15581-m-nanninga

SOCIAL SUPPORT AND PARENTING SKILLS 99 DISCUSSION We found that children of families with low family social support and parents with poor parenting skills were more likely to enrol in psychosocial care. Children’s psychosocial problems mediated this association rather than moderating it. The association between poor parenting skills and psychosocial care enrolment was completely mediated by children’s psychosocial problems and the association of family social support partially. We found no association between positive parenting and children’s enrolment in psychosocial care. Interpretation and fit with other studies To our knowledge, this study is the first to examine the associations between family social support, parenting skills and children’s enrolment in a broad field of psychosocial care, i.e. comprising preventive child health care, child and adolescent social care, and child and adolescent mental health care. Our finding that low family social support is associated with children’s psychosocial care enrolment is in accordance with studies in the field of child and adolescent mental health care, showing that children and adolescents in families receiving little social support are more likely to enrol in this kind of care [26,30]. The finding that low family social support is directly related to children’s psychosocial care enrolment suggests that a family’s need for professional care originates to a significant extent in problems in the family and is not only based on problems of the child [48]. However, a family may also receive less social support because their child is involved in psychosocial care, for example because of the stigma attached to psychosocial problems [49,50]. Poor parenting skills, i.e. poor supervision and inconsistent disciplining, were also associated with a higher likelihood of children’s enrolment in psychosocial care. The finding that positive parenting was not associated with children’s care enrolment could be due to the fact that the vast majority of the included parents scored high on the positive parenting subscale. This high mean score may reflect parents’ tendency to provide socially desirable answers in a society in which this type of parenting, i.e. positively reinforcing good child behaviour, is currently receiving a great deal of attention [51]. Children’s psychosocial problems mediated rather than moderated the associations examined. This means that children of families with low family social support were more likely to have psychosocial problems and that these problems in turn made enrolment in psychosocial care more likely. This may be interpreted as meaning that social support for the family might buffer the impact of children’s psychosocial problems, or in some cases