Multiple factors contribute to the vulnerability of adolescents to physiological and psychological disturbances following parental divorce. These include father absence, interparental conflict, economic distress, multiple life stressors, parent adjustment, and short-term crisis. Clinical and societal problems manifested in these vulnerable adolescents are discussed. Systems theory is used to explain this vulnerability of adolescents and to identify appropriate interventions and policies to promote health in this population. Policies recommended include required divorce mediation, early referrals for family and sibling therapy, and school programs to identify and support those most vulnerable.
Divorce rates have gone from fewer than 20% of all marriages in the 1960s to nearly 50% in the 1990s (Delaney, 1995). Traditionally, the biological family serves as a haven for children from the stresses of the world. When divorce occurs, this haven no longer exists and adolescents are unable to normally experience the childhood events of school, sports, and family.
Although the traditional biologic family is no longer living together in divorce, the interrelationships and interdependencies among the family members continue. However, these relationships must change and can cause stress because of conflicts among all family members involved.
The Adjustments of Divorce
The process of divorce involves a series of transitions and reorganizations. For children, this involves coping with changing geographical locations, changing schools, changing mental and physical health of family members, adjusting to a single-parent household, and remarriage and the addition of new family members.
Adolescents from families of divorce not only deal with the normal developmental stages associated with this age group, but are faced with additional stresses placed upon them by their parents' divorce. These include: (1) father absence; (2) interparental conflict; (3) economic distress; (4) parent adjustment; (5) multiple life stressors; and (6) short-term crisis. The result of all of these factors could be a vulnerability to both physiological and psychosocial disturbances in this adolescent population.
Father absence as a factor in influencing children's responses to divorce is based on the notion that boys need a positive relationship with their father to develop a sense of masculinity, to develop controls over behavior, to develop an appropriate conscience, and to perform up to their ability academically (Kalter, Kloner, Schreier, & OkIa, 1989). Kalter (1987) stated that fathers are frequently responsible for setting and enforcing limits on behavior; therefore, if the father is absent this can result in aggressive behavior. Some studies have shown that this effect may be offset by the presence of a stepfather to fulfill this role (Amato & Keith, 1991; Hetherington, Cox, & Cox, 1985). Wallerstein and Corbin (1989) also found that a poor father-daughter relationship was significantly associated with poor adjustment in girls 10 years following the divorce. Amato and Keith (1991) found some support for the parental absence perspective in their review of 23 studies related to parental absence. Children of divorce were found to have lower levels of well being than children who experienced parental loss by death (Amato & Keith).
Interparental conflict stimulates anger and anxiety in children because the children love both parents (Kalter et al., 1989). By fighting, the parents are role modeling aggressive behavior as a way of resolving conflict (Kalter et al.). This demonstration of hostilities often continues many years after the divorce (Kalter, 1987).
Aggressive behavior is one of the common problems seen in children of divorce and may be the result of the anger, conflicting loyalties, or learned aggression from this interparental conflict (Kalter et al., 1989). In their evaluation of 92 studies that showed the impact of divorce on the well being of children, Amato and Keith (1991) found support for the hypothesis that children's well being is inversely correlated with the level of postdivorce conflict that exists between the biological parents. Wallerstein and Corbin (1989) found that parental conflict that involved blaming the other parent for the divorce was linked to poor psychological adjustment in daughters of divorce.
Buchanan, Maccoby, and Dornbusch (1991) found that depression, anxiety, and deviance in adolescents were associated with a perception of "feeling caught" between parents as a result of interparental conflict. Factors that were found to influence the perception of "feeling caught" included high discord and hostility between parents, low cooperative communication between parents, the amount of time spent with each parent, closeness of the parent-adolescent relationship, and age and sex of the adolescent (Buchanan et al.).
A move toward poverty
Emery and Coirò (1995) reported that 29% of Caucasian women and 44% of minority women move into poverty following a divorce. As a result, adolescents' nutrition and health may decline. Living in poverty may result in residing in neighborhoods where health care and social services are not available, and may also stigmatize these adolescents and result in their entry into deviant subcultures (Amato & Keith, 1991).
Aseltine (1996) found that adolescents in single-parent families with financial stresses were more vulnerable to the effects of depression than youth in two-parent families with financial stresses. Another consequence of economic distress following divorce is that the mother may immerse herself in work to deal with financial pressures, with the children viewing this as a form of abandonment (Kalter, 1987).
