Child Mental Health Research Articles

Development and evaluation of a personalised sleep care plan on child and adolescent in-patient mental health wards.

The study evaluated a package of measures to improve sleep on psychiatric wards admitting patients from children and young people's services (CYPS). Sleep disturbance has significant impact on adolescent mental health, and in-patient wards can directly cause sleep disturbance, independent of the problem that led to admission. We developed a CYPS-specific package (TeenSleepWell) that promoted a better sleep environment, enhanced staff education about sleep, screened for sleep disorders, and raised awareness of benefits and side-effects of hypnotics. This included personalised sleep care plans that allowed a protected 8 h sleep period when safe. Evaluation over 2 years showed enhanced in-patient care: 57% of patients were able to have a protected sleep period. There was no increase in adverse events and there was a decrease in hypnotics issued. Improving sleep during in-patient CYPS admissions is possible and personalised sleep care plan should be a care standard.

Mediterranean Diet and Mental Health in Children and Adolescents: A Systematic Review.

Childhood and adolescence are periods of critical importance in the development of mental health disorders. The Mediterranean diet (MD) has been linked to multiple positive health outcomes, including reduced incidence of mental health disorders and fewer psychiatric symptoms. This study aimed to investigate the association between adherence to an MD and mental health outcomes in children and adolescents. A systematic literature review was conducted of original research that explored the relationship between psychiatric symptoms or disorders and adherence to an MD. The literature search was conducted on PubMed, Scopus, Web of Science, MEDES, Dialnet, and Latindex from inception to November 2022, and the Newcastle-Ottawa Scale was used to evaluate the quality of studies. A total of 13 studies (6 cross-sectional, 4 case-control, 2 randomized clinical trials, and 1 longitudinal cohort) out of 450 met the inclusion criteria. A total of 3058 children or adolescents with a mean age range from 8.6 to 16.2 years were included. Among the reviewed studies, 5 (71.42%) of those looking at attention-deficit/hyperactivity disorder, 4 (80%) examining depression, and 2 (50%) assessing anxiety found a significant protective association. Seven articles (53.84%) were found to be of high quality and 6 (46.15%) of moderate quality. Adherence to an MD could be a protective factor for mental health in child and adolescent populations. This suggests that promoting an MD could help prevent the onset of clinical psychiatric symptoms, reduce symptom severity, and improve prognosis in young patients. PROSPERO registration no. CRD42021276316.

Risk rates and profiles at intake in child and adolescent mental health services: A cohort and latent class analyses of 21,688 young people in South London

Risk rates and profiles at intake in child and adolescent mental health services: A cohort and latent class analyses of 21,688 young people in South London

The implementation of a zero-suicide framework in a child and youth mental health service in Australia: processes and learnings

The implementation of a zero-suicide framework in a child and youth mental health service in Australia: processes and learnings

Parent-child relationship measures and pre-post treatment changes for a clinical preschool sample using DC:0-3R.

To reduce psychopathologies in children, various treatment approaches focus on the parent-child relationship. Disruptions in the parent-child relationship are outlined in the most recently revised versions of the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0-3R/DC:0-5). The measures used to assess the parent-child relationship include the Parent-Infant Relationship Global Assessment Scale (PIRGAS) and the Relationship Problems Checklist (RPCL), which cover, e.g., essential concepts like over- or underinvolvement of the caregiver. However, not much is known about the cross-sectional and predictive value of PIRGAS and RPCL scores at admission to discharge, namely whether changes in these scores are correlated with child and maternal psychopathologies and changes through treatment. Based on clinical records of 174 preschool-aged children of the Family Day Hospital, we report related basic descriptive data and changes from admission to discharge for the parent-child relationship, child behaviour, and maternal psychopathology. We used a Pearson correlation or a point-biserial correlation to describe the associations and performed a paired t-test to examine differences before and after measurement. Our results show overall improvements in our parent-child relationship measures and in child and maternal psychopathology. However, we observed little or no correlation between the parent-child relationship measures and child or maternal psychopathology. We highlight potential drawbacks and limitations of the two relationship measures used that may explain the results of this study on the associations between the variables assessed. The discussion emphasizes the assessment of DC:0-3R/DC:0-5, which are popular in clinical practice for economic reasons.

