Parental Rejection and Mental Health Problems in College Students: Mediating Role of Interpersonal Difficulties

Received 22 Dec, 2017

Accepted 28 Mar, 2019

Published 30 Sep, 2019

College students are said to have an increasing trend of mental health problems that lead to various negative academic, personal and social outcomes. The current study aimed to determine the mediating role of interpersonal difficulties between parental rejection and mental health problems of college students. A total of 321 college students selected through purposive sampling aged 15to 20 years provided self-report data on EMBU-A (Gerlsma, Arrindell, Van der Veen, & Emmelkamp, 1991), Urdu version of Depression Anxiety Stress Scale (DASS; Aslam, 2007) and Interpersonal Difficulties Scale (IDS; Saleem, Ihsan, & Mahmood, 2014). Pearson Correlation was used to ensure that parental rejection, mental health problems and interpersonal difficulties are related. Results of path analysis revealed that parental rejection has an indirect effect on mental health through interpersonal difficulties. Implications for counselling services are discussed.

College is an important venue when one learns not only academic skills, emotional maturity but also social etiquettes. College years are said to be very crucial developmental years because of the transition from childhood to adulthood (Blimling, 2003). College years is considered a very important step in an individual life yet it brings many stressor, challenges and issues including physical maturation, new meaning to self, autonomy from the family, sense of independence and expanding social interactions (Bayram & Bilgel, 2008). This new changing environment needs a great deal of demands ranging from leaning of new academic and communication skills, personal adjustment related to goal orientations and career and interpersonal relationships (Rodgers & Tennison, 2009).

All these changing demands and constant adjustment may make college students more vulnerable for developing mental health problems (Eisenberg, Gollust, Golberstein, & Hefner, 2007). A substantial proportion of college students are suffering from mental health problems (Hunt& Eisenberg, 2010) where anxiety and depression tops the list (Shiels, Gabbay, & Exley, 2008). In a prevalence study of Turkish college students Bayram and Bilgel (2008) found that around 27% reported moderate or above severity of depression 41% and 27% were reported moderate and above level of anxiety and stress. In a local study on 1850 university participants, the prevalence of mental health problems was found around 31% showing an alarming trend in mental health functioning in Pakistan (Saleem, Mahmood, & Naz, 2013).These mental health problems are transitory in nature but if they persist may result into serious negative outcomes that may hamper the normal functioning of the college students. These consequences ranges from drug abuse and violence (Pauley, & Hesse, 2009), low self-esteem (Pajor, Broniarczyk-Dyła, & Świtalska, 2015), loneliness (Fiori & Consedine, 2013), poor academic performance (Deb, Strodl, & Sun, 2014), disrupted life satisfaction (Tamini & Far, 2009) and so on.

Another important challenge of college years is ever expanding social demands where social relationships become more intense and demanding and individual has to learn new skills to handle social interactions that help an individual improve psycho-social and emotional functioning (Al-Khatib, Awamleh, & Samawi, 2012; Yeun & Woo, 2018), failure to do so may result in relationship and interpersonal problems (Lange & Couch, 2011). Interpersonal difficulties can be defined as recurrent problems encountered by an individual while interacting with others (Horowitz, Rosenberg, & Bartholomew, 1993). Interpersonal problems and mental health concerns are found to be associated e.g. individual having poor interpersonal relationship may experience isolation (Davila & Beck, 2002), depressive symptomatology and low self-esteem (Huprich Lengu, & Evich, 2016; Katz, Conway, Hammen, Brennan, & Najman, 2011). Keeping in view of the long term negative consequences of interpersonal problems on the social-emotional and personal functioning of an individual, the current research will address the role of interpersonal difficulties as a mediator for mental health problems in college students.

An alarming increase in the prevalence and intensity of mental health problems in college students has attained attention from the researchers to identify yearly and timely risk and protective factors. One of the most fundamental factor is the quality of parent-child relationship, which has been studied from different theoretical frame works. The pioneer work of attachment theory on this impotent bond postulates that every individual built an internal working model based on his relationship with attachment figure, that model becomes a template for future relationship with others (Bowlby, 1973). Secure attachment style would result into a positive image about oneself and others, whereas, if a child has an insecure bond would perceive other relationships as untrustworthy and rejecting (McFadyen-Ketchum, Bates, Dodge, & Pettit, 1996). Another view point came from Baumrind (1966) about parenting prototype comprising three distinct parenting styles namely authoritative, authoritarian and permissive parenting. Parental acceptance-rejection is another theoretical framework that explains that parent-child relationship can be described in two dimensions namely parental acceptance which is characterized by affection and quality relationship, rejection on the other side, comprised rejection and distant relationship (Rohner, Khaleque, & Cournoyer, 2005).

