title: The health consequences of child mental health problems and parenting styles: unintentional injuries among European schoolchildren.
abstract: OBJECTIVE
  Unintentional injury is the leading cause of death for schoolchildren. We assessed the association between externalizing psychopathology, parenting style, and unintentional injury in European children in the community.
  
  
  METHODS
  Data were drawn from the School Children Mental Health in Europe project and included 4517 schoolchildren across seven diverse European regions. Past-year injuries serious enough to seek medical attention were reported by mothers. Child mental health problems were assessed using validated measures and reported by the mothers, teachers, and children. Parenting styles were based on The Parenting Scale and the Parent Behaviors and Attitudes Questionnaire.
  
  
  RESULTS
  Children with attention-deficit/hyperactivity symptoms and oppositional defiant symptoms had a higher risk of injury compared to other children whether based on parent report (OR=1.47, 95% C.I. 1.2-1.9), teacher report (OR=1.36, 95% C.I. 1.1-1.7), or parent and teacher report combined (OR=1.53, 95% C.I. 1.1-2.1). Children who self-reported oppositional symptoms also had higher risk of injury (OR=1.6, 95% C.I. 1.1-2.4). Low-caring behavior of parents increased the risk of injury (OR=1.4, 95% C.I. 1.1-1.9).
  
  
  CONCLUSIONS
  Unintentional injury is a potential adverse health consequence of child externalizing problems. Interventions to improve parent-child relationships and prevention as well as focused treatment for externalizing problems may reduce the burden of injury.
authors: Mailman School of Public Health, Columbia University, Department of Epidemiology, New York, United States.
authors: Katherine M
authors: KM
authors: Keyes
authors: Mailman School of Public Health, Columbia University, Department of Epidemiology, New York, United States; New York State Psychiatric Institute, New York, United States.
authors: Ezra
authors: E
authors: Susser
authors: Mailman School of Public Health, Columbia University, Department of Epidemiology, New York, United States; New York State Psychiatric Institute, New York, United States.
authors: Daniel J
authors: DJ
authors: Pilowsky
authors: Mailman School of Public Health, Columbia University, Department of Epidemiology, New York, United States.
authors: Ava
authors: A
authors: Hamilton
authors: The Romanian League for Mental Health, Bucharest, Romania.
authors: Adina
authors: A
authors: Bitfoi
authors: Center for Applied Sciences of Health, Leuphana University of Luneburg, Luneburg, Germany.
authors: Dietmar
authors: D
authors: Goelitz
authors: Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands.
authors: Rowella C W M
authors: RC
authors: Kuijpers
authors: Clinic of Psychiatry, Faculty of Medicine, University of Vilnius, Vilnius, Lithuania.
authors: Sigita
authors: S
authors: Lesinskiene
authors: New Bulgarian University, Sofia, Bulgaria.
authors: Zlatka
authors: Z
authors: Mihova
authors: Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands.
authors: Roy
authors: R
authors: Otten
authors: École des Hautes Études en Santé Publique, Department of Epidemiology and Biostatistics, Paris, France. Electronic address: Viviane.Kovess@ehesp.fr.
authors: Viviane
authors: V
authors: Kovess
mesh_terms: D019958:Attention Deficit and Disruptive Behavior Disorders / Q000523:psychology; D002648:Child; D003430:Cross-Sectional Studies; D005060:Europe; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008603:Mental Health; D009035:Mothers / Q000523:psychology; D016487:Parenting / Q000523:psychology*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000209:etiology
keywords: ADHD; Caring; Conduct; Oppositional disorder; Parenting style; Unintentional injury