Higher Strengths And Difficulties Questionnaire Scores Research Articles

51 Mental Health Trajectories of Children and Caregivers who Accessed School-based Health Centres during the COVID-19 Pandemic

Abstract Background School-based health centres (SBHCs) improve health care access for students with mental health concerns, especially for disadvantaged communities who face access barriers. During the pandemic, health care access was restricted; however our SBHCs remained accessible. How SBHCs supported children’s and parents’/caregivers’ mental health during the pandemic is unclear. Objectives The primary objective of this study was to compare the trajectory of mental health symptoms in children who used SBHCs during the pandemic compared to those who did not. Design/Methods This was a prospective longitudinal cohort study of children who used SBHCs serving disadvantaged children with developmental and mental health conditions. A mental health survey which included the Strengths and Difficulties Questionnaire (SDQ) and the Generalized Anxiety Disorder-7 (GAD-7) was used at three time points during the pandemic for children registered with SBHCs. The primary analysis compared the trajectory of SDQ scores over time between children who accessed the SBHCs during the pandemic and those that did not. The secondary analysis was the same, using the GAD-7 scores for parents/caregivers. Results There were 435 children included in the study. The mean age was 10.7 years (SD=3.2). Two hundred and ninety-five children (67.8%) identified as male. One hundred and twenty-eight (29.4%) children had an annual family income of less than $30,000.00. After adjusting for age, gender, and diagnoses, children who attended SBHCs had higher SDQ scores over time relative to children who did not (0.15, 95% CI 0.03 to 0.28, p=0.02). Specifically, the total SDQ score increased by 0.14 (95% CI: 0.02, 0.27; p = 0.03) per month in those who accessed SBHCs during the pandemic, while the change in total SDQ score per month was -0.01 (95% CI: -0.06, 0.03; p = 0.55) in those who did not. Parents of children who attended SBHCs also had higher GAD-7 scores over time (0.16, 95% CI = 0.06 to 0.27, p = 0.002) compared with those whose children did not visit the SBHCs. Conclusion Mental health symptoms and anxiety symptoms worsened among children and parents/caregivers who attended a SBHC at least once during the pandemic. SBHCs may have decreased access barriers for children and parents/caregivers with socioeconomic risk factors who experienced mental health symptoms during the pandemic, when other healthcare options were limited. Longitudinal studies with longer follow up would help determine the role of SBHCs in supporting at-risk children and parents/caregivers with mental health needs during the pandemic.

Longitudinal changes of mental health problems in children and adolescents treated in a primary care-based health-coaching programme – results of the PrimA-QuO cohort study

BackgroundIn Germany, 19.1% of boys and 14.5% of girls are affected by mental health problems (MHP). Paediatricians are usually the first in line to be contacted but they often do not feel adequately trained to diagnose and treat MHP in primary care. A major statutory health insurance fund introduced a health coaching (HC) programme to strengthen primary care consultation for MHP. The HC includes a training concept for paediatricians, standardised guidelines for actions and additional payments. The aim of this study was to investigate the potential effects of the HC programme on the change of MHP in children and adolescents.MethodsA prospective cohort study was conducted in Bavaria, Germany, in 2018 and 2019. Data were collected at 2 points 1 year apart using an online questionnaire. Parents of patients with developmental disorder of speech and language, head/abdominal pain, conduct disorder or non-organic enuresis were approached by their health insurance. Families treated according to the HC programme form the intervention group while all others serve as controls. MHP was assessed using the Strengths and Difficulties Questionnaire (SDQ) as a child self-assessment (SDQ-S)/or external assessment by parents (SDQ-P). Determinants of SDQ total score were analysed using linear mixed effects models.ResultsCross-sectional (n = 1090) and longitudinal analyses (n = 599) were performed. At baseline, a total of 23.5% had an SDQ total score “at risk” (SDQ-S > 15/SDQ-P > 13). There were no significant differences between intervention and controls. After full adjustment for all potential confounders, higher SDQ scores indicating more problems were significantly associated with male sex (2.000, p < 0.001) whereas a high parental education level was significantly associated with decreased SDQ scores (-2.127, p =0.034). There was a significant improvement in the control group over time (-0.814, p = 0.001) while the SDQ scores in the intervention group remained stable (-0.012, p = 0.020).ConclusionThis evaluation of the HC programme could not prove a clinically relevant intervention’s effect on the MHP developmental course. Nevertheless, (HC) paediatricians have crucial potential to improve the care of MHP patients. Targeting families with less access to support measures might help reduce the burden of MHP and be a step towards continuous improvement of care.

