Child Mental Health Survey Research Articles

Characteristics of children with a psychiatric disorder in 1999, 2004 and 2017: an analysis of the national child mental health surveys of England.

While research has described the profile of children with poor mental health, little is known about whether this profile and their needs have changed over time. Our aim was to investigate whether levels of difficulties and functional impact faced by children with a psychiatric disorder have changed over time, and whether sociodemographic and family correlates have changed. Samples were three national probability surveys undertaken in England in 1999, 2004 and 2017 including children aged 5-15 years. Psychiatric disorders were assessed using the Development and Well-Being Assessment (DAWBA), a standardised multi-informant diagnostic tool based on the tenth International Classification of Diseases (ICD-10). The impact and difficulties of having a disorder (emotional, behavioural or hyperkinetic) were compared over time using total difficulty and impact scores from the Strengths and Difficulties Questionnaire (SDQ). Analyses explored the impact of having any disorder, as well as for each disorder separately. Regression analyses compared associations between disorders and sociodemographic factors over time. Parent- and adolescent-reported total SDQ difficulty and impact scores increased between 1999 and 2017 for children and adolescents with disorders. No differences were noted when using teacher ratings. No differences in total SDQ difficulty score were found for children without a disorder. Comparison of sociodemographic correlates across the surveys over time revealed that ethnic minority status, living in rented accommodation and being in the lowest income quintile had a weaker association with disorder in 2017 compared to 1999. Our study reveals a concerning trend; children with a disorder in 2017 experienced more severe difficulties and greater impact on functioning at school, home and in their daily lives, compared to children with a disorder in earlier decades. Research is needed to identify and understand factors that may explain the changing nature and level of need among children with a disorder.

Risk of new onset and persistent psychopathology in children with long-term physical health conditions: a population-based cohort study.

Children and young people (CYP) with long-term physical health conditions (pLTCs) have increased risk of psychopathology compared to physically healthier peers. We explored risk factors for new onset and persistent psychiatric disorders in CYP with pLTCs compared to CYP without pLTCs. This 3-year follow-up study involved a UK representative sample of CYP from the British Child and Adolescent Mental Health Surveys (N = 7804). We examined potential baseline predictors of new onset and persistent psychiatric disorders at follow-up in four groups of children based on the presence of any physical and/or any psychiatric conditions at baseline. Psychiatric disorders were assessed using standardised multi-informant diagnostic assessment. Separate multivariable binary logistic regressions were conducted for each group. In CYP with pLTCs, rented housing (aOR = 1.42, 95% CI 1.01 to 1.99), non-traditional family structure (aOR = 2.08, 95% CI 1.42 to 3.05), increased parental distress (aOR = 1.09, 95% CI 1.04 to 1.14), and greater peer relationship difficulties (aOR = 1.29, 95% CI 1.19 to 1.39) predicted future psychiatric disorder. Only peer relationship difficulties predicted persistent disorder (aOR = 1.27, 95% CI 1.17 to 1.38) in this group. A greater number of factors predicted the onset of psychiatric disorder in CYP with pLTCs compared to physically healthier peers and similarly, a higher number of factors predicted persistent disorder in CYP without pLTCs. CYP with pLTCs might comprise a group with different vulnerabilities, some of which are potentially tractable and may be useful indicators of patients who require preventable or management interventions.

Predictors of contact with services for mental health problems among children with comorbid long-term physical health conditions: a follow-up study

Children with long-term physical health conditions (pLTCs) are at increased risk of developing mental health comorbidities, although most do not access services for their mental health. No previous studies have examined the determinants of contact with services for mental health concerns among this group of children. This 3-year longitudinal study involved a population-based sample of children aged 5–16 years from the British Child and Adolescent Mental Health Surveys conducted in 1999 and 2004. In children with comorbid pLTCs and mental health disorders at baseline (N = 397), we examined associations between several child-, family- and service-related factors and (a) contact with primary health care, (b) contact with paediatrics and (c) contact with child and adolescent mental health services over 3-year follow-up (2002 and 2007). Separate multivariable binary logistic regressions were conducted for each service. The impact of mental health difficulties on the child and contact with the teacher predicted contact with all three services. Adolescent age, female gender, larger family size, some or marked academic difficulties, and having parents with educational qualification(s) were specific predictors of contact with primary health care. Male gender, stressful life events, and contact with primary health care were specific predictors of contact with child and adolescent mental health services. No other factors predicted contact with paediatrics. Our findings highlight the role of child-, family-, and service-related factors in accessing mental health care in children with comorbid pLTCs and mental health disorders which could inform planning and provision of services to reduce unmet mental health needs.

