The Influence and Development of Depression in the Life of the Youth (Community)

Introduction                                                                   

There has been a mourned increase in people with depression in Kenya. Depression as a mental health problem has for a long time been a neglected issue. HoIver the concern is there. Majority of the people have little or no knowledge of psychiatric or psychological issues that may affect one. Youths are faced with traumatic stressful situations from home to the outside world that may affect their performance. German 1972, reports that Africans have been reluctant to report their mental health problem yet they will report their physical symptoms. He goes ahead to explain that in most cases they are not aware that their physical symptoms are signs of a psychological problem like depression. In Kenya many youths would rather pray than announce their problems and if they do so it is to those who have no or little knowledge of the problem.

Statement of the problem.

Depression is a serious illness the second most common shared feeling among congregation. Murray and Lopez 1996, describe depression as the second common most disease by 2020 after cancer. They say it is the top five leading causes of disability adjusted life years (DALY) and premature death worldwide. An estimated 10 million Americans suffer depression, costing the government an estimate of 46 billion us dollars in in sick leaves medical expenses counselling and lost productivity per year (Johnson and indirik, 1997.p.52) research shows that 80% of these cases can be successfully treated with medication. Some people still have strong superstitions and beliefs which links depression with cure and bewitchments. This has resulted to so many depressed people and their families to keep away from the public and medical treatment and instead go for prayers.

Purpose of the study

The findings of this study will inform the community on how to improve their life’s and come out in the open. It will also make them understand the effect of the disease in the society the issues of superstition, negative belief, will stop lowering their self-esteem and also their relationship in the society and parent at large.

Objectives

The overall objectives of the study are to find out the prevalence of depression in the youth community demonstrating need for program in the community all over.

The specific objectives include;

• To find out if members in the families suffer depression.
• To find out if there is need for programmes to assist.
• To find out how the depressed people think and view themselves.
• To find out if there are strong superstitions and belief that link to depression and if prayers work without medical treatment.

Research questions (Hypothesis)

1. Do youth suffer depression?
2. Is there need for member’s assistance to come from the community programmes?
3. The depressed have a negative self-concept.
4. How do the government policies contribute in helping the depressed?

Significance of the study

The findings of this study will be beneficial to the community in implementing programs that are of half, at the same time it could be used to inform the authorities’ reforms agendas. The youths play a big role in the community and so it will make them more aware of psychological problems that affect them and seek assistance whenever necessary.

Sample size

The study concentrates on youths (13-25 years) only. The study will only cover Kahawa and Roysambu wards. The research findings could be different with a wider perspective and holistic representation. The will use a self-made questionnaire to gather personal data and the BDI-11 to assess depression prevalence.

Chapter two: literature review

In the general and nontechnical sense of the word, depression consists of teachings of sadness or a path accompanied by symptoms such as irritability, poor concentration, diminished or increased appetite or loss of interest in activities usually enjoyed. Many people view depression and its symptoms as a continuum, from mild symptoms as part of normal daily life. For example, in response to an upsetting situation, to severe symptoms that can be persistent and disabling and require clinical intervention.

Prior to 1980, clinical formulations of depression distinguished betIen neurotic and psychotic and non-endogenous (response to an environmental stress) and endogenous (internally induced or biological) Depression. These categories Ire not always defined operationally and the validity of distinctions was not consistently supported empirically. The World Health Organization (WHO) reported by 2020, mental health problems due to work pressure are expected to become the second most common cause of disability and death (Hermos and Gabriel 2000) Pizom (2006) also concluded that there is very little research on factors to mitigate depression at the work place. According to Jenison and Beridge (2012), stress at the work place contributes to depression, they argued that stress impaired one’s ability to function in capacity, it impairs working memory, and they attribute school, work place accidents and development of disorders to stress.

Depression falls within the large category of mood disorders. I focus on the most common mood disorders. Which is DSM-iii (but not DSM-IV) Ire called uni-polar affective disorders. Unipolar disorders involve periods of depression, but not manic. Mood disorders involving manic can be serious but are much less common and are not discussed further.

What causes depression?

Scientific theories fall into two broad groups; psychological theories typically associated with advocates of psychotherapy, and biological theories associated with advocates of somatic treatments. Neither type of theory explicitly addresses the other, but they are not mutually exclusive and actually complement each other. For example genetic predispositions and life events can interact (Kendler etal, 1995), and biological characteristics can affect the response to psychotherapy (Simons et al, 1995).

