those with cohabiting parents. One explanation for these increased risks may have been the actual experience of the separation process and the emotional crisis possibly associated with the separation, itself. Parental separation may also expose children to loss of social, economic and human capital. Other explanatory factors may derive from characteristics typical of separating parents such as lower relationship satisfaction and higher conflict levels also before the separation.
Psychosomatic symptoms are related to stress, but despite the fact that two homes require adaptation to different neighborhoods and family climates, the results showed lower risks for psychosomatic symptoms for children in joint physical custody than in single care residency. Although children in interviews brought up the hassles of joint physical custody, most children also stated that close relationships with both their parents are more important.
69% of the 147,839 children surveyed lived in “nuclear” (intact) families, 11% in joint (equally-shared) physical custody, 8% mostly with one parent and 13% only with one parent. The majority of those living mostly or only with one parent lived with their mother. About every sixth child in these arrangements lived with the father.
Children in nuclear families reported the least problems. Children in joint physical custody had slightly more problems, followed by those living mostly with one parent. Children who lived with only one parent reported most problems on all items. Also, the proportion of children who always or often suffered from different symptoms was highest among the latter group. These patterns were similar for girls and boys. For the sexes taken together, sleeping problems were most frequent: 22% among those living only with one parent, 19% living mostly with one parent, 14% in joint physical custody and 13% in nuclear families. Also, suffering often or always from headaches was common: 19% among those living with only one parent, 17% living mostly with one parent, 14% in joint physical custody and 12% in nuclear families.
Girls suffered from more problems than boys. Sadness was the most frequent problem for girls in all living arrangements, followed by sleeping problems and headaches. For boys, sleeping and concentration problems were most common.
The results indicated that the potential stress from living in two homes could be outweighed by the positive effects of close contact with both parents.
Notably, the authors noted the potential shortcomings of their own analysis, and the need for more research. They recognized that it was possible that the difference in psychosomatic health between children in nuclear families and joint physical custody may, at least partly, be explained by family factors associated with the parents’ separation or divorce. Separated parents more often have psychological problems and poor economy than co-living parents and may have had relationship problems and conflicts also before the separation. Such factors directly affect children’s psychological health and symptom load and could be important for how families arrange custody and children’s housing after the split-up. In this study, children living with only one parent reported the least satisfaction with their relationships to their parents, followed by those living mostly with one parent. Children with joint physical custody were slightly less satisfied with their parent relations than those in nuclear families.
Positive relationships to parents have been found to be more common in children in joint physical custody than in single care, in particular to the fathers. Children’s satisfaction with their material resources was included as a potential mediator since economic stress has previously been shown to be associated with psychosomatic symptoms in children and is more common among children with separated parents. Also, these conditions reduced the differences in psychosomatic health between the living arrangements.
While the survey attempted to identify children’s material resources and parent relationships, other types of information were lacking on the families’ socioeconomic situation and the level of parents’ cooperation or conflict. Children’s reports of satisfaction with these aspects may possibly reflect their own personalities and coping strategies rather than the actual strain on the family. The lack of objective data on the families’ situations is an important limitation since such factors are associated both with children’s living arrangements and directly with their psychosomatic health.
Another limitation is the lack of information on when the children had experienced the parental separation. Ideally, the results of this study should be confirmed by studies with a longitudinal design and access to information on psychological as well as socioeconomic family factors.
Comment: As the authors noted, isolating the parenting arrangement from all other potential factors is extraordinarily difficult. It appears clear, however, that regardless of how we get there, enhanced relationships with both parents and the constructive involvement of both parents in the lives of the children result in reduced “psychosomatic” issues.
Much like the goals envisioned by Hippocratic Oath, to which is often attributed the command “do no harm” (primum non nocere), the divorce process and the legal system should itself not cause harm to children. However, it is often said that our legal system is “broken;” that delays, alone, greatly aggravate the emotional health of all concerned; that the adversarial system elevates family tensions, further infecting the children of parents already going through crisis.
The legal system keeps trying, although with woefully inadequate resources. Mental health professionals are being employed as an adjunct to the legal system as mediators and parenting coordinators. However, if divorce cases are going to take years to resolve, and involve costs equivalent to a college education, it is unlikely that the legal system will do no harm.
It may be difficult for parents to commit and invest themselves fully in alternatives such as the Collaborative Divorce Process or Mediation. However, it would seem that this level of commitment is what this Swedish study has shown pays off.