Pain and suicidality in children and adolescents: a longitudinal population-based study

Suicidality is a common public health concern in young people. Previous research has highlighted pain as a key correlate of suicidality in young people. However, the long-term experience of pain may vary between individuals, and the relationship between distinct pain trajectories and suicidality is poorly understood. This study aims to describe the number and nature of distinct pain trajectories, their demographic and clinical correlates, including baseline suicidality, and whether identified pain trajectories may predict future suicidality. Secondary data analyses were performed, using longitudinal data from the British Child and Adolescent Mental Health Survey (N = 7977), collected at five timepoints between 2004 and 2007 on a population-based sample of UK youth (5–16 years). Data were collected from up to three respondents (parents, teachers, and 11 + year-olds). Latent Class Growth Analysis was used to identify distinct pain trajectories, explore predictors of these trajectories, and establish whether trajectories predicted future suicidality. We identified the following four pain trajectories: increasing (33.6%), decreasing (4.5%), persistent/recurrent probability of pain (15.7%), and no pain (46.2%). Pain trajectories were associated with unique demographic and clinical correlates. Only the persistent/recurrent (vs. no-pain) trajectory was predicted by baseline suicidality (aOR = 2.24; 95% bootstrap-CI = 1.59–3.26). Furthermore, the persistent/recurrent trajectory predicted future suicidality (aOR = 1.03, 95% bootstrap-CI = 1.01–1.06), after controlling for baseline suicidality, psychiatric disorder, age, and gender. Findings provide a better understanding of correlates associated with distinct pain trajectories and long-term risk of suicidality in young people, suggesting a bidirectional pain–suicidality association and emphasising the need of targeted support for young people with persistent/recurrent pain.

Mental health and school absenteeism in children with long-term physical conditions: A secondary analysis of the British Child and Adolescent Mental Health Surveys 2004 and 2007.

Children and young people (CYP) with long-term physical conditions (LTCs) are more likely to have poorer mental health and more school absenteeism compared with CYP with no LTCs. However, there is limited longitudinal research, and the extent to which these difficulties persist in CYP with LTCs is unknown. Furthermore, little is known about the relative impact of different types of LTC on mental health and absenteeism. We investigated cross-sectional and longitudinal associations of different LTCs with mental health and school absenteeism in a large (N=7977) nationally representative survey of CYP in Great Britain and its 3-year follow-up. Psychopathology was assessed using the parent-reported Strengths and Difficulties Questionnaire (SDQ), and diagnosis of any psychiatric disorder using the Development and Wellbeing Assessment (DAWBA). Days absent and persistent absence (missing 10% or more of school days) were reported by parents. Compared with those with no LTCs, CYP with any LTC had higher SDQ total difficulties scores at baseline (adjusted mean difference 1.4, 1.1-1.6) and follow-up (1.1, 0.8-1.4) and were more likely to have a psychiatric disorder at baseline (adjusted odds ratio [aOR] 1.59, 1.34-1.89) and follow-up (1.75, 1.44-2.12). Children with any LTC also missed more days of school at baseline (adjusted incidence rate ratio 1.47, 1.31-1.64) and follow-up (1.17, 1.00-1.36) and were more likely to be persistently absent (aOR baseline 1.78, 1.48-2.14; follow-up 1.27, 1.00-1.61). Neurodevelopmental disorders, migraines and atopic conditions were particularly strongly associated with both mental health and absenteeism. Children with LTCs had poorer mental health and more school absence than those with no LTCs. Clinicians should routinely enquire about mental health and school attendance in CYP with LTCs and should collaborate with families and schools to ensure these children are provided with sufficient mental health and educational support.