Another factor contributing to vulnerability of adolescents following divorce is parental adjustment, especially of the primary custodial parent (Kalter et al., 1989). Haber (1990) stated that divorce represents a significant loss for one or both spouses and can result in temporary dysfunction. This may include alcohol or drug abuse, depression, violence, or physical health problems (Haber, 1990). And, as mentioned, the primary custodial parents may immerse themselves in their work to build their own self-esteem (Kalter, 1987). Kalter et al. (1989) found positive correlations between three standardized measures of adjustment in the custodial mother and child adjustment as assessed by parent and child report using standardized instruments. This study showed support for the parental adjustment hypothesis.
Multiple life stresses
The multiple life stress hypothesis suggests that children of divorce are more likely to have difficulty when multiple stresses are involved (Kalter et al., 1989). Multiple life stresses include changing geographical location or schools, dealing with parental adjustment to the divorce, decreased financial resources, and remarriage of the biological parents. This hypothesis, therefore, incorporates all of the factors previously discussed and adds the influence of other common stressors that occur postdivorce.
Wallerstein and Corbin (1989) found that daughters of divorce showed signs of feeling estranged from and rejected by their mothers. This was due either to the long hours their mothers were involved in their profession, or to the physical and emotional exhaustion the mothers experienced when not at work. In some cases, this led to sexual activity and drug use for these female adolescents (Wallerstein & Corbin, 1989).
Some studies have suggested that the stress of parental absence is less when remarriage has occurred. Aseltine (1996) showed evidence that youth in stepfamilies are significantly less depressed than youths in single-parent families.
The short-term crisis hypothesis suggests that the initial difficulties in children following parental divorce will decrease over time (Kalter et al., 1989). Frost and Pakiz (1990) found that both boys and girls from recently disrupted families were described by their mothers as functioning significantly worse than adolescents from homes that had been disrupted earlier. However, Hetherington, Cox, and Cox (1985) found that negative life changes following divorce were associated with behavior problems in children 6 years following the divorce. Wallerstein and Corbin (1989) found that fewer than 40% of girls who were 16 to 18 years old 10 years following parental divorce were doing well. However, Kalter et al. (1989) found no support for the short-term crisis hypothesis.
As shown in this review of the literature, multiple factors have been identified that contribute to both the shortterm and long-term effects of divorce on adolescents. Most of this research has been performed on low-to-upper-class, white populations. This does limit the application of these findings to similar populations, however, but suggests that studies should be conducted on minority populations to determine whether the same factors contribute to maladjustment in diverse populations.
Clinical and Societal Problems of Adolescents From Families of Divorce
Researchers have suggested many clinical and societal problems that may occur in adolescents following divorce. Adolescents may experience regression and avoid primary developmental tasks, including a failure to become involved in their peer groups (Kalter, 1987). Depression has also been reported in adolescents as a result of divorce (Aseltine, 1996; Buchanan et al., 1991). This is strongly associated with family conflict, parent-child relationship problems, financial problems, and personal and family stresses that occur along with the divorce (Aseltine, 1996). Buchanan et al. (1991) also found high anxiety, especially in older adolescents, as a result of feeling "caught" between their parents. In comparing adolescents from intact families with adolescents from disrupted families, Doherty and Needle (1991) found lower self-esteem and a lower sense of mastery, defined as perceived control over one's life, in adolescents from disrupted families.
Kalter et al. (1989) have suggested that without a regular, ongoing relationship with their father, boys may develop an unstable sense of masculinity. Precocious sexual activity and difficulty establishing gratifying and lasting adult heterosexual relationships have been associated with female adolescents following parental divorce (Kalter, 1987).
In addition to clinical issues that affect the individual adolescent, researchers have also identified many social issues that may result following parental divorce. Kalter (1987) has suggested that aggression may be stimulated in adolescents from families of divorce for three reasons: anger at being abandoned or rejected by the parent no longer in the home; the feeling of being abandoned by a mother who now must work; and lack of consistent limits on expression of aggression in the absence of a strong father figure. In addition, as adolescents observe hostility between parents over the years following divorce, this behavior is learned as a means of solving problems and coping with disagreements (Kalter).
