Module 1: Family Dynamics and Health

Family dynamics significantly impact health in both positive and negative ways. Having a close-knit and supportive family provides emotional support, economic well-being, and increases overall health. However, the opposite is also true. When family life is characterized by stress and conflict, the health of family members tends to be negatively affected. 

Positive Aspects of Family Dynamics and Health

A family's social support is one of the main ways that family positively impacts health. Social relationships, such as those found in close families, have been demonstrated to decrease the likelihood of the onset of chronic disease, disability, mental illness, and death.(1) Marriage in particular has been studied in the way it affects health. Marriage is thought to protect well-being by providing companionship, emotional support, and economic security. Marriage is associated with physical health, psychological well-being, and low mortality.(2) One study found that “controlling on or taking into account every other risk factor for death that we know, including physical health status, rates of all-cause mortality are twice as high among the unmarried as the married.” (3) Another study found that “on the whole, marriage produces a net improvement in avoiding the onset of disease, which is called primary prevention.”(4) Married people are more likely to avoid risky behavior, such as heavy drinking and high fat diets, and married people are also more likely to see the doctor for checkups and screenings.(5)

One does not have to be married to obtain the health benefits from family. Studies have also confirmed that social support from parents, friends, and relatives has positive effects, especially on mental health. “Prospective cohort studies have confirmed the direct beneficial effects of various forms of social support on global mental health, incidence of depressive symptoms, recovery from a unipolar depressive episode, psychologic distress, psychologic strain, physical symptoms and all-causes of mortality.” (6) Social integration and social support, like marriage, have protective effects on reducing mortality risks. For example, “those reporting higher levels of support from close friends and family exhibit lower heart rate and systolic blood pressure, lower serum cholesterol, and higher immune function.” (7) Thus, available data provide evidence to support the idea that one’s social environment or family situation “does get under the skin to affect important physiologic parameters, including neuroendocrine, immune, and cardiovascular functioning.”(8)

Negative Aspects of Family Dynamics and Health

Though good familial relations and social support serve as protective factors against mortality risks and improve overall health, studies have shown that not all familial relations positively impact health. Problematic and non-supportive familial interactions have a negative impact on health. “There is increasing evidence that poor-quality relationships can actually harm physical and mental health. Indeed, persons in unhappy marriages exhibit worse physical and mental health than unmarried persons.” (9) Further, marriages characterized by an unequal division of decision making and power are associated with high levels of depression on the part of both spouses.(10) Growing up in an unsupported, neglectful or violent home is also associated with poor physical health and development.(11)

Women Prevented From Accessing Health Care

Family power dynamics and gender roles may have a negative impact on a woman’s health and her ability to seek health care. In many cultures, for a woman to access health care, she must receive permission from her husband, father, or mother in-law and must be accompanied by a male to her appointments. “Researchers have noted that gender inequities play a role- across many cultures- in women’s ability to obtain needed medical care for sexual and reproductive health concerns, have recognized that family dynamics, in addition to institutional sources, are a key part in the practice of unequal treatment.” (12) For example, in Malawi, gender roles shape the ability of men and women to access health care. “Women in Malawi, as in a number of other developing countries, have less power to make decisions about using resources and often have to seek their husband’s approval before incurring expenses for health care.”(13) In Afghanistan, men continue to prevent women from receiving health care at hospitals with male staff even if they have life-threatening conditions.(14) A survey conducted in Afghanistan found that 12% of women stated that their main reason for not giving birth in a health care structure was because their husbands did not allow them to access a health facility.(15) In Turkey, a pregnant woman must also seek permission from her mother-in-law and/or husband to seek care. However, most people in rural Turkey only seek care for serious, life-threatening conditions. Thus, some family members delay access to care for minor conditions until they worsen or signs are visible, which can have a significant negative impact on health. The National Maternal Mortality Study conducted in Turkey documents that delays in recognizing the problem and delayed health-seeking by the family contributed to 30% of all pregnancy-related deaths in Turkey.(16)

Family Dynamics and Children

Families characterized by conflict, anger, and aggression have particularly negative effects on children. Physical abuse and neglect represent immediate threats to the health of children. In addition, “the fact that children’s developing physiological and neuroendocrine systems must repeatedly adapt to the threatening and stressful circumstances created by these environments increases the likelihood of biological dysregulations that may contribute to a buildup of allostatic load, that is, the premature physiological aging of the organism that enhances vulnerability to chronic disease and to early mortality in adulthood.” (17) Children who grow up in risky families are also especially likely to exhibit risky behaviors such as smoking, alcohol abuse, and drug abuse.  “Anger and aggression are highly noxious agents in a family environment. Conditions ranging from living with irritable and quarreling parents to being exposed to violence and abuse at home show associations with mental and physical health problems in childhood, with lasting effects in the adult years.” (18)

Children as Caretakers

Family can also have a negative impact on children if the illness of a parent or family member results in a child taking on the role of a caretaker. When a child acts as a caretaker, s/he often misses school and oftentimes must assume the personal and domestic responsibilities that his/her parents are no longer able to complete.(19) A national survey estimates that 1.3 to 1.4 million young people aged 8 to 18 years serve as family caregivers to ill or disabled family members. Some child caregivers do everything adult family caregivers do, including administering injections and medications, which they are often untrained to do.(20) Though families frequently have no other choice but to have a child serve as a caretaker, putting a child in this role may jeopardize their educational, social, and emotional development.(21)

