Child Mental Health Problems Research Articles

Longitudinal impact of psychosocial status on children's mental health in the context of COVID-19 pandemic restrictions.

Emerging research suggests that the prevalence of child and adolescent mental health problems has increased considerably during the COVID-19 crisis. However, there have been few longitudinal studies on children’s mental health issues according to their social determinants in this context, especially in Europe. Our aim was to investigate the association between family socioeconomic status (SES) and children' mental health during the period of school closure due to COVID-19. Longitudinal data came from 4575 children aged 8–9 years old in 2020 and participating in the ELFE population-based birth cohort that focuses on children’s health, development and socialization. Parents completed the Strengths and Difficulties Questionnaire (SDQ) when children were (a) 5 years of age and (b) 9 years of age, which corresponded to the period of school closure due to the COVID-19 pandemic in France. We retrieved data from the ELFE cohort collected on children from birth to age 5 years (birth, 1 year, 2 years, 3,5 years and 5 years). Socioeconomic status (SES) was measured based on information obtained when the child was 5 years old. Data were analyzed using multinomial logistic regression models. Children’s elevated levels of symptoms of Attention-deficit/Hyperactivity disorder (ADHD) during the period of school closure were significantly associated with prior low family SES (aOR 1.26, 95% CI 1.08–1.48). Children’s elevated symptoms of hyperactivity/inattention and of emotional symptoms were associated with decline in income during the COVID crisis (respectively, aOR 1.38, 95% CI 1.16–1.63 and aOR 1.23, 95% CI 1.01–1.51). Moreover, when testing interactions, a low prior SES was significantly associated with a higher risk of emotional symptoms aOR 1.54 (1.07–2.21), only for children whose families experienced a decline in income, while gender, parental separation and prior mental health difficulties were not associated. This study underlines the impact of the financial crisis related to the COVID-19 epidemic on children’s mental health. Both pre-existing family SES before lockdown and more proximal financial difficulties during the COVID crisis were negatively associated with children’s psychological difficulties during the period of school closure. The pandemic appears to exacerbate mental health problems in deprived children whose families suffer from financial difficulties.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00787-022-02010-w.

Mental health of children with and without special healthcare needs and of their caregivers during COVID-19: a cross-sectional study

ObjectiveTo describe mental health outcomes and measures of pandemic burden of children with and without special healthcare needs, and their caregivers following the second wave of the COVID-19 pandemic in...

Experience in the Child/Youth Mental Health Centre of Leganés (Madrid) during the first lockdown

IntroductionThe municipality of Leganés has been very vulnerable to the effects of the crisis derived from the COVID-19 pandemic (both due to the incidence of the infection and the socioeconomic situation). Multiple studies show that children and adolescents, especially those with a psychiatric background, have been one of the most affected groups during the confinement.ObjectivesFirstly, to describe the characteristics of clinical care at the Child/Youth Mental Health Centre of Leganés (Madrid) during the first lockdown (March-June 2020). Secondly, to present data on the clinical evolution of the patients along this period (n = 720).MethodsDescriptive study and literature review.ResultsClinical care during the period of strict confinement was mainly by telephone, although the most serious cases were attended in person. In addition, referral to Intensive outpatient programs was interrupted. The results show 56% of patients remained stable. Anxious symptoms (35%) and behavioural disturbances (24%) were most frequently referred (Figure 1), It is noteworthy that the most critical cases (such as suicide attempts or domestic violence) were observed in adolescents and that at least 11% of patients increased their use of electronic devices.ConclusionsThe first confinement stage was particularly stressful for families and especially for children and adolescents, although most patients remained psychopathologically stable. However, other studies have found a significant increase in child and adolescent mental health problems during the following months (de-escalation stage).DisclosureNo significant relationships.