Screening for Children's Chronic Health Conditions and Their Strengths and Difficulties in Primary Care.

This study explores parents' perceptions of their child's health status and their strengths and difficulties using 2 validated instruments in primary care settings. This cross-sectional study was conducted between February 2018 and October 2019. Parents of children aged 2 to 18 years completed the Children with Special Health Care Needs (CSHCN) screener and the Strengths and Difficulties Questionnaire (SDQ) as well as demographics. The CSHCN uses 5 questions to identify children with chronic health conditions. Three subgroups were created: children with no chronic health condition (NCHC), chronic health condition with no functional limitations (NFLs), and chronic health condition with functional limitations (FLs). Higher SDQ scores indicate higher degrees of a factor. Associations between CSHCN subgroups and SDQ scores, controlling for demographics, were analyzed with multiple linear regressions. In total, 970 parents' surveys (87.9% completed surveys) were included in this analysis: 76.4% of respondents were married, 56.4% had an annual household income ≥$50,000%, and 61.7% were employed full time; 53.0% of the index children were males, 72.1% were White, and 61.4% had private insurance. Mean (SD) total SDQ scores across the 3 CSHCN subgroups were significantly different (NCHC, 7.7 [4.8]; NFL, 12.6 [6.6]; FL, 16.0 [6.7], p < 0.001). The mean SDQ prosocial scores were higher in the NCHC subgroup (p < 0.001), as hypothesized. The SDQ means for the 3 subgroups remained significantly different after controlling for demographics. Children with FLs had significantly higher total SDQ scores than children in the other 2 subgroups, which may aid clinicians in the early identification of children who would benefit from behavioral health resources.

Mental health and health-related quality of life in preschool-aged childhood cancer survivors. Results of the prospective cohort study ikidS-OEVA.

Long-term survivors of childhood cancer are at increased risk for sequelae such as poor mental health (MH) or impaired health-related quality of life (HrQoL). We aimed to evaluate early adverse effects on MH and HrQoL in young childhood cancer survivors (YCCS) before school entry. In a nationwide prospective cohort study, children with cancer other than brain tumors diagnosed at preschool age and completed cancer treatments were identified from the German Childhood Cancer Registry. The comparison group was children of the same age without a cancer diagnosis who participated in the prospective population-based health survey ikidS. MH problems and HrQoL were assessed by parental versions of the Strengths and Difficulties Questionnaire (SDQ) and the questionnaire for health-related quality of life in children (KINDL), respectively. Associations between cancer and MH as well as HrQoL were analyzed by multivariable linear regression. Of 382 YCCS contacted, 145 were enrolled (mean age 6.6years) and 124 analyzed. Compared to children without a cancer diagnosis (3683 contacted, 2003 enrolled, 1422 analyzed), YCCS had more MH problems (13% vs. 3%) and slightly worse HrQoL (median 78.7 vs. 80.2 points). In the adjusted analysis, YCCS had higher SDQ scores (2.2 points, 95% confidence interval [CI] 1.3, 3.0) and lower KINDL scores (-2.4 points, 95% CI -3.7, -1.1) compared to children without cancer diagnosis. Already at preschool age, YCCS may be at increased risk of MH problems and impaired HrQoL. This could have impacts on subsequent school performance and educational attainment. Follow-up health care for YCCS may include early screening for MH problems and reasons for HrQoL deficits.

