Exploring Strategies to Support Adolescent Mental Health after Parental Divorce: A Scoping Review

Abstract

The recent acceleration in divorce rates and diversification of nuclear families has resulted in an increase in single-parent households. Divorce is one of the most adverse events in a child’s life. Various literature highlights the detrimental effects of parental divorce on children and adolescents, but few studies have emphasized possible support strategies or interventions available to assist in the mental health of adolescents after divorce. The objective of this study was to gain an overview of the strategies and interventions available to adolescents exposed to parental divorce. The current study employed a scoping review method to evaluate the coverage of literature on strategies available to support adolescent mental health after parental divorce. The following databases were searched: Academic Search Premier, Africa-Wide Information, African Journal Online, CINAHL, and JSTOR. A total of eight studies were included in this review. The results show that most mental health interventions target the known mediator of risk, such as parenting problems or family conflict. Although the parents, caregivers, or teachers of these adolescents reported improvement after the intervention, the adolescents reported no effect.

1. Introduction

A family is a group of people bonded together by blood, a place of residence, and economic cooperation [1]. The environment that individuals experience influences their overall growth and development in many important ways as families, schools, neighborhoods, peers, and cultural aspects all play a vital role in shaping their development [2]. Healthy familial and social interactions and relationships are crucial to individual and family well-being. Relationships, however, may disintegrate, resulting in separation and/or divorce.

Divorce and separation can also influence the mental health of all individuals involved. Mental health is defined as a state of mental well-being that enables people to cope with the stresses of life, such as divorce; realize their abilities; learn well; and work well [2].

Divorce is described as a salient aspect of society as it results in rippling implications for the couple as well as for all other individuals involved, especially adolescents. Each year, a plethora of children worldwide experience the divorce or separation of their parents. Adolescents of divorced parents are said to be more likely to engage in risky sexual behaviors [3], live in poverty [4], have a reduced sense of belonging [5], and later experience their own family instability [6]. Furthermore, physical aspects that appear as symptoms amongst children include diminished sleep and appetite and a lack of concentration. A divorce, occurring for any reason, is a painful event for families and those closely affected, and the phenomenon is increasingly taking place in almost every society at a growing rate [7]. Decades of research focusing on the impact of the family on the health and well-being of children and adolescents shows that children living with both their parents, or their married biological parents, consistently have better physical, emotional, and academic well-being. Divorce is described as the end of old relationships and the start of new relationships, as both parties will encounter a new life, with fresh values and different lifestyles, and although some of the past challenges fade away, unfamiliar challenges may emerge. This may lead to further stressful experiences such as disruption in parent–child relationships, loss of emotional support from one or both parents, and economic hardship, as the house will only have one income. Moreover, other stressful life events may include moving to a different neighborhood, changing from one school to another, losing contact with grandparents, and paternal or maternal remarriage. In a post-divorce era, adolescents face problems in their material lives, their emotional well-being is affected, and, more generally, they experience challenges in terms of caring and socialization [7].

Due to the increase in social and cultural changes that are constantly taking place, in many countries where divorce was once a taboo, it is now becoming commonplace. Countries such as Iran and India, which once had very low levels of divorce, have been recording higher rates of divorce [7]. Adolescents’ adjustment to divorce in families is something of major concern. They are often the only members in the family who tend to lose in the process and aftermath of the divorce. For example, when parents remarry, the adolescents enter a new socialization process which means they need to assimilate, adapt, and adjust to the new family. This readjustment may mean a break in emotional attachments; additionally, they may feel a sense of loneliness and be undecided about which parent to live with [8]. Children are dependent on their parents for their needs longer than any other known species. This dependency may cause them to have a fear of abandonment [9]. Divorce is characterized by the absence of one of the parents. When one parent leaves, the adolescent may feel rejected. The loss adolescents feel at divorce is like that experienced when a parent dies. However, previous research has shown that the immediate reaction of adolescents to divorce does not predict their long-term outcomes [9].

