Highlights in child mental health research: April 2019

What’s new this month in child mental health research?

Access to mental health services for Australian children

The April 2019 Research Highlights contain two important research articles that discuss issues related to the current state of access to mental health services for Australian children (Sawyer et al. 2019; Hiscock & Paton, 2019).  These studies are likely to be of significant interest to practitioners, researchers, service providers (e.g. early childhood services, infant and child mental health services), and policy-makers with a role in supporting children and families.

• The research study by Sawyer and colleagues (2019) used survey data to identify the percentage of young Australians (aged 6–17 years) with mental disorders who received treatment with health professionals that met the criteria for “minimally adequate treatment” (MAT) in the 18 months following the survey.
• The research study by Hiscock and Paton (2019) provides a valuable insight into the barriers/enablers to mental health care for Australian children with complex mental health presentations, from the perspective of healthcare professionals. The study also presents the clinicians’ perspectives regarding what components would be required for an optimal model of care.

Potentially-modifiable factors that may promote children’s mental health

This month’s Research Highlights includes multiple research articles that discuss the latest findings on potentially-modifiable factors that may promote children’s emotional wellbeing and mental health.  These articles will be of interest to professionals, researchers, organisations and policymakers with an interest in children’s emotional wellbeing and mental health, especially prevention and early intervention.

• Environmental factors (neighbourhood-built environments) – A review of current research evidence by Alderton and colleagues (2019) reported that “studies tended to find [that] greater access to or quantity of neighbourhood nature or public open space were associated with better mental health” in children (p. 1).
• Environmental factors (residential greenspace) – A North American study by Mazdia and colleagues (2019) found that increased exposure to residential greenspace (e.g. parks, community gardens) was associated with a reduction in problematic internalising and externalising behaviours in children.
• Positive parenting practices – A North American study by Yui and Bard (2019) found that “positive parenting practices demonstrated robust protective effects independent of the number of adverse childhood experiences” (Yui & Bard 2019, p. 1). This suggests positive parenting practices may be a potentially-modifiable independent protective factor for children who have experienced adversity.

Childhood gender‐typed behavior and emotional or peer problems: a prospective birth‐cohort study (United Kingdom)

Authors:  Anna‐Sophia Warren, Kimberley A. Goldsmith, and Katharine A. Rimes
Journal:  Journal of Child Psychology and Psychiatry

Highlights and Key Messages:

This study used a large UK population cohort to investigate the relationship between childhood gender-typed behaviour and emotional problems across childhood and adolescence (i.e. 6–16 years old).  The study also explored the relationship between gender-typed behaviour and peer problems.

The key findings were:

• For boys, more gender-nonconforming behaviour was associated with greater subsequent emotional and peer problems throughout childhood and adolescence.
• For girls, more gender-nonconforming behaviour was associated with fewer subsequent emotional problems throughout childhood and adolescence.
• More female-typical behaviours were generally associated with subsequent emotional and peer problems. This overall finding applied to both boys and girls.

The results of this study are likely to be of interest to researchers, practitioners and educators who work with children and families.

Warren and colleagues (2019) highlight that further research is needed to investigate possible factors that may reduce these associations between more female-typical behaviours and emotional problems/peer problems. The authors also suggest that future studies may wish to explore the possible negative effects of female-typical behaviours and/or the possible positive effects of male-typical behaviours.

Read the Abstract here.

Depression, Anxiety, and Peer Victimization: Bidirectional Relationships and Associated Outcomes Transitioning from Childhood to Adolescence (Australia)

Authors: Forbes, Miriam K.; Fitzpatrick, Sally; Magson, Natasha R.; Rapee, Ronald M.

Journal: Journal of Youth and Adolescence

Highlights and Key Messages:

Depression, anxiety and peer victimisation often co-occur.  This co-occurrence has made it difficult for researchers to untangle the nature and direction of the relationships between these factors.

This Australian study examined a large cohort of children across time to help clarify the direction and nature of these aforementioned relationships. Two waves of data during the transition from childhood to early adolescence were used: the first when participants were aged 10–11 and the second wave when they were aged 12–13.

The key findings, which were applicable to both boys and girls, were:

• Peer victimisation at age 10–11 predicted both depression and anxiety symptoms at age 12–13.
• Depression and anxiety symptoms at age 10–11 predicted peer victimisation at age 12–13.
• Depression, anxiety symptoms and peer victimisation were all found to have bidirectional relationships.
• All three of the constructs (i.e. depression, anxiety symptoms and peer victimisation) at age 10–11 were also found to independently predict negative wellbeing outcomes.

Depression, anxiety and peer victimisation were all found to act independently as risk factors for negative outcomes. As a consequence, Forbes and colleagues (2019) propose that early interventions should simultaneously target depression, anxiety and peer victimisation in children.

