Highlights in child mental health research: April 2024

This month’s highlights include:

Parental risk factors related to the mental health of youth from immigrant families

This review aimed to identify modifiable parental factors that could inform parenting interventions that may prevent mental health problems in young people with immigrant parents. 56 studies from high-income countries were included, including 2 from Australia. The study found that risk factors that were associated with negative mental health outcomes included parent-youth acculturative conflict, parental withdrawal, interparental conflict and parent mental health problems including parent stress, acculturative stress, anxiety/depression.

Resilience and emotional and behavioural wellbeing of Aboriginal and Torres Strait Islander children

In this study, researchers co-designed a new measure for resilience with Aboriginal Torres Strait Islander and refugee-background communities. This measure was used to determine children’s personal, family and community strengths, gender differences and associations between resilience and wellbeing. 1132 parents/caregivers of children aged 5-12 years old were included in the study, 344 of these were mothers of Aboriginal and/or Torres Strait Islander children aged 5-9. The study found that resilience scores were strongly associated with wellbeing and high mental health competence. Child personal (e.g. self-identity, positive sense of the future) and family strengths (e.g. family connectedness, knowing that they are loved) were higher in Aboriginal and Torres Strait Islander children, than other children in the Childhood Resilience Study sample (such as children from refugee families).

Adverse childhood experiences and adolescent anxiety and depression symptoms

This study used a large Australian community-based sample to examine the association between a range of adverse childhood experiences (ACEs) and depression and anxiety symptoms in adolescents. The study found bullying victimisation and parental psychological distress were major contributors to elevated anxiety or depressive symptoms even after demographic characteristics and coexisting ACEs were taken into account.  A larger total number of ACEs experienced by children was associated with greater odds of elevated depressive or anxiety symptoms. However, most individual ACEs such as household alcohol or drug abuse, unsafe neighbourhood, household financial stress were not associated with elevated anxiety and depressive symptoms after taking into account other factors that may interfere with the association (such as demographic characteristics and co-existing ACEs).

Childhood maltreatment, childhood adversity and mental health of people from OOHC

This study analysed data from OOHC experienced participants (n=395) in the Australian Maltreatment Study (ACMS) and compared it to the wider study sample (n=8503). Associations between experiences of maltreatment and other ACEs were examined in relation to adult mental health outcomes. Almost one in five children in OOHC sample had experienced all types of maltreatment and were more likely to have experienced at least three types of maltreatment (physical, emotional and sexual) than no maltreatment. Mental health was worse for those who experienced multiple types of maltreatment and have experienced OOHC, compared to those who experienced multiple types of maltreatment without OOHC experience.

Why is this important?

• Parental factors play a major role in youth mental health.
• Many youths in high-income countries have at least one overseas-born parent.
• This review aimed to identify modifiable parental factors to inform parenting interventions that may prevent mental health problems in young people with immigrant parents.

What did they do?

• The authors undertook a systematic review and meta-analysis of studies in high-income countries that investigated the effects of immigrant parent risk and protective factors on mental health outcomes of young people aged 0-18 years.
• A total of 56 studies were included for analysis, with the majority from the US and two from Australia.

What did they find?

• 16 parental factors were identified as having associations with young people’s mental health outcomes (e.g. self-esteem, general stress, acculturative* stress, anxiety symptoms and depressive symptoms). Parental factors were grouped into 3 categories:
  • parent-level factors, e.g. parent mental health, interparental conflict
  • parent-youth factors, e.g. differences in acculturation between parent and youth and
  • parenting factors, e.g. authoritarian style parenting, providing autonomy to child/adolescent.
• Caring and supportive parenting and parental monitoring were found to be protective factors against negative mental health outcomes such as stress, anxiety and depression symptoms.
• Risk factors that were associated with negative mental health outcomes included parent-youth acculturative conflict, parental withdrawal, interparental conflict and parent mental health problems including parent stress, acculturative stress and anxiety/depression.
• There is an emerging evidence base suggesting that parenting factors that burden the young person (e.g. high parental expectations and pressure in relation to academic achievement, family obligations, language brokering) can have negative mental health consequences for youth. However, prioritising family harmony and making sacrifices can support positive mental health.