An analysis of English national policy approaches to health inequalities: ‘transforming children and young people’s mental health provision’ and its consultation process

BackgroundA national policy for England, published in 2017, entitled ‘Transforming Children and Young People’s Mental Health Provision’ aimed to address the increasing prevalence mental health problems in children and tackle inequalities. In the context of this policy’s implementation as ongoing and the effects of the Covid-19 pandemic, the need for appropriate, timely and ongoing national government commitment is vital.MethodsA narrative review using a problem representation evaluation [1], we critiqued the policy and related consultation documents using a social determinants of health perspective. We also reviewed wider policy discourses through engaging with stakeholder responses, providing an innovative methodological contribution to scholarship on public health policy and health inequalities.ResultsWe found absences and oversights in relation to inequalities (most notably the lack of acknowledgement that mental health can cause inequalities), access, workforce capacity, and the impacts of cuts and austerity on service provision. We suggest these inadequacies may have been avoided if stakeholder responses to the consultation process had been more meaningfully addressed. We illustrate how ‘problems’ are discursively created through the process of policy development, justified using specific types of evidence, and that this process is politically motivated. Local policy makers have a critical role in translating and adapting national policy for their communities but are constrained by absences and oversights in relation to health inequalities.ConclusionsThis narrative review illustrates how policy discourse frames and produces ‘problems’, and how the evidence used is selected and justified politically. This review contributes to the existing transdisciplinary field of knowledge about how using methods from political and social science disciplines can reveal new insights when critiquing and influencing policy approaches to health inequalities.

The relationship between childhood maltreatment and mental health problems: coping strategies and social support act as mediators

BackgroundChildhood maltreatment significantly increases the risk of developing mental health problems in adolescence and adulthood. The present study examines if coping strategies and social support mediate the relationship between childhood maltreatment and mental health problems.MethodsData analyzed were from the 2012 Canadian Community Health Survey Mental Health (CCHS-MH, N = 25,113), a national population survey. A structured diagnostic interview, the World Health Organization version of Composite International Diagnostic Interview (WHO-CIDI), was used to assess mental health status. Multiple mediation analysis with structural equation modelling is used to test the mediating effects of coping skills and social support in the relationship between childhood maltreatment and mental health problems.ResultsOur findings demonstrate that both coping strategies and social support mediated the link between childhood maltreatment and major depressive episode (mediation proportion: 18.3%), generalized anxiety disorder (mediation proportion: 19.8%), and suicide ideation (mediation proportion: 15.9%). By and large, the study results showed that coping skills and social support had both direct and indirect effects on the studied mental health problems with coping skills having a stronger impact.ConclusionsPersonal resources play an important resilience role in the associations between maltreatment and mental disorders with positive coping strategies, an internal resource, having a stronger protective presence. This research reinforces the need for strengthening positive coping strategies as well as social support as preventive strategies to improve mental health for individuals who have experienced childhood maltreatment.

Development of Mental Health Problems of Girls and Boys in Residential Care Between 2008 and 2020

Development of Mental Health Problems of Girls and Boys in Residential Care Between 2008 and 2020 Abstract. Objective: Studies show a high prevalence of mental health problems in children and adolescents in youth-welfare facilities compared to the general population. However, to date, studies on this development over time are lacking. The present study examines the development of mental health problems and psychosocial functioning in the years 2008 to 2020. Method: Mental health problems were assessed with the CBCL, psychosocial functioning with Axis VI of the MAS. In total, data from 3,269 children and adolescents from residential-care facilities located throughout Germany were included in the analysis. Results: a decrease in externalizing behaviour was observed regarding the frequency of mental health problem in children and adolescents in youth-welfare facilities from 2008 to 2020. Particularly boys aged 12 and older show less deviant behavior. Older girls show high internalizing behavior problem scores over time, but there is no consistent trend. More than a quarter of the institutionalized children in youth-welfare institutions show severely impaired psychosocial functioning at a consistent level over time. Conclusions: In light of the age and gender effects associated with the development of mental health problems over time, there is a need to regard the care situation in youth-welfare institutions.

