2.2 Life fields resources and pressures national health report 2022

nuclear family or school) contains resources and opportunities, but also burdens and risks. Particular challenges arise in each case during the transition from one living environment to the next; for example, z. B. the entry into school becomes a critical phase for children.

The nuclear family

The womb is the "first environment" of a human being. The mostly irreversible and serious effects of addictive substances or certain medications on the fetus have been extensively documented (Dratva, Stronski& Chiolero, 2017; Singer et al., 2018). Early childhood, in addition to pregnancy, has been shown to be a particularly critical period and crucial for development and health opportunities. This is where the bond or relationship with close caregivers is formed. Feeling understood and supported by one's parents and the entire family remains of great importance for well-being and mental health into adolescence and is associated with lower use of psychoactive substances (Delgrande Jordan, Eichenberger, Kretschmann& Schneider, 2019).

There are a number of factors that can demonstrably burden conditions within the family. This includes, in particular, a chronic burden on the family due to poverty and precarious employment situation, chronic mental illness or addiction of the parents, social isolation as well as domestic violence. In Switzerland, most children grow up. Adolescents grow up in a resource-rich family climate. Around 90% of children and adolescents feel well supported by their families.

Structure of the nuclear family today

What is the structure of today's nuclear family and how has it changed over the past decades? If parents live in the same household with only children, they are called first families. If parents live in the household with at least one child who is not in common, then it is a so-called continuation family ("patchwork family"). In Switzerland, the vast majority of children, adolescents and young adults up to the age of 25 still live in a household in a first family with both parents (80%), a good 14% with single parents (12.1% mothers, 2.3% fathers) and just under 6% in continuation families with married or unmarried parents. Looking at trends over the past forty years, we see that the number of couple households with children has remained relatively stable, while single-parent households have more than doubled. Another important change in the structure of the nuclear family concerns the existence of siblings. Compared to 1970, significantly fewer children grow up with two or more siblings today: Households with three or more children have decreased from 27.1% in 1970 to 16.8% (years 2012/2014) (BFS, 2017a). About the same number of children live as only children in a household at the time of the survey (41.2%) as live with only one sibling (42.1%). The majority of children up to six years of age residing in Switzerland live in a family with a migrant background 2 (54.4%). In this context, 33.5% have both parents with migration experience, and 20.9% have one of the two parents (cf. Graph G2.2).

Excursus: Children who grow up outside their families

No nationwide information is yet available on the frequency of out-of-home placements. In 2016, it is estimated that approximately 1% of children and adolescents aged 0 to 18 in Switzerland were placed with a third party. This represents 18,900 children and youth. About three-quarters of the children and adolescents involved lived in children's and adolescents' homes and about one-quarter lived in foster families. The literature shows that the living conditions of the families of origin are often characterized by poverty, parental addictive behavior or psychological difficulties and experiences of violence. Surveys of Swiss residential youth show high prevalence rates of mental and behavioral health problems (Averdijk, Ribeaud& Eisner, 2018).

Social resources within the nuclear family

Population-based information on attachments , understood as close emotional relationships that young children have with their mothers or other close caregivers, is not available. To date, only studies exist that have examined, in smaller samples, which factors promote or inhibit the development of secure attachments. For example, a new Swiss study examined the influence of social isolation and precarious living situation on the formation of a secure attachment between mother and child. The author concludes that these stressful factors can impair attachment, as the associated chronic stress reduces the mother's sensitivity, which is necessary for attachment formation (Neuhauser, 2018).

Representative surveys on their relationship with parents are available for the age groups of children and adolescents aged 11 and older and young adults (e.g. B. HBSC 3 , COCON 4 , TREE 5 ). For the younger age group, the overall picture is positive: a large majority of 11- to 15-year-old adolescents in the 2018 HBSC survey said their family was eager to help them (84%) and also willing to support them in decision-making (92%). The majority of adolescents also feel they receive the emotional support they need (89%) and can talk to family about problems (84%; cf. Graph G2.3).

The extent of family support measured in this way has not changed over the past four years (Delgrande Jordan et al., 2019). Girls overall feel slightly less well supported by family than boys, and older youth (ages 14-15) feel less well supported than 11- to 13-year-olds. At this age stage, both genders rate the mother as a more important caregiver: 78% of girls and 82% of boys say that they can talk to their mother about things that really bother them. Fathers play this role for 53% of girls and 70% of boys. Adolescents from families with a migration background (defined here as having at least one parent who was not born in Switzerland) consistently feel somewhat less supported by their families than adolescents from families without a migration background. They are also much more likely to report that their parents do not know what they do in their free time (33% vs. 22%), who their friends are (31% vs. 18%), where they are after school (20% vs. 12%), and where they go in the evening (24% vs. 17%).

As the results of the TREE study show, more than 80% of young adults aged 26 also maintain a close and trusting relationship with at least one parent (Bertogg& Szydlik, 2016) .

Domestic violence

The following further figures on violence in the family are based on data on cases of child abuse identified and registered by child protection organizations, children's clinics or the police. However, a significant number of unreported cases must be amed for these sources, as child abuse and domestic violence very often go undetected.

