Perceived parental alcohol problems and consequences in youth

Background: Heavy drinking has psychological, social, and health consequences that go beyond the drinking person. Not least children of parents with alcohol problems are at risk of experiencing alcoholrelated harm that can have severe consequences for mental health and health behavior. Numerous studies have focused on severe and often clinical cases of parental alcohol problems, such as alcohol use disorders. By solely studying more severe clinical definitions of parental alcohol problems, we risk overlooking many people, who are never in contact with the treatment setting. From a public health perspective more studies based on the general population, including potential cases of less severe parental alcohol problems are needed, as these could be more numerous and therefore might have large public health impact.


Aim: This thesis examines the impact of perceived parental alcohol problems on harmful drinking patterns, mental health outcomes, and educational attainment among a national representative sample of secondary education students in Denmark. The aim was to test the hypotheses that young people with perceived parental alcohol problems: - have more harmful drinking patterns (paper 1), - are more likely to experience self-injury, suicide ideation, and suicide attempt (paper 2), - experience more emotional symptoms and depression (paper 3), - have higher risk of high school dropout or complete with lower grades (paper 4) compared to young people without parental alcohol problems. Further, we tested whether the associations differed depending on the gender of the young person, and the parent with alcohol problems, cohabitation with the parent with alcohol problems (paper 1 and 2), and how severely the young person has been affected by parents drinking, as well as possible effect-modification by family socioeconomic position (paper 3 and 4). 

Materials and methods: The papers in this thesis use data from the Danish National Youth Study 2014, a national representative survey of 75,853 upper secondary school students. The survey included questions on perceived parental alcohol problems, alcohol use, and mental health. The survey data was linked to national registers to identify parents’ educational level, family income, and educational achievement of the participants. In paper 1 differences in drinking patterns were analyzed using zero inflated negative binominal regression and multiple logistic regression models. In paper 2-4 multi-level (logistic, linear, and Poisson) regression modeling was applied to account for the hieratical structure of the data of students clustered within schools and school classes. 

Results: In paper 1 we found that both boys and girls with parental alcohol problems were more likely to have an early intoxication debut age, binge drink frequently, and have a higher weekly alcohol consumption than young people without parental alcohol problems. Paper 2 showed that perceived parental alcohol problems were associated with higher odds of self-injury, suicide ideation, and suicide attempts. In paper 3 perceived parental alcohol problems were associated with higher odds of frequent emotional symptoms and depression in all social strata. Severity of parental alcohol problems were associated with frequent emotional symptoms and depression in a dose dependent manner. The results of paper 4 showed that perceived parental alcohol problems were associated with a higher dropout rate and lower grades in high school. In contrast to our hypothesis, the relative effect of parental alcohol problems on dropout rates was larger among young people from high compared to low socioeconomic position. Across all papers, effects were similar for perceived maternal and paternal alcohol problems. 

Conclusion: The results of this thesis show that young people with perceived parental alcohol problems are a high-risk group for experiencing negative consequences in youth independent of their own gender or the gender of the parent with alcohol problems, and the family socioeconomic position. Thereby, the results generalize previous findings based on clinical cases of alcohol abuse to parental alcohol problems as perceived by young people in a representative group of young people in secondary education in Denmark. In addition, we found no excess risk of low family socioeconomic position and parental alcohol problems in the association with internalizing problems and higher rates of dropout and lower grades in high school. The results of this thesis emphasize the need for early identification and treatment of alcohol problems in families at all social levels, as well as the establishment of support services for young people with parental alcohol problems.