Highlights in child mental health research: December 2019
Various, Australia, December 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 research studies on:
- Climate change and children’s mental health – This article by Sanson and colleagues (2019) discusses the mental health effects of climate change on children. For example, children’s awareness of climate change can lead them to respond psychologically in negative ways. This may include feelings of “worry, fear, sadness, anger, and a sense of powerlessness” (p. 203). The authors offer ideas on how practitioners, organisations, and policy-makers might be able to respond in a way that supports children’s resilience and well-being.
- Children in rural communities – A study of 539 children by Peters and colleagues (2019) has found that children and adolescents from rural and remote areas in NSW showed poorer mental wellness when compared to the general Australian population. They suggest this “provides evidence of generally lower levels of psychological wellness in children and adolescents in regions that are rural, with remote regions having the worst scores” (p. 7). Personal and family factors made a significant and larger contribution to the mental wellness of the children in the study – with the degree of rurality not having a significant role. Factors associated with poorer mental wellness included being of younger age, being male, having a lower household income, and having parents who had a lower sense of community.
- Resilience in children exposed to intimate partner violence – A systematic review led by Australian researchers has found that the psychological well-being of mothers was a significant predictor of positive emotional and behavioural outcomes in children (i.e. a protective factor for resilience). There was preliminary evidence for additional protective factors of positive parenting behaviours and parental use of emotion coaching. Practitioners and service providers have a vital role in providing, and ensuring access to, parenting and parent mental health supports to these families.
- Complex post-traumatic stress disorder – This research translation article provides an overview of the new diagnosis of complex post-traumatic stress disorder (complex PTSD). The diagnosis was developed for the ICD-11 (International Classification of Diseases 11th Revision) to capture the psychological impact of complex and interpersonal trauma, such as child abuse and neglect. Emerging evidence has supported complex PTSD as a distinct diagnosis from PTSD. It is characterised by an additional feature of disturbances in self-organisation.
- Parental divorce in childhood – A meta-analysis of 54 research studies by Auersperg et al. (2019) has found that individuals exposed to parental divorce in childhood are at a heightened risk of developing various mental health presentations, including depression, anxiety, distress, suicidal ideation, and suicide attempts. The findings demonstrate the importance of providing programmes that support children and their parents both during and after a divorce. They also support strategies that seek to reduce high-conflict parental divorce (e.g., mediation).
Click the “Continue Reading” button below to view the key messages of each featured article.
Climate change and children's mental health
Responding to the Impacts of the Climate Crisis on Children and Youth (Australia)
Authors: Sanson, Ann V.; Van Hoorn, Judith; Burke, Susie E. L.
Journal: Child Development Perspectives
- This paper discusses the impact of climate change on children. It also offers insights on how practitioners, organisations, and policy-makers might respond to support the resilience and well-being of children and youth.
- Children are not only subject to the physical effects of climate change. They can also be subject to psychological and mental health effects.
- Disasters related to climate change have been found to lead to “significant increases” in depression, anxiety, posttraumatic stress disorder, sleep problems, learning difficulties, and cognitive deficits (p. 202).
- Most children and young people in developed countries are aware of climate change due to the media, social media, their families, and their schools.
- Children’s awareness of the crisis of climate change can lead them to respond psychologically in ways that are negative. This can include feelings of “worry, fear, sadness, anger, and a sense of powerlessness” (p. 203).
- A recent Australian survey of 7- to 24-year olds found that 89% of respondents were worried about the effects of climate change (Chiw & Ling, 2019).
- Additional resources are needed to guide adults in supporting children through climate change. An example of such resources is provided by the Australian Psychological Society (see links below).
- Sanson and colleagues (2019) offer various ideas for responding to the impacts of the climate crisis on children including:
- Practitioners, parents, and schools working together to build essential characterises within children that will build their resilience and adaptability in response to climate change. This includes building individual characteristics (e.g. emotional self-regulation), interpersonal skills (e.g. negotiation, conflict-resolution), and social and civic engagement.
- Listening to children and providing opportunities for active engagement. That is, to treat children as “active agents” of change in our responses to climate change (p. 202). Through allowing children to take action and adopt a meaningful role, we can help them cope, adapt, and increase feelings of control, resilience, and hope.
- Prioritising research into the psychological impact of climate change on children, particularly into effective interventions and what characteristics will be essential for resilience and adaptation. The authors propose that funding bodies responsible for research grants should prioritise this area of need.
- Practitioners advocating and educating the public and policy-makers about the impacts of climate change on children, as well as possible actions and responses.