Cognitive theories assume that cognitive activities, especially information processing functions such as stimulus recognition and recall and problem solving, determining depressive symptoms. Aaron Beck (1967 a, b) suggested that stressful events activate negative cognitive schemes, or long standing perspectives that guide the interpretation of data. This results in information processing errors, such as selective attention to unrepresentative data, drawing conclusions from inadequate data and over generalization. When such errors become habitual, the resulting pattern of sustained negative affective and behavioural responses leads to depression. An alternative cognitive theory is “learned helplessness”, derived from animal studies in which inescapable noxious stimuli lead to an automatic “helplessness” response or no attempt to escape. Seligman (1975) suggested that depression in human is caused by cognitive, motivational and effective deficits that results from repeated exposure to uncontrollable outcomes.

Behavioural theories assume that depression is a learned response to the environment through reinforcement and conditioning. Poor social skills may lead to negative social interactions that reinforce low self-esteem. Behavioural therapies for depression are based on principles of operant and classical conditioning that is manipulating the environment to reinforce or extinguish behaviours.

The interpersonal theory of depression postulates that real or perceived losses activate depression in persons with undue interpersonal dependency, which may result from early childhood losses, disturbed intra-familial relationships, or genetic or biological predisposing factors (Klerman, 1989a). Psycho-dynamic theories of depression emphasize the psychological meaning, consciously and unconsciously, of loss, whether of relationship, opportunities, or self-esteem, and the relationship of current loss to early childhood experiences.

Furthermore, studies on mental health problems during child and youth development phases indicate that families of children diagnosed with a depressive disorder tend to be dysfunctional. The dysfunctions include unhealthy quality of marital interactions, presence of psychiatric disorders among parents, and maladaptive parental behaviours. These dysfunctions have been shown to be mediating factors for children to develop psychiatric disorders. It has also been shown that in this type of family setting, there exists a high rate of parent-to-parent or parent-to-child conflicts that make members highly vulnerable to develop a psychiatric disorder. Previous studies in this area also show that youths brought up in these homes where one psychiatric disorder occurs often have one or more co-morbid psychiatric disorders. This effect seems to be stronger when both parents suffer from any psychiatric disorder. Compared to depressed youths of non-depressed parents, youths with a family history of depression have been found to suffer more severe and chronic forms of depression, more relapses, psychiatric co-morbidity, impaired psychosocial functioning, and suicidal behaviour.

World Health Organization (WHO)-based studies indicate that the prevalence of psychiatric disorders previously seen in adult life has increased enormously among children and youths in the past few years. Four percent of 12- to 17-year olds and 9% of 18- to 24-year olds have been shown to suffer from major depressive disorder (MDD). These WHO studies also indicate that depression is the most prevalent disorder worldwide with wide reaching consequences in youth. Further, it has been shown that some forms of parenting styles are associated with child abuse. A study by Khasakhala et al. (2012) found that there Ire statistical differences (p < 0.05) between perceived paternal permissive parenting behaviour and emotional and physical neglect of the youths, perceived paternal authoritarian parenting behaviour and emotional and physical abuse of the youths, while perceived uninvolved parenting behaviour was found to be associated with both emotional and physical neglect of the youths. In the study, mothers who had authoritarian parenting style emotionally and physically abused their youths, while those who Ire uninvolved, emotionally and physically neglected their youths. Uninvolved parents give negative attention to the behaviours and activities their youths display; this is the opposite of approval, and therefore, this behaviour does not protect the youth from developing psychiatric disorders. Studies also indicate that untreated MDD in youths is associated with later development of anxiety disorders, bipolar mood disorders, and substance abuse disorders. It has also been shown that youths with co-morbid depression come from dysfunctional families and have severe substance abuse disorders. Depression has been shown to be associated with youth suicidal behaviour which is a major problem in many countries, as it is the third leading cause of death in young people.

In Kenya, the prevalence of depression among youths attending general health facilities and those in secondary schools has been found to be high. The prevalence of clinically depressive symptoms in Kenya is 43.7% among youths in public schools in Nairobi province, while the prevalence of those attending general health facilities is 41.3%. Khasakhala et al. (2012) found that more than a quarter of youths in high school suffer from MDD which has a relationship with aspects of perceived maladaptive parenting behaviour. Parental psychopathology has also been shown to be associated with maladaptive parenting behaviour. Thus, these family dysfunctions are characterized with poor communication, poor problem solving, and the presence of hostile criticism in the family. Therefore, a parent with mental disorder has poor interactive skills perceived as a maladaptive parental behaviour by children; this is a mediator for children to develop psychopathology, in particular MDD. The nature of this association is of considerable interest to mental health workers and scientists alike, in part because it may be possible to reduce the odds that children will develop psychiatric disorders if parents are helped to modify their parental behaviour or access psychiatric treatment in case the parent has a psychiatric disorder.

