Association between parental divorce and mental health outcomes among Lebanese adolescents: results of a national study

Parental separation is a circumstance where both children and parents experience discomfort and pain, leading to intense stress. Thus, many children and adolescents may find it difficult to cope with their parents’ divorce. In Germany, in 2017, a considerable number of children went through a parental divorce [1]. According to the Center for Disease Control and Prevention (CDC), divorce rates in the United States had reached 787,251 in 2017, in 45 reporting States and D.C., with a divorce rate of 2.9 per 1000 population [2]. Divorce prevalence has also increased in European countries, with 2.6 per 1000 population per year in Denmark [3], 4.8 in Russia [4], and 2.1 in Belgium [3]. In Lebanon, divorce rates are 1.6 per 1000 population [4], and they have jumped from nearly 7000 in recent years to 8580 in 2017, an increase of 22.5%, with North Lebanon recording the highest number, followed by Beirut [5], likely resulting in increased behavioral problems in the offspring of divorced parents.

Divorce is the result of a decoupling process that begins even before a parent leaves the house and has severe repercussions in the future [6, 7]. Parents and children might be, thus, often confronted with specific stressors at the various stages of the divorce process even after it has occurred. Post-divorce stressors can include reduced financial resources, parental wrangling over custody, housing and neighborhood relocation, new school, and new friends. As for pre-divorce stressors, they considerably generate feelings of alienation and stacked dissatisfaction with the marital relationship [6]. On the road to divorce, these feelings can manifest and develop into devastating hostile or brutal parental interactions, painful for parents [8], but also with consequences on the well-being of children [9]. Broken and dysfunctional family relationships and the dreadful out-turn of divorce disruption could affect the mental health of children [10].

Many parents caught up by the burden of their divorce and struggling with their own emotions tend to become oblivious to their children’s need for support, whether emotional or physical, neglecting them because of lacking resources and time. Sometimes children are stuck between their parents; they experience difficult psychological situations and become drained from emotional abuse (“If you love me, then you cannot love your father’s new girlfriend!”). In this context, those children may try to reduce conflicts between their parents and feel triangulated between them, serving as messengers between both [11]. Additionally, parents can go through spikes of debilitating emotional stress resulting in severe mental health problems, consequently neglecting their children, which may impact their physical needs such as food, clothing, and health matters, including vaccination follow-up [12]. Furthermore, the intense emotional stress of the parents could become uncontrollable to the point where a child can be physically punished because of parental depression and irritability [13].

Interparental Conflict (IPC) following divorce consists of several factors, including anger, unsettled grief, hostile contempt, uncooperative co-parenting, verbal and physical fighting, and legal conflict between the parents [14, 15]. In the context of IPC, previous authors displayed the best outcomes in children with two high-quality parents and low IPC. Hence, young adults whose fathers had moderate contact/moderate support and low IPC had significantly higher academic achievement and marginally lower externalizing problems [16]. Nevertheless, some findings suggest that if granted adequate parenting time, quality parenting in one parent may be protective and lead to positive child outcomes even in the presence of IPC [16].

Studies have shown that the offspring of separated parents could involve in risky sexual behavior, live in poverty, and have adaptation problems reported as academic failures and difficulties (e.g., lower grades and quitting school), disruptive behavior (e.g., behavioral and drug addiction issues), depressed mood [17], miserable humor, and major anxiety disorder [10].

Several studies reported the link between the age of children at the onset of parental separation and the way they will adapt and cope with another model of a family [18, 19]. A child of 2 years old will not understand divorce, while a teenager can grasp the complexity of the parental decision to separate. Children and adolescents can experience various affective disorders and psychological repercussions, depending on their age, gender, maturity, and the presence of a support system. Indeed, teens with divorced parents may be more anxious [20, 21], depressed [17, 21], aggressive, stressed, delinquent, prone to addiction, and have more suicidal ideation [21]. Additionally, a nationally representative study of Norwegian 8-year-olds found that children of divorced parents are significantly overweight [22]. Moreover, children of separated parents have more emotional and behavioral problems and reduced academic and social performances [23].

Although parental divorce is a considerable public health problem for children and adolescents, it could be a positive change, especially when the child experiences a high conflict level. However, most children with divorced parents are resilient with no behavioral evidence of psychological problems. It is essential to recognize that those often experience worries and stress on occasions where both parents have to meet, such as graduation or marriage [24].

To the best of our knowledge, few studies showed the impact of divorce on adolescents in Lebanon. Maalouf et al. [25] found that one out of two adolescents whose biological parents were divorced, separated, or deceased has a psychiatric disorder, noting that these participants were only recruited from one district (Beirut). Hence, the need for a national representative study. This same study revealed that the 30-day prevalence of psychiatric disorders was 26.1%, with anxiety disorders (13.1%) and ADHD (10.2%) being the most prevalent disorders. Only 6% of those with disorders reported seeking professional help. Parental marital status, not attending school, having a chronic medical condition, having a family history of psychiatric disorders, and propensity to bullying and being victimized by peers emerged as correlates of having psychiatric disorders [25]. More information regarding the impact of divorce on the mental health of Lebanese adolescents is still missing. Therefore, the objective of this study was to explore the association between divorce and mental health outcomes, particularly depression, anxiety, and suicidal ideation among Lebanese adolescents. The practical implication of our study relates to evaluating the possible influence of previous or recent parental divorce on adolescent mental health to warn the parents about the importance of secure attachment.