The Association between Cyberbullying Victimization and Depression among Children: A Moderated Mediation Model

Cyberbullying victimization is becoming more prevalent and adversely affects mental health. This research explores the relationship between the two variables and the underlying mechanism, especially for children, as the impact of mental health in childhood might last a lifetime. Primary school students (N = 344; Mage = 9.90; 43.90% girls) completed self-report questionnaires regarding cyberbullying victimization, self-perceived social competence, optimism, and depression at school. Gender and grade were controlled as covariates. Depression was positively predicted by cyberbullying victimization, while self-perceived social competence played a partially mediating role. In addition, optimism directly and indirectly moderated the effects of cyberbullying victimization on depression. Specifically, the effects were stronger for children with low levels of optimism. Therefore, efforts to enhance children’s self-perceived social competence and optimism may reduce their depression resulting from cyberbullying victimization.

Study protocol for a randomized controlled trial of supportive parents – coping kids (SPARCK)—a transdiagnostic and personalized parent training intervention to prevent childhood mental health problems

BackgroundTo meet the scientific and political call for effective prevention of child and youth mental health problems and associated long-term consequences, we have co-created, tested, and optimized a transdiagnostic preventive parent-training intervention, Supportive parents – coping kids (SPARCK), together with and for the municipal preventive frontline services. The target group of SPARCK is parents of children between 4 and 12 years who display symptoms of anxiety, depression, and/or behavioral problems, that is, indicated prevention. The intervention consists of components from various empirically supported interventions representing different theorical models on parent–child interactions and child behavior and psychopathology (i.e., behavioral management interventions, attachment theory, emotion socialization theory, cognitive-behavioral therapy, and family accommodation intervention). The content and target strategies of SPARCK are tailored to the needs of the families and children, and the manual suggests how the target strategies may be personalized and combined throughout the maximum 12 sessions of the intervention. The aim of this project is to investigate the effectiveness of SPARCK on child symptoms, parenting practices, and parent and child stress hormone levels, in addition to later use of specialized services compared with usual care (UC; eg. active comparison group).MethodsWe describe a randomized controlled effectiveness trial in the frontline services of child welfare, health, school health and school psychological counselling services in 24 Norwegian municipalities. It is a two-armed parallel group randomized controlled effectiveness and superiority trial with 252 families randomly allocated to SPARCK or UC. Assessment of key variables will be conducted at pre-, post-, and six-month follow-up.DiscussionThe current study will contribute with knowledge on potential effects of a preventive transdiagnostic parent-training intervention when compared with UC. Our primary objective is to innovate frontline services with a usable, flexible, and effective intervention for prevention of childhood mental health problems to promote equity in access to care for families and children across a heterogeneous service landscape characterized by variations in available resources, personnel, and end user symptomatology.Trial registrationClinicalTrials.gov ID: NTCT05800522

Impact of a national audit on child and adolescent psychiatrists' prescribing practices.

A look back review of South Kerry Child and Adolescent Mental Health Services (CAMHS) in Ireland, known as the 'Maskey report' (MR), highlighted substandard prescribing practices. The aim of this 'Maskey Impact Study' (MIS) was to explore changes to child and adolescent psychiatrists' prescribing practices following the MR. The study was cross-sectional and mixed method. A study specific questionnaire was distributed electronically to psychiatrists working in CAMHS (n = 160). 102 psychiatrists participated in the study (response rate 63.8%). Perceived improvement in prescribing practices included improved medical record keeping (63.7%), consent documentation (53.9%), medication information provision (41.2%) and physical health monitoring (60.8%). However, 43.1% of psychiatrists reported a reluctance to prescribe medication even when clinically indicated and 50% were more likely to avoid off-label use. Most respondents reported increased stress levels (80.4%) with higher stress being significantly associated with reticence in prescribing (χ2 = 11.746, p < .001) and avoiding off-label use (χ2 = 15.392, p < 0.001). Thematic analysis highlighted increased medication hesitancy, enforced 'meaningless' bureaucracy and medication mistrust among families. Although improvements reported are welcomed, the increased hesitancy of medication use, avoidance of prescribing more than one medication, and avoidance of off-label use, is of concern with potential unintended adverse consequences. Reluctance in prescribing may deprive youth of access to evidence-based treatments and limit exposure of NCHDs to the safe practice of consultant-initiated psychopharmacology. Further research will be important to determine if this impacts clinical care. Continued education in psychopharmacology is essential along with increased public awareness of the evidence for medication, to help restore public confidence and trust in psychopharmacology.