There is need therefore to document the negative and important roles that parents/caregivers play not only to help their children successfully transit into teenage/adulthood but also because this transition should have a healthy relationship void of psychopathology. The primary question addressed in this paper is whether the presence of parental psychiatric morbidity and perceived maladaptive parental behaviour serve as useful indicators of associating MDD in youth age 13 to 25 years. The main aim of this paper was to assess the relationship between parents, psychiatric disorders and maladaptive parental behaviours and youths MDD. The hypothesis of the study was that parents with a psychiatric disorder face challenges in bonding with their children as they exhibit maladaptive parenting behaviour, a mediator for their offspring’s to develop psychiatric disorders. This study was designed to address the magnitude of the burden of disease related to psychiatric disorders in a family setting in Kenya, which remain unrecognized and undertreated. Studies carried out in developed countries indicate that parental psychopathology is associated with maladaptive parenting behaviour, and maladaptive parenting behaviour is associated with an increased likelihood of youths developing mood disorders.

Method

Participants

Participants in this study included 250 purposefully sampled youth attending the outpatient psychiatric clinic at various healthcare institutions in in the Kiambu and Naironi regions. They Ire recruited into the study after psychological interview and Ire diagnosed with any DSM IV axis I psychiatric disorder including bipolar mood disorder, schizophrenia, post-traumatic stress disorder, any other anxiety disorder, substance use disorder, alcohol use disorder, and conduct disorder. The age range of the youths recruited was 13 to 22 years with a mean age of 16.92 years, median of 17 years, and standard deviation of 2.151. They were categorized into three groups: 13 to 15, 16 to 18, and 19 to 22 years.

The researcher, however, did not succeed in recruiting all parents, only 226 and 202 biological mothers and fathers, respectively, Ire reached. The youths Ire selected to participate in the study if they had a DSM-IV axis I psychiatric disorder, scored above 25 points on the Mini Mental State Examination (MMSE) and had at least one parent (biological) enrolled in the study.

Procedure

Approval for data collection was obtained from the healthcare institutions in Nairobi and Kiambu regions. Consent from every parent and youth above 17 years of age and parental consent for youth’s between ages 13 to 17 years who assented to participate Ire obtained prior to study participation. Among the excluded youths (5.7% (15)), six did not return to the clinic for follow-up despite several telephone reminders about their appointment dates, five parents did not sign the consent forms, and four youths had severe psychotic disorder and, therefore, did not meet the final criteria (scored less than 25 points on the Mini Mental State Examination).

Measures

Closed-ended, face-to-face interviews Ire conducted with participants in these healthcare institutions using a researcher-formulated socio-demographic, structured clinical interview schedule using Mini International Neuropsychiatric Interview for Children and Adolescents (MINI Kid) administered to the adolescents 13 to 17 years and Mini International Neuropsychiatric Interview for Adults (MINI Plus) to parents and youth above 17 years of age. Both MINI Kid and MINI Plus are structured diagnostic interview schedules developed for the diagnoses of DSM-IV and ICD-10 psychiatric disorders. These structured questionnaires are designed to meet the need for a short but accurate structured psychiatric interview for multi-centre clinical trials and epidemiology studies. These schedules Ire used in this study as a first step in outcome tracking and confirming the axis I DSM-IV disorders. The interview questions are designed to elicit specific diagnostic criteria according to DSM-IV diagnosis.

The MMSE, a most commonly used test for assessing memory and cognition problems, was filled for all respondents. In this study, the MMSE was used to screen for the presence of cognitive impairment on mental activities such as memory, thinking, calculation, language, constructional ability, reasoning, decision making, orientation in time and place, attention, immediate and recall memories, and dealing with concepts, i.e., abstraction. Developed by Dr. Marshal Folstein in the 1970’s, the MMSE has been used not only as a clinical tool but also as a research tool in developed countries such as UK and USA and in developing counties including Kenya, Ecuador, Uganda, and South Africa. It has been translated into over 50 languages, and it is a very useful broad screening test, especially when it is suspected that mental functions are severely compromised.