The longitudinal relationship between child emotional disorder and parental mental health in the British Child and Adolescent Mental Health surveys 1999 and 2004

BackgroundResearch suggests parental psychopathology has an adverse effect on child mental health. However, due to the interactional nature of parent-child relationships and with a high rate of emotional disorders reported in school-age children, it is important to know whether the effect is reciprocal. MethodsWe explored the longitudinal relationship between child and parent mental health in the British Child and Adolescent Mental Health Surveys (N=7,100 child-parent dyads) and their three-year follow-ups. The Development and Well-Being Assessment with DSM-IV diagnostic criteria was used to measure child psychiatric diagnoses, while parental mental health was assessed using the General Health Questionnaire. Multivariable logistic regression was used to explore the longitudinal association between child emotional disorder and parent mental health. ResultsParents of children who had an emotional disorder at baseline were more likely to have poor mental health three years later compared with parents whose children had no psychiatric diagnosis (33.3% versus 16.7%; crude odds ratio=2.52; adjusted odds ratio=2.19, 95% CI=1.58 to 3.05, p<0.001). Children of parents with poor mental health at baseline were more likely to develop an emotional disorder three years later compared with children whose parents had good mental health (5.2% versus 2.5%; crude odds ratio=2.08; adjusted odds ratio=1.63, 95% CI=1.18 to 2.25, p=0.003). LimitationsThe findings of this research are limited by the survey data collected, the measures used and survey dropout. ConclusionsWe detected a bi-directional relationship between child and parent mental health, suggesting that effective intervention for one individual may benefit other family members.

Exploring the relationship between pain and self-harm thoughts and behaviours in young people using network analysis.

Self-harm thoughts and behaviours (SHTBs) are a serious public health concern in young people. Emerging research suggests that pain may be an important correlate of SHTBs in young people. However, it remains unclear whether this association is driven by the shared association with other correlates of SHTBs. This study used network analysis to delineate the relationship between SHTBs, pain and other correlates of SHTBs in a population-based sample of young people. We performed secondary analyses, using data from 7977 young people aged 5-16 years who participated in the British Child and Adolescent Mental Health Survey in 2004. We used χ2 tests and network analysis to examine the complex interplay between SHTBs, pain and other correlates of SHTBs, including psychiatric disorders, childhood trauma, stressful life events, parental distress, family dysfunction, peer problems and inhibitory control deficits. Pain was associated with a doubled risk of SHTBs, and likewise, SHTBs were associated with a doubled risk of pain. Furthermore, network analysis showed that although pain was significantly associated with all measured correlates of SHTBs, except family dysfunction, pain was most strongly associated with SHTBs, after accounting for these measured correlates. To the best of our knowledge, this is the first study to utilise network analysis to provide novel insights into the complex relationship between SHTBs, pain and other known correlates of SHTBs in young people. Results suggest that pain is an independent correlate of SHTBs. Future research should aim to identify underlying mechanisms.

Teachers' concerns about pupils' mental health in a cross-sectional survey of a population sample of British schoolchildren.

Schools are becoming central to the identification and referral of children and young people with poor mental health. Understanding how well a teacher concern predicts mental disorder in a child or young person is important for mental health teams who need to respond to referrals. This secondary analysis of the 2004 British Child and Adolescent Mental Health Survey used the first item of the Strengths and Difficulties Questionnaire (SDQ) Impact subscale to indicate concern about a child or young person's mental health. Mental disorder according to DSM IVR criteria was assessed using the multi-informant Development and Well-Being Assessment. We compared the proportion with and without mental disorder according to the presence or absence of teacher concern. Teacher concern was moderately predictive (49% with teacher concern had a disorder) and sensitive (teacher concern present among 56% with disorder), while lack of teacher concern was highly predictive (only 5% had disorder) and specific (94% no disorder). Teacher concern was associated with significantly poorer mental health (mean teacher SDQ total difficulty score 19.6, SD 5.6 with disorder, mean 15.0; SD 5.1 if no disorder) compared to children without teacher concern (mean 9.6, SD 5.5 with disorder, and 4.9; SD 4.3 if no disorder; F (3, 5,931)=1527.228, p=.001). If both teacher and parents were concerned, the child or young person was much more likely to have a disorder. A lack of teacher concern can reassure mental health practitioners in the vast majority of cases. While teacher concern does identify those with poorer mental health, it is only moderately predictive of a disorder. When concerned about a child or young person, discussions with parents or others who know them may help teachers identify those who most need support. The emphasis on schools as a major setting to provide support and identify the need for referral to specialist mental health services means service commissioners, providers and practitioners could benefit from insight into how predictive a teacher's concern is of childhood mental health conditions and how this may vary with the type of disorder If teachers are not concerned about a child, practitioners can be reassured that there is unlikely to be a significant problem with their mental health, although this will be less certain in schools whose pupils are likely to have a higher than average levels of difficulty Teacher concerns do not necessarily differentiate between clinically impairing and mild/ moderate mental health difficulties, but do identify children in poorer mental health Asking for corroboration of concern from other sources increases the strength of the association to severe mental health disorders.