A cross-sectional investigation of psychosocial stress factors in German families with children aged 0–3 years during the COVID-19 pandemic: initial results of the CoronabaBY study

BackgroundPsychosocial stress during the COVID-19 pandemic is increasing particularly in parents. Although being specifically vulnerable to negative environmental exposures, research on psychosocial stress factors in infants’ and toddlers’ families during the pandemic is so far sparse. The CoronabaBY study investigates the perceived pandemic burden, parenting stress and parent and child mental health problems in families with children aged 0–3 years in Bavaria, Southern Germany. Further, the relationships between these psychosocial stressors are examined and sociodemographic characteristics that may be predictive of these factors will be explored.MethodsParticipants were cross-sectionally surveyed via smartphone app. Standardized questionnaires on perceived pandemic burden, parenting stress, parental symptoms of depression and anxiety, infants’ crying, sleeping and feeding problems or toddlers’ emotional and behavioral problems were applied.ResultsN = 991 parents (Mage = 33.7 years, SD = 4.5; 93.7% mothers, 91.5% born in Germany) with infants (n = 554; Mage = 5.9 months, SD = 3.0) or toddlers (n = 435; Mage = 25.9 months, SD = 6.5) participated in the first half-year of 2021. Sixty-five percent of the parents perceived a high pandemic burden, 37.7% experienced parenting stress and 24.1% showed affective symptoms (anxiety: 30.1%, depression: 18.5%). Feeding problems, crying/ sleeping problems and multiple regulatory problems were found in 34.8%, 26.2% and 13.5% of the infants, respectively. Amongst toddlers, 8.5% showed noticeable behavior and emotional problems. Children`s mental health problems correlated moderately with parenting stress and parental affective symptoms and weakly with perceived pandemic burden. A lower financial status, higher parental education and increasing child age were significant but weak predictors for higher parenting stress, affective symptoms and higher psychological problems in children.ConclusionsA majority of the surveyed families with infants and toddlers experience the pandemic as stressful. The main challenges are parental affective symptoms and limited resources for childcare due to parenting stress. Overall, infants and toddlers show similar levels of mental health problems when being compared to pre-pandemic studies, but staggered detrimental effects on children`s mental health might occur if the stressful conditions persist. This is already indicated by correlations between parental and child psychosocial stress factors.

Child's Play: Examining the Association Between Time Spent Playing and Child Mental Health.

It is theorised that adventurous play offers learning opportunities that help to prevent mental health problems in children. In this study, data from two samples is used to examine associations between the time that children aged 5–11 years spent playing adventurously and their mental health. For comparison, time spent playing unadventurously and time spent playing outdoors are also examined. Study 1 includes a sample of 417 parents, Study 2 includes data from a nationally representative sample of 1919 parents. Small, significant associations between adventurous play and internalising problems, as well as positive affect during the first UK-wide Covid-19 lockdown, were found; children who spend more time playing adventurously had fewer internalising problems and more positive affect during the Covid-19 lockdown. Study 2 showed that these associations were stronger for children from lower income families than for children from higher income families. The results align with theoretical hypotheses about adventurous play.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10578-022-01363-2.

The protective role of father behaviour in the relationship between maternal postnatal depression and child mental health.

Maternal depression, especially when severe and long-lasting, is associated with adverse mental health outcomes in children. We aimed to assess, for children of mothers with persistent postnatal depression symptoms, whether positive father behaviours would decrease risk for conduct and emotional symptoms. Using data from 4009, mother-father-child trios from the Avon Longitudinal Study of Parents and Children we examined associations between maternal depression trajectories and positive father behavioural profiles across the postnatal period (child age: 2-21months), and child conduct and emotional symptom trajectories across middle childhood (child age: 3.5-11years). Positive father behaviour was much less common in families where mothers experienced high-persistent depression symptoms (33%) than in families where mothers did not (56%); of note, these fathers also had higher levels of depression symptoms. Using person-level analysis, exposure to high-persistent maternal depression symptoms increased child risk for a high trajectory of both conduct (odds ratio, 2.69; 95% CI: 2.00, 3.60) and emotional symptoms (odds ratio, 2.47; 95% CI: 1.83, 3.31). However, positive father behaviour (toward child and mother) reduced the odds of following high trajectories of conduct symptoms by 9% (x=4.52, p<.001) and of emotional symptoms by 10% (x=4.12, p<.001), even after controlling for father depression symptoms. Using variable-level analysis, we did not identify an interaction between maternal depression and positive father behaviour. For conduct problems, we identified a direct effect of positive father behaviour and lower conduct problems. For emotional symptoms, father behaviour interacted with child age, where the largest decrease was seen at age 9, when symptoms were highest across the sample. Positive father behaviour can be protective against chronic mental health problems for children exposed to persistent maternal postnatal depression symptoms.