Parent-child relationship has a long lasting impact on the growth and development of an individual and there are number of studies carried out in literature to investigate the influence of parenting of individual functioning. Research evidence suggest that if parenting is supportive, warmth, and encouraging the consequences would be in high self-esteem (Antonopoulou, Alexopoulos, & Maridaki- Kassotaki, 2012), high academic performance (Seth & Ghormode, 2013) and so on. If a child perceive his parenting as rejecting and dismissing tend to experience more internalizing and externalizing problems (Aunola & Nurmi, 2005), anger and hostility (Muris, Meesters, Morren, & Moorman, 2004) and lack of emotional regulation (Ebrahimi, Kharbou, Ahadi, & Hatami, 2015). Parenting styles and rearing practices not only influence personal and emotional aspect of individual’s life but also how he relates and interact with other people. Number of studies shown that individuals who perceive rejection and distance from their parents have a greater deal of difficulty in social interactions, experience isolation and unable to develop and maintain social relationships (Altay & Gure 2012; Mallinckrodt, 2000).

Another line of research is devoted to identify the cultural influence on the parenting styles and the differential impact on the mental health functioning of individuals (Chao, 1994). In individualistic culture, authoritative parenting is considered as controlling and interfering where in collectivistic cultures, authoritative parenting is viewed as a sign of love and affection (Saleem, Mahmood, & Subhan, 2015). In individualistic culture, where autonomy and independence is valued, parents promote and facilitate self-reliance, self-growth and assertiveness (Tamis-Le Monda et al., 2007). In collectivistic cultures, conformity and dependence is promoted and cultivated and parents tend to control and guide and expect greater deal of submissiveness and obedience (Chao & Tseng, 2002). In Pakistan being a collectivistic and religious society, parents are considered a source of emotional, moral, religious and social guide where both parents have distinct roles to play and have differential impact on children. In this tradition culture, parental acceptance and approval is much needed.

To conclude the above literature, we can say that parent-child relationship has a long lasting impact on the growth and development of an individual. Parenting styles may play a role of a risk or a protective factor in the development of mental health problems in college students that lead to serious short and long term negative consequence. Parental attachment pattern play a role of an internal working model that become a base for future interpersonal and emotional relationship. The present study was designed to study the association of perceived parental rearing practices, interpersonal problems and mental health problems in a sample of Pakistani college students. As mentioned earlier, Pakistani is a collectivistic culture, where parents and family have been given more importance than the individual himself and parents play a key role in the growth and development. Most of the previous studies have looked at the combined influence of parenting on mental health functioning. In addition to investigation the association, this study also aimed to identify the differential impact of fathers and mothers on the development of interpersonal problems and mental health functioning. Therefore, the current research is aimed to find out the predictive relationship between parental rejection and mental health problems in college student, and to identify the mediating role of interpersonal difficulties in mental health problems.

The objectives of present study are:

1. To find out the predictive relationship between parental rejection and mental health problems among college students.
2. To identify the mediating role of interpersonal difficulties on the relationship between parental rejection and mental health problems among college students.

METHOD

Sample
A purposive sampling technique was used to select a sample of 321 participants (54 % boys and 46% girls) of two classes (53% 1^st year and 48% 2^nd year) from four different colleges of the Lahore with the age range of 15-20 (M =17.32, SD = 1.00). The four government colleges of Lahore were selected randomly, two boys and two were girls’ colleges. Most participants were between 15 and 20 years of age and were living with their both parents.

Measures
Demographic Form. Demographic Form comprised the basic information of the participants namely age of the participants, class, gender, and family system were included in the current research.

My Memories of Upbringing (EMBU-A). EMBU-A (Gerlsma, Arrindell, Van der Veen, & Emmelkamp, 1991) was used to measure Perceived Parental Rejection. EMBU-A comprised two forms for father and mother separately. The scale consisted of 27 items with three factors, Emotional warmth, Rejection and overprotection. EMBU-A is a self-report measure that provides individual perception of parental rearing practices. In the current paper, only Rejection (6 items) subscale was used for both parents in Urdu (The National language of Pakistan). The response options are 0(Never), 1(Sometimes), 2(Often) and 3(Always). For the present study, Cronbach’s alpha of all two subscales for fathers and mothers (Rejection α = .78, .74 respectively). The scoring range is between 0-18 and higher score represents more perceived rejection form both parents