Perceived parental behaviour by youth in the study was assessed using the Egna Minnen Betraffande Uppfostran (EMBU) questionnaire, in English as ‘own memories of childhood upbringing’ (Arrindell et al. 1999). This is a self-administered questionnaire about perceived parental behaviour. Youths Ire asked to recall in what way their parents Ire alike and in what way the parents differed using the questionnaire that has 81 items. In each question, the youths considered how their father behaved and then how their mother behaved towards them. The 81 items in the questionnaire measure two constructs that has a total of eight factors, four parenting styles and forms of child abuse which are further computed into four types of parental behaviours. Parenting styles include authoritative, authoritarian, permissive, and uninvolved, while the forms of child abuse include emotional abuse, emotional neglect, physical abuse, and physical neglect. The four types of parental behaviour are the following: (1) no emotional attachment computed from two forms of child abuse (emotional abuse and physical abuse) and the authoritarian parenting style, (2) rejecting parental behaviour computed from both emotional and physical child neglect, (3) under-protective parental behaviour computed from both permissive and uninvolved parenting style, and (4) authoritative parental behaviour from the computation of authoritative parenting style.

The socio-demographic questionnaire was filled in the presence of both youth and parent(s). The structured psychiatric interview schedule and MMSE for each participant Ire conducted confidentially on one-to-one but later Ire matched. The researcher received intensive training on the administration of structured interview questionnaires both MINI Kid and MINI Plus. Commitment checks Ire regularly carried out for youth and their parents to ensure that the study protocol was adhered to. Interviews lasted approximately 50 to 60 min. Each participant was first screened for any psychiatric disorder using MINI Kid or MINI Plus screen. The participants Ire asked if they had any specific feeling or behaviour in the past on the screener, and the response was either ‘yes’ or ‘no’. For items on the screener with a ‘yes’, the participants Ire further interviewed to make a specific DSM-IV-TR diagnosis using MINI Kid or MINI Plus main questionnaire. These questionnaires (MINI Kid and MINI Plus) have high reliability and validity and been adapted and translated into Kiswahili for the East African region. The youths filled out the self-administered EMBU questionnaire, where they rated perceived specified parenting behaviour of each parent since childhood on a Likert scale from 1 (0 as no never) to 4 (3 as yes always). Higher scores on the three types of parenting behaviour indicated maladaptive parental behaviour, while high score on perceived authoritative parenting behaviour was considered adaptive parental behaviour.

Statistical analysis

Data analysis using SPSS version 16 to describe each DSM-IV diagnosis (multiple) of each participant was done by summing up the ‘yes’ responses that met each criterion for DSM-IV I disorder. A chi-square test was run to assess the association of covariates, both the socio-demographic data and psychiatric disorder among the youths and their parents separately. Using the chi-square test, further associations between perceived parenting behaviour and depressive disorder Ire assessed. Lastly, multiple logistic regression of maternal depression and parenting behavioural problems was used to assess the association with youth MDD, controlling for age and gender. Given the large number of repeated chi-square tests, the p value was set at 0.01 based on a conservative Bonferroni criterion.

Results

A total of 250 youths Ire recruited, but only 245 Ire included in the final analysis. Five youths declined to allow their parents to participate as they Ire (sexually) abused in a family setting.

Factors associated with major depressive disorders (MDD) in youths

Bivariate analyses

Table 1 presents the analysis of MDD among youths in relation to background characteristics. The occurrence of MDD was associated with late adolescence, 16 to 18 years (OR = 2.66, 95% CI 1.40 to 5.05, p = 0.003), but marginally associated with younger adolescents 13 to 15 years (OR = 1.93, 95% CI 0.93 to 4.01, p = 0.078) compared to the age category of 19 to 22 years.

Table 1

Major depressive disorder among youth in relation to socio-demographic characteristics and duration of mental disorder

The italicized value is at p < 0.05. CI, confidence interval; OR, odds ratio; UD, undefined.

Table 2 presents the analyses of MDD among the youths in relation to mental health status of the parents. Under-protective behaviour of fathers was associated with reduced cases of MDD among the youth (OR = 0.16, 95% CI 0.04 to 0.72, p = 0.017). The occurrence of MDD among the youths was associated with death of the fathers with reference to the absence of MDD in fathers (OR = 2.24, 95% CI 1.12 to 4.51, p = 0.023).

Table 2

Major depressive disorder among youths in relation to mental health status of the parents

Italicized values are at p < 0.05. CI, confidence interval; OR, odds ratio.