Pediatric Hearing Loss and the Multidisciplinary Approach. The Hearing Disability Team (HDT) Experience

Hearing loss is among the utmost common disorders in children and a late diagnosis can impact language and cognitive development. With the aim of implementing an early hearing detection program (EHDP), the Emilia Romagna region has officially approved, since 2012, a NHS program distinguishing well babies and NICU children. Aim of this study is to evaluate the results of the application of these regional guidelines through data flow from the Child and Adolescent Mental Health Services (CAMHS). Data of children born between 2012 and 2018 and admitted to the service in the same period were collected, 84 children (56 males,28 females) were enrolled; 65% of the children were taken in charge by CAMHS within the first year of life. Concerning the NHS results, 77 (91%) children resulted fail at the screening test (6 unilateral fails), while the result was not available in one case; 6 children resulted pass. Most cases, 79 (94%), presented bilateral hearing loss. In particular, 14 (17.8%) children had a profound hearing loss, 10 (12.6%) a severe hearing loss, 10 (12.6%) a mild hearing loss (6 were conductive), 22 (27.8%) a moderate hearing loss, and 23 (29.2%) a moderate/severe hearing loss. Finally, 5 resulted affected by unilateral hearing loss (2 profound hearing loss, 3 severe). This study confirmed that regional recommendations about early diagnosis of hearing loss have been applied and most children accessed the CAMHS timely. To this aim synergism between hospital and territorial services, determining the implementation of the organization system was the keystone.

Associations between parental socioeconomic status and mental health in Chinese children: the mediating roles of parenting practices.

The significance of socioeconomic status (SES) in child mental health is well-established in Western populations; however, there is little evidence on this topic in Chinese populations. The possibility that Chinese families with different SES elicit different parenting practices that cause positive or negative child mental health outcomes warrants further investigation. This study examined the associations of SES, parenting practices, and child mental health among 1401 Chinese school children and their parents residing in Shanghai. SES was measured by a composed index of parental education levels, occupations, and household incomes. The Alabama parenting questionnaire (APQ; child version) and the strengths and difficulties questionnaire (SDQ; parent version) were used to assess parenting practices and child mental health. We also explored the underlying mechanisms between parental SES and the mental health of children by testing different parenting practices as mediators of the relationships. The results showed that a higher SES is positively associated with better mental health in children. Positive involvement and deficient monitoring can mediate the relationship between SES and child mental health outcomes. Negative discipline did not significantly mediate the above relationship. The results highlight the significance of positive involvement and sufficient monitoring in promoting children's mental health and provide evidence for designing effective programs to improve parenting skills.

The Translation of Recovery-Oriented Social Work Practice in Child and Youth Mental Health: A Scoping Review

Abstract Recovery-oriented practice has become taken for granted and seen as the most ideal way of working for social workers alongside other allied health practitioners in the mental health field. Recovery-oriented practice is defined as a person-centred and strengths-based approach, providing interventions, as well as facilitating environmental and multidisciplinary resources to support the individual’s independence. The applicability of recovery in a child and youth mental health (CYMH) context, however, continues to be questioned. Although some research has explored what recovery means for young people, there is scant literature that examines how recovery-oriented practice is enacted when working with children and their families. This scoping review, guided by the Arksey and O’Malley’s framework explores how recovery is conceptualised and translated into practice with children aged two to twelve years who have identified ‘mental health concerns’ and their families. Qualitative and grey literature from the last twenty years was thematically analysed. The findings highlight the primacy placed on global recovery-oriented principles and expose the superficial articulation of the application of recovery-oriented practice with children. Findings underscore the need to critically investigate how social workers enact recovery approaches when working in a clinical CYMH setting, dominated by the medical model which prioritises evidence-based intervention and marginalises children’s knowledge.