– According to a survey of 20 of the 26 children's hospitals operating in Switzerland, a total of 1388 cases of child maltreatment were observed in 2015, with psychological abuse (31%) followed by physical abuse (28%) being the most common, followed by neglect and sexual abuse (both 20%). Children under one year of age accounted for 18% and children under 2 years of age accounted for almost a quarter (Swiss Society of Pediatrics, 2016). – Around 3890 cases of sexual abuse are recorded annually in Switzerland by organizations that deal with child protection in some way. This corresponds to 0.3% of all children under 18 years of age. Girls are affected by this form of violence significantly more often and to a more severe extent (Maier, Mohler-Kuo, Landolt, Schnyder& Jud, 2013). – A representative survey of parents conducted on behalf of the Federal Social Insurance Office FSIO in 2017 concluded that about half still use corporal punishment, albeit rarely. Around one in four parents regularly use psychological violence by hurting the child with words, threatening to hit or withdrawing love (Schobi et al., 2017).

The social network of the nuclear family

The nuclear family is not in a social vacuum. For the well-being of the family, but also for their ability to cope with difficult situations, it is of central importance how their social environment is shaped. One of the most important indicators here is the experienced loneliness. 67% of parents in Switzerland never feel lonely, 28% only sometimes (Swiss Health Survey, SGB, 2017). This means that the vast majority have good social resources. This is also indicated by the response to the question of how easy it is to get neighborly help: For 66% of parents, this is easy, for 23% it is possible, and for only 11% it is difficult.

Among parents with at most compulsory schooling, the proportion who never feel lonely is 52%, among parents with an upper secondary degree it is 66%, and among parents with a tertiary degree it is 71%. Parents with a migration background in Switzerland have significantly worse social resources than parents without a migration background (cf. see graph G2.5). This difference is evident regardless of social status in terms of parents' educational attainment and their labor market integration (Bachmann, 2014).

Those who suffer from particularly stressful daily lives often lack the time and energy to maintain their social contacts. For example, parents who suffer from financially precarious living conditions, who cannot reconcile gainful employment and family work, or who have to care for a seriously ill or dying child, withdraw from their social network and at the same time suffer from this isolation and lack of support (Hennig, Ebach, Stuth& Haegglund, 2012; Inglin, Hornung& Bergstraesser, 2011; Struffolino, Bernardi& Voorpostel, 2016). The social framework (z. B. Influence on the extent of this problem. Can inhibit or promote social participation of families.

Families in vulnerable situations

Families in vulnerable situations often have multiple aspects of stress, which negatively influence each other and thus amplify the consequences. In addition to financial scarcity and associated worries, these multiple stresses include, in particular, unemployment or insecure employment conditions, dependence on social welfare and associated feelings of shame, social isolation, chronic parental stress and illness, and stressful housing situations (Amacker, Funke& Wenger, 2015; Guggisberg, Hani& Berger, 2016; Struffolino et al., 2016; Zurcher et al., 2016). Accordingly, these multiple problem situations also have multiple effects on the developmental and realization opportunities, health, and well-being of children and adolescents in these families. In 2014, a total of 234,000 children lived in Switzerland. Adolescents in households at risk of poverty. Of these, nearly 73 000 were affected by so-called absolute poverty (Guggisberg et al., 2016). The rate of absolute poverty refers to the level of household income according to the guidelines of the Swiss Conference for Social Welfare (SKOS) 7 . Persons defined as poor in this way do not have the financial means to participate in social life. In relation to the permanent resident population of Switzerland under the age of 18, 5% of children and adolescents were poor in 2014. Children and adolescents in single-parent households are particularly likely to live in precarious circumstances: 15% of them are affected by poverty. Other risk factors for child poverty in Switzerland are: high number of children (family with three and more children), migration background, parents without post-compulsory education and without gainful employment (Guggisberg et al., 2016).

Excursus: Single-parent families

Single-parent families are often in a particularly critical living situation. Single-parent women in particular are disproportionately affected by poverty, even though the majority of them are employed. This is due u.a. to the fact that family responsibilities usually mean that they can only work part-time and often under particularly precarious employment conditions (hourly wage, on call, etc.) suffering (Struffolino et al., 2016). Various studies point to the particularly high burden, chronic stress and exhaustion, and health impairments of single mothers in Switzerland. Single parents have a higher risk of isolation than the rest of the population. Compared to parents who live with their partner, single parents are significantly more likely to report feelings of loneliness and are more likely to have a limited social network (Gazareth& Modetta 2006; Bachmann, 2014).

Poverty entails multiple aspects of stress in different domains of life. One of the most important of these is housing. Children in families at risk of poverty are significantly more likely to live in housing that is overcrowded, too dark, too damp, exposed to noise and traffic, and polluted or littered (Guggisberg et al., 2016). The affected children and adolescents perceive housing as a primary problem of their living situation (Zurcher et al., 2016). Families experiencing poverty most often have to forego regular paid leisure activities and vacation trips in their daily lives. Many parents in precarious financial situations forgo meeting their own needs in order to provide their children with what is considered normal in their social environment (Guggisberg et al., 2016). Parental social and financial resources show an association with the quality of parent-child relationships from early childhood (Neuhauser, 2018) into adolescence and early adulthood (Bayard, Malti& Buchmann, 2014; Bertogg& Szydlik, 2016).