Healthy Lifestyle Behaviours Are Associated with Children's Psychological Health: A Cross-Sectional Study.

Protecting children’s mental health is important and studies have shown that diet and exercise can have a positive impact. There are limited data available, however, from representative populations of children on the relationship between regular healthy lifestyle behaviours and psychological health. Data were obtained from the New South Wales Child Population Health Survey, 2013–2014. Parents were asked about diet, physical activity and screen time behaviours and completed the Strengths and Difficulties Questionnaire (SDQ) for one child aged 5–15. Higher SDQ scores indicate poorer psychological health and risk for mental health problems. Multivariable linear and logistic regression examined the relationships among dietary consumption, physical activity, screen time and SDQ scores, adjusting for potential confounding. Meeting screen time recommendations was most strongly associated with a lower SDQ total difficulties score (5–10 years: −1.56 (−2.68, −0.44); 11–15 years: −2.12 (−3.11, −1.12)). Children and adolescents who met screen time recommendations were also significantly less likely to have any score in the at-risk range. Children and adolescents meeting vegetable intake guidelines had significantly lower total difficulties scores (5–10 years: −1.54 (−3.03, −0.05); 11–15 years: −1.19 (−3.60, −0.39)), as did adolescents meeting discretionary food guidelines (−1.16 (−2.14, −0.18)) and children consuming the recommended fruit intake (−1.26 (−2.42, −0.10)). Our findings indicate that more effective interventions to increase the proportion of young Australians who meet the guidelines for diet and screen time would contribute to protecting their mental health.

The Strengths and Difficulties Questionnaire as a Mental Health Screening Tool for Newly Arrived Pediatric Refugees.

Many refugee children have exposure to trauma prior to arrival and during resettlement. Mental health screening in primary care among resettled refugee children is needed. The Strengths and Difficulties Questionnaire (SDQ) was used to screen refugee children age 4-18years at their Domestic Medical Examination and three other primary care visits in their first year of resettlement. We tested the association between time and SDQ score or intervention/referral, and differences based on geographic origin. SDQ scores were highest upon arrival (Ps < .0005). Referrals were most common at the six-month visit compared to arrival and one month (Ps < .01). Iraqi children had higher SDQ scores at all visits (Ps < .03). The SDQ can be used in primary care to screen newly arrived refugee children. Practitioners should screen at arrival to identify difficulties. Those with difficulties continuing at six months may need an intervention or referral.

Early postnatal maternal trait anxiety is associated with the behavioural outcomes of children born preterm

Maternal ante- and postnatal anxiety have been associated with children's socio-emotional development. Moreover, maternal anxiety has been studied as both a contributing factor and consequence of preterm birth, and children born preterm are more likely to develop behavioural problems compared to term-born controls. This study investigated the association between maternal anxiety measured soon after birth and mental health in 215 ex-preterm children, born at <33 weeks, who participated in the Evaluation of Preterm Imaging Study. Children were followed-up at a median age of 4.6 years (range 4.2–6.6), and received behavioural and cognitive evaluation. Maternal trait anxiety was assessed with the Spielberger State-Trait Anxiety Index at term corrected age. Primary outcome measures were children's Strengths and Difficulties Questionnaire (SDQ) and Social Responsiveness Scale 2 (SRS-2) scores, indicative of generalised psychopathology and autism symptomatology, respectively. IQ was assessed with the Wechsler Preschool and Primary Scales of Intelligence. The final sample, after excluding participants with missing data and multiple pregnancy (n = 75), consisted of 140 children (51.4% male). Results showed that increased maternal trait anxiety at term corrected age was associated with children's higher SDQ scores (β = 0.25, 95% CI 0.09–0.41, p = 0.003, f2 = 0.08) and SRS-2 scores (β = 0.15, 95% CI 0.02–0.28, p = 0.03, f2 = 0.04). Our findings indicate that children born preterm whose mothers are more anxious in the early postnatal period may show poorer mental health outcomes at pre-school age. Further research is needed to investigate preventative measures that can be offered to high-risk premature babies and their families.