In recent years, there has been an increase in the research investigating various spheres of adolescent development and life [10]. The findings of these studies highlight the paucity of research on adolescent mental health globally [11,12]. This is particularly concerning, as the rates of mental health diagnoses have increased considerably and a growing number of adolescents now require pharmacological and psychotherapeutic treatments [13,14]. Adolescents whose parents are separated due to divorce have an increased risk of emotional, social, and behavioral problems [13,14]. These may include acting out, an increase in depressive episodes, and difficulty adjusting to adversities and distress [13,14]. On average, adolescents experience more behavioral, emotional, physical, social, and academic problems after divorce compared to their peers from intact families. Thus, it is important to provide adolescents from divorced families with support that can buffer the effect that the divorce of their parents can have on them. Strategies and interventions in the current paper refer to both structured and unstructured programs available to adolescents to assist with their mental health during and after the divorce of their parents. Although research on the impact of parental divorce on adolescent mental health is not always clear in the literature, there is a general consensus among scholars that adolescents experiencing parental divorce are at a higher risk than their peers for a variety of negative developmental outcomes [15]. Thus, the present study aimed to gain an overview of existing strategies and interventions available to support adolescent mental health after parental divorce.

2. Materials and Methods

The aim of the current review was to present the evidence of strategies proposed or available for adolescents to support their mental health after their parents divorced. In order to address the aims of the current study, a scoping review method was employed. The present study was performed according to Reporting Items extension for Scoping Reviews (PRISMA-ScR) [16].

2.1. Search Strategy and Inclusion Criteria

A scoping review was conducted to address these aims of gaining an overview of the strategies or interventions available to adolescents during or after their parents’ divorce. It was carried out between the months of June 2022 and December 2022. The following databases were searched to identify relevant literature: Academic Search Premier; Africa-Wide Information; African Journal Online; CINAHL; and JSTOR. This investigation was followed by checking through the reference lists of relevant articles to see if there were any details or possible sources to include in the current review. Keywords used in the search included:

“adolescents or teenagers or young adults” AND “divorce or separation or divorced parents or break up or parting” AND “strategies or interventions” AND “mental health”.

For the current study, no language restrictions were applied during title and abstract screening; however, during data extraction, the articles eligible for inclusion were restricted to English language studies only.

In order to provide a comprehensive scope of the literature, the following were set as inclusion criteria: (a) the studies had to be published within the time frame of 2000–2022; (b) articles had to focus on or discuss strategies or interventions available for adolescents after or during divorce; and (c) the focus of the intervention or strategies had to be on the adolescent or youth’s mental health.

2.2. Selecting Information and Data Extraction

After removing duplicates and identifying possible articles, titles were screened, and thereafter abstracts were read, to determine whether they should be included or excluded. The authors (ER and LBK) reviewed all the documentation and extracted data about strategies and interventions that are either proposed or implemented for adolescents to promote positive mental health outcomes using a standardized form including the following information: author/s, year, country, methodology, population, key characteristics identified, and highlighted outcomes.

2.3. Reporting and Analysis of Data

Using tables, the studies included in the review were characterized in order of year of publication. The key characteristics of the interventions or strategies were summarized in the table text form.

2.4. Search Results and Included Studies’ Characteristics

To obtain an overview of the interventions and strategies available for adolescents of divorced parents, different types of interventions were considered, as well as strategies employed by any form of support such as counselors, teachers, local clinics, and local community centers, etc.

3. Results

As demonstrated in Figure 1 (the flow diagram of the review), out of the 84 results identified through the databases, title and abstract screening for keywords relating to the topic of interest was undertaken for all documents, and 33 documents were identified for full-text review. In total, eight articles that discuss the characteristics of various strategies and interventions available for adolescents of divorced parents were selected for the study. Various publication types were included, e.g., qualitative and quantitative studies, reports, and reviews. Four of the studies focused on the United States of America (USA); two were conducted in South Africa; one in China; and one in the Netherlands. The results are presented in

Table 1. Data extraction.