Beyond Shared Care in Child and Adolescent Psychiatry

Abstract Based in the multicultural context of Montreal, Quebec, Canada, this article reviews shared care and collaborative care models which privilege consultations between primary and specialty care in children's mental health. An overview of Canada's two largest child psychiatric epidemiological studies outlines the nonclinical community prevalence in Ontario (18.5%) and Quebec (15%) of children's mental health problems along with salient family and community risk factors. Given the high prevalence of children's mental health problems and the burden of care undertaken by primary care practitioners, the interface between the first line of care and mental health services is crucial yet often characterized by poor communication, a lack of mutual comprehension, and limited collaboration. Collaborative mental health care has been defined as “a family physician or other primary care provider working together with a psychiatrist or other mental health worker in a mutually supportive partnership.” This definition is extended to describe a spectrum of partnerships in child and adolescent psychiatry (CAP): shared care, collaborative care, and related collaborative community practices. The author's experience with these models is presented with an overview of a pilot study on CAP shared care in Montreal. Two other recent trends in Quebec are explored: an innovation called “Medical Specialists Responding in Child and Adolescent Psychiatry” for community mental health-care teams and the pair aidant or “peer helper” model reaching out to patients and families with a member who suffers from mental health problem to serve as a helper, a model, and part of the support network.

School-Based Interventions for Child and Adolescent Victims of Interpersonal Violence

Background: Interpersonal violence against children and adolescents can affect their mental health and functioning in the long term. To reduce mental health problems in children and adolescents, school-based mental health interventions have been shown to be beneficial. A review of school-based interventions designed to mitigate posttraumatic symptoms after interpersonal violence is lacking to date. Methods: We searched for original studies published in English or German until November 2019 in 6 electronic databases. Supplementary search strategies to reduce publication bias were implemented. Peer-reviewed original studies assessing school-based interventions for children and adolescents under the age of 21 after interpersonal violence were included. Relevant data was extracted, synthesised and assessed qualitatively. The methodological quality of included studies was assessed. Results: Of 5,021 unduplicated publications, 15 studies met eligibility criteria. The included studies were almost exclusively conducted in the USA; over half utilised a randomised-controlled design. Studies mainly focussed on Posttraumatic Stress Disorder (PTSD) or depression. In all studies, implemented interventions partially or fully mitigated posttraumatic symptoms. Nine school-based interventions, five of which were based on cognitive behavioural therapy (CBT), were identified. School staff were often involved in intervention implementation besides mental health professionals. Conclusions: School-based interventions can be beneficial to reduce mental health problems in children and adolescents after interpersonal violence. Trained school staff aided by mental health professionals can implement trauma-informed practices at school. While school-based interventions may be a feasible way to provide children and adolescents with accessible mental health care, further research on school-based trauma interventions outside the USA is necessary.

Outcomes Accountability Systems for Early Childhood Disruptive Behaviors: A Scoping Review of Availability.