Joint and independent neurotoxic effects of early life exposures to a chemical mixture: A multi-pollutant approach combining ensemble learning and g-computation.

Exposure to mercury (Hg) is associated with adverse developmental effects. However, Hg occurs with a multitude of chemicals. We assessed the associations of developmental exposure to multiple pollutants with children's neurodevelopment using a novel approach. Hg, polychlorinated biphenyls (PCBs), and perfluoroalkyl substances were measured in maternal and children's blood at 5-years (n=449 and 419). At 7-years, children were administered Boston Naming Test (BNT) and the Strengths and Difficulties Questionnaire (SDQ). We used the G-formula combined with SuperLearner to estimate independent and joint effects of chemicals at both ages. We constructed flexible exposure-response relationships and assessed interactions. Most chemicals showed negative relationships with BNT scores. An inter-quartile range (IQR) increase in maternal Hg and perfluorooctanoic acid (PFOA) was associated with 0.15 standard deviation [SD] (95% Confidence Interval [CI]: -0.29,-0.03) and 0.14 SD (95%CI: -0.26,-0.05) lower scores in BNT, whereas a joint IQR increase in the mixture of chemicals was associated with 0.48 SD (95%CI: -0.69,-0.25) lower scores in BNT. An IQR increase in PFOA was associated with 0.11 SD (95%CI: 0.02,0.26) higher total SDQ difficulties scores. Maternal ∑PCBs concentrations were associated with lower SDQ scores (β=-0.09 SD; 95%CI: -0.19,0), whereas 5-years ∑PCBs showed a negative association (β=-0.09 SD; 95%CI: -0.21,0). Finally, a joint IQR increase in the mixture was associated with 0.22 SD (95%CI: 0.04,0.4) higher SDQ scores. Using a novel statistical approach, we confirmed associations between prenatal mercury exposure and lower cognitive function. The potential developmental effects of PFASs need additional attention.

Emotional and behavioral problems in children of depressed mothers: a school-based study in Southern Brazil

ABSTRACTThe present study aimed to verify the association between maternal depression and emotional and behavioral problems in school children in Pelotas, Southern Brazil, considering that maternal depression increases children’s vulnerability for developing psychiatric disorders. This is a cross-sectional study with a school-based sample conducted between August 2015 and November 2016 and it is part of a major project entitled ‘Healthy Childhood in Context: A Multidisciplinary Investigation’. Schoolchildren aged between 7 and 8 years and one of their respective parents or a primary caregiver were included in the study. Maternal depression was assessed using the Mini International Neuropsychiatric Interview (MINI). The presence of emotional and behavioral problems in children was verified by the Strengths and Difficulties Questionnaire (SDQ) – parents version. Children of depressed mothers exhibited higher mean scores in all SDQ domains and in the total score when compared to children of non-depressed mothers. Lower socio-economic status was also associated with higher SDQ scores. Our results showed the effects of both maternal depression and poverty on children emotional and behavioral problems, which evidence the need for child mental health preventive care, and free quality assistance for both mothers and their children.

Parental Sexual Orientation and Children's Psychological Well-Being: 2013-2015 National Health Interview Survey.

Debate persists about whether parental sexual orientation affects children's well-being. This study utilized information from the 2013 to 2015 U.S., population-based National Health Interview Survey to examine associations between parental sexual orientation and children's well-being. Parents reported their children's (aged 4-17years old, N=21,103) emotional and mental health difficulties using the short form Strengths and Difficulties Questionnaire (SDQ). Children of bisexual parents had higher SDQ scores than children of heterosexual parents. Adjusting for parental psychological distress (a minority stress indicator) eliminated this difference. Children of lesbian and gay parents did not differ from children of heterosexual parents in emotional and mental health difficulties, yet, the results among children of bisexual parents warrant more research examining the impact of minority stress on families.