Interpersonal Difficulties Scales. Interpersonal Difficulty Scale (IDS) was used to assess the interpersonal problems consist of 59 items (for more details Saleem, Ihsan, & Mahmood, 2014). The scale was used to measure six dimensions of interpersonal problems and the Cronbach’s Alpha for six subscales (Proneness to passivity = .83; Low self-confidence α = .87; Lack of social support α = .77; Lack of assertiveness α = .89; Lack of boundaries α = .79; and Unstable relations α = .83). Items were scored from 0 to 4. The response options were 0(never), 1 (rarely), 2(sometimes), 3(often) and 4(always). The scoring range is between 0-236 and higher score represents more interpersonal difficulties

Depression Anxiety Stress Scales – Short Form (DASS-SF). Urdu (The National language of Pakistan) version of Depression Anxiety Stress Scales (DASS; Aslam, 2007) originally developed by Lovibond and Lovibond (1995) was used to measure the mental health problems in college students. DASS is a self-report measure which comprised 21 items. The response options of this measure are; (0) not at all, (1) occasionally, (2) often and (3) always. In the current research, we used the total score, which had a Cronbach’s alpha of .88 in our sample. The scoring range is between 0-63 and higher score represents more mental health problems.

PROCEDURE

Institutional Ethical Committee approved the research project for any ethical consideration. Six Government sector colleges of Lahore were initially contacted and briefed about aims and objectives of study. Four colleges provide consent for data collection, after obtaining official permission from the authorities, research participants were contacted through the respective Deans/HODs who further provided an enrollment list of students and after considering the inclusion criteria (age range of 15-20 and living in an intact family), every 3^rd participant was selected from the list. Selected participants were then approached with the help of class instructors. Data were collected in groups of approximately 15 to 20 students using pencil-and-paper measures. After reviewing informed consent, participants completed the research protocol of measures comprising a demographic from, EMBU-A, IDS and DASS. Participants spent average 20 minutes to complete the research protocol. At the end a debriefing session was carried out for any quarries of the participants. Initial data comprised 330 participants but 9 research protocol discarded on the basis of incomplete information. The final analysis was carried out on 321 participants.

Inter-correlations between the variables
Person’s correlation was applied to determine the relationship between parental rejection, interpersonal difficulties and mental health problems of college students (Table 1). As predicted both father and mother rejection has significant positive relationship with mental health problems and interpersonal difficulties of the college students p < .001.

Table 1:	Summary of Interfactor Correlations of Parental Rejection, Interpersonal Difficulties and Mental Health Problems of College Students (N = 321)
Note. DASS Total =Depression Anxiety Stress Scale Total, IDS-Total=Interpersonal Difficulties Scale Total df=320, ***p<0.001

Table 1 indicates that a high positive relationship was found among parental rejection, mental health problems and interpersonal difficulties in college students. In other words, higher perceived parental rejection is positively associated with more mental health problems and poor interpersonal relationship in college students.

Interpersonal Difficulties as Mediator Between Parental Rejection and Mental Health Problems
To test the mediation effects of interpersonal difficulties between parental rejection and mental health problems, Model 4 of PROCESS (72) software was used.

Table 2:	Role of Interpersonal Difficulties as a Mediator between Father Rejection and Mental Health Problems in College Students (N=321)
*p<0.05. ***p<0.001

Table 3:	Role of Interpersonal Difficulties as a Mediator between Mother Rejection and Mental Health Problems in College Students (N=321)
*p<0.05. ***p<0.001

Table 2 and 3 represents the results of mediation analysis based on two predictors. The mediation model included parental rejection where father’s and mother’s rejection was taken as separate independently variables, interpersonal difficulties as mediator and mental health of college students as outcome variable for both predictors. The results were consistent with the correlation results where total effect of father’s and mother’s rejection on the student’s mental health had significant and positive relationship. The direct effect of the father’s rejection on mental health functioning was by controlling the mediating variable interpersonal difficulties was significant (b = .20, ^***p< .001). The direct effect of mother’s rejection on mental health functioning was by controlling the mediating variable interpersonal difficulties was also significant (b = .29, ^***p<.001).

Further, to confirming the significant full mediation effect, the indirect effect was also significant where both father and mother rejection predict positively with the interpersonal difficulties of the college students (Father: b = .12, ^*p<.036) with the R² = .01 and F =4.41; (Mother: b = .16, ^***p<.004) with the R²= .03 and F=8.08. The path b where the mediator interpersonal difficulties are showing the direct effect on the outcome variable that is mental health of college students also showed significant positive relationship (Father: b = .40, ^***p <.001); (Mother: b=.38, ^***p <.001).