Early childhood disruptive behaviors are common mental health problems among American youth, and if poorly-managed, pose costly psychological and societal burdens. Outcomes accountability systems in clinical practice are vital opportunities to optimize early intervention for common mental health problems; however, such systems seem rare. A scoping review was conducted to summarize the current availability of outcomes accountability systems in clinical programs addressing early childhood disruptive behaviors, particularly in the US. We used PsycINFO to identify peer-reviewed literature published in English from 2005 to 2021, from which we selected 23 publications from the US, UK, and Netherlands on outcomes accountability systems within clinical programs treating common childhood mental health problems. Only 3 out of 23 publications described outcomes accountability efforts specifically for early childhood problems. Within the 3 studies, only one UK-based study specifically targeted early childhood disruptive behaviors. We did not find publications specifically describing outcomes accountability efforts in US-based clinical programs to treat early childhood disruptive behaviors. There are multi-level challenges preventing changes to the prevalent US model of paying a fee for each unit of child mental healthcare, with little regard for patient outcomes. However, opportunities exist to improve US-based accountability efforts; from top-down expansion of financial incentives, accountability initiatives, and PDT evidence-based practices to an iterative, bottom-up development of meaningful outcomes measurement by providers. Greater adoption of outcomes monitoring in US clinical practice for common mental health problems can optimize management of early childhood disruptive behaviors and mitigate long-term societal and economic burdens.

Associations between illicit drug use in early adulthood and mortality: Findings from a National Birth Cohort

Illicit drug use is known to be associated with premature mortality. Whether exposure to socioeconomic disadvantage and mental health problems in childhood help to explain this association, is unclear. We analysed data from 11,250 participants in the 1970 British Birth Cohort study. At 10-years of age, socioeconomic disadvantage (parental socioeconomic position, material disadvantage, family disruption) and mental health problems with antisocial behaviour, attention, and anxiety were reported by mothers and teachers. At 30-years of age, study members provided information on their illicit drug use, exposure to socioeconomic disadvantage and mental health problems. At 30-years, 19.2% of participants had used an illicit drug in the past year. Mortality was elevated for eight of the twelve drugs assessed. Family disruption, maternal, and teacher assessments of antisocial behaviour at 10-years were associated with illicit drug use at 30-years. There was, however, very little change in these associations when exposure to childhood socioeconomic disadvantage (% change in hazard ratios [HR] 0–10%) or mental health problems (0.4–11.9%) were added to the sex-adjusted model. Adding exposure to socioeconomic disadvantage (0.8–38.9%) and mental health problems (31.7–74.1%) in adulthood to the sex-adjusted model resulted in marked attenuation in HRs for all drugs. These findings imply that interventions which provide opportunities for education, employment and access to effective mental health treatments in early adulthood may help to reduce mortality among drug users.

A scoping review of the Choice and Partnership Approach in child and adolescent mental health services.

Child and adolescent mental health (CAMH) problems are prevalent and inefficient mental health (MH) care systems can contribute to poor outcomes. The Choice and Partnership Approach (CAPA) is a MH care delivery model aiming to provide efficient, high-quality care. Although widely used, no CAPA research review exists. We conducted a scoping review to fill this gap. Medline, Embase, and PsycINFO databases were searched from inception to June 2021. Grey Matters and Google were used to search the grey literature. We identified 5322 records. Removal of duplicates left 4720 documents, which were successively screened and data extracted by pairs of co-authors. The final dataset comprised six published and three non-published studies, conducted primarily at CAMH sites in England, Scotland, Australia, or Canada. Each study had multiple research objectives, which we summarized into seven categories. Positive outcomes were reported for most objectives, but attributing causality to CAPA was hampered by research methodology. Observational designs were used in all studies and approaches to analyzing data varied considerably. Research gaps included the lack of healthcare economics studies of CAPA and no assessment of facilitators and barriers. Current research on CAPA provides intriguing findings meriting further investigation. We suggest strategies to improve future studies.

Treatment Readiness among Primarily Latine Families Seeking Parent-Child Interaction Therapy (PCIT) in an Urban Setting.

