Highlights in child mental health research: August 2024

This month’s highlights include:

Co-producing an intervention to prevent mental health problems in children in contact with child welfare services

This mixed methods study aimed to design a secondary prevention intervention which focused on children and young people (CYP) who are in contact with child welfare services. The authors found that CYP who had experienced adversity were most at risk of developing mental health problems. Early intervention with CYP who have experienced trauma and adversity was identified as being important and effective at reducing mental health problems. In partnership with CYP, their parents/caregivers, and professionals, the authors proposed a three-phased, youth activity-based intervention designed to support CYP and their families.

Children’s screen time and psychosocial symptoms at five years of age – the role of parental factors

This study examined (through parents’ self-reported data), whether parental factors such as psychological distress and parenting style explained the relationship between children’s (five years old) usage of e-media and any psychosocial symptoms. The authors found that children’s increased screen time was associated with psychosocial symptoms. Parental depression, stress and parenting style dimensions were generally not found to explain children’s screen usage and associated psychosocial symptoms. However, the association between children’s screen time and psychosocial symptoms was stronger for children whose mothers were stressed and/or depressed.

The views of mental health clinicians on self-harm and suicidal behaviours in children

This qualitative study explored the views of 26 mental health clinicians from New South Wales on self-harm and suicidal behaviours in children (below 12 years). The authors found that children can manifest different self-harm methods than older adolescents, such as hair pulling and head banging. The authors proposed that parental involvement, timely assessments and early interventions for emotion regulation and interpersonal skills can prevent future self-harming and suicidal behaviours.

The exposure of culturally and racially marginalised migrant children to domestic and family violence in Australia

The scoping review investigated how children and young people from culturally and racially marginalised (CARM) migrant backgrounds experience domestic and family violence (DFV) and how the DFV service system responds to their needs. The most common form of DFV experienced by children and young people from CARM backgrounds was physical abuse. They also found that DFV services were often regarded with fear and distrust by people from CARM backgrounds and that the support available was limited. Practitioners may benefit, for example, from training such as mandatory cultural safety training that includes effect of key visa types in children and young people from CARM backgrounds in accessing specific social, health, and community services.

Why is this important?

• Mental health problems in children and young people (CYP) are increasing, however these challenges are not evenly distributed within society. CYP who find themselves in contact with child and welfare services are particularly vulnerable to experiencing mental health problems.
• Although secondary prevention interventions have been shown to improve CYP mental health outcomes, less is known about CYP who are in contact with child welfare services.

What did they do?

• This was a mixed methods study that combined a systematic review, interviews, focus groups and co-production workshops.
• The authors reviewed previous systematic reviews (54 papers) of effective interventions to prevent mental health problems among CYP (3–17 years).
• They then conducted 4 focus groups with 25 child welfare and mental health practitioners, interviewed 23 CYP (11–25 years) and 18 parents/caregivers in contact with child welfare services from the North East of England.
• Findings from the systematic review, interviews and focus groups informed the co-production workshops with CYP and child welfare practitioners. These were conducted at 2 timepoints and had a total of 25 participants (10 CYP and 15 practitioners).

What did they find?

• Adversity and trauma were identified as the main risk for poor mental health for CYP in contact with child welfare services.
• Recognising adversity, trauma, and not overlooking early ‘warning signs’ can provide opportunities to intervene before CYP develop diagnosable mental health disorders.
• Early intervention with CYP who have experienced adversity and trauma before the onset of mental health problems can be effective at reducing mental health problems.
• Supportive relationships, particularly between the parent/caregiver and child, were key to improvements in child mental health. Other potentially protective or helpful factors were positive friendships and intimate relationships, wider family relationships, and positive relationships with professionals.

What does this mean for practice?

• The authors propose a youth activity-based intervention for practitioners which involves three phases:
  • a relationship building phase between the practitioner and CYP
  • a family component phase whereby the practitioner meets with the CYP and their family, as well as separate sessions with CYP and parents/caregivers
  • an ending phase which reinforces CYP learning, related behaviour changes, and provides information on accessing support and services.
• Building secure and trusting relationships with CYP who have experienced adversity and trauma is key to supporting mental health.
• The authors highlighted the importance of taking a trauma-informed approach to intervention with CYP in contact with child welfare.

Why is this important?

• Children’s increased usage of e-media (electronic media) has been associated with internalising and externalising symptoms.
• Research has shown that there is a relationship between parents’ psychological distress and children’s e-media usage.

What did they do?

• The study explored whether parents’ psychological distress (parental depression and stress) and parenting style dimension explained the association between children’s screen time and psychosocial symptoms such as internalising and externalising symptoms.
• Data was from the Finnish CHILD-SLEEP birth cohort study. Participants were initially recruited for the study prenatally and were subsequently contacted at various ages of the child. For this particular study, the parents of 671 children from the initial group completed a survey when their child was five years of age. In total they surveyed 455 fathers and 643 mothers.
• In this study, e-media was defined as screen time (viewing TV and other electronic devices).
• Parents reported on how much time their child spent watching screens at five years of age. Parents also reported on their child’s developmental and emotional symptoms to identify any internalising or externalising symptoms, as well as attention and concentration difficulties, and hyperactivity and impulsivity.
• Mothers and fathers were asked to report on their level of depressive symptoms, stressfulness and parenting style.

