Parental depression in the relationship between parental stress and child health among low-income families in Hong Kong.

Introduction: Low-income families face increased exposure to stressors, including material hardship and limited social support, which contribute to poor health outcomes. The poor health and behavioural problems in children from these families may exacerbate parental stress. This study explored the bidirectional relationship between parental stress and child health, along with its mediators and moderators, among low-income families in Hong Kong.

Methods: In total, 217 families were recruited from two less affluent communities between 2016 and 2017; they were followed up at 12 and 24 months. Each parent-child pair was assessed using parent-completed questionnaires on socio-demographics, medical history, parental stress, health-related quality of life, child health and behaviour, family harmony, parenting style, and neighbourhood cohesion.

Results: Thirty-eight parents (17.5%) reported significantly higher levels of stress than the control group. These individuals were more likely to be single parents (41.2% vs 18.5%), victims of intimate partner abuse (23.7% vs 10.9%), have a household income below 50% of the Hong Kong population median (50.0% vs 29.9%), and be diagnosed with mental illnesses (23.7% vs 5.1%). A bidirectional inverse relationship was observed between parental stress and child health at respective time points, with cross-effects from baseline child health to later parental stress, and from baseline parental stress to later child health. The relationship was mediated by the level of parental depression.

Conclusion: Parental stress both precedes and results from child health and behavioural problems, with reciprocal short-term and long-term effects. Screening and intervention for parental depression are needed to mitigate the impacts of stress on health among parents and children.