What does this mean for practice?

• The findings from this study highlight two key considerations for practice:
  • The nature and expression of caring and supportive parenting and monitoring are influenced by cultural values and beliefs that shape the parenting styles of immigrant-origin parents.
  • The acculturation experiences of immigrant families may influence parenting practices, subsequently influencing youth mental health.
• Due to the unique experiences of immigrant families that affect parenting and parent-child relationships, genuine partnerships with immigrant communities is required when developing parenting programs and interventions. Modifications to existing programs should be strength based, celebrating cultural strengths, resilience and unique family dynamics.

* Acculturation is the process wherein individuals are exposed to a new culture and attempt to incorporate aspects of this culture into their daily living. The acculturation process within immigrant families poses additional challenges because parents and their children tend to adapt to a host country at different rates leading to parent-youth acculturative conflict.

Why is this important?

• Resilience is a process of drawing on internal or external strengths to regain, sustain or improve adaptive outcomes despite adversity.
• In this study, researchers co-designed a new measure for resilience for use with both Aboriginal Torres Strait Islander and refugee-background communities to determine children’s personal, family and community strengths, gender differences and associations between resilience and wellbeing.

What did they do?

• 1132 parent/caregivers of children aged 5–12 years were recruited to the Childhood Resilience Study. 344 of these were mothers of Aboriginal and/or Torres Strait Islander children aged 5-9 who formed a subset of the larger study as part of the Aboriginal Families Study.
• Resilience was measured using the culturally adapted Child Resilience Questionnaire (using parent/caregiver reports) for all participants of the Child Resilience Study. Some questions were completed by certain sub-groups of children, e.g. ‘connectedness to language’ scale was only completed for multilingual children. Child emotional/behavioural wellbeing and mental health was assessed with the parent-reported Strengths and Difficulties Questionnaire (SDQ). A limitation of the study was that child-reported measures were not conducted.

What did they find?

• Compared to other children in the Childhood Resilience Study, children from the Aboriginal Families Study sub-group had higher resilience scores in the personal (e.g. identity and positive futures) and family domains (connectedness and basic needs).
• Resilience scores were strongly associated with wellbeing and high mental health competence.
• Child personal strengths (e.g. self-identity, positive sense of the future) and family strengths (e.g. family connectedness, knowing that they are loved) were higher in Aboriginal and Torres Strait Islander children than in other children in the Childhood Resilience Study sample (such as children from refugee families).
• High resilience scores were associated with lower SDQ total difficulties score. This was true after taking to account child age, gender, maternal age and education, and family location.
• Aboriginal and Torres Strait Islander girls had better resilience-related outcomes compared to boys. The authors suggested that this may be due to differences in development trends for academic and social outcomes between boys and girls.

What does this mean for practice?

• It is important to adapt resilience measurement tools to take into account the cultural and social and emotional wellbeing experience and needs of Aboriginal and Torres Strait Islander children.
• Family strengths potentially support Aboriginal and Torres Strait Islander children at both an individual and cultural level. The findings from this study reflect the importance of collective values and kinship structures. Strengthening family resources and support could be a strategy when working to foster resilience in Aboriginal and Torres Strait Islander children.
• Additional support for Aboriginal and Torres Strait Islander boys may be required to strengthen resilience factors such as connections with schools and emotional/behavioural skills, grounded in cultural knowledge and priorities.

Why is this important?

• Adverse childhood experiences (ACEs) are traumatic experiences during childhood (0-17 years) and include childhood maltreatment, poor parenting practices, household dysfunction, violence and socio-economic adversity. Exposure to ACEs is known to have an impact on mental health in adulthood.
• This study examines the association between a range of ACEs and depression and anxiety symptoms in adolescents using a large Australian community-based sample.

What did they do?

• Researchers analysed ACEs reported for a sample of children aged <1-7 years old and anxiety and depressive symptoms at 16-17 years of age using the Longitudinal Study of Australian Children (LSAC).
• Anxiety symptoms were assessed based on the 8-item Children’s Anxiety Scale (CAS-8). Depressive symptoms were assessed using the Short Mood and Feelings Questionnaire (SMFQ). Both measures were self-reported by the adolescent.
• The ACEs investigated were financial hardship, parental psychological distress, hostile parenting, bullying victimisation, inter-parental conflict (verbal and physical), parental alcohol or substance abuse and unsafe neighbourhood.
• A limitation of this study is that data on child maltreatment, a key ACE associated with mental health outcomes, was not collected by LSAC.
• What did they find? Experiencing bullying or parental psychological distress before the age of 7 years increased the risk of a child developing anxiety and depressive symptoms in adolescence.
• Bullying victimisation and parental psychological distress were the major contributors to elevated anxiety or depressive symptoms even after demographic characteristics and coexisting ACEs were taken into account.
• A larger total number of ACEs experienced by children was associated with greater odds of elevated depressive or anxiety symptoms. However, most individual ACEs such as household alcohol or drug abuse, unsafe neighbourhood, household financial stress were not associated with elevated anxiety and depressive symptoms after taking into account other factors that may interfere with the association (such as demographic characteristics and co-existing ACEs).

What does this mean for practice?

• Anxiety and depression in adolescence may be mitigated or prevented by evidence-based interventions that target bullying victimisation and parental psychological distress.
• Further research is needed to understand the effect of other ACEs, such as experiences of child maltreatment, on mental health outcomes in adolescents.

Why is this important?

• Children and young people in out-of-home care (OOHC) live with a foster, or kinship carer or within a residential care setting until they can safely return home, or they are able to live independently.
• Previous experiences of maltreatment, adversity and entering OOHC can affect the mental health of people who have experienced OOHC.
• This study provides an understanding of the maltreatment and childhood adversity experienced by those from OOHC to support prevention and response to maltreatment for children and young people who enter OOHC.

What did they do?

• This study analysed data from OOHC-experienced participants in the Australian Maltreatment Study (ACMS) sample. The ACMS surveyed 8503 Australians aged 16-65 years, who were asked to recount their experiences of maltreatment and other adverse childhood experiences.
• The study investigated associations between maltreatment and other adverse childhood experiences (ACEs) on adult mental health outcomes.
• Maltreatment includes experiences of emotional abuse, sexual abuse, physical abuse, neglect and exposure to domestic violence.

What did they find?

• A total of 395 participants from the ACMS sample had experienced OOHC at some point in their childhood.
• Those who had experienced OOHC reported higher rates of multi-type maltreatment than those who had not experienced OOHC.
• Almost one in five children in OOHC sample had experienced all types of maltreatment and were more likely to have experienced at least three types of maltreatment (physical, emotional or sexual) than no maltreatment.
• The care-experienced subgroup reported all ACEs at a higher proportion than age-peers who had not experienced OOHC. ACEs included experiencing parent separation, economic hardship or exposure to domestic violence.
• Twice as many care-experienced respondents reported being treated unfairly due to their race or ethnicity compared to those who had not experienced care. This study does not capture the proportion of Aboriginal and Torres Strait Islander respondents in the data. However, the authors highlight the significant over-representation of Aboriginal and Torres Strait Islander children involved in the child protection system as a cause for this cohort to have experienced more racism and unfair treatment.
• The care-experienced group also reported poorer mental health than people without a care experience. This included higher rates of depression and post-traumatic stress disorder (PTSD). PTSD was three times higher in the study’s care-experienced participants than the non-care experienced study participants.
• Mental health was worse for those who experienced multiple types of maltreatment and had experienced OOHC than those without a care experience who had experienced multiple types of maltreatment.

What does this mean for practice?

• These findings indicate that interventions that focus on a single type of maltreatment experience may not be suitable for the OOHC population. Holistic approaches that assume multiple types of maltreatment may be more appropriate for those who have experienced OOHC.
• The study found high rates of ACEs, in addition to maltreatment for care-experienced individuals, suggesting the need to consider broader family and community factors that could impact the mental health of care-experienced individuals.
• The high rates of mental health difficulties in those who have experienced OOHC suggest the need for proactive/early mental health interventions for young people experiencing or who have experienced OOHC.