What did they find?

• More time spent on screens was associated with attention difficulties, hyperactivity, and internalising and externalising symptoms in children.
• The authors found that for the most part, parental depression, stress, and parenting style dimensions did not explain the association between child’s screen time and any observed psychosocial symptoms.
• However, the association between children’s screen time and psychosocial symptoms was stronger for children whose mothers were stressed/depressed.

What does this mean for practice?

• As children’s increased screen time was associated with an increase in psychosocial symptoms, those who work in clinical practice may offer clinical guidance around children’s screen use, mental health, and the parents’ own mental health.
• Those in clinical practice should inquire about children’s screen time at an early age and offer guidance to parents about reducing screen time for their children.
• Families engaging in active mediation and discussion around screen time usage may help in reducing children’s long-term psychosocial symptoms.

Why is this important?

• Self-harm and suicide are major public health concerns that are becoming more common in Australian children and presenting earlier.
• For clinicians, these behaviours are challenging to identify early (e.g. because they often rely on parental reports and these behaviours can present differently in younger children).
• It is important for mental health clinicians in public health services to understand, identify and respond to self-harm and suicidal behaviours in children (below 12 years).

What did they do?

• The authors conducted a brief demographic survey followed by eight semi-structured interviews and two focus groups with 26 mental health clinicians from the Illawarra Shoalhaven Local Health District in NSW, Australia. The clinicians worked in the emergency departments, inpatient and/or community mental health settings.
• The interview questions focused on the definition, screening, assessment and treatment of self-harm and suicidal behaviours in children. The clinicians were also asked about how they engaged with parents supporting children with self-harm and suicidal behaviours.
• They used inductive reflexive thematic analysis to analyse the data. This is a collaborative approach where researchers reflect on the data for richer interpretation of meaning (e.g. sense-check ideas, explore multiple interpretations) without the need to reach a consensus.

What did they find?

• Clinicians noted there was increased social awareness about child self-harming behaviours but also expressed concern about the unregulated information about self-harm on social media.
• Children can use different self-harm methods than older adolescents, such as hair pulling and head banging. This is often due to limited access to other means. Clinicians screened for self-harm and suicide behaviours by asking parents about these types of behaviours. They also asked children about their intentionality in developmentally appropriate ways (e.g. by using appropriate language, making the child feel comfortable by asking the parent to leave the room or by using drawings for the child to express themselves).
• Parental involvement in the assessment and treatment process is important to help assess for and respond to child self-harm and suicidal behaviours but also because parents need support in managing their own emotions and in developing strategies to help their children.
• Schools can play a vital role in responding to child self-harm and suicidal behaviours, but staff often lack appropriate training and resources and can respond in unhelpful ways (e.g. they can overreact to situations or not be able to ensure appropriate privacy for the child).
• There are significant gaps in mental health services for children. This includes a lack of age-appropriate inpatient units, long wait times to access treatment and limited training for health professionals working in acute care settings.

What does this mean for practice?

• Teaching young children about emotion regulation skills and interpersonal skills can help them cope with life stressors and lessen the likelihood of future suicidal behaviour.
• Interventions that take a whole-team approach (e.g. of mental health and medical clinicians, parents, carers and school staff) can effectively support children with self-harm and suicidal behaviours.

Why is this important?

• The prevalence of domestic and family violence (DFV) against children and young people from culturally and racially marginalised (CARM) migrant backgrounds in Australia is not well known.
• The study aimed to explore how children and young people from CARM migrant backgrounds experience DFV and how the DFV service system responds to their needs.

What did they do?

• DFV was defined as any kind of abuse (physical, sexual, emotional, psychological, or financial) that includes actions that try to control, dominate, or scare someone, and happen in family or intimate relationships.
• The authors searched four academic databases and grey literature (published between 2003–2023) for resources on children and young people from CARM backgrounds in Australia who had experienced domestic and family violence.
• They included 19 articles in the scoping review that were analysed thematically. These included peer-reviewed articles, book chapters, books, and publicly available grey literature.

What did they find?

• Most studies were conducted in South Australia (n = 5) or Victoria (n = 5) and included primary research articles (n = 13) or research reports from government and non-government sources (n = 4).
• The authors noted that there were contradictory findings on whether children from CARM backgrounds were either under- or over-represented in state systems of care and/or had experienced DFV. This was likely due to a lack of official definitions and/or systematic recording of CARM backgrounds. They suggested this supports the argument that this population is invisible across DFV and social service systems.
• Children and young people from CARM backgrounds experienced various forms of DFV that included emotional and economic abuse, but physical abuse was most common. DFV was most often perpetrated by a male family member.
• There were gaps in the DFV service system in addressing the unique needs of CARM groups. There was also a lack of awareness by professionals about which services were available for children and young people.
• Engagement with DFV services by people from CARM backgrounds was often accompanied by feelings of fear and distrust due to the perceived threat of child removal among the CARM groups.

What does this mean for practice?

• For practitioners to better support children and young people from CARM backgrounds who have been exposed to DFV, they should focus on building trust and work to understand and alleviate fears about accessing support services.
• Practitioners may benefit from specific training (e.g. in cultural safety and experiences of intersecting forms of inequality such as racism, poverty, etc.) and approaches that support the safety and well-being of both the child and the non-violent parent or carer.