Of a total of 2000 questionnaires distributed, 1810 (81.0%) were completed and collected back. Table 1 summarizes the sociodemographic characteristics of the participants. The mean age was 15.42 ± 1.14 years, with 53.3% of females. Additionally, 11.9% of adolescents had separated/divorced parents. The results showed that 57.1% of the participants had depression; 43.4 and 2.4% had probable and very probable social fear, respectively. Furthermore, 52.3 and 3.7% had probable and very probable social avoidance, respectively. Finally, 28.9% of the participants had suicidal ideation.

The description of the social avoidance and fear, depression, and suicidal ideation scores is summarized in Table 2.

No significant association was found between Leibowitz’s social fear scale and depression (r = 0.035; p = 0.162); however, a positive correlation was found between Leibowitz’s social avoidance scale and depression (r = 0.122; p < 0.001).

Divorce continues to be a problematic social experience in the Arab world, particularly in traditional communities, which may resent change and perceive any conflict as a threat to their integrity and social solidarity [41]. The practical implication of our study relates to evaluating the possible influence of parental divorce on adolescents’ mental health to warn the parents about the importance of secure attachment and quality parenting time. Thus, updating data on parental divorce would reduce the gap in the national literature. Furthermore, exploring the correlation between divorce and psychological distress among Lebanese adolescents is crucial to develop effective intervention programs.

This national study, targeting a group of schoolchildren from different regions representing the whole country, explored the link between parental divorce and its deleterious effect on mental health in adolescents. After adjusting for covariates, the results showed the association between divorce and social fear and avoidance, higher depression, and suicidal ideation.

The results of our study showed that 57.1% of the participants had depression; this rate is higher than the one obtained in a previous study conducted among a sample of Lebanese adolescents – 26% revealed severe depression [40]. Likewise, in our study, 43.4 and 2.4% had probable and very probable social fear, respectively. Furthermore, 52.3 and 3.7% had probable and very probable social avoidance, respectively. Finally, 28.9% of the participants had suicidal ideation, higher than the 16% obtained in 2005 on a sample of 5038 Lebanese adolescents. The latter study had addressed risk factors for suicidal ideations [42], i.e., poor mental health, alcohol use and drug abuse, victimization, and lack of parental understanding or support.

Previous studies revealed that 39.9% of adolescents with non-separated parents and 40.4% of those with separated parents suffered from long-term depression [43]. As for suicidal ideation, adult daughters of divorced parents had 83% higher odds of suicidal ideation than their female peers who had not experienced parental divorce [44]. Furthermore, the results of a study conducted in Spain (Galicia) showed that parental separation led to a mean increase of approximately 20% in depressive symptoms, anxiety (generalized), hostility, paranoid ideation, and interpersonal alienation [45]. Interparental conflicts, economic strain, family moves, and parental depression might explain the association between parental separation and adolescents’ mental health [43].

Our study emphasized the blatant correlation between parental divorce and social fear/avoidance, consistent with other studies explaining this correlation by the fact that the period preceding the divorce is most often marked by communication problems between parents, creating an atmosphere of pressure in the family and a feeling of unpredictability and tension for the child [20, 46]. These feelings have a significant association with the behavior of adolescents, who may disclose fears and anxieties and uncontrollable outraging bursts, especially in situations within the family. Children and adolescents may show intense specific fears in case this situation persists long enough. Parents sometimes respond to these fears by indifference or sarcasm, causing intimidated young people to conceal their fears and distress or even pretend not to have, which can result in social phobias or panic attacks in adolescence [47]. Moreover, as soon as the child discovers parental separation, the process of mourning begins. Fears for the future emerge, alongside confusion over which parent is less responsible for the divorce and with which parent the child is supposed to live. Such situations predispose the child to higher stress, which is a mediating factor for the development of fear and anxiety [48].

Our results also showed that parental divorce was significantly associated with higher depression, in line with those of other studies [49, 50]. Living in a single-parent family often involves limited resources, whether financial or social (support and parental supervision), which in turn are likely to be linked to poorer mental health in the offspring, such as depression [43]. It also results in reduced time spent with one of the parents, which usually means less involvement [51]. Furthermore, previous research revealed that the absence of the father could affect the psychological adjustment of boys more than girls. Boys are likely to need a male role model during adolescence. Also, initiating and maintaining close relations is more difficult for boys [50].

Parental divorce was associated with increased suicidal ideation in Lebanese adolescents, in line with previous findings [52‐54]. Indeed, women who used to live with their fathers were significantly more likely to report lifetime suicide attempts than those who lived with their mothers [55]. Moreover, a previous study revealed that children staying with one of their parents did not experience more suicidal ideation compared to their peers [56]. However, children living without parents had higher stress and higher risk for mental disorders (suicidal ideation) than those living with a single parent [56]. Research indicates that suicidal risk in children of divorced parents is related to several factors, including ineffective parent-child communication, weak family cohesion, and insecure attachments [57].

Our findings reveal that teens with divorced parents had higher social fear and avoidance, depression, and suicidal ideation, highlighting the need for adequate prevention programs to support both children and parents during this emotionally difficult period. Consequently, enrolling separated parents in special prevention programs can guide them in creating a protective and supportive environment for their children. Further studies should focus on improving these programs to boost adolescents’ confidence and build a better society in the long run.