Prevalence of Depressive Symptoms Among Children Exposed to Parental Incarceration in the 2019 and 2021 National Health Interview Survey (NHIS)

Depression is a prevalent mental health disorder among 2.7 million (4.4%) children aged 3-17 in the United States (US), with adverse childhood experiences (ACEs) being a contributing factor. Parental incarceration is an ACE associated with various negative social and health outcomes for this demographic. Such outcomes include inequitable healthcare access, increased risk of housing instability, mental health problems, poor educational performance, and a 10% increased risk of antisocial behavior compared to peers who do not have incarcerated parents. This study aimed to investigate the relationship between parental incarceration and the prevalence of depressive symptoms among children aged 4-17. Methods: Using cross-sectional data from the 2019 and 2021 National Health Interview Survey (NHIS) child survey, the association between parental incarceration exposure and depressive symptom outcomes was investigated. To construct the dependent outcome of interest, child depressive symptoms, key survey responses were selected across three domains of interest: 1) reported feelings (including feeling depressed, anxious, worried, or unhappy), 2) reported difficulties (such as difficulties with changes, controlling behavior, concentrating, and making friends) and 3) reported mental health care received (including therapy, and/or medication for mental health challenges). Covariates considered included child age, sex, race, poverty status, insurance coverage, parent education, and region. Data analysis incorporated a Poisson error variance into general linear models for hypothesis testing, accounting for the complex survey design. Results: The study included 13,502 participants, among whom 6.2% had been exposed to parental incarceration. Children exposed to parental incarceration reported a significantly higher prevalence of depressive symptoms (88 per 100, 95% CI: .85-.91) compared to children who had not been exposed to parental incarceration (58.9 per 100, 95% CI: .58-.59). After adjusting for covariates, exposure to parental incarceration was associated with an excess of 28 cases of depressive symptoms per 100 children (95% CI: .25-.29, P-value< .0001). Significant associations with depressive symptoms were observed for child age, race, and parental incarceration. Conclusions: Experiencing parent removal from the household due to incarceration was associated with increased difficulties and negative mental health outcomes for children. The results emphasize the urgent need for policies such as decarceration and early interventions in the form of bolstered mental health support to address the mental health impact that results from the adverse experience. By illuminating the link between ACEs, such as parental incarceration and depressive symptoms, this research underscores the importance of a holistic approach to support the well-being of impacted children.