Chi-squire test of MDD among youths in relation to other mental health status of the youths are presented in Table 3. MDD was associated with conduct disorder, any anxiety disorder, any drug abuse problem, and alcohol use disorders.

Table 3

Major depressive disorder among youths in relation to other psychiatric disorders

Italicized values are at p < 0.05.

The analyses of MDD among youths in relation to other mental health status of the youths are presented in Table 4. The occurrence of MDD was associated with conduct disorder (OR = 2.93, 95% CI 1.04 to 8.26, p = 0.035), any anxiety disorder (OR = 2.41, 95% CI 1.20 to 4.87, p = 0.012), any drug abuse (OR = 3.40, 95% CI 2.01 to 5.76, p < 0.001), alcohol use (OR = 3.29, 95% CI 1.94 to 5.57, p < 0.001), and suicidal behaviour (OR = 5.27, 95% CI 2.39 to 11.66, p < 0.001).

Table 4

Major depressive disorder among youths in relation to other mental health status of the youths

Italicized values are at p < 0.05. CI, confidence interval; OR, odds ratio.

Multivariable analyses

Multiple logistic regressions Ire used to model the occurrence of MDD using factors during bivariate analyses, as tabulated in Table 5. Eight independent indicator variables of MDD among the youth Ire identified. Adjusting for other factors, age category 16 to 18 years was associated with occurrence of MDD (AOR = 2.74, 95% CI 1.09 to 6.93, p = 0.033). Rejecting maternal behaviour was identified to be associated with MDD in youth (AOR = 2.165, 95% CI 1.060 to 4.422, p = 0.034). The occurrence of MDD in mother was identified to be associated with MDD in youth (AOR = 5.27, 95% CI 1.10 to 14.76, p < 0.001). The occurrence of MDD in father was not identified to be associated with MDD in youth (AOR = 0.51, 95% CI 0.21 to 1.23, p = 0. 135). However, death of the father was identified to be associated with MDD among the youths (AOR = 4.69, 95% CI 1.50 to 14.69, p = 0.008). Other mental health disorders of the youths Ire also identified to associated with MDD, which included any anxiety (AOR = 4.03, 95% CI 1.47 to 11.08, p = 0.007), alcohol use (AOR = 2.41, 95% CI 1.19 to 4.89, p = 0.015), and suicidal behaviour (AOR = 4.52, 95% CI 1.38 to 14.81, p = 0.013).

Table 5

Adjusted odds ratios of major depressive disorder among Kenyan youth

Italicized values are at p < 0.05. AOR, adjusted odds ratio; CI, confidence interval.

Discussion

Our main findings indicate that Kenyan youths with MDD seeking mental health treatment services are more likely to have mothers with MDD and are more likely to perceive their mothers as exhibiting a rejecting parenting behaviour. This finding is similar to previous studies which have shown that the presence of psychiatric disorders among parents, which is associated with maladaptive parental behaviours, is a mediating factor for children to develop psychiatric disorders. Focusing first on the intergenerational associations of MDD, our findings are comparable to studies that use the ‘top-down’ approach which consistently shows that children of depressed parents have a substantially increased risk to experience not only depressive disorders but also other DSM-IV disorders. These results are also comparable to ‘bottom-up’ studies that examine clinically referred depressed children and adolescents, which showed increased rates of depression and other forms of psychopathology in parents. Although perceived parenting behaviour models play different roles for different youth psychosocial outcomes, overall, our results support the attachment theory which highlights the importance of specific perceived parenting behaviour, the attachment between a child and their parents. Our findings are consistent with the notion that parental depression has a negative impact on the emotional and behavioural functioning of offspring. This is because parental depression leads to family disruption and marital discord which has a negative impact to the mental Ill-being of children.

Our study found that youths with MDD also Ire more likely to have other co-existing DSM-IV axis I disorders (substance abuse, any anxiety, and conduct disorder), suggesting that co-morbid psychiatric disorders also need attention during treatment. The perceived rejecting maternal behaviour as shown in this study is a negative factor inducing severe psychological distress; therefore, a child with depressive disorder tries to escape from internalizing their feelings (depression) by acting out (externalizing them) and, in the process, starts abusing alcohol/substances. This is a similar finding by Rankin et al. (1998). This raises the possibility that parental behaviour may be a risk factor in the development of multiple psychiatric disorders in the same child.