These research findings are likely to be of interest to practitioners, researchers, educators, and policymakers who seek to promote children’s emotional wellbeing and mental health.

Read the Abstract here. 

Read more about the study via Macquarie University’s website here.

Reducing Inequities in Early Childhood Mental Health: How Might the Neighborhood Built Environment Help Close the Gap? A Systematic Search and Critical Review

Authors:  Amanda Alderton; Karen Villanueva; Meredith O’Connor; Claire Boulangé; Hannah Badland

Journal:  International Journal of Environmental Research and Public Health

Highlights and Key Messages:

The association between the environment and children’s mental health is currently an emerging topic of interest for researchers, practitioners and policymakers. This developing research area may be of particular interest to those in the prevention and early intervention sectors who are seeking to identify potentially-modifiable factors that may promote children’s emotional wellbeing and mental health.

The authors of this research article identified a need for a critical review of the research literature investigating the associations between the neighbourhood build environment and young children’s (aged 0–8 years) mental health. Fourteen studies met inclusion criteria with most examining nature or public open space (i.e. publicly accessible land that may be used for recreation, such as parks).

From their review of current research evidence, the authors discovered that “studies tended to find greater access to or quantity of neighbourhood nature or public open space were associated with better mental health” (p. 1).

As highlighted by Alderton and colleagues, however, it important to recognise that there are still significant gaps in this emerging and promising area of research. Further studies are certainly required, particularly to examine “the potential for modification in the built environment to reduce mental health inequalities” in children.

Read the full text here.

Parents’ use of mobile computing devices, caregiving and the social and emotional development of children: a systematic review of the evidence

Authors:  Beamish, Nicola; Fisher, Jane; Rowe, Heather

Journal:  Australasian Psychiatry

Highlights and Key Messages:

As Beamish and colleagues (2019) highlight, the rapidly-increasing use of mobile devices presents new and unique challenges for relationships and social interactions, including those between parents and their children. The authors of this article performed a much-needed systematic review in order to synthesise and evaluate the research evidence about:

• the use of mobile devices by parents
• the potential harms and benefits of parents’ mobile device use for parental caregiving, the parent-child relationship, and young children’s social and emotional development.

From their systematic review of the emerging body of research (i.e. eight research studies that met their inclusion criteria) the authors found that:

• parents’ mobile device use was “associated with altered attention and responsivity to children by their caregivers,” as well as “changes in child behaviour” (p. 132).
• “use of mobile devices during parenting activities may be infrequent and brief, but it can be a potent distraction that reduces caregiver responsiveness” (p. 132).

As Beamish and colleagues importantly highlight, it is critical to recognise that the associations found do not allow any conclusions to be made regarding causality. It is also vital to acknowledge that further research is needed to extend the emerging body of evidence on this topic and to further explore any potential impacts of parental mobile devise use on children’s development, wellbeing and mental health. This area of research also appears particularly worthy of exploration given the rapid growth in the use of mobile devices (Beamish et al., 2019).

This research article is likely to be of interest to researchers and practitioners whose work involves children and families.

Read the Abstract here.

Positive Parenting Matters in the Face of Early Adversity (USA)

Authors:  Yamaoka, Yui; Bard, David E.

Journal:  American Journal of Preventative Medicine

Highlights and Key Messages:

While a wealth of research has illustrated the negative relationship between adverse childhood experiences (ACEs) and mental health outcomes, a lack of studies exist that explore the individual impact of ACEs and positive parenting practices (PPPs) simultaneously.

Yui and Bard (2019) sought to address this knowledge gap. The researchers used a large sample of 29,997 North American children aged 0–5 years to investigate the effects of ACEs and positive parenting practices on children’s early social-emotional skills and general development. In their study, ‘positive parenting practices’ were defined as activities during which the parent engages their child – e.g. storytelling, singing, reading a book, family outings.

The key findings of the study were:

• “The number of adverse childhood experiences was associated with both social-emotional deficits and developmental delay risks in early childhood; however, positive parenting practices demonstrated robust protective effects independent of the number of adverse childhood experiences” (p. 1). That is, positive parenting practices were an independent protective factor.
• The absence of positive parenting practices increased the risks of social-emotional deficits and developmental delay. Importantly, “the risks associated with an absence of positive parenting were often greater than “the risks associated with having four or more ACEs” (p. 1).
• Overall, “positive parenting practices appear to mitigate negative effects of adversities” on children’s social-emotional skills and general development during this early developmental period (p. 5).

The identification of positive parenting practices as a potentially-modifiable protective factor for social and emotional development in children who have been exposed to early adversity is likely to be of significant interest to practitioners, organisations and policymakers, particularly given that ACEs are prevalent and are associated with significant financial costs.