Suicidality, mental disorder and the utilization of mental health services among Australian adolescents

IntroductionSuicidality among adolescents continues to be a serious public health concern worldwide, and suicide is the leading cause of death for young Australians. However, to develop effective preventive interventions, it is essential to understand the types and rates of mental health service utilization among adolescents. This study investigated the association between suicidality and mental health service utilization among Australian adolescents, and to test whether service use is affected by the simultaneous presence of suicidality and mental disorders. MethodAdolescents aged 13–17 years (n = 2134) were used in this study from The Second Australian Child and Adolescent Mental Health and Wellbeing Survey – Young Minds Matter (YMM), which is a nationwide cross-sectional survey. Data were collected through face-to-face interviews with parents using a structured-questionnaire, while, adolescents completed a computer-based self-reported questionnaire privately. The YMM reported four types of mental health service: (1) health services – any services provided by a qualified health professional, regardless of where that service was provided; (2) school services – any services such as counseling or support programs provided by school or any educational institution; (3) telephone counseling services; and (4) online services. Both bivariate and multivariate analyses were used to assess the relationships between independent variables (suicidality, mental disorder) and their distributions over outcome variables (mental health services), adjusting for relevant sociodemographic and potential risk factors such as age, gender, remoteness, household income, family type, family functioning, parents' education, parents' employment, substance use by the child. An interaction between mental disorders and suicidality were included in the regression to examine whether and to what extent service use is affected if an adolescent has both suicidality and a mental disorder. ResultsOverall, 168 (8%) adolescents reported suicidality and prevalence of suicidality (ideation, plan and attempt) was higher in adolescents with mental disorders (P < 0.01 for all). Suicidality was high among girls irrespective of mental health condition. Both bivariate and multivariate analyses using child data and parent data showed a strong and significant association between suicidality and mental health service utilization among adolescents. Online service and health services were more likely to be accessed by adolescents with suicidality as reported in child data and parent data, respectively; while, school and telephone counselling service were less utilized within the same population. However, still, a large number of adolescents with suicidality did not access any services, even the incidence of seeking any mental health service was higher among adolescents with suicidality compared to those with a mental disorder. ConclusionThe limited number of suicidal adolescents is using mental health services, which is alarming for prevention of suicide. Further research is warranted to understand the quality of service received by adolescents and the factors influencing service utilization due to mental health-related problems. Also, interventions to improve care, prevention and monitoring are solely required for this group of people.

Emotional disorder and absence from school: findings from the 2004 British Child and Adolescent Mental Health Survey

Emotional disorder may be associated with absence from school, but the existing evidence is methodologically weak. We studied the relationships between anxiety, depression and emotional difficulties, and school absence (total, authorised and unauthorised) using data from the 2004 British Child and Adolescent Mental Health Survey (BCAMHS). The BCAMHS was a cross-sectional, community survey of 7977 5- to 16-year-olds. Emotional disorder was assessed using the Development and Wellbeing Assessment (DAWBA), and emotional difficulties using the Strengths and Difficulties Questionnaire (SDQ) completed by teachers and parents. Teachers reported days absent in the previous school term. Multivariable negative binomial regression was used to examine the impact of emotional disorder and difficulties on absence. Age, gender and general health were explored as moderators. Anxiety, depression and emotional difficulties were associated with higher rates of all types of absence [rate ratios for total absence: anxiety 1.69 (1.39–2.06) p < 0.001; depression 3.40 (2.46–4.69) p < 0.001; parent-reported emotional difficulties 1.07 (1.05–1.10) p < 0.001; teacher-reported emotional difficulties 1.10 (1.08–1.13) p < 0.001]. The strongest association was observed for depression and unauthorised absence. Relationships were stronger for secondary compared to primary school children. Health and educational professionals should be aware that children with poor attendance may be experiencing emotional ill health, regardless of absence type. The absence may provide a useful tool to identify those who require additional mental health support. Findings highlight the widespread burden of emotional disorder and the need to support those with emotional ill health in continuing to access education.