Inadequate social skills
It has been suggested that parental absence, whether due to one parent moving from the home or work responsibilities of the custodial parent, can result in inadequate learning of social skills such as cooperation, negotiation, and compromise (Amato & Keith, 1991). Hetherington et al. (1985) conducted a longitudinal study comparing children from mother-custody families with nondivorced families and found that early aggressive or antisocial behavior was predictive of a later lack of social competence over the 6 years represented in the study.
In their review of studies reporting influences of divorce on children, Amato and Keith (1991) found that boys from divorced families exhibited more difficulty in adjusting socially. Delaney (1995) has suggested that the sustained stress in children following divorce predisposes children to increased illness, resulting in absence from school and lack of participation in school activities that can exacerbate feelings of social isolation.
Increased substance abuse
Substance abuse has also been suggested as a societal problem in adolescents from families of divorce. Doherty and Needle (1991), in comparing children in disrupted families with those in A continuously married families, found that substance abuse by boys in disrupted families was significantly greater -* than substance abuse by boys in intact families and girls in disrupted families. Wallerstein and Corbin (1989) reported in their 10-year follow-up study of daughters of divorce that adolescent girls have suggested they become involved with drugs because of the lack of discipline in the home stemming from the mother's involvement with her profession. Frost and Pakiz (1990), in their study assessing adjustment of youth over a 10-year time span, found significant relationships between marital disruption and adolescent reports of antisocial behaviors such as cigarette smoking, marijuana smoking, involvement with alcohol and drugs, and appearances in juvenile court.
A theoretical model is a systematic way of looking at an issue and can be used to describe, explain, and predict phenomena within health care. Family systems theory focuses on the interaction between family members within a particular family and interaction of me family with other systems (Artinian, 1994). This theory will be further described here and will be used to explain the effects of divorce on adolescents, as well as to plan appropriate policies to promote wellness within this group.
Adjustment to stressors
A system is defined as a set of interacting elements (Artinian, 1994). A family is a group of individuals who interact and are interdependent and, therefore, are considered to be a system. A family consists of subsystems that include mother-famer, parent-child, and sibling-sibling. The family is also part of larger systems that include communities, health care systems, and educational systems. Exchanges occur bom within and outside the family system.
Family systems theory can be used to show how families adjust to changes that occur within the system. This is based on six assumptions. The first is that the family system is different from die sum of its parts. Second, mere are logical relationships within the subsystems and wim outside systems. Third, family systems will evolve to promote greater adaptability to change. Fourth, family systems constantly change in response to stress from within and outside the system. Fifth, individuals within the family are interdependent parts of the system. Sixth, family systems function to maintain homeostasis (Artinian, 1994).
Families that adapt to change or stressors most readily are Üiose that are negentropic or tend to be open - both inside and outside the family environment (Johnson, 1993). Families who are less open to the environment, or entropie, tend to adjust poorly to change or conflict (Johnson). As already discussed, divorce can cause multiple stresses mat influence the adjustment of adolescents. In order to better adapt, family systems should be supported in developing openness wimin the family structure and with the outside environment.
Forchuk and Dorsay (1995) proposed mat the goal of family systems nursing is to assist families to find solutions to problems that the families themselves have identified. In a nonjudgmental way, the nurse would offer comments and introduce questions to family members as a way of getting those involved to view the problem in new and more open ways (Forchuk & Dorsay).
Delaney (1995) suggested that although divorce occurs and disrupts the family system as it existed, the family system still exists and continues to function as a family. Therefore, the goal in promoting health within the family system must be to support openness within the family and its subsystems and openness with environmental systems.
Vulnerability and Resilience in Adolescents
Multiple stressors have been identified as contributing to the vulnerability of adolescents from families of divorce. Family systems theory has been suggested as a model to be used in assisting the disrupted family system to adapt to these multiple stressors. The literature also suggests that certain factors promote resilience in adolescents rather man vulnerability to the effects of divorce (Rutter, 1987).
This information is useful in two respects. First, it would identify those adolescents who are most vulnerable to the effects of divorce because mey have not been exposed to the protective mechanisms that can promote resilience. Second, the protective mechanisms that prevent vulnerability can be used in planning policies to promote resilience in all adolescents who have experienced the stress of parental divorce.
Protective factors to stress
Garmezy (1985) has identified durée broad sets of protective factors in stressresistant children. These include: personality features, such as self-esteem; family cohesion and absence of discord; and the availability of external support systems to encourage coping efforts in children. Emery and Coirò (1995) suggested that a good relationship with at least one parent and good relationships with peers can promote resilience in adolescents following parental divorce.