Fig. 1: Mediation Path Framework of Father’s Rejection, Interpersonal Difficulties and Mental Health Problems of College Students

The overall effect of the model was showing the role of mediator interpersonal difficulties between parental rejection and mental health of the college students is significant but less than the direct effect of the predictor variable on outcome variable (Father: b=.16, ^***p<.001); (Mother: b=.23, ^***p<.001). To determine the reliability of these paths 5000 bootstrapping iterations was used that also showed significant results. Therefore, the overall results showed that that maternal rejection has more significant effect than paternal rejection on mental health problems.

Fig. 2: Mediation Path Framework of Mother’s Rejection, Interpersonal Difficulties and Mental Health Problems of College Students

DISCUSSION

College years are said to be a transition between adolescent to adulthood. During this phase of rapid bio-psycho-social growth and development, individual need to learn new skills to adjust with ever changing demands and expectations. Failure to adjust and cope with academic, parental, personal, emotional or social challenges, college students may be at greater risk of mental health problems. Many prevalence studies (e.g. Saleem et al., 2013) have shown that a large number of college students are suffering from serious mental health problems which may result into negative consequences. Therefore, current research is focusing on identifying different risk and protective factors that may lead or prevent college students from mental health problems. Another important dimension of growth and development of an emerging adult is expanding social demands, where individual need to learn new social skills to adjust with social expectations, pressures and challenges (Saleem, Mahmood, & Naz, 2013). During this phase of dealing with authority, living in a socially and academically competitive environment, a college student may experience interpersonal difficulties (Rodgers & Tennison, 2009).

Among other many risk factors, parenting may play a role of a risk or protective factor for emerging adult for interpersonal problems and mental health concerns. A wealth of research evidence revealed that the quality of early parent-child experience continue to influence child relationship in later years (Ikiz & Caker, 2010). Attachment theory has emphasized that child secure attachment with the caregiver especially the mother, tend to provide a secure base for self, gives a sense of security and help the child to develop health social interactions (Arbona & Power, 2003).Similarly in terms of parenting styles and perceived parental practices, rejection and control from parents may lead to different internalizing and externalizing problems (Saleem et al., 2015).

Keeping in view the importance ofparent-child relationship that continue to influence intrapersonal and interpersonal domains of an individual life , the present study aimed to investigate the possible mediating role of interpersonal difficulties in relations to parental rejection and mental health problems in college students. The present study contributed significantly in highlighting that interpersonal difficulties mediate the relationship between parental rejection and mental health problems. The findings of the current research are in line with previous literature that parental rejection lead to more mental health issues (e.g. Muris et al., 2004).Literature has supported the notion that if an individual perceive his parental bond rejecting, distant and dismissing tend to experience lack of self-competence, low self-esteem (Aunola & Nurmi, 2005).

One of the most interesting findings of the current research is the most significant predictor of interpersonal problems and mental health problems is maternal rejection. In collectivistic culture, parents tend to play a significant role in shaping behavior and learning of value system (Chao & Tseng, 2002). Mothers have distinct roles to play in collectivistic cultures where childhood period is somewhat prolonged and children get more time to spend with their mothers. Mothers are considered as a source of love, concern and care and children share more with mothers. Fathers, on the other hand, is considered as a sign of power, control and aloof and mainly responsible for earning for the family. Mother -child relationship is more expressive, relax and mothers usually play a mediating role between father and the children. Keeping in view the importance of this crucial and critical bond, if a child perceive rejection from mother may lead to more serious negative consequences.

CONCLUSION

The present study provides an empirical evidence that interpersonal difficulties of college students mediate between prenatal rejection and mental health problems. Specifically speaking, maternal rejection is more critical and crucial in Pakistani collectivistic cultural context that becomes a more significant risk factor for mental health functioning of the college students. Early and timely intervention and awareness programs re needed for college students to prevent them from the negative consequences of interpersonal difficulties and mental health problems both at within and outside college campuses.

LIMITATIONS AND SUGGESTIONS

There are number of limitations observed in the current research. Firstly, in the current research, cross-sectional research design was used. Future research may focus on identifying the mediation role through a longitudinal data. A second limitation is the research participants, the current study college students were participated who were enrolled in public sector colleges of highly urbanized city. The future research may also look into not only diverse population with different cultural and sub cultural backgrounds. Another limitation is related to the measure which we used in our research based on the early childhood memories of upbringing of parental raring practices. A more direct approach can be used by involving both parents and adult children to identify the relationship among parental bonding, interpersonal difficulties and mental health problems. Therefore, it is important to establish the generalizability of research findings on a more diverse population outside college. Finally, the implication of this research is to consider these risk and protective factors as the important components in the interventional programs of college students counselling services. The counselling programs needs to address these issues to reduce the mental health problems by enhancing the communication of college students with themselves and others.

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