Increased Sleep Disturbances in Thai Children With Attention-Deficit Hyperactivity Disorder Compared With Typically Developing Children

This study compares sleep disturbances in Thai children aged 5–12 years with attention-deficit hyperactivity disorder (ADHD) and typically developing children using the Children’s Sleep Habits Questionnaire (CSHQ)–Thai version. Fifty-five children with ADHD and 110 typically developing children were enrolled. Their parents completed the CSHQ, the ADHD rating scales, and the Strengths and Difficulties Questionnaire (SDQ). Children with ADHD had significantly higher scores in all subscales of the CSHQ compared to controls. Among children with ADHD, children with higher SDQ scores (> 15) appeared to have more sleep disturbances than those with relatively lower SDQ scores. Moreover, fewer sleep-related behavioral problems were observed in the medication treated group, which is particularly new to the field and for some perhaps not unexpected clinically.

Low and Very Low Food Security are Associated with Differences in Emotional and Behavioral Problems among Children and Adolescents in the US

The adverse association between food insecurity and emotional and behavioral problems (EBP) among children and adolescents has been studied, but little work has examined if more severe food insecurity is associated with higher EBP.Using a national sample of households (HH) with children and adolescents, we examined the association between EBP and food security status (FSS) (i.e., food secure (FS), low food secure (LFS), and very low food secure (VLFS)). Data were collected from a total of 22,522 children and adolescents from 2011 to 2013.The Strengths and Difficulties Questionnaire (SDQ) and the 10‐item USDA HH Food Security Survey were used to measure EBP and FSS. Negative binomial and logistic regressions were used to test the associations between total SDQ score, high SDQ score (SDQ score 蠅 6), and FSS. All models adjusted for demographic and socioeconomic confounders.Compared to FS HH, children and adolescents in LFS or VLFS HH had higher SDQ scores (LFS, incidence rate ratio (IRR) 1.22, p&lt;0.001; VLFS IRR 1.37, p&lt;0.001) and had increased odds of having a high SDQ score (LFS, odds ratio (OR) 1.35, p&lt;0.05; VLFS OR 2.07, p&lt;0.001). Compared to LFS HH, VLFS HH had a mean IRR that was 0.12 higher (p&lt;0.01) and a mean OR that was 0.43 higher (p&lt;0.01).Compared to LFS HH, children and adolescent in VLFS HH have higher EBP. In addition, compared to FS HH, children and adolescents in LFS and VLFS have higher EBP. This work was supported by FRAC.

A three generation study of the mental health relationships between grandparents, parents and children

BackgroundIt is well known that children of parents with mental illness are at greater risk of mental illness themselves. However the patterns of familial mental health problems across multiple generations in families are less clear. This study aimed to examine mental health relationships across three generations of Australian families.MethodsMental health data, along with a range of family demographic information, were collected from over 4600 families in Growing Up in Australia: The Longitudinal Study of Australian Children, a nationally representative cohort study. The social and emotional wellbeing of two cohorts of children aged 4–5 years and 8–9 years was measured using the parent-rated Strengths and Difficulties Questionnaire (SDQ). The mental health of mothers and fathers was measured using the Kessler 6-item K6 scale, and the mental health history of maternal and paternal grandmothers and grandfathers was measured using a dichotomous parent-report item. Multivariate linear regression analyses were used assess the relationships between grandparent and parent mental health and child social and emotional wellbeing at ages 4–5 years and 8–9 years.ResultsBoth cohorts of children had greater mental health distress with higher SDQ scores on average if their mother or father had a mental health problem. For children aged 8–9 years, a history of mental health problems in maternal grandmothers and grandfathers was associated with higher SDQ scores in grandchildren, after controlling for maternal and paternal mental health and other family characteristics. For children aged 4–5 years, only a mental health history in paternal grandfathers was associated with higher SDQ scores.ConclusionsThe mental health histories of both parents and grandparents play an important role in the social and emotional wellbeing of young children.