Highlights in child mental health research: April 2023

Why is this important? 

• This study provides a comprehensive assessment of the associations between experiences of child maltreatment and mental disorders (MDs) in Australia.

What did they do?

• A population-representative survey of 8,503 Australians (aged 16 years and older) was conducted.
• Using the Mini International Neuropsychiatric Interview, the following MDs were measured: post-traumatic stress disorder (PTSD), generalised anxiety disorder, alcohol use disorder, and major depressive disorder.
• Child maltreatment was assessed using items from the Juvenile Victimisation Questionnaire-R2. The study measured five types of child maltreatment: physical abuse, sexual abuse, emotional abuse, neglect, and exposure to domestic violence.

What did they find?

• The prevalence of any MD increased from 21.6% in non-maltreated participants to 48.0% for those who experienced any child maltreatment, and 54.8% for those who experienced two or more types of child maltreatment.
• All forms of child maltreatment were associated with 2-3 times higher likelihood of any MD compared to those with no maltreatment. However, emotional abuse, sexual abuse and multi-type maltreatment were the strongest predictors of MDs.
• The association between child maltreatment and MDs did not significantly differ after adjusting for socio-economic factors, and remained consistent across age cohorts (16-24 years, 25-44 years, 45 years and older).

What does this mean for practice?

• All forms of child maltreatment, including emotional abuse and exposure to domestic violence, increase the risk of MDs.
• The impact of maltreatment is long-lasting, with MDs persisting throughout life, long after the maltreatment occurred. Prevention of child maltreatment is therefore an opportunity to reduce MDs in Australia.
• Child maltreatment prevention strategies could include improving parenting skills and supporting healthy family interactions, such as though implementation of evidence-based parenting interventions and targeted delivery of nurse home visiting programs.

Why is this important? 

• Poor self-regulation is a risk factor for negative health and wellbeing outcomes, such as experiences of stress, mental health concerns and externalising behaviours.
• Mindfulness-based interventions (MBIs) can support children’s development of emotional, behavioural and cognitive self-regulation.

What did they do?

• This study reviewed research on MBIs in early childhood settings conducted between 2010 and 2021.
• 18 research studies were reviewed. The studies included a total of 2,387 children aged 3-6 years from Australia, Canada, Korea, Singapore, and the United States.

What did they find?

• There was strong evidence for MBIs improving behavioural regulation (including reductions in hyperactivity, aggression, and impulsivity) and cognitive regulation (including increased attention, executive function, and working memory).
• There were mixed findings for MBIs improving emotional regulation.
• Almost all studies found MBIs to be effective in improving at least one form of self-regulation (behavioural, cognitive, or emotional regulation).
• The benefit of MBIs appeared strong among children with executive function challenges, behavioural problems and/or learning difficulties.
• More intensive MBI programming (longer duration and higher frequency of sessions) was more likely to lead to positive outcomes.
• Educators consider MBIs feasible, acceptable and simple to deliver, however MBIs that require facilitation by external instructors were challenging to sustain.

What does this mean for practice?  

• MBIs delivered in early childhood settings appear to be beneficial in improving self-regulation, particularly behavioural and cognitive regulation.
• Educators should be supported through professional development opportunities to deliver MBIs that can be embedded into the daily structure and culture of their classrooms.
• MBIs may be especially beneficial for young children struggling with self-regulation.
• Involving parents/caregivers may encourage uptake of mindfulness activities at home.

Why is this important? 

• Digital-based health interventions (DBIs) are becoming increasingly available as a means of providing health support and promoting wellbeing.
• This study sought to understand a current gap in literature regarding the characteristics and potential challenges of implementing DBIs for children and young people (CYP).

What did they do?

• A search was conducted for clinical trials of DBIs published between 2018 and 2022.
• 34 studies were included in the review.

What did they find?

• Three quarters (76%) of the DBIs were for mental health disorders, many of which applied cognitive behaviour therapy (38%).
• Most DBIs were delivered via computer (50%), followed by smartphones (38%).
• DBIs for CYP took the form of guidance (e.g., delivery of information), reminders and monitoring (e.g., daily check-ins), tasks and activities (e.g., virtual reality game), supportive feedback (e.g., chat sessions), and/or reward systems (e.g., badges).
• Potential ethical challenges when implementing DBIs included: consent (e.g., the requirement of parental and/or CYP consent), data privacy (e.g., unauthorised third-party access to confidential patient information or accidental data leakage), and potential adverse events/ effects relating to physical or psychological harms.
• Potential interpersonal challenges included: caregiver attitudes, involvement and the decisions made regarding their child’s healthcare.
• Potential societal challenges included: limited availability of digital technology (particularly in rural communities), a lack of diversity in trials, language barriers, and sex differences in patterns and preferences of digital technology use.

What does this mean for practice?

• DBIs that target mental health in CYP are becoming increasingly common. However, potential challenges when implementing DBIs may arise including ethical (consent and privacy), interpersonal (caregiver influence) and societal (availability and accessibility of DBIs) challenges.
• Accessibility is a primary benefit of DBIs, but considerable barriers to use still exist. These include inadequate access to technology and low digital literacy in some communities.
• The authors recommend several actions to address these challenges including:
  • Co-designing mental health DBIs for CYP in collaboration with CYP with lived experience of mental health challenges and with their caregivers,
  • Ensuring security and privacy concerns are addressed during development of DBIs,
  • Considering how CYP consent is provided to minimise confidentiality concerns and other barriers to use,
  • Integrating proactive detection and responses to safety concerns and adverse events,
  • Integration of DBIs in non-clinical settings, such as schools, to increase access.

Why is this important?

• Movement behaviours (MBs), including physical activity, low sedentary behaviour and sleep duration can positively impact the health of children and young people (CYP).
• This study aimed to provide a review of the impact of combinations of MBs on CYP’s psychological, educational and physical health outcomes.

What did they do?

• The authors conducted a search of international literature published before June 2020 which explored movement behaviours and health outcomes in CYP.
• 141 studies were included in this review. Included studies came from 57 countries, including the United States, Canada, and Australia.

What did they find?

• Physical activity and sedentary behaviours (e.g. screen time, sitting) were measured and reported frequently in the included studies for both children and adolescents. Sleep duration was captured and reported less frequently, particularly for adolescents.
• High physical activity and low sedentary behaviours were associated with positive health, psychological, and educational outcomes.
• When sleep was included, the combination of all three MBs produced the most favourable outcomes.
• Together, high physical activity, low sedentary behaviour and longer sleep duration were associated with the most favourable mental health outcomes, health-related quality of life, and wellbeing.

What does this mean for practice?

• Practitioners can support child mental health and wellbeing by informing children and families about the importance of sleep and movement.
• A combination of MBs should be encouraged to support the best possible outcomes for CYP. For example, increasing physical activity may not produce beneficial outcomes if sleep remains is low.
• More research is required that focuses on the relationship between sleep and physical, psychological and educational outcomes in CYP, especially in adolescents.