'I'm still su!c!dal when you're done with the paperwork': an inductive framework thematic analysis of #camhs on TikTok.

Young people are sharing their experiences of Child and Adolescent Mental Health Services (CAMHS) in the United Kingdom on TikTok. Little is known about the content of these videos and their influence on young people's attitudes towards seeking professional mental health support. This study explored how CAMHS is represented in a sample of 100 #camhs TikTok videos using participatory inductive framework thematic analysis. Four themes were developed alongside young people as co-researchers: (a) CAMHS can be frustrating and unhelpful, but sometimes life-saving, (b) Young people can feel their distress is invalidated by CAMHS, (c) CAMHS makes young people feel responsible for their distress, and (d) Young people may not feel CAMHS professionals are trustworthy. Video content described dismissive responses to expressions of suicidal ideation, professional knowledge being privileged over lived experience, and breaches of confidentiality. Some shared positive experiences of CAMHS helping to keep them safe. Together, the themes reflect a representation of CAMHS as a service where adults are powerful and young people occupy a subjugated position. This may influence young people's professional help-seeking behaviour. Recommendations for clinical practice and future research are presented.

The use and potential of artificial intelligence for supporting clinical observation of child behaviour

BackgroundObservation of child behaviour provides valuable clinical information but often requires rigorous, tedious, repetitive and time expensive protocols. For this reason, tests requiring significant time for administration and rating are rarely used in clinical practice, however useful and effective they are. This article shows that Artificial Intelligence (AI), designed to capture and store the human ability to perform standardised tasks consistently, can alleviate this problem.Case studyWe demonstrate how an AI‐powered version of the Manchester Child Attachment Story Task can identify, with over 80% concordance, children with insecure attachment aged between 5 and 9 years.DiscussionWe discuss ethical issues to be considered if AI technology is to become a useful part of child mental health assessment and recommend practical next steps for the field.

Effects of educational disruption and changes in school context on children's mental health: Associations with school level disadvantage and individual bullying involvement

AbstractNatural disasters happen across the world. The situations are different but the disruption to children's education and wellbeing is similar. This study focused on the school context changes caused by the COVID‐19 global disaster, and the impact of these changes on children's mental health. The aim was to better understand the associations between any mental health changes and children's school level of deprivation and pre‐disaster involvement in bullying. Cross‐sectional data were collected from 4316 children aged 6–11 years old, from 57 schools across England and Wales. Data were collected before the national lockdowns, early 2020, and 3–5 months after the final return to school, summer 2021, when schools were operating under a range of context restrictions. Child data included bullying involvement at school and health‐related quality of life; teacher data included reports of each child's internalising, externalising and prosocial behaviours. School‐level disadvantage was determined by the proportion of children in each school eligible to receive free school meals (an indicator of family disadvantage). The results showed that victims of bullying pre‐lockdown, and pupils from schools with a higher concentration of disadvantage, had significantly reduced externalising behaviours once back in the restricted school context. Victims had also increased their prosocial behaviours. It is possible that the restricted school context may have been a relief for the most vulnerable pupils. This study adds a new phase of understanding to the global disaster literature and the initial return to school when the environment is the same but the context has changed.

