title: Cumulative effect of family environment on psychiatric symptomatology among multiethnic adolescents.
abstract: OBJECTIVE
  To examine the influence of family adversity and support on levels of psychiatric symptomatology in Hawaiian and non-Hawaiian adolescents.
  
  
  METHODS
  More than 4000 students from five high schools in Hawaii completed a survey during the 1992-1993 school year about their family environment and mental health. The response rate was approximately 60%. Logistic regression analyses were performed and responses for Hawaiians and non-Hawaiians were compared.
  
  
  RESULTS
  Hawaiian adolescents experienced significantly more adversity than their non-Hawaiian counterparts. The cumulative effect of family adversity had a greater effect on psychiatric symptomatology than any single indicator. Family support reduced the risk for internalizing symptoms, particularly for Hawaiian adolescents. The influence of family support was less clear for externalizing symptoms, increasing the risk for some adolescents and decreasing the risk for others.
  
  
  CONCLUSIONS
  We identified strong associations between family adversity and levels of psychiatric symptomatology. We found that Hawaiian adolescents are at increased risk for psychiatric symptomatology, given the presence of family adversity and the effect of reduced family support. However, risk was also substantial for non-Hawaiians. Clinicians need to assess the family environment routinely and implement family-oriented interventions.
authors.affiliation: Native Hawaiian Mental Health Research Development Program, Department of Psychiatry, University of Hawaii, John A. Burns School of Medicine, Honolulu 96813, USA. goebertd@jabsom.biomed.hawaii.edu
authors.forename: D
authors.initials: D
authors.lastname: Goebert
authors.forename: L
authors.initials: L
authors.lastname: Nahulu
authors.forename: E
authors.initials: E
authors.lastname: Hishinuma
authors.forename: C
authors.initials: C
authors.lastname: Bell
authors.forename: N
authors.initials: N
authors.lastname: Yuen
authors.forename: B
authors.initials: B
authors.lastname: Carlton
authors.forename: N N
authors.initials: NN
authors.lastname: Andrade
authors.forename: R
authors.initials: R
authors.lastname: Miyamoto
authors.forename: R
authors.initials: R
authors.lastname: Johnson
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D000704:Analysis of Variance; D003430:Cross-Sectional Studies; D005006:Ethnicity / Q000523:psychology*; D005195:Family Relations / Q000208:ethnology*; D005260:Female; D006254:Hawaii / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000208:ethnology*; D008603:Mental Health; D008913:Minority Groups / Q000523:psychology*; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012424:Rural Population; D012494:Sampling Studies; D012959:Socioeconomic Factors; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D014505:Urban Population