(1) Background: Given the high prevalence of childhood mental health problems and their long-lasting negative consequences if left untreated, it is important to investigate factors that affect family engagement in psychological interventions such as Parent–Child Interaction Therapy (PCIT), including caregiver treatment readiness and readiness for change (RFC). Specifically, Latine families experience greater mental health disparities and have unique cultural factors that affect engagement. The current project examined caregiver pretreatment readiness among primarily Latine Spanish- and English-speaking families. (2) Methods: Participants were 100 caregivers (96% female) of young children ages 2 to 7 who sought PCIT services from a community mental health center in Washington, D.C. Families completed written and observational assessment measures at pretreatment and throughout PCIT, which were used for the current study. (3) Results: Caregivers reported high readiness and importance of treatment at intake, with higher RFC among Spanish-speaking caregivers. Regardless of language, caregivers who reported more frequent and problematic child misbehavior and who were from a multi-caregiver household tended to report more RFC and treatment importance at intake. Pretreatment RFC also predicted family completion of the first phase of PCIT although there was a high attrition rate for the sample as only 18% of families completed treatment. (4) Conclusions: These findings provide insight into the implementation of standard PCIT among Spanish- and English speaking families and highlight the benefits of assessing pretreatment caregiver readiness to inform clinical decision-making.

Regional mapping of early childhood risk for mental disorders in an Australian population sample.

Population-level profiles of risk for later childhood mental disorders have been identified in patterns of early developmental vulnerabilities using Australian Early Developmental Census. We sought to demonstrate the geographical distribution of these early childhood risk profiles for mental illness, to inform policy decisions for place-sensitive provision of health and allied services. Using geographic information system techniques, we mapped the regional percentage of children at highest risk for mental disorders across the state of New South Wales (NSW), according to Local Government Areas, for 82 891 children in the NSW Child Development Study. A high proportion (>10%) of children at risk of later mental disorders were located in regional and socioeconomically disadvantaged areas, with a few metropolitan regions showing similarly high proportions of the population at risk. These findings highlight the potential to identify place-sensitive needs for early intervention and prevention programs for emerging mental health problems in children.

Motor development problems in infancy predict mental disorders in childhood: a longitudinal cohort study.

Motor development problems as early at 8-10months of age were predictive of neurodevelopmental disorders before the 8th birthday. The findings call for clinical attention and more research on preventive potentials in the community child health care. •Children with ASD, ADHD and ID have high prevalence of early motor development problems. •Motor development problems in infancy predicted neurodevelopmental disorders before the 8th birthday. • This observation could improve early identification and prevention of mental health problems in childhood.

Recommendations for the surveillance of mental health problems in childhood, adolescent, and young adult cancer survivors: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group

Recommendations for the surveillance of mental health problems in childhood, adolescent, and young adult cancer survivors: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group

Recommendations for the surveillance of mental health problems in childhood, adolescent, and young adult cancer survivors: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group.

Survivors of childhood, adolescent, and young adult (diagnosed when <25 years of age) cancer are at risk of mental health problems. The aim of this clinical practice guideline is to harmonise international recommendations for mental health surveillance in survivors of childhood, adolescent, and young adult cancer. This guideline was developed by a multidisciplinary panel of experts under the sponsorship of the International Guideline Harmonization Group. We evaluated concordance among existing survivorship clinical practice guidelines and conducted a systematic review following evidence-based methods. Of 7249 studies identified, 76 articles from 12 countries met the inclusion criteria. Recommendations were formulated on the basis of identified evidence in combination with clinical considerations. This international clinical practice guideline strongly recommends mental health surveillance for all survivors of childhood, adolescent, and young adult cancers at every follow-up visit and prompt referral to mental health specialists when problems are identified. Overall, the recommendations reflect the necessity of mental health surveillance as part of comprehensive survivor-focused health care.

Clinical characteristics, activity levels and mental health problems in children with long coronavirus disease: a survey of 510 children.

Background:Whether long coronavirus disease pertains to children as well is not yet clear.Methods:The authors performed a survey in children suffering from persistent symptoms since initial infection. A total of 510 children infected between January 2020 and January 2021 were included.Results:Symptoms such as fatigue, headache, muscle and joint pain, rashes and heart palpitations and issues such as lack of concentration and short-term memory problems were particularly frequent and confirm previous observations, suggesting that they may characterize this condition.Conclusion:A better comprehension of long coronavirus disease is urgently needed.