Highlights in child mental health research: January 2021
Various, Australia, January 2021
The 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 the 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?
- Coronavirus (COVID-19) and children: Resources, research, and reports
- The relationship between peer victimisation and emotional difficulties in children
- Views of Australian clinicians on the paediatric mental health service system
- Conflict between parents and the wellbeing of Australian children
- The interaction between trauma and sleep in children and adolescents
What’s new this month in child mental health research?
This month’s highlights include:
This review of 85 longitudinal studies identified a clear bi-directional (i.e. two-way) relationship between peer victimisation and internalising problems (e.g. depression, anxiety) in children. This was established for both girls and boys, as well as young children and adolescents.
This study interviewed 143 clinicians to better understand their perceptions of the paediatric mental health service system in Australia. Clinicians identified various barriers to service access, including: multidimensional family factors, service fragmentation, out-of-pocket costs, long wait times and inadequate training of paediatricians and general practitioners.
This study investigated the emotional-behavioural functioning of children exposed to interparental conflict (IPC), as well as the trajectories (i.e. pathways) of IPC from a child’s birth to age 10-11 years old. Data from over 4,800 families was analysed with four distinct trajectories of mother-reported IPC identified. Children exposed to trajectories with high levels of IPC at any point during the study had more difficulties with emotional-behavioural functioning than children with consistently low exposure to IPC over time.
This review article explores the relationship between trauma and sleep in children and adolescents. It highlights the reciprocal (i.e. two-way) relationship between trauma and sleep, and notes that this can be overlooked in clinical care. The researchers outline clinical options for evaluating and treating sleep disturbances in the context of trauma (and vice versa). They also suggest that any clinical evaluation of a child presenting with sleep problems should include an evaluation of the child’s trauma history. Similarly, children presenting with a history of trauma should be evaluated for sleep disturbances.
The relationship between peer victimisation and emotional difficulties in children
The bidirectional relationships between peer victimization and internalizing problems in school-aged children: An updated systematic review and meta-analysis (Australia)
Authors: Christina, S., Magson, N.R., Karar, V., and Rapee, R.M.
Journal: Clinical Psychology Review
- This systematic review and meta-analysis explored the associations between internalising problems (e.g., depression, anxiety) and peer victimisation in children.
- Peer victimisation was defined as “involving all types of bullying victimisation (i.e., physical, verbal, relational, and cyberbullying)” (p.10).
- Data from 85 studies (with a total of over 100,000 participants) was analysed. Studies included school-aged children (with a mean age range between 6 and 16 years old).
- Key findings included:
- A bidirectional (i.e. two-way) relationship between peer victimisation and internalising symptoms was established, with each significantly predicting the other.
- This bidirectional relationship was demonstrated for both girls and boys, and for younger children and older adolescents.
- This bidirectional relationship remained consistent across varying periods of time (up to 5 years). This suggests that an experience of either peer victimisation or internalising problems “predicts a greater likelihood of the other many years into the future” (p.23).
- Some forms of victimisation more strongly predicted later internalising symptoms, such as cyber victimisation.
- This research is relevant to professionals working with, or developing programs for, school-aged children to support their wellbeing. Children showing overt internalising behaviours may be at increased risk of peer victimisation, and those experiencing peer victimisation can be at increased risk of internalising symptoms.
- Programs or models of practice that target both problems (i.e., peer victimisation and internalising problems) simultaneously “should have bi-directional benefits” (p.28). That is, such programs should have two-way benefits for both child mental health and peer victimisation.
Views of Australian clinicians on the paediatric mental health service system
Clinicians’ perceptions of the Australian paediatric mental health service system: Problems and solutions (Australia)
Authors: Paton, K., Gillam, L., Warren, H., Mulraney, M., Coghill, D., Efron, D., Sawyer, M., and Hiscock, H.
Journal: The Australian and New Zealand Journal of Psychiatry
- This study explored the views of Australian clinicians on the barriers and facilitators of access to paediatric mental health services in Australia.
- Clinicians included child and adolescent psychologists, psychiatrists, paediatricians and general practitioners.
- Data from 143 clinicians from Victoria and South Australia was analysed. These clinicians participated in semi-structured phone interviews in 2018-2019.
- Clinician-identified barriers to paediatric mental health services included:
- Multidimensional family factors (e,g. complexity of the child’s condition, location of services, age of the child, parental circumstances).
- Service fragmentation (i.e. a lack of coordination between services).
- Long wait times (in both public and private services).
- High out-of-pocket costs.
- Inadequate training for paediatricians and general practitioners in child mental health.
- Rural and regional services had additional barriers to access, however these services generally had a better sense of collaboration between clinicians. This was perceived as a mechanism for more coordinated care.