Are children with unrecognised psychiatric disorders being excluded from school? A secondary analysis of the British Child and Adolescent Mental Health Surveys 2004 and 2007.

There is limited research that explores the association between exclusion from school and mental health, but it seems intuitively plausible that the recognition of mental difficulties by key teachers and parents would influence the likelihood of exclusion from school. A secondary analysis of the British Child and Adolescent Mental Health survey 2004, (n = 7997) and the 2007 follow-up (n = 5326) was conducted. Recognition of difficulty was assessed via a derived variable that combined the first item of the Impact supplement of the Strengths and Difficulties Questionnaire which asked parents and teachers if they thought that the child has difficulties with emotions, behaviour and concentration, and the presence/absence of psychiatric disorder measured by the Development and Well-being Assessment. Adjusted logistic regression models demonstrated that children with recognised difficulties were more likely to be excluded [adjusted odds ratio (OR) 5.78, confidence interval 3.45-9.64, p < 0.001], but children with unrecognised difficulties [adjusted OR 3.58 (1.46-8.81) p < 0.005] or recognised subclinical difficulties [adjusted OR 3.42 (2.04-5.73) p < 0.001] were also more likely to be excluded than children with no difficulties. Children with conduct disorder and attention deficit hyperactivity disorder were most likely to be excluded compared with other types of disorder. Exclusion from school may result from a failure to provide timely and effective support rather than a failure to recognise psychopathology.

The relationship between exclusion from school and mental health: a secondary analysis of the British Child and Adolescent Mental Health Surveys 2004 and 2007.

Children with poor mental health often struggle at school. The relationship between childhood psychiatric disorder and exclusion from school has not been frequently studied, but both are associated with poor adult outcomes. We undertook a secondary analysis of the British Child and Adolescent Mental Health Surveys from 2004 and its follow-up in 2007 to explore the relationship between exclusion from school and psychopathology. We predicted poorer mental health among those excluded. Psychopathology was measured using the Strengths and Difficulties Questionnaire, while psychiatric disorder was assessed using the Development and Well-Being Assessment and applying Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM IV) criteria. Exclusion from school and socio-demographic characteristics were reported by parents. Multi-variable regression models were used to examine the impact of individual factors on exclusion from school or psychological distress. Exclusion from school was commoner among boys, secondary school pupils and those living in socio-economically deprived circumstances. Poor general health and learning disability among children and poor parental mental health were also associated with exclusion. There were consistently high levels of psychological distress among those who had experienced exclusion at baseline and follow-up. We detected a bi-directional association between psychological distress and exclusion. Efforts to identify and support children who struggle with school may therefore prevent both future exclusion and future psychiatric disorder.

The predictors of persistent DSM-IV disorders in 3-year follow-ups of the British Child and Adolescent Mental Health Surveys 1999 and 2004.

The identification of the factors that influence the persistence of psychiatric disorder may assist practitioners to focus on young people who are particularly prone to poor outcomes, but population-based samples of sufficient size are rare. This secondary analysis combined data from two large, population-based cross-sectional surveys in Great Britain (1999 and 2004) and their respective follow-ups (2002 and 2007), to study homotypic persistence among the 998 school-age children with psychiatric disorder at baseline. Psychiatric disorder was measured using the Development and Well-Being Assessment applying DSM-IV criteria. Factors relating to the child, family, and the severity and type of psychopathology at baseline were analysed using logistic regression. Approximately 50% of children with at least one psychiatric disorder were assigned the same diagnostic grouping at 3-year follow-up. Persistent attention-deficit/hyperactivity disorder and anxiety were predicted by poor peer relationship scores. Persistent conduct disorder was predicted by intellectual disability, rented housing, large family size, poor family function and by severer baseline psychopathology scores. Homotypic persistence was predicted by different factors for different groups of psychiatric disorders. Experimental research in clinical samples should explore whether these factors also influence response to interventions.