Author (Year)	Location	Methodology	Study Participants	Focus Area	Key Characteristics	Results
Johnson and Wiechers 2002 [17]	South Africa	Literature review followed by an empirical investigation.	8 adolescents	The paper focused on evaluating the effects of a specific group intervention that aimed to promote the self-concept of adolescents of divorce.	Eight adolescents whose parents only recently divorced were evaluated before and after taking part in a group intervention program. The program, which was 10 weeks long, was divided into an affective component, a cognitive component, and a support component focusing on conflict and anger management.	The results indicate that the program did not protect the adolescents from the effect of divorce; however, the findings of the research indicate that a group intervention program can reduce feelings of anxiety and depression and enhance the self-concept of adolescents.
Zhou et al. 2008 [18]	USA,	Randomized experimental trial	218 adolescents	The New Beginnings Program aimed to prevent mental health problems and promote competence in children from divorced families.	The program is a theory-based and parenting-focused preventive intervention which aims to assist with children’s adjustment to divorce; it has previously shown significant effects in reducing adolescents’ mental health and social adaptation problems, and in promoting competence.	The finding from this study indicates that program-induced improvement in maternal effective discipline mediated the intervention effect on adolescents’ GPA (grade point average). Program-induced improvement in mother–child relationship quality mediated the intervention effect on adolescents’ mental health problems.
Botha and Wild 2013 [19]	South Africa	Pilot study	25 adolescents	This paper incorporates a pilot study that aimed to evaluate the effectiveness of the Children of Divorce Intervention Program (CODIP) at two South African schools.	The CODIP is a preventative oriented group program which aims to foster resilience by helping children cope more effectively with possible problems brought about by their parents’ divorce.	The study indicates that children who experience parental divorce may benefit from participation in the CODIP. Although there was no statistically significant improvement in children’s understanding of divorce-related events, the results from teacher and parent reports indicated some improvement in children’s general adjustment after receiving the intervention.
Whitten and Burt 2015 [20]	USA	Intervention	Evidence-based literature that has been previously published	This study discussed group interventions as a method to assist Mental Health Counselors (MHCs) in their efforts to improve adolescents’ relational and social competencies.	The authors of this paper advocate for a creative combination of expressive techniques and group counseling as a method to improve adolescents relational and social competencies.	The use of expressive and group techniques potentially allows adolescents of divorced parents the opportunity to improve their social and relational skills and use them in a number of situations.
Boring et al. 2015 [21]	USA	Randomized experimental trial	147 adolescents	The study evaluates an online coping skills program—Children of Divorce–Coping with Divorce (CoD–CoD)—that aims to prevent mental health problems in children and adolescents from separated or divorced families.	The study evaluates the effectiveness of CoD–CoD which aimed to strengthen coping after divorce and reduce mental health problems of youth while maximizing program completion rates. The CoD–CoD program focuses on improvement of four aspects of coping that have been associated with adjustment of youth following parental divorce, namely: increased active coping; coping efficacy; reduced avoidant coping; and negative divorce appraisals.	The findings from the study indicate that CoD–CoD improved self-reported mental health outcomes for children of divorce, and that some of these effects were stronger for youth with higher baseline problems.
Pelleboer-Gunnink et al. 2015 [22]	Netherlands	Randomized controlled trial	156 adolescents	This study utilized a randomized controlled trial to evaluate the school-based, child-directed prevention program Kids in Divorce Situations (KIDS).	The study focuses on social support and learning of social problem-solving skills, which are enhanced through role-playing, conversations, and assignments.	The study found that children with a good father–child relationship are relatively unaffected by adversity surrounding divorce. In addition, children experience decreased contact with their father as a primary negative effect of divorce.
Huang 2020 [23]	China	Review	Existing literature from previous reviews or research studies	This article made use of previous literature to review the risk factors that may result in parental divorce to be a crisis, and also the protective factors that may shield children from potential problems.	The study identified interventions with three age groups shown to prevent or reduce children’s post-divorce adjustment problems, which were then discussed.	Through this review, the author identified cognitive behavioral therapy or nondirective counseling as interventions that can help identify emotions and conceptualizations that are not adaptive in their current situations.
Hara et al., 2022 [24]	USA	Experimental design	9 adolescents	This study investigated the effects of a highly interactive online cognitive behavioral youth coping program.	The Children of Divorce–Coping with Divorce (CoD–CoD) program targets active and avoidant coping, coping efficacy, and divorce appraisals.	The study found that CoD–CoD interrupted an average decline in daily feelings such as happiness, energy, and calmness in a sample of youth exposed to high-interpersonal conflict divorce.

below and discussed in more detail thereafter, with the focus being the identification of available strategies and interventions for adolescents of divorced parents.

Review Findings

The current study aimed to evaluate the coverage of literature on strategies available to support adolescent mental health after parental divorce. Overall, the eight studies that were included in the current paper noted that adolescents whose parents are divorced are at an increased risk of a variety of psychosocial problems. These include, inter alia, lower self-concepts; high levels of anxiety and depression; and maladaptive development and behavior, such as trouble controlling their anger and displaying risky behavior, e.g., drinking and smoking [17,18,19,20,21,22,23]. To alleviate certain risks during adolescents’ parents’ divorce, the researchers Johnson and Wiechers employed a ten-week program [17]. The program was divided into three components, namely: an affective component, with a cognitive component and a support component focusing on conflict and anger management. Johnson and Wiechers’s program shows that a group intervention program can reduce feelings of anxiety and depression and enhance the adolescent’s self-concept, thus indicating that interventions focused on reducing these psychosocial problems are beneficial to adolescents of divorced parents [17].

