不容忽略：家庭混乱及矛盾对儿童成长的负面影响 | BMC Public Health
论文标题：The relationship between household chaos and child, parent, and family outcomes: a systematic scoping review
期刊：BMC Public Health
作者：Samantha Marsh, Rosie Dobson & Ralph Maddison
家庭混乱（household chaos），表现为家庭中缺乏秩序或环境的混乱，往往与一系列儿童和家庭的负面问题有关。BMC Public Health 近期发表的一项研究强调，需要在儿童福祉研究中考虑家庭混乱的重要性。Samantha Marsh博士在这篇博客中讨论了她的范围综述文章。
自二十一世纪初以来，家庭混乱现象及其对儿童福祉和发育的影响逐渐引起人们的关注。然而尽管如此，目前尚未有综述将现有文献进行全面的整合。我们在BMC Public Health 上发表的系统性范围综述文章旨在填补这一空白。
Household chaos, represented by the level of disorganisation or environmental confusion in the home, has been associated with a range of adverse child and family outcomes. This review aims to (1) identify how household chaos is measured, (2) chart study details of household chaos literature, and (3) map the existing literature with respect to the relationship between household chaos and child, parent, and family outcomes. We expect that this review will highlight the need to consider the importance of household chaos in child well-being research, particularly in those families where children may be more vulnerable to the adverse effects of household chaos.
We searched five electronic databases (last updated September 1st 2018) in addition to Google Scholar, and identified publications via a 3-stage screening process, which was conducted by two researchers. Published studies were included if they investigated the association between household chaos and child, parent, or family outcomes. Research that investigated household chaos as a mediator or moderator, or that investigated how the relationship between household chaos and the outcome of interest was mediated or moderated, were also included.
One hundred twelve studies in 111 publications were included. The majority were conducted in the United States (n = 71), and used either cross-sectional (n = 60) or longitudinal (n = 49) study designs. Outcomes of interest were categorised into seven categories: (1) cognitive and academic (n = 16), (2) socio-emotional and behavioural (n = 60), (3) communication (n = 6), (4) parenting, family, and household functioning (n = 21), (5) parent outcomes (n = 6), (6) hormone (n = 8), and (7) physical health and health behaviours (n = 19). There was consistent evidence for significant correlations between household chaos and adverse outcomes across all seven categories in diverse populations with respect to age, disease status, and socio-economic status (SES).
There is consistent evidence for associations between household chaos and a number of adverse child, parent, and family-level outcomes. Household chaos may also help describe variations in outcomes between low SES and child development.
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Household chaos represents the level of disorganisation or environmental confusion in the family home, and is characterised by high levels of background stimulation, lack of family routines, absence of predictability and structure in daily activities, and an overly fast pace of family life [1, 2]. Importantly, the construct of household chaos has been associated with a diverse range of adverse childhood outcomes, including poorer social-emotional functioning, cognitive development, academic achievement, and behavioural problems [3,4,5,6,7,8,9].
Household chaos has been linked with caregiver education, family income, and, perhaps not surprisingly, the number of people living in the household, whereby a lower level of caregiver education, lower family income, and a greater number of people in the home are associated with greater levels of chaos . Despite this, the construct also been demonstrated to be distributed across socioeconomic status (SES) , and further, associations between household chaos and adverse child outcomes remain after controlling for SES [3, 11]. For example, one study showed that household chaos was associated with reduced cognitive ability and IQ in children, even after controlling for parent education/IQ, the home literacy environment, parental negativity, parental warmth, stressful events, and housing conditions . Household chaos may therefore represent a unique risk factor for various adverse childhood outcomes, rather than simply reflecting residual confounding with, for example, SES .
In addition to the main effects of household chaos, the construct has also been shown to both mediate and moderate relationships between known child risk factors and adverse outcomes. For example, one study documented that the relationship between household chaos and maternal executive function was moderated by SES, suggesting that the adverse effects of household chaos may be exacerbated in socioeconomically distressed contexts . Other studies have also shown that household chaos may mediate relationships between child behavioural problems and bedtime resistance , and poverty and socioemotional adjustment .
Given the varied ways in which household chaos is associated with adverse child outcomes, it is not surprising that there appears to be growing interest in the construct. Yet despite this interest, and a seemingly large body of evidence demonstrating links between household chaos and a range of adverse child outcomes, no review has been conducted in this field to date. To this end, the goal of this study was to undertake a review to investigate the relationship between household chaos and child-, parent-, and family-level outcomes.
We decided that the ideal method of synthesising the knowledge base at this time, due to the disparate nature of outcomes assessed, age range and disease status of participants, frequency and duration of follow-up, and study designs used, was a systematic scoping review. The scoping review methodology allowed us to (1) investigate how household chaos is measured, (2) summarise the research on how household chaos is included as a primary risk factor of child, parent, and family outcomes, and (3) map the existing literature, with respect to relationships between household chaos and child, parent, and family outcomes. This enabled us to assess not only how household chaos is measured, which is necessary to ensure findings are generalisable across studies, but also what dimensions have been investigated. It also enabled us to summarise the extant scientific research without focussing on a specific outcome, research design, study population (e.g. disease population), or setting , therefore allowing us to make recommendations for future systematic reviews and meta-analysis within the field. This review seems timely given that there is also a need to better understand if effects are independent of other known risk factors, or instead reflect an important confounding factor.