Recommendations for Health Policy
As seen in me literature, me detrimental effects of divorce on adolescent children may be caused by multiple stressors both during and after the divorce. Plans to promote health in this vulnerable population should include prevention or alleviation of stressors, and the promotion of resilience in those who are identified as most vulnerable. Recommendations for interventions to promote health in this population are based on the family systems model. This model suggests that families who are both open and growth-oriented within and outside the family system are most successful (Johnson, 1993).
One of the significant stressors identified has been interparental conflict, both at the time of divorce and many years later. Divorce mediation is a model that focuses on the family as a system that is reorganizing and restructuring. The role of the mediator is to act as a neutral party to assist divorcing parents in resolving conflicts about both financial and custodial arrangements.
Dillon and Emery (1996) conducted a study involving couples who were randomly assigned to mediation or litigation groups at the time of their divorce. Based on reports from the mothers, it was shown that parents in the mediation group were more likely to have been communicating about the child on a weekly basis.
It was also reported by the mothers that the noncustodial parent was more likely to be involved in current decisions about the child and more likely to have seen the child in the past month than those in the litigation group. This study was conducted 9 years after divorce and mediation occurred, and therefore has shown long-term benefits of the mediation process (Dillon & Emery, 1996).
Currently, some state laws require mediation; however, in most states, it is voluntary. Mediators are trained in the process of mediation, but are not necessarily qualified in family therapy. To prevent immediate and long-term adverse effects of divorce on adolescents, all states should pass a mandatory requirement for mediation with a qualified mental health professional in divorces involving children. Litigation would only be pursued if the mediator judges the parents incapable of cooperating with the process of mediation. This law would then be a step toward promoting both open communication within the family system and collaboration regarding the child's development in the years following divorce.
Support within the school system
The literature supports the concept that there are long-term adverse effects of divorce on children (Wallerstein, 1991). To continuously monitor vulnerability of adolescents following divorce, policies to promote identification of vulnerable students and provide support for this group should be instituted within the school systems.
Mulholland, Watt, Philpott, and Sarlin (1991) studied academic performance in children of divorce. They found that about a third of subjects in the divorce group were "vulnerable" in the academic domain. There was little evidence of immediate adjustment to divorce, but strong indications of long-term insidious and progressively adverse consequences as the time from divorce increased (Mulholland et al.). This suggests that policies in middle and high schools would be most appropriate in identifying vulnerable adolescents.
Adolescents often are not easily identified as vulnerable because they are often far removed from the actual divorce event (Mulholland et al., 1991).
School nurses should take an active role in assessing adolescent students, as well as educating teachers, that academic performance may be an indication of maladjustment postdivorce (Mulholland et al., 1991).
Because these effects are slow to develop over the years following divorce, an important indicator would be a student who has performed well and then shows a decline in academic performance. Once these students are identified, support through open interactions with the external system of the school should be implemented. These interactions should include open communication between teacher and student, as well as open interaction between peers.
Peer support groups
The formation of peer support groups within the schools can be an effective intervention (Emery & Coirò, 1995). These groups function to promote an important developmental task of adolescents, the development of relationships outside of the family (Emery & Coirò). For adolescents from families of divorce, peer support groups can function to emphasize support, to allow identification and expression of divorce-related feelings, to promote problem-solving and anger control skills, and to enhance selfesteem (Anable, 1991).
Multiple factors have been identified in the literature as contributing to vulnerability of adolescents following divorce. These include father absence, interparental conflict, economic distress, parent adjustment, multiple life stressors, and short-term crisis. Clinical problems associated with this vulnerable population include regression, depression, anxiety, loss of self-esteem, an unstable sense of masculinity in boys, and precocious sexual activity and difficulty in establishing lasting adult heterosexual relationships in girls. Societal problems associated with this population include aggression, inadequate social skills, and antisocial behavior such as cigarette smoking, alcohol and drug abuse, and appearances in juvenile court.
Systems theory was used to explain this phenomenon and identify appropriate interventions and policies to promote health in those adolescents identified as most vulnerable following divorce.
Policies recommended include required divorce mediation, early referrals for family and sibling therapy, and school programs to identify and support those most vulnerable. Nurses should actively promote development of these policies and are well qualified to participate in the implementation.
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