In addition to reviewing literature on the possible risk factors that may result from parental divorce, and which usually contribute to parental divorce becoming a crisis, Huang also reviewed literature on the possible protective factors, e.g., good parent–child relationships [23]. The latter study found that cognitive behavioral therapy or nondirective counseling can assist in alleviating the possible risks. Adolescents in Huang’s study recognized the emotions and conceptualizations that are not adaptive in their current situations. Furthermore, the researcher identified that group therapy might be a more useful method of intervention for adolescents [23].

Many researchers tend to focus on family relationships after divorce and its impact on the lives of everyone affected. Zhou et al. attempted to implement an intervention which aimed to prevent mental health problems and promote competence in adolescents from divorced families through a theory-based and parenting-focused preventive intervention [18]. These scholars, in their attempt to help adolescents adjust to parental divorce, found that their program helped with adolescents’ school performance and improved the overall relationship quality between adolescents and their parents and other important relationships.

Similarly, Pelleboer-Gunnink et al. sought to evaluate a school-based intervention directed at children using a randomized controlled trial [22]. Their study found that father–child communication is specifically relevant, and that the quality of the father–child relationship is a resilience factor in post-divorce child adjustment. This suggests that children with a good father–child relationship are relatively unaffected by adversity surrounding divorce [22]. Furthermore, their study suggests that a school-based intervention for children can be effective in encouraging children’s emotional well-being and parent–child communication after parental divorce.

Similarly, Botha and Wild evaluated the effectiveness of the Children of Divorce Intervention Program (CODIP) at two South African schools [19]. The results suggest that children who experience parental divorce may benefit from participation in the CODIP. According to the results from teacher and parent reports, it was indicated that some improvements were seen in adolescents’ general adjustment after receiving the intervention.

Furthermore, Boring et al. evaluated the online coping skills program which aims to prevent mental health problems in children and adolescents from divorced or separated families [21]. Their study assesses the efficacy of a five-module online program named Children of Divorce–Coping with Divorce (CoD–CoD) that was intended to strengthen post-divorce coping and decrease mental health problems of youth while maximizing the rate at which the program is completed.

Likewise, Hara et al. [24] investigated the effects of the highly interactive online cognitive-behavioral youth coping program, CoD–CoD [24], on children exposed to high levels of interparental conflict (IPC). The CoD–CoD program focuses on active and avoidant coping, coping efficacy, and divorce appraisals through psychoeducation delivered via videos and narrated text, interactive activities to learn and practice coping skills, testimonials, and tracking of skills practice. The latter study aimed to build on the existing evidence of CoD–CoD’s efficacy. Based on the results of the two existing experimental trials—the studies by Boring et al. [21] and Hara et al. [24]—CoD–CoD may be considered a promising program for children and adolescents of divorced parents to help reduce adjustment problems for children from separated and or divorced families, including those experiencing high levels of IPC.

Overall, through the report of parents and, in a few cases, adolescents, it should be noted that adolescents benefited from programs that utilized group settings as a form of implementing their interventions or strategies [17,18,19,20,21,22,23]. Furthermore, an effort to alleviate present stressors such as maladaptive behavior and poor parent–child interaction is beneficial for both parents going through divorce and their adolescents. Assisting adolescents in understanding their parents’ divorce, making sense of the changes brought about by the divorce, and expressing their own feelings and needs in a group setting has been reported as beneficial to the mental health and well-being of adolescents. Furthermore, the restoration and emphasis on the parent–child relationship and communication is regarded as pivotal in the implementation of interventions to foster better mental health outcomes. It is believed that a good parent–child relationship assists with better adaption of the adolescent after the divorce.