- Clinician suggestions for improving the service system included:
- Improving access to child psychiatry expertise.
- Greater training opportunities for paediatricians and general practitioners.
- Co-located multidisciplinary services (i.e., multiple services available in one location).
- Increased access to specialist mental health support via
- These findings will be of interest to practitioners, organisations and policy makers who work to support the wellbeing of Australian children and their families. The findings provide an increased understanding of barriers to mental health access in Australia, thus providing an opportunity for the sector to proactively plan and collaborate on how these barriers might be overcome.
Conflict between parents and the wellbeing of Australian children
Trajectories of interparental conflict and children’s emotional-behavioural functioning at 10-11 years: an Australian population-based study (Australia)
Authors: Giallo, R., Seymour, M., Fogarty, A., Feinberg, M., Christensen, D., Gartland, D., Wood, C., Brown, S., and Cooklin, A.
Journal: European Child & Adolescent Psychiatry
- This Australian study explored the relationship between interparental conflict (IPC), including the severity and length of the conflict, and children’s emotional-behavioural functioning at age 10-11 years old.
- More specifically, the study investigated:
- The trajectories (i.e. pathways) of interparental conflict following birth (as reported by mothers)
- The emotional-behavioural functioning of children exposed to IPC.
- Data from over 4,800 Australian families was analysed, drawing on a nationally representative sample from Growing up in Australia: Longitudinal Study of Australian Children.
- The study identified four distinct trajectories of mother-reported IPC in families:
- Relatively infrequent instances of IPC (experienced by 9% or most children).
- Chronic and frequent IPC from birth (approximately 8% of children).
- Steadily increasing IPC over time (5% of children). These children were exposed to the greatest amount of IPC by the end of the study period.
- Decreasing IPC over time (2% of children). In this trajectory of IPC, the highest level of conflict occurring in the first postnatal year.
- Children exposed to trajectories with high levels of IPC at any point during the study had more difficulties with emotional-behavioural functioning than children with consistently low exposure to IPC over time. Escalating levels of IPC increased emotional-behavioural difficulties for these children; this suggests children do not habituate (i.e., get used to) to repeated exposure to IPC.
- These findings will be of interest to practitioners, legal and other health professionals who work with Australian families who may be experiencing parental conflict, especially those working with families during or post separation where high conflict can occur.
- Early intervention for early childhood exposure to IPC is critical to support child wellbeing and development. Professionals who work with families (particularly during the postnatal period but also throughout early and middle childhood) should enquire about parents’ relationship conflict and provide appropriate intervention or referral. This may help to alter the course of more problematic trajectories of IPC – and the impact that these can have on child mental health.
The interaction between trauma and sleep in children and adolescents
Afraid and awake: The interaction between trauma and sleep in children and adolescents (USA)
Authors: Fellman, V., Heppel, P., and Rao, S.
Journal: Child and Adolescent Psychiatric Clinics of North A
- This review article explores the relationship between trauma and sleep in children and adolescents. Traumatic experiences and sleep problems are both common in children and adolescents, however their relationship with each other is often overlooked in clinical care.
- While previous studies have explored the relationship between trauma and sleep problems, most have focused on adults.
- The article cites growing evidence of a reciprocal (i.e. two-way) relationship between sleep disruption and poor mental health in children who have been exposed to trauma (e.g. adolescents with post-traumatic stress disorder and anxiety).
- Complex trauma is often under-identified and under-treated in children and adolescents. Complex trauma (i.e. repeated or multiple traumas that cause long-term damage) is associated with sleep problems, nightmares, insomnia, fatigue, night anxiety, and poor-quality sleep. Problems with sleep can also itself be a risk factor for developing Post-Traumatic Stress Disorder (PTSD).
- Sleep problems can exacerbate symptoms of complex trauma and PTSD (e.g. irritability, poor decision-making). It can also disrupt the ability to benefit from psychotherapy by inhibiting mechanisms for change such as fear extinction (i.e. relearning that a trigger for fear is safe).
- Of relevance to clinical practice is that the researchers suggest that any clinical evaluation of a child presenting with sleep problems should include an evaluation of the child’s trauma history. Similarly, children presenting with a history of trauma should be evaluated for sleep disturbances.
- The article explores clinical options for evaluating and treating sleep disturbances in the context of trauma (and vice versa). It provides steps, frameworks, and questionnaires to guide these evaluations and discusses evidence for various treatment options (e.g. psychoeducation, psychological approaches and psychopharmacology).
- The authors highlight the restorative role that sleep has in healing from trauma, and the need for trauma-focused treatment.