As the authors highlight, this important study provides further support for policies that promote positive parenting practices in early childhood prevention efforts targeting children’s social-emotional wellbeing – e.g. evidence-based parent training programs and parenting resources.

Read the full text here.

Adequacy of treatment for child and adolescent mental disorders in Australia: A national study (Australia)

Authors:  Sawyer, Michael G.; Reece, Christy E.; Sawyer, Alyssa C. P.; Hiscock, Harriet; Lawrence, David

Journal:  Australian & New Zealand Journal of Psychiatry

Highlights and Key Messages:

This article discusses multiple important research findings related to the adequacy of treatment for child/adolescent mental health disorders in Australia. It is likely to be of significant interest to researchers, practitioners, organisations (e.g. early childhood services, infant and child mental health services), and policymakers.

The researchers used data from the 2013-2014 Australian national survey of mental health to identify the percentage of children and adolescents aged 6–17 years with mental disorders who received treatment with health professionals that met the criteria for ‘minimally adequate treatment’ (MAT) in the 18 months following the survey. The study also investigated the factors that were associated with children and adolescents having received ‘minimally adequate treatment’ with health professionals.

The key findings were:

• In the 18 months after being identified as having a mental disorder, only 11.6% of children and adolescents had contact with health professionals that was sufficient enough to meet the criteria for ‘minimally adequate treatment’.
• 8%. of children with mental disorders who also had severely impaired functioning, and parents who perceived that their children required help had no contact with health professionals at all. Only 20.2% of those children had received ‘minimally adequate treatment’.
• Those children with mental disorders who had moderately or severely impaired functioning were more likely to have received ‘minimally adequate treatment.’

Sawyer and colleagues (2019) propose that the aforementioned findings “may be contributing to the unchanging high prevalence of childhood mental disorders” in Australia (p. 1).

Find the Abstract here.  

Strengthening care for children with complex mental health conditions: Views of Australian clinicians (Australia)

Authors:  Paton, Kate; Hiscock, Harriet

Journal:  PLoS ONE

Highlights and Key Messages:

“In Australia, up to half of all children and adolescents meeting criteria for mental health disorders receive sub-optimal levels of treatment (or no treatment at all) despite the availability of effective treatments” (Paton and Hiscock 2019, p1). Children particularly at risk of inadequate treatment are those with complex mental health conditions.

This important study by Paton and Hiscock (2019) investigated clinicians’ perspectives about the barriers/enablers to service access and optimum care in Australia for children with complex mental health conditions. These perspectives were obtained through an analysis of 30 semi-structured interviews conducted with health professionals in metropolitan and regional locations. Health professionals interviewed included pediatricians, psychiatrists, and psychologists.

Key findings included:

– Healthcare professionals identified the following factors as barriers to children with complex mental health conditions accessing services and optimal care (see pp. 4 – 8):-

• Healthcare system factors – For example, a lack of policies/procedures for coordination of care, the structure of the healthcare system (such as shared responsibilities by state and federal levels), and the pluralistic structure of healthcare services (such as both publicly-funded and private services).
• Financing structure factors – For example, the introduction of the National Disability Insurance Scheme (NDIS) and its associated uncertainty for specific conditions/programs.
• Parent and family factors – For example, “many areas of children’s care are substantially influenced by the capacity of parents to advocate on behalf of their child” (p. 7). The system of care is also difficult to navigate for caregivers/families.

– Healthcare professionals identified the following factors as enablers to children with complex mental health conditions accessing services and optimal care (see pp. 8-9):

• Healthcare system factors – For example, the physical proximity of professionals and the collaborative relationships that this proximity may foster (this was identified as a potential advantage of regional service providers).
• Financing structure factors – For example, “the Medicare Benefits Scheme is considered to underpin access to care” in Australia, and enables primary and secondary care (p. 9).
• Parent and family factors – For example, “informed and capable parents” were perceived as “major enablers of optimal care” (p. 9).

Highlights and Key Messages (continued):

-Healthcare professionals proposed that an optimal model of care (see p. 10) would:

• empower parents to support, manage and advocate for their children’s care within the system, including through providing tools, resources and support.
• involve service providers working collaboratively, purposefully and in a multidisciplinary manner to simplify, streamline and optimise service delivery.
• involve workforce capacity building that seeks to increase the knowledge of professionals regarding the treatment of complex mental health conditions.
• strengthen and build the capacity of the education systems given the significant amount of time that children spend at school.
• co-locate and integrate services to foster coordinated care, including through the use of technology when being in the same place is impossible (e.g. video conferencing).

This article is a must-read for all clinicians, researchers, service providers (e.g. early childhood services, infant and child mental health services), and policymakers whose day-to-day activities and responsibilities involve a consideration of the emotional well-being of children and families.

 Find the full text here.