Participation Mediates the Relationship Between Family Climate and Mental Well-Being Amongst Children with and Without Disability in a Cross-Sectional Swedish Registry-Based Study

Poor mental health (problems and well-being) among children, particularly those with disabilities, represents a significant individual and public health burden, with multifactorial origins including family environment and participation limitations. Family climate also impacts participation, suggesting the three structures may be interlinked. Furthermore, children with disabilities face additional obstacles increasing their vulnerability to poor mental health, such as limitations to participation. Therefore, the present study aimed to (1) investigate whether participation mediated the relationship between family climate and mental health and (2) whether possible relationships differed by disabilities. The Swedish Statistics (SCB) register on the conditions of life for children (barnULF) was utilised. This interview-based registry study employs a repeated cross-sectional design, where children are recruited yearly and invited to participate in the study. The present study used data from 2013-2019, resulting in 3676 children aged 10-18, of whom 510 reported some type of disability. Structural Equation Models (SEMs) mediation analyses were conducted to assess the possible mediating role of participation between family climate and mental health (well-being and problems separately), including models with and without covariates (age and gender). Multigroup analyses were conducted to assess whether children with and without disability differed. Results showed that participation significantly mediated the relationship between family climate and mental well-being but not mental health problems, amongst all children. Models including covariates indicated mediating models for both well-being and problems, but only amongst children without disabilities. However, model fits were poor. Implications of the study direct preventative strategies to focus on family climate as a route to improve mental well-being and highlight the importance of earlier strategies amongst children with disabilities and in particular girls.