Child-Caregiver Relational Closeness and Child Mental Health in Nonparental Care Settings

This dissertation examines child-caregiver relational closeness and child mental health within nonparental care systems in Low- and Middle-Income countries (LMICs). Five key factors impacting the well-being of orphaned, separated, and vulnerable children in LMICs are explored using the Positive Outcomes for Orphans (POFO) dataset: child maltreatment, social support, child-caregiver relationships, and nonparental care systems. First, I examined the relationship between maltreatment, social support, and mental well-being. Findings showed that maltreatment was associated with lower mental well-being, where social support (emotional support, tangible support, positive social support) was associated with greater mental well-being, even in the concurrent presence of maltreatment. Second, I examined the association between child-caregiver relational closeness and child mental well-being. Child-caregiver dyads where both the child and caregiver reported close relationships had the highest level of mental well-being. Discordance between child-reported and caregiver-reported closeness led to greater differences in mental well-being, with child-reported closeness being the stronger indicator of child mental well-being. Finally, I introduce the Structural Iatrogenesis framework, which examines how bureaucratic nonparental care systems that are designed to protect children may worsen child mental health. Policy and practice implications are outlined based systemic facilitators and barriers, including prioritizing kinship care, harnessing technological resources, and enforcing global standards of care. These findings highlight the need for a comprehensive approach to addressing child mental health within global nonparental care systems, emphasizing the importance of enhancing child social support, strengthening child-caregiver relational closeness, and reforming care systems to better support the needs of vulnerable children and youth.