Children in rural communities
Social determinants of psychological wellness for children and adolescents in rural NSW (Australia)
Authors: Peters I; Handley T; Oakley K; Lutkin S; Perkins D
Journal: BMC Public Health
- This study explored the under-researched topic of mental wellness of children and adolescents living in rural and remote Australia.
- The study used data of 539 children from NSW who were part of the Australian Rural Mental Health Study (ARMHS). Children were between 4 and 17 years old.
- The study compared the mental wellness of these rural children with normative Australian data. This was done using the parent report of the Strengths and Difficulties Questionnaire (SDQ).
- It also investigated what factors (i.e., personal, community, family, rurality) were associated with the mental wellness of these children.
- The study found that children and adolescents from rural and remote areas in NSW had poorer mental wellness compared to the general Australian population. The researchers suggested that this “provides evidence of generally lower levels of psychological wellness in children and adolescents in regions that are rural, with remote regions having the worst scores” (p. 7).
- The largest significant contributors to mental wellness were:
- Age – Similar to the general population, younger children generally demonstrated poorer mental wellness.
- Gender – Similar to the general population, males generally demonstrated poorer mental wellness.
- Family socio-economic status and parental employment – Poorer mental health was observed in families with lower household incomes and unemployed parents.
- Parent’s sense of community – Poorer mental health was observed in families where parents had a lower sense of community.
- Personal and family factors made a significant and larger contribution to the mental wellness of the children in the study – with level of rurality not having a significant role.
- After other factors were controlled for, the level of rurality and the socioeconomic status of a community were not significant contributors to mental wellness. However, these findings should be approached cautiously and need further investigation. This is particularly true for community socio-economic status, as that finding was in contrast to past national and international research.
- Practitioners and service providers in rural and remote areas should be mindful that children who are younger, male, live in lower income households, and/or with unemployed parents might be at a higher risk of mental health difficulties.
- As the researchers note, these findings support initiatives and policies that:
- seek to strengthen community interconnectedness and a sense of community in rural and remote areas
- seek to increase affordability, accessibility, and availability of timely mental health supports for families in rural and remote areas. This will be particularly critical for families with a lower household income and/or parental unemployment.
Resilience in children exposed to intimate partner violence
Factors promoting emotional‐behavioural resilience and adjustment in children exposed to intimate partner violence: A systematic review (Australia)
Authors: Fogarty, Alison; Wood, Catherine E.; Giallo, Rebecca; Kaufman, Jordy; Hansen, Michelle
Journal: Child Development Perspectives
- This article presents the findings of a systematic review of 15 articles exploring factors associated with emotional-behavioural resilience in children exposed to IPV.
- Intimate partner violence (IPV) is “any act within a current or previous intimate relationship that causes physical, sexual, or psychological harm” (p. 375).
- Children’s exposure to IPV does not only include exposure to physical violence, but also to psychological and sexual violence.
- Children exposed to IPV are at an increased risk of negative emotional, behavioural, and social outcomes. These include anxiety, depression, post-traumatic stress, behavioural difficulties, and peer difficulties.
- Importantly, not all children that are exposed to IPV show negative outcomes. Some will show resilience and positive wellbeing.
- The psychological wellbeing of mothers (i.e. maternal mental health) was a significant predictor of positive emotional-behavioural outcomes (i.e. resilience) in children exposed to IPV. The researchers state that this highlights the importance of identifying mental health concerns in mothers exposed to IPV – and providing support to access psychological services. This could lead to positive flow-on effects for child well-being.
- Preliminary evidence was also found to suggest some other predictive factors for emotional and behavioural resilience. These factors were:
- Use of emotion coaching (of children by parents)
- Positive parenting behaviours (e.g., positive discipline, consistency)
- The temperament of the child (e.g., ease of temperament)
- Only 4 studies explored the prevalence of emotional and behavioural resilience in children exposed to IPV. In these studies, prevalence varied considerably from 20% to 90%. The researchers propose this variability was related to differences in study samples. For example, the prevalence of resilience was 90% in a community-based cohort study, but 20% in a parenting support services sample where children may have been exposed to more severe and more frequent IPV.
- As the researchers propose, this could include:
- Building parent’s awareness of children’s emotions.
- Strengthening parent’s capacity to respond to children’s emotions, such as via emotion-coaching strategies.These findings demonstrate the importance of providing parenting support to families exposed to intimate partner violence.
- Practitioners and service providers can play a vital role in providing, and ensuring access to, parenting and parental mental health supports.
Complex post-traumatic stress disorder
Assessment of mental health problems in children following early maltreatment: What will the new diagnosis of complex PTSD add?
Authors: DeJong, Margaret; Wilkinson, Simon
Journal: Developmental Child Welfare
- This research translation article provides an overview of the new diagnosis of complex post-traumatic stress disorder (PTSD).