Competing Factor Models of Child and Adolescent Psychopathology.

Co-occurring psychological disorders are highly prevalent among children and adolescents. To date, the most widely utilised factor model used to explain this co-occurrence is the two factor model of internalising and externalising (Achenbach 1966). Several competing models of general psychopathology have since been reported as alternatives, including a recent three factor model of Distress, Fear and Externalising Dimensions (Krueger 1999). Evidence for the three factor model suggests there are advantages to utilising a more complex model. Using the British Child and Adolescent Mental Health Survey 2004 data (B-CAMHS; N=7997), confirmatory factor analysis was used to test competing factor structure models of child and adolescent psychopathology. The B-CAMHS was an epidemiological survey of children between the ages of 5 and 16 in Great Britain. Child psychological disorders were assessed using the Strength and Difficulties Questionnaire (Goodman 1997), and the Development and Wellbeing Assessment (Goodman et al. 2000). A range of covariates and risk variables including trauma, parent mental health and family functioning where subsequently utilised within a MIMIC model framework to predict each dimension of the 2 and three factor structure models. Two models demonstrated acceptable fit. The first complimented Achenbach's Internalising and Externalising structure. The three factor model was found to have highly comparable fit indices to the two factor model. The second order models did not accurately represent the data nor did an alternative three factor model of Internalising, Externalising and ADHD. The two factor and three factor MIMIC models observed unique profiles of risk for each dimension. The findings suggest that child and adolescent psychopathology may also be accurately conceptualised in terms of distress, fear and externalising dimensions. The MIMIC models demonstrated that the Distress and Fear dimensions have their own unique etiological profile of risk. This study directly informs future measurement models of child and adolescent psychopathology and demonstrates the effectiveness of a three factor model.

Diagnostic efficiency of the SDQ for parents to identify ADHD in the UK: a ROC analysis.

Early, accurate identification of ADHD would improve outcomes while avoiding unnecessary medication exposure for non-ADHD youths, but is challenging, especially in primary care. The aim of this paper is to test the Strengths and Difficulties Questionnaire (SDQ) using a nationally representative sample to develop scoring weights for clinical use. The British Child and Adolescent Mental Health Survey (N = 18,232 youths 5–15 years old) included semi-structured interview DSM-IV diagnoses and parent-rated SDQ scores. Areas under the curve for SDQ subscales were good (0.81) to excellent (0.96) across sex and age groups. Hyperactivity/inattention scale scores of 10+ increased odds of ADHD by 21.3×. For discriminating ADHD from other diagnoses, accuracy was fair (<0.70) to good (0.88); Hyperactivity/inattention scale scores of 10+ increased odds of ADHD by 4.47×. The SDQ is free, easy to score, and provides clinically meaningful changes in odds of ADHD that can guide clinical decision-making in an evidence-based medicine framework.

Distinct relationships between social aptitude and dimensions of manic-like symptoms in youth.

Difficulties with interpersonal relationships have been reported in children and adolescents with manic symptoms, even if they do not fulfil criteria for a manic episode. The role of social aptitude (SA) in youths with manic symptoms has never been examined in the general population. Moreover, no study has examined whether SA is differentially associated with dimensions of manic symptoms. We hypothesised that youth with predominantly undercontrol manic symptoms (characterised by irritability) would show lower levels of SA; conversely, youth with predominantly exuberant symptoms would show better than average social skills. Our sample comprised 5325 participants from the 2004 British Child and Adolescent Mental Health Survey (B-CAMHS04), mean age 10.3 years, SD = 3.3, 48 % girls. Manic symptoms were assessed with the Development and Wellbeing Assessment by interviewing parents and young people. Children and adolescents with manic symptoms had a lower SA score, compared to the general population by parent report, but not by self-report. SA score was higher in youths with predominantly exuberant manic symptoms compared to the general population; whereas the youths with predominantly undercontrol manic symptoms had lower SA scores by parent and self-report. Our results provide further evidence for the distinction between exuberant and undercontrol manic symptoms and highlight the need to focus on SA in future research.Electronic supplementary materialThe online version of this article (doi:10.1007/s00787-015-0800-7) contains supplementary material, which is available to authorized users.