Children as Medical Interpreters

Oftentimes when a family moves to a new country, children will learn to speak the new language better and faster than their parents. For this reason, parents and older family members tend to use their children as medical interpreters, since they themselves would not be able to communicate with health care providers. However, it is very important that parents or other family members do not put their children in these situations. First, “it is particularly stressful and even frightening for a young child to interpret, because children usually lack the sophistication of language to be able to convey complicated information, and may be overwhelmed by having to convey emotionally laden information.”(22) In addition, family dynamics of hierarchy and cultural beliefs may interfere with the ability of a child to interpret well. A patient may not want to speak of embarrassing symptoms, or issues related to mature topics in front of a child. This can be detrimental to all parties involved. A doctor gives the example from her experience with a Spanish-speaking patient whose son acted as the medical interpreter. The patient fabricated symptoms for three visits to her physician because she was too embarrassed to say in front of her son what the real problem was, and felt unable to request an interpreter when none was offered. Only when the son was not available and an interpreter had to be called was the patient able to express the true nature of her complaints. (23)  Thus, “the inappropriate use of nonprofessional interpreters may compromise quality of care. Children do not have the medical vocabulary or health literacy to understand fully and communicate accurately to their ill relative or to other family members. They may be embarrassed or overwhelmed by having to ask sensitive questions or relay bad news. If they are pressed into service in hospitals, it seems likely that they have additional caregiving roles at home.”(24) Lastly, when children are used as interpreters, the power dynamics of the family shift. The child who acts as an interpreter carries great power, which suppresses the authority of the parents and reverses the traditional familial power structure.(25)

Footnotes

(1) George, L. K., & Durham, N. C. (2016). The health-promoting effects of social bonds.

(2) Ross, C., Mirowsky, J., and Goldsteen, K. “The Impact of the Family on Health: The Decade in Review.” Journal of Marriage and the Family. 52. (1990):1059-1078.

(3) George, L. K., & Durham, N. C. (2016). The health-promoting effects of social bonds.

(4) Ross, C., Mirowsky, J., and Goldsteen, K. “The Impact of the Family on Health: The Decade in Review.” Journal of Marriage and the Family. 52. (1990):1059-1078.

(5) Ibid.

(6) Broadhead, W., Kaplan, B., James, S., et. al. “The Epidemiologic Evidence for a Relationship Between Social Support and Health.” American Journal of Epidemiology. 117.5 (1983).

(7) Seeman, T. “Social ties and health: The benefits of social integration.” Annals of Epidemiology. 6.5 (1996).

(8) Ibid.

(9) George, L. K., & Durham, N. C. (2016). The health-promoting effects of social bonds.

(10) Ross, C., Mirowsky, J., and Goldsteen, K. “The Impact of the Family on Health: The Decade in Review.” Journal of Marriage and the Family. 52. (1990):1059-1078.

(11) George, L. K., & Durham, N. C. (2016). The health-promoting effects of social bonds.

(12) Regmi, K., Smart, R., & Kottler, J. “Understanding Gender and Power Dynamics Within the Family: a Qualitative Study of Nepali Women’s Experience.” The Australian and New Zealand Journal of Family Therapy. 31.2 (2010).

(13) Department for International Development. (1 Jan. 2005) “REACH: Challenging Barriers to Health Care.” https://www.gov.uk/dfid-research-outputs/reach-challenging-barriers-to-health-care-in-malawi

(14) Synovitz, R. (3 Mar. 2004) Afghanistan: Gender Taboos Keep Women From Seeking Medical Care.” Radio Free Europe. https://www.rferl.org/a/1051746.html.

(15) IbnSina and ICRH. (Oct. 2002) “KAP Survey regarding reproductive health.” http://icrhm.org/sites/default/files/KAPsurveyKabulICRHIbnSina.pdf.

(16) Ay, P., Hayran, O., Topuzoglu, A., et. al. “The influence of gender roles on health seeking behaviour during pregnancy in Turkey.” The European Journal of Contraception and Reproductive Health Care. 14.4 (2009).

(17) George, L. K., & Durham, N. C. (2016). The health-promoting effects of social bonds.

(18) Repetti, R., Taylor, S., and Seeman, T. “Risky Families: Family Social Environments and the Mental and Physical Health of Offspring.” Psychological Bulletin. 128.2 (2002): 330-366.

(19) Robson, E. “Invisible Carers: Young People in Zimbabwe’s Home-Based Healthcare.” Area. 32.1 (2000):59-69.

(20) Levine, C. “Use of Children as Interpreters.” JAMA. 296.23 (2006).

(21) Aldridge, J., and Becker, S. “Children as Carers: The Impact of Parental Illness and Disability on Children’s Caring Roles.” Journal of Family Therapy. 21.3 (1999): 303-320.

(22) O’Neill, S. “Language in the Cross-Cultural Encounter Working with and without Medical Interpreters.” In Perspectives in Cross-Cultural Psychiatry. Ed. Anna Georgiopoulos and Jerrold Rosenbaum. (Lippincott Williams & Wilkins: Philadelphia, 2005).

(23) Ibid.

(24) Levine, C. “Use of Children as Interpreters.” JAMA. 296.23 (2006).

(25) Ibid.