Burden of Mental Disorders and Suicide Attributable to Childhood Maltreatment

The proportion of mental disorders and burden causally attributable to childhood maltreatment is unknown. To determine the contribution of child maltreatment to mental health conditions in Australia, accounting for genetic and environmental confounding. This meta-analysis involved an epidemiological assessment accounting for genetic and environmental confounding between maltreatment and mental health and 3 cross-sectional national surveys: the Australian Child Maltreatment Study (ACMS) 2023, National Study of Mental Health and Well-being 2020-2022, and Australian Burden of Disease Study 2023. Causal estimates were derived on the association between childhood maltreatment and mental health conditions from a meta-analysis of quasi-experimental studies. This was combined with the prevalence of maltreatment from the ACMS to calculate the population attributable fraction (PAF). The PAF was applied to the number and burden of mental health conditions in Australia, sourced from 2 population-based, nationally representative surveys of Australians aged 16 to 85 years, to generate the number and associated burden of mental disorders attributable to child maltreatment. Physical abuse, sexual abuse, emotional abuse, or neglect prior to age 18 years. Proportion and number of cases, years of life lost, years lived with disability, and disability-adjusted life-years of mental health conditions (anxiety, depression, harmful alcohol and drug use, self-harm, and suicide attempt) attributable to childhood maltreatment. Meta-analytic estimates were generated from 34 studies and 54 646 participants and applied to prevalence estimates of childhood maltreatment generated from 8503 Australians. Childhood maltreatment accounted for a substantial proportion of mental health conditions, ranging from 21% (95% CI, 13%-28%) for depression to 41% (95% CI, 27%-54%) of suicide attempts. More than 1.8 million cases of depressive, anxiety, and substance use disorders could be prevented if childhood maltreatment was eradicated. Maltreatment accounted for 66 143 years of life lost (95% CI, 43 313-87 314), primarily through suicide, and 184 636 disability-adjusted life-years (95% CI, 109 321-252 887). This study provides the first estimates of the causal contribution of child maltreatment to mental health in Australia. Results highlight the urgency of preventing child maltreatment to reduce the population prevalence and burden of mental disorders.

Practitioner Review: Assessment and treatment of body dysmorphic disorder in young people.

Body dysmorphic disorder (BDD) is a relatively common and highly impairing mental disorder that is strikingly underdiagnosed and undertreated in Child and Adolescent Mental Health Services (CAMHS). The only clinical guidelines for the management of BDD in youth were published nearly 20 years ago, when empirical knowledge was sparse. Fortunately, there has been a surge in research into BDD over the last 10 years, shedding important insights into the phenomenology, epidemiology, assessment and treatment of the disorder in young people. This review aimed to provide an overview of recent research developments of relevance to clinicians and healthcare policymakers. We summarise key findings regarding the epidemiology of BDD in youth, which indicate that the disorder usually develops during teenage years and affects approximately 2% of adolescents at any one point in time. We provide an overview of aetiological research, highlighting that BDD arises from an interplay between genetic and environmental influences. We then focus on screening and assessment strategies, arguing that these are crucial to promote detection and diagnosis of this under-recognised condition. Additionally, we summarise the recommended treatment approaches for BDD in youth, namely cognitive behaviour therapy with or without selective serotonin reuptake inhibitors. The review concludes by highlighting key knowledge gaps and priorities for future research including, but not limited to, better understanding aetiological factors, long-term consequences and treatment.

Transdiagnostic considerations are critical to understanding childhood neurodevelopmental disorders

Growing dissatisfaction with the current categorical diagnostic systems has led to a movement toward transdiagnostic dimensional approaches to assessment of childhood mental health disorders. We argue that a transdiagnostic approach is especially important and appropriate when screening for neurodevelopmental disorders during early childhood. In the early childhood years, symptoms often appear in the form of developmental delays that could portend a variety of different disorders. Early intervention at this point is critical, even though a final endpoint disorder is not yet apparent. Intervening early has the potential to grow the area of weakness, possibly correcting or at least ameliorating these delays. Early intervention requires a multidisciplinary approach integrating efforts across settings and providers that monitor the development of young children. We argue here that young children’s language ability is central to the development of social cognition, and a prerequisite for adequate social functioning. Social deficits are defining features of a subset of neurodevelopmental disorders such as autism spectrum disorder and social (pragmatic) communication disorder. Critically, impairment in social functioning is common in additional neurodevelopmental disorders such as attention-deficit/hyperactivity disorder (ADHD), learning disorders, and even motor disorders. For this reason, we argue that, at the earliest sign of a possible neurodevelopmental disorder, children should be screened for language deficits prior to initiating a focused assessment for a specific type of neurodevelopmental disorder such as ADHD. Any detected language deficits should be considered in the design and implementation of the assessment, as well as the ultimate intervention plan.

Neighborhood material versus social deprivation in Canada: different patterns of associations with child and adolescent mental health problems.

