Highlights in child mental health research: August 2019

Highlights:

Is there a potential influence of mother’s anxiety and depressive symptoms before and after birth on infant social-emotional development?

This was the question that researchers sought to answer in this Australian study. The researchers used data from 282 pregnant women and their children to measure:

• Maternal symptoms of anxiety and depression (measured in early pregnancy, the third trimester of pregnancy, 6 months post-birth and 12 months post-birth).
• Infant’s social and emotional development (measured at 12 months of age)

The study found that “both initial maternal depression and anxiety symptom levels (and the growth of these symptoms over time) predicted more problems with children’s social and emotional development” (p. 1).

These findings add to existing research evidence supporting the importance of parental mental health in children’s development and mental health.

The researchers emphasise that their results support the need for early “targeted screening, assessment and interventions to address maternal mental health issues for at-risk parents during pregnancy.”

The authors also stress the importance of monitoring of young children whose parents have experienced mental health problems.

Read the Abstract here

Highlights:

Two Australian studies have been published that explore the effects of racism on Aboriginal and Torres Strait Islander (ATSI) children’s social and emotional well-being.

Study 1

Using data of 1,060 ATSI children (aged 6 to 12 years) from The Longitudinal Study of Indigenous Children, Macedo and colleagues (2019) aimed to explore the effect of racism on social-emotional wellbeing (SEWB) indicators at 1 to 2 years post-exposure.

Key findings included:

• “Exposure to racism was associated with…a 41% increased risk for total emotional and behavioural difficulties.”
• Younger children exposed to racism were at a higher risk for total emotional and behavioural difficulties.
• Older children exposed to racism were at a higher risk for hyperactive behaviour.

The researchers concluded that their findings demonstrate the need for supports that target the mental health and well-being of ATSI children. They also emphasise the need for additional research and policies that aim to decrease racism in Australia.

Read the full-text here

Study 2

This study, also by Macedo and colleagues (2019), explored the protective role of ethnic-racial identity (ERI) affirmation on the relationship between racism and ATSI children’s social and emotional well-being.

The researchers defined ethnic racial identity as a “multidimensional concept that…involves perceptions and attitudes about group belonging, exploration of cultural practices and behaviours, understanding of stereotypes held by in-group and out-group members, and the levels of commitment and attachment to one’s ethnic racial group” (p. 2 – 3).

Using data from 408 ATSI children (aged 7 to 12 years) from The Longitudinal Study of Indigenous Children, the researchers found that:

• Just over half of the sample (around 51%) presented with a high level of ethnic racial identity affirmation.
• Those children who had low ERI affirmation and who were exposed to racism were at an increased risk of total emotional and behavioural difficulties, as well as hyperactive behaviour. The joint effects of low ERI affirmation and racism were greater than the sum of each of their individual effects.

The researchers suggest that strategies promoting ethnic-racial identity affirmation may hold promise for promoting the social-emotional wellbeing and resilience of ATSI children (p. 2).

Read the full-text here

Highlights:

This Australian study used a sample of 1,507 pregnant women, who were followed up until 4 years post-birth, to investigate:

• The association between mother’s exposure to violence (e.g. abuse during childhood, intimate partner violence) and their mental/physical health following childbirth.
• The association between mother’s exposure to violence and their children’s emotional-behavioural difficulties at age 4.
• The association between mother’s mental/physical health and their children’s emotional-behavioural difficulties at age 4.

Key findings included:

• Almost one in three women reported being exposed to intimate partner violence in the 4 years post-birth.
• Maternal exposure to violence and poor maternal physical/mental health were associated with increased odds of children’s emotional-behavioural difficulties at age 4.
• Multiple instances of maternal exposure to violence or poor maternal physical/mental health at multiple points in time increased the odds of children showing later emotional-behavioural difficulties.
• For children whose mothers had been exposed to childhood abuse but had not been exposed to later intimate partner violence, the odds of experiencing emotional-behavioural difficulties were similar to those of children whose mothers had not experienced any exposure to violence. That is, resilience was observed when the inter-generational cycle of violence was broken.

The researchers highlight that these findings support prevention and early intervention strategies that target family and domestic violence, including those that aim to break the inter-generational transmission of violence and disadvantage.

Read the free full-text here

Highlights:

CareTrack Kids (CTK) is a study that was developed to evaluate the quality of care for Australian paediatric patients. Quality of care was measured via adherence to clinical practice guidelines (CPGs).

This article specifically reports on the results for Australian paediatric patients (i.e. aged 15 years and younger) with depression and/or anxiety. The medical records of children with depression and anxiety were analysed. Each record was examined to determine the degree of adherence to assessment and management practice guidelines.

The key findings were:

• “Australian children with eligible assessments for depression or anxiety received appropriate care at an average of 72% and 81% of the time, respectively” (p. 8).
• “Approximately one-third of children’s medical records related to depression and one-half for anxiety showed full documented adherence” to CPG’s.
• The highest levels of adherence were for medication prescription guidelines.
• The lowest levels of adherence were for guidelines related to:
• Ensuring that paediatric patients with depression had an emergency safety plan (44%).
• Ensuring that parents of paediatric patients with anxiety were made aware of the risk/benefits of anxiety medication (51%).
• Ensuring that other possible causes for mental health symptoms had been explored (e.g. peer victimisation, child maltreatment).
• Levels of guidelines compliance were lower for general practices than for other healthcare settings (such as hospital inpatient settings).

The researchers highlight that these findings offer multiple possible targets for improvement in the quality of care for children with depression and anxiety. Examples include:

• Ensuring paediatric patients with depression have an emergency safety plan.
• Conducting a thorough assessment, including of other possible causes for mental health symptoms.
• Providing families with information regarding medications.

The researchers suggest that these areas could be targeted by national initiatives, particularly for general practitioners.

Read the abstract here

Highlights:

• Researchers performed a systematic review of qualitative research investigating what children and young people with long-term conditions, their caregivers, and their health professionals perceive to be important aspects of mental health/wellbeing interventions.

• Data from 57 studies was synthesised.

• The synthesis identified five overarching themes that were perceived as important aspects of mental health/well-being interventions for children and young people with long-term physical conditions (p. 1):

• “Getting in and staying in” (p. 7) – This includes promoting availability of, accessibility of, and engagement with interventions, as well as maintaining the effects of an intervention beyond its end date.
• “Therapeutic foundation” (p. 8) – Ensuring a therapeutic foundation to interventions (including therapeutic relationships) whereby children and young people feel safe, valued and able to express their emotions/experiences.
• “Social support” (p. 9)- Social support from peers and professionals that helps the child or young person to access an intervention, strengthen their social relationships, develop novel skills, and create a “hopeful alternative” view of the future.
• “A hopeful alternative” (p. 9) – Participating in daily activities and socialising can help the child or young person to create a “hopeful alternative” view of the future. This can also assist with creating a sense of identity that is not confined to their illness.
• “Empowerment” – Promoting feelings of empowerment can have a positive long-term impact on their mental health and ability to access supports.

The researchers conclude that when the aforementioned themes are linked together and “interventions can provide an environment that allows young people to share their experiences and build empathetic relationships, it can enable participants to access social support and increase feelings of hope and empowerment” (p. 1).

These findings have important implications for the development and delivery of mental health interventions for children and young people with long-term conditions.

Read the full-text here