Mental health related contact with education professionals in the British Child and Adolescent Mental Health Survey 2004

Purpose – The purpose of this paper is to describe mental health-related contact with educational professionals amongst children in the British Child and Adolescent Mental Health Survey (BCAMHS) 2004. Design/methodology/approach – BCAMHS 2004 was a community-based survey of 5,325 children aged 5-16, with follow-up in 2007. This paper reports the percentage of children with a psychiatric disorder that had mental health-related contact with education professionals (categorised as teachers or specialist education services) and the percentage with specific types of psychiatric disorders amongst those contacting services. Findings – Two-thirds (66.1 per cent, 95 per cent CI: 62.4-69.8 per cent) of children with a psychiatric disorder had contact with a teacher regarding their mental health and 31.1 per cent (95 per cent CI: 27.5-34.7 per cent) had contact with special education either in 2004 or 2007, or both. Over half of children reporting special education contact (55.1 per cent, 95 per cent CI: 50.0-60.2 per cent) and almost a third reporting teacher contact in relation to mental health (32.1 per cent, 95 per cent CI: 29.7-34.6 per cent) met criteria for a psychiatric disorder. Practical implications – Many children in contact with education professionals regarding mental health experienced clinical levels of difficulty. Training is needed to ensure that contact leads to prompt intervention and referral if necessary. Originality/value – This is the first paper to report on mental health-related service contact with education professionals in the 2004 BCAMHS survey along with its 2007 follow-up. It identifies high levels of teacher contact which represent challenges in supporting staff with training, resources and access to mental health services.

Trajectories of Psychopathology in Relation to Mental Health Related Service Contacts over Three Years in the British Child and Adolescent Mental Health Survey 2004

Introduction Previously, a number of observational studies have found no association between contact with services and improved outcomes in children with psychopathology, despite the existence of effective interventions. The British Child and Adolescent Mental Health Survey (BCAMHS) 2004 is a study of 5,325 children aged 5-16, with data on parent-reported mental health-related public sector service contacts and psychopathology over three years, allowing exploration of the association in a large community-based dataset. Aims • Describe the trajectories of children in contact and not in contact with services over three years from 2004-2007 • Explore the association between mental health-related service contact over the study period and outcomes in terms of parent-rated psychopathology Methods This study is a secondary analysis of children's trajectories by service contact status (no contact, contact 2004 only, contact 2007 only, contact 2004 & 2007). The main measure of psychopathology over time was the well-validated Strengths and Difficulties Questionnaire. Multivariable linear regression was used to examine the association between contact and outcomes in children with a psychiatric disorder at baseline in 2004. Results Children in contact with services demonstrated the highest levels of psychopathology over time, and the 2007-only contact group displayed a trajectory of increasing difficulties. Overall, contact with services was not associated with improvement in outcomes, following adjustment for measured confounders. Conclusions The effectiveness of contact alone with services was not demonstrated in our findings. Despite methodological limitations, this underlines the need for continuing development and consistent implementation of effective interventions, alongside initiatives evaluating outcomes within services.

How do child and adolescent mental health problems influence public sector costs? Interindividual variations in a nationally representative British sample.

Policy and practice guidelines emphasize that responses to children and young people with poor mental health should be tailored to needs, but little is known about the impact on costs. We investigated variations in service-related public sector costs for a nationally representative sample of children in Britain, focusing on the impact of mental health problems. Analysis of service uses data and associated costs for 2461 children aged 5-15 from the British Child and Adolescent Mental Health Surveys. Multivariate statistical analyses, including two-part models, examined factors potentially associated with interindividual differences in service use related to emotional or behavioural problems and cost. We categorized service use into primary care, specialist mental health services, frontline education, special education and social care. Marked interindividual variations in utilization and costs were observed. Impairment, reading attainment, child age, gender and ethnicity, maternal age, parental anxiety and depression, social class, family size and functioning were significantly associated with utilization and/or costs. Unexplained variation in costs could indicate poor targeting, inequality and inefficiency in the way that mental health, education and social care systems respond to emotional and behavioural problems.

Editorial Perspective: School exclusion is a mental health issue

Editorial Perspective: School exclusion is a mental health issue