The extent to which family poverty affects children and adolescents depends, among other things, on how well the parents or the single parent manage to cope with the stressful situation. This ability to cope with difficult daily demands, in turn, has much to do with one's resource situation and contextual conditions (z. B. Family-friendliness of the employer or geographical proximity of home, work and daycare center).

Parents with mental illness

Mental illness is widespread and accounts for a large share of today's disease burden (Schuler, Tuch, Buscher& Camenzind, 2016). If one parent is affected, this usually means an exceptionally heavy burden for the entire family. In addition to impairing intrafamily relationships, mental illness often leads to social withdrawal and weakens the social resources of all family members. Little information is available to date on how many children and youth in Switzerland are affected by this problem.

Mental illness is widespread. If one parent is affected, this usually means an exceptionally heavy burden for the entire family.

A study that recorded affected adults and children in contact with the care system in the Winterthur region indicates that many of the children of mentally ill parents live in a family environment with multiple stresses (Gurny, Cassee, Gavez, Los& Albermann, 2007) and that their risk of developing a mental disorder themselves is increased by a factor of 3 to 7 (Albermann& Muller, 2016). In addition to mental illness, there are other intra-family problems such as poor parenting skills, couple conflicts, violence and neglect. 31% of the children and adolescents included in the Winterthur study live with single parents, 26% with both parents, 25% in the home and the remaining 18% in other living situations (Albermann& Muller, 2016).

Using the 2017 SGB data, we can estimate how common mental distress is among mothers and fathers in Switzerland (n = 6877). 8 Overall, 4% of parents surveyed reported suffering from severe psychological distress and 8% from moderate to severe depression symptoms. Both indicators also point to significant mental health impairments from a clinical perspective (cf. in addition Schuler et al., 2016). There are clear differences according to the social status and living situation of the parents: single mothers, for example, suffer twice as often from depression symptoms compared to mothers in couple relationships. Parents with only compulsory schooling are also three times more likely to exhibit symptoms of depression than parents with tertiary education (chart G2.6).

The consequences of a parent's alcohol dependence for children are also diverse, sometimes severe, and can run through the entire life course (World Health Organization, 2018). Their living conditions are often characterized by an unsafe and disorderly family atmosphere, unpredictable ways of acting, and avoidance of criticism and conflict. Fluctuating parenting styles often result in volatile and unreliable parent-child relationships, which can affect children's mental health and the development of their social resources, and also increase the risk of problematic substance use in adolescence (Bayer-Oglesby, Nieuwenboom, Frey& Schmid, 2015; Bohnki, 2014).

To date, there are no reliable figures on the prevalence of alcohol dependence among Swiss parents and the number of children and adolescents affected by it. However, SGB data can be used to estimate the prevalence of high-risk alcohol use among parents, which corresponds to the average daily alcohol consumption of at least 40g of pure alcohol (ca. 4 glasses of wine) per day for women and 60g of pure alcohol (approx. 6 glasses of wine) per day for men is equivalent to. 9 0.9% of parents exhibit such a pattern of use, which extrapolates to between 12,000 and 23,000 parents in Switzerland. In relation to the age group of 0-4-year-old children, Dratva, Grylka-Baschlin, Volken and Zysset (2019) arrived at a proportion of just under 2% of affected children of preschool age. High use is not only a health risk for the parent (including the risk of developing alcohol dependence), but it has potentially negative consequences for the children involved (u. a. Model learning in dealing with addictive substances).

Social relationships with peers

At the latest when children enter kindergarten, reference persons outside the nuclear family are added step by step to the social network of children and adolescents. Because of their similar interests and needs, peers are important play and conversation partners, and children often feel better understood by them than by adults. Having friendships and feeling supported by peers, then, has a positive impact on children and adolescents' psychological well-being (Inchley et al., 2016). No Swiss data are available on the relationship networks of children under eleven years of age.

Circle of friends of adolescents and young adults

The vast majority of 16- to 25-year-olds have supportive social relationships. However, 4.2% feel lonely quite often to very often.

The vast majority of 16- to 25-year-olds also have supportive social relationships, according to data from the 2017 SGB. This has not changed in the past ten years (SGB 2007, 2012). Young adults aged 21 and older in particular report supportive social relationships, which may have to do with couple relationships that are already widespread in this age group. Among 16- to 20-year-olds, the percentage of those who sometimes miss a person with whom personal problems can be discussed at any time is higher (see chart G2.7). However, this age group does not report feelings of loneliness more frequently than young adults aged 21 and older. Overall, 4.2% of 16- to 25-year-olds feel lonely fairly often to very often. As with 11- to 15-year-olds, adolescents and young adults in this age group who grow up in a family with a migrant background have a higher risk of lacking social resources and small support networks.

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