- Complex PTSD is a novel diagnosis resulting from years of effort and research to reach a diagnosis that captures the psychological impact of complex and interpersonal trauma, such as child maltreatment.
- Complex PTSD was created for the International Classification of Diseases 11th Revision (ICD-11), which will be released in 2022. It is supported by various field trials and research studies, which have found emerging evidence for complex PTSD as a distinct diagnosis from PTSD.
- It has been proposed that complex PTSD is characterised by an additional feature of “disturbances in self-organisation,” in conjunction with the usual core features of PTSD (i.e. hypervigilance, re-experiencing, avoidance) (p. 360).
- Self-organisation disturbances will be addressed via specific criteria including (p. 361):
- “Affect dysregulation”
- “Negative self-concept” (i.e. negative thoughts about the self)
- “Difficulties in relationships”
- The authors welcome the “new proposed ICD diagnosis of CPTSD as it captures very well many of the clinical presentations that we see of [children] and young people who have experienced early and chronic psychological trauma in the form of abuse and neglect” (p. 370).
- Practitioners should have an “in-depth understanding of psychological trauma and its manifestations” to ensure appropriate, effective diagnoses and treatments. If required, professional development and training should be sought.
- Practitioners should be mindful that it is not uncommon for children with a history of early maltreatment to present with possible traits of Autism Spectrum Disorder (ASD) or Attention-Deficit/Hyperactivity Disorder (ADHD). These children need to be carefully assessed through a trauma-informed lens, with careful consideration of the impacts of maltreatment and attachment on their presentation.
- The symptoms of Autism Spectrum Disorder and the symptoms of early complex trauma exposure can overlap. This can make it challenging to diagnose ASD in that sub-population with various complexities to be considered.
- In some cases, hyperarousal due to PTSD and/or emotional dysregulation due to complex PTSD might lead to a presentation akin to ADHD. One possible approach posed by the researchers is to first treat the PTSD, and then observe if the ADHD-like symptoms reduce. If ADHD criteria persist, then diagnosis and treatment may be appropriate. Of course, however, a child can still exhibit co-morbid ADHD and complex PTSD.
- While some studies have supported complex PTSD as a distinct condition from PTSD in children and adolescents, additional research is still needed to validate the diagnosis in this population and to develop developmentally-appropriate assessment measures.
- Importantly, not all children who experience early maltreatment and who exhibit difficulties will necessarily meet complex PTSD criteria (e.g., they will not meet criteria if they do not have the 3 core PTSD features). These children can still be at considerable risk, even though they do not reach the threshold for diagnosis. Future research should develop appropriate assessment methods for this sub-population.
Parental divorce in childhood
Long-term effects of parental divorce on mental health – A meta-analysis
Authors: Auersperg F; Vlasak T; Ponocny I; Barth A
Journal: Journal of Psychiatric Research
- What are the long-term effects of parental divorce on the mental health of children? This was the main question explored in this meta-analysis of 54 research studies comprising over 500,000 participants.
- Participants had all reached 18 years of age. They also required exposure to parental divorce during childhood (i.e. exposure prior to age 18).
- “A significant association was found between parental divorce and every aspect of mental health” (p. 107) including:
- Suicidal ideation and attempts
- The researchers concluded that individuals exposed to parental divorce in childhood are at a heightened risk of developing a range of mental health presentations. However, the effect sizes decreased over time from 1990 to 2017.
- The authors discuss possible mechanisms that might help explain the long-term impact of parental divorce on children’s mental health, including:
- A child being separated from a parent that they are attached to might foster sub-optimal attachment styles (e.g., insecure attachment), which have been linked with some mental health presentations (e.g., depression).
- Parental divorce might lead to social and economic disadvantage, which in turn might negatively impact on psychological development and increase psychological vulnerability.
- Some persisting stigma associated with divorce might increase children’s stress levels and lead to an increased vulnerability to mental health difficulties.
- Parental divorce might activate stress pathways and associated hormones within the brain, which might contribute to increased psychological vulnerability.
- These findings have implications for practitioners who work with children and families to support children’s social-emotional wellbeing. Practitioners should be mindful that children whose parents have divorced may be at a higher risk of mental health problems.
- The researchers suggest their findings offer support for:
- Programmes that support children and their parents both during and following a divorce. These should focus on resilience building and providing coping strategies. Programmes could be offered in health centres of schools.\
- Initiatives that reduce the chances of finances as a barrier to accessing supports, such as financial support or tax benefits.
- Strategies that reduce the risk of high-conflict parental divorce given this is particularly negative for children. Strategies include mediation and careful monitoring of any potential psychological effects on children/parents.