Highlights in child mental health research: June 2020

Highlights

• This study investigated the proportion of Australian children with mental health problems that received minimally adequate mental health care.

• Minimally adequate mental health care was defined as: 4 to 7 attendances to Medicare Benefits Scheme (MBS) funded professionals with medication or as more than 8 attendances (regardless of medication use) over a 12-month period.

• Researchers analysed linked data of 4,348 children over a 10-year period (from age 4 to age 14 years) from the Longitudinal Study of Australian Children (LSAC), the MBS, and the Pharmaceutical Benefits Scheme (PBS).

• Using the Strengths and Difficulties Questionnaire (SDQ), the study found four trajectories (i.e. pathways) of mental health difficulties (p. 366):

1. Low symptoms (around 74% of children) – Children that continuously showed a low level of mental health symptoms over the 10-year period.
2. High-decreasing symptoms (around 6%) – Those that initially demonstrated a high level of mental health symptoms that decreased over time.
3. Moderate-increasing symptