Highlights in child mental health research: August 2019
Various, Australia, August 2019
This monthly research summary provides a selection of recently released papers, systematic reviews, and meta-analyses related to infant and child mental health.
Each summary includes an introductory overview of the content for that month, followed by a list of selected articles. Each article is accompanied by a brief synopsis which presents the key messages and highlights. Links to abstracts, full-text articles and related resources, where available, are provided.
What's new this month in child mental health research?
This month’s highlights include Australian research studies on:
- Infant mental health – Porter and colleagues (2019) investigated the potential influence of mother’s anxiety and depressive symptoms (before and after birth) on infant’s social-emotional development.
- ATSI children and racism – Macedo and colleagues (2019) have published two studies exploring the effects of racism on Aboriginal and Torres Strait Islander (ATSI) children’s social and emotional well-being.
- Intergenerational impacts of family violence – Using a sample of 1,507 pregnant women, Gartland and colleagues (2019) explored research questions related to the intergenerational impacts of family violence. This included investigating the association between mother’s exposure to violence and children’s emotional-behavioural difficulties at age 4.
- Quality of mental health care – A study by Ellis and colleagues (2019) evaluated the quality of care for Australian children and adolescents with depression and/or anxiety
You can also read about what children with long-term physical conditions, their caregivers, and their health professionals perceive to be important aspects of mental health and wellbeing interventions.
- Complaint handling guide: upholding the rights of children and young people
To support organisations to create child safe cultures and to build their capacity to handle complaints, the National Office for Child Safety has developed this Guide.
The complete Guide is supplemented by an information sheet and reference guide to assist organisations with navigating the material.
You can access the National Office for Child Safety resources here
Infant mental health
Perinatal maternal mental health and infant socio-emotional development: A growth curve analysis using the MPEWS cohort (Australia)
Authors: Porter E; Lewis AJ; Watson SJ; Galbally M
Journal: Infant Behaviour and Development
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
ATSI children and racism
Effects of racism on the socio-emotional wellbeing of Aboriginal Australian children (Australia)
Authors: Macedo, D. M.; Smithers, L. G.; Roberts, R. M.; Paradies, Y.; Jamieson, L. M.
Journal: International Journal for Equity in Health
Does ethnic-racial identity modify the effects of racism on the social and emotional wellbeing of Aboriginal Australian children? (Australia)
Authors: Macedo, D. M.; Smithers, L. G.; Roberts, R. M.; Haag, D.G.; Paradies, Y.; Jamieson, L. M.
Journal: PLOS ONE
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.
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.
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).
Intergenerational impacts of family violence
Intergenerational Impacts of Family Violence – Mothers and Children in a Large Prospective Pregnancy Cohort Study (Australia)
Authors: D. Gartland; R. Giallo; H. Woolhouse; F. Mensah; S.J. Brown
Journal: The Lancet
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
Quality of mental health care
Assessing the quality of care for paediatric depression and anxiety in Australia: A population-based sample survey (Australia)
Authors: Ellis LA; Wiles LK; Selig R; Churruca K; Lingam R; Long JC; Molloy CJ; Arnolda G; Ting HP; Hibbert P; Dowton SB; Braithwaite J
Journal: The Australian And New Zealand Journal Of Psychiatry
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
Children with a long-term physical condition
Experiences of interventions aiming to improve the mental health and well‐being of children and young people with a long‐term physical condition: A systematic review and meta‐ethnography
Authors: Shaw, Liz; Moore, Darren; Nunns, Michael; Thompson Coon, Jo; Ford, Tamsin; Berry, Vashti; Walker, Erin; Heyman, Isobel; Dickens, Christopher; Bennett, Sophie; Shafran, Roz; Garside, Ruth
Journal: Child: Care, Health and Development
- 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