In a nationwide study, we aimed to study the association of neighborhood deprivation with child and adolescent mental health problems. We used data from the Canadian Health Survey on Children and Youth (N = 47,871; age range: 1-17years) and linked these to Neighborhood Material and Social Deprivation data calculated using Canada's Census of Population. Using a series of logistic regressions, we studied the association between living in deprived areas and mental health problems among children and youth. We used bootstrap replicate weights for all analyses and adjusted them for individual sociodemographic characteristics. In the adjusted model, the parent-reported developmental disorder was associated with more socially deprived neighborhoods (OR 1.29; 95% CI 1.07, 1.57 for most vs. least deprived quintiles). However, mental health service need or use was associated with living in less materially deprived areas (OR 0.78; 95% CI 0.63, 0.96 for most vs. least deprived quintiles). Among mental health problemsreported by the youth (12-17years old), poor/fair general mental health, alcohol drinking, and cannabis use were associated with neighborhood social deprivation in the adjusted models. In contrast, poor/fair general mental health, suicide ideas, alcohol drinking, and cannabis use were all negatively associated with higher materially deprived quintiles. Our study provides further support for the existing evidence on the association between neighborhood deprivation, particularly social deprivation, and the mental health of children and adolescents. The findings can help public health policymakers and service providers better understand and address children's mental health needs in their neighborhoods.

The impact of social media use on psychiatric symptoms and well-being of children and adolescents in the Post-COVID-19 era: a four-year longitudinal study.

This longitudinal study examined the long-term effects of the COVID-19 pandemic on social media use and its impact on psychiatric symptoms and well-being of 3,697 Israeli children and adolescents aged 8 to 14. Data were collected from October 2019 to June 2023, covering four school years and five measurement points prior to, throughout and post- COVID-19. Social media usage, psychiatric symptoms (depression, anxiety, somatization, and general distress), as well as subjective well-being (positive and negative emotions, and life satisfaction) were assessed. The analysis also probed the extent to which social support and extracurricular activities moderated the associations between social media use and mental health outcomes. The results of the growth mixed-effects models indicated a significant increase in social media use and psychiatric symptoms, and a significant decrease in subjective well-being over time. Greater social media use was related to more psychiatric symptoms and negative emotions, but also to more positive emotions and life satisfaction. Social support buffered the negative effects of excessive social media use on mental health, whereas extracurricular activities increased positive emotions, but also psychiatric symptoms related to social media use. These findings highlight the need for targeted interventions to regulate social media usage, given its lasting consequences on the mental health of children and adolescents in the wake of the COVID-19 pandemic.

Caregiver and Child Mental Health During 3 Years of the COVID-19 Pandemic.

Coronavirus disease 2019 (COVID-19) lockdowns (stay-at-home orders) had significant mental health consequences in 2020 to 2021 for caregivers and children. Little is known about "postlockdown" periods in 2022 to 2023. We investigated the mental health experiences of Australian families throughout the 3 years of the COVID-19 pandemic (2020-2023), by demographic characteristics and lockdown length. A total N = 12 408 caregivers (N = 20 339 children, aged 0-17 years) completed Australia's only representative, repeated, cross-sectional, National Child Health Poll across 6 waves (June 2020-April 2023). Caregivers reported mental health for themselves (Kessler-6, poor versus not) and each child (self-rated mental health, poor/fair versus good/very good/excellent), and perceived impacts of the pandemic on own/child mental health (negative versus none/positive). Binary logistic models were fitted to predict marginal probabilities of each mental health measure by state/territory group (proxy for lockdown length), over time, adjusted for potential demographic confounders. Poor caregiver Kessler-6 was similar between genders but more common for sole caregivers, and those with a home language other than English and lower education. Poor/fair child self-rated mental health was similar between genders and increased with child age. Perceived negative impacts were more common for females and socially advantaged caregivers. Overall, negative mental health experiences increased with lockdown length, peaking with the height of lockdown in July 2021, before declining. Negative mental health experiences of Australian caregivers and children decreased during postlockdown periods of 2022-2023; however, social gradients persisted. These data can inform more precise mental health policies that enable better use of limited mental health infrastructure.