The result in this study indicate that multiple independent variables associated with MDD in youth include the following: rejecting maternal parenting behaviour, maternal MDD, and other co-morbid psychiatric disorders among youths. Rejecting maternal parenting behaviour and depressive disorder in a parent are associated with greater odds for children to develop MDD. Rejecting behaviour plays an important role in the development of psychiatric disorders in children, and this had an association with parents’ psychiatric disorders. This finding may explain the dysfunctional family nature in this study population. Parental psychopathology, in particular depressive disorder in mothers, could have a paring to genetic predisposition which in turn is associated with greater odds for children to develop depressive disorder. This explains how disconnected this family setting functions. There is increased conflict in this type of family setting. The perceived maternal rejecting parenting behaviour obstructs the interaction between mother and her children. The rejecting parenting behaviour in such a family setting is perceived by children to be a poor emotional expression, ‘I have no interest in you’ and therefore disconnects the child from the mother, creating a barrier for the child to explore and form connecting bonds with his/her parent(s). This barrier results into insecure attachment which was described earlier. This non connectedness between the child and parent leads to confusion, conflict, and frustration in the growing child, a precursor for a child to develop psychopathology which presents as either an internalizing (depression/anxiety) or externalizing disorder (alcohol abuse/conduct).

As indicted by the results of this study, a high proportion of youth who perceived that their mother had rejecting parenting behaviour had higher odds of developing depression and abusing alcohol/substance (multiple substances). This finding is comparable to prior family studies in patient samples, which revealed that parental psychopathology is associated with maladaptive parental behaviour and, in turn, is associated with increased odds of psychopathology among their children. This demonstrates that children who perceive their mothers to have rejecting parental behaviour are more likely to develop MDD than children of parents with other parental behaviour.

Previous studies suggest potential explanations for how parental characteristics may contribute to MDD in their children. Rejecting maternal behaviour may restrict the child’s development of autonomy that leads to competence which allows the developing child to explore their environment. Perceived parenting rejection by mothers may lead to a dysfunctional parent–child bond, which may result in difficulties for the child to explore the environment, leading to a helplessness experience. In addition, rejection may keep the child from engaging in social situations, thereby restricting the opportunities to learn social skills and therefore remain inferior. These findings are of interest, in particular, if the onset of mental disorders among youth can be prevented, whereby parents can be assisted to modify their child-rearing practices.

More importantly, from these results, rejecting maternal parenting behaviour may play a role in the development of psychopathology in children whether or not a mother has psychopathology. This is more so because rejecting maternal parenting behaviour is relatively more common in our society; therefore, it may be important to educate the public about these abnormal parenting styles that are associated with an increased risk of offspring to develop psychopathology. This data is consistent with previous research findings which have indicated that parental psychopathology is associated with maladaptive parental behaviour, which is also associated with increased risk of the children to develop psychopathology. Perceived rejecting maternal parental behaviour was the only independent variable, where higher scores on the rejecting-ineffective parenting scale Ire associated with higher odds of MDD among the youth. Perceived rejecting maternal parenting behaviour therefore influences family life, and parental psychopathology is linked to poor child-rearing practices. This social life around the growing child defines important tasks that the growing person needs to achieve.

Limitations

While interpreting the results of this study, three paramount limitations should be taken into account. First, the cross-sectional nature of the study limited the ability to make inferences about causality. I cannot be sure whether parents Ire connected to their children, because majority had psychopathology and abnormal parenting behaviour which are associated with youth negative psychological outcomes (psychiatric disorder). Nevertheless, I did control for several potentially spurious variables (age, other psychiatric disorders among youth, and parental psychopathology/parenting behaviour) that helped strain the relationship between parents as role models and youth psychiatric disorders. Future research that uses longitudinal designs can help address this issue.

A second limitation of this study is reliance on self-report data by youth on perceived parenting behaviour. This assessment measure did not provide more detailed information about the parent–child relationship. Additional information on the nature or quality of the relationship parents have with their children would help provide a clearer picture of how parents with or without a psychiatric disorder influence youth to develop a psychiatric disorder. This information would allow studying the potential effects of parenting qualities. Nevertheless, our study suggests that parenting behaviour as perceived by children, and parental psychiatric disorders have a powerful influence on children to develop psychiatric disorder. Hence, continued research to further understand this relationship is warranted.

Third, this study was done in the Nairobi and Kiambu regions, where mental health services are scarce and inaccessible. Therefore, when interpreting these results, it is important to consider that the respondents might not have understood the meaning of psychiatric disorders.

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