4. Discussion

Divorce, which has become an increasingly common phenomenon in families across the globe, is a stressful experience for adolescents. There are multiple factors determining whether adolescents can adjust well after parental divorce. When designing the appropriate interventions for adolescents of divorce, it is better to take the possible risk and protective factors into account that have the ability to reduce the adolescents’ adaption or protect them from worse outcomes. Under optimal circumstances, stressors are transitory and manageable. Ubiquitous stressors include those that are related to practical transitions (changes in household composition, residency, school, and neighborhood) that are inherent to reorganization of the family structure. Other stressors, such as IPC, parental distress, loss of time with one or both parents, and reduced economic resources represent an increased burden for some adolescents [25,26]. The adjustment to divorce presents a considerable challenge to families with adolescents and initiates a developmental shift felt throughout the family system. Working at multiple levels at once is often necessary in helping families navigate these complex interrelationships and progress toward honoring the connections among members old and new, while supporting effective boundaries around new family structures.

It is evident in the literature that group interventions implemented through support structures such as schools, clinics, and churches are widely used and have been proven to show changes in adolescents with previous behavioral, social, and emotional problems. The adolescents in these studies did not report any changes, but close related family members, such as their parents, described changes in the behaviors of the adolescents [17,18,19,20,21,22,23]. Overall, these studies suggest that protective factors, such as close and secure relationships with both parents after divorce, are essential in promoting adolescent mental health, as well as providing them with an opportunity and a safe space to express their feelings and how the divorce has affected their overall well-being. Adolescents may also benefit from the opportunity to ask questions in a safe environment with the significant adults in their lives. Thus, it is recommended that strategies focus on group settings that equip adolescents with skills that could help them adapt cognitively, emotionally, and socially with a focus on their relationships with both their parents after divorce. It is important that interventions become accessible to adolescents in environments they regard as safe spaces, such as the schooling environment or on an online platform. Future researchers should discuss the results and how they can be interpreted from the perspective of previous studies.

Professionals, such as counselors, psychologists, or mental health workers, can play an important role in facilitating the mediation process between parents to guarantee, where appropriate, the endurance of a cooperative parental relationship in which adolescents’ access to their non-residential parents can be negotiated. Where mediation is not possible, family courts can play an important role in determining what constitutes appropriate access to a non-residential parent, as adolescents benefit greatly from continuity in the quality of their living circumstances. However, these recommendations have implications in terms of cultural, legal, and economic spheres. In terms of culture, it is believed that mothers should carry the burden of taking care of the children; however, in many cases, this is not possible, as these women are often financially dependent on the husband and, after divorce, the mother loses her economic stability, which affects the overall well-being of the children. Secondly, research recommends that both parties be actively involved in the lives of their children, which is often not possible. Additionally, legally, the child’s mental health needs to be considered when decisions of custody and visitation are made.

5. Recommendations

The findings of the current study indicate that parental divorce affects adolescent well-being in a variety of ways. Although interventions are currently made available to assist families in their divorce process, limited to no information is available on strategies that are in place to help adolescents through this difficult time. The studies highlighted in the current paper indicate that interventions and strategies focused on group settings with parental involvement could assist in the adaption of adolescents after their parents’ divorce. Thus, a focus on cognitive behavioral aspects, as well as social and interpersonal relations, such as communication between parent and child—particularly the father–child relationship—could foster better outcomes for adolescents. It is also recommended that safe spaces such as schools, churches, or community centers, which are familiar spaces to adolescents, be used to implement these interventions through community projects or after school support groups. Furthermore, Whitten and Burt [20] encourage a creative combination of techniques for expressive and group counseling, as their study found that the use of expressive and group techniques allows members the opportunity to improve their social and relational skills and use them in diverse situations in which they may be needed [20].

6. Conclusions

This study aimed at reviewing literature to present evidence of the strategies and interventions available to support adolescents’ mental health after parental divorce. The findings from this review support previous literature, which states that parental divorce profoundly influences the individuals that develop in these environments. Thus, adaptive coping is needed to deal with these stressors. Adolescents of divorced parents have an increased risk of a variety of problems in comparison to adolescents from intact families. Fostering well-functioning adolescents who are overall satisfied in all aspects of their lives is a key contributor to optimal development. It is recommended that strategies focus on group settings that equip adolescents with skills that could help them adapt cognitively, emotionally, and socially, with a focus on their relationships with both their parents after divorce. In conclusion, divorce is an event that has the potential to affect adolescents in several negative ways. Although some groups may focus on divorce, few discuss creatively combining expressive techniques and group work. This study adds to the body of literature and provides key insights into the basic characteristics of strategies or interventions to support adolescents’ post-divorce. Several intervention programs have been developed and directed at adolescents of divorced parents, yet empirical data on the effectiveness of these interventions are limited.