A Parent-Reported Study of Parental Health, Parentification, and Attachment

Background and Purpose: Previous studies have demonstrated that parental health has a significant impact on child-wellbeing, including behavioral and academic outcomes. One potential impact of poor parental health could be increased parentification - a role reversal, where children step in to provide emotional or instrumental support to their parents. Stepping into adult roles as children can disrupt attachment – the strength and quality of the parent-child relationship. Poor attachment in childhood is associated with increased risk of maltreatment. The purpose of this study was to investigate whether parental health and parentification were independently related to attachment. In addition, we examined whether the relationship between parentification and attachment was stronger when parents are in poor health.

Methods: The Well-being and Parenting Study is a cross sectional correlational study that utilized an online survey distributed via social media and flyers in public places. Parents with at least one child under 18 were encouraged to participate. Following bot-detection data cleaning, 217 complete responses were retained. The sample was composed primarily of White, non-Hispanic (42%), Hispanic (38%) and Black, non-Hispanic (7%) parents, with 72% of respondents being women. Two scales were used: the Parentification Inventory and the Parent-Child Relationship Scale, which measures attachment. The Parentification Inventory was modified from an adult-child self report questionnaire to a parent self-report questionnaire, reflecting parent’s perspectives of their child’s behavior, and demonstrating strong internal consistency (α = .899) . Linear regression models were used to examine whether health status or parentification were significant predictors of attachment, controlling for demographic characteristics of the parent and child. An interaction analysis was used to examine whether the relationship between parentification and attachment changed depending on health status.

Results: Linear regression analysis revealed that poor parental health status was a significant predictor of lower parent-child attachment, controlling for demographic characteristics of parents and children. Emotional parentification significantly predicted lower attachment (β =-.405, p<.001), explaining 31.2% of variance in attachment scores (R2=.31, F(7, 198) = 12.835, p<.001). Instrumental parentification was a stronger predictor of lower attachment (β = -.501, p<.001), explaining 38.3% of variance in attachment scores (R2=.383, F(7, 198) = 17.558, p <.001). An interaction analysis revealed that the relationship between parentification and attachment did not significantly differ by parental health status (β = -.084, p = .716).

Conclusions and Implications: Poor parental health can limit a parent’s ability to engage in attachment promoting behaviors. Relying on children to fill instrumental and emotional support roles may contribute to impairment of the parent-child relationship as it may lead to the child experiencing stress, burnout, or resentment. Importantly, although this study used a novel method of assessing parentification (parent appraisal), the findings broadly align with literature examining parentification through child appraisal. Potential interventions include regular screening for parentification of children in school and of parents in health settings, providing psychoeducation to parents and children alike on the effects of caregiver burden on children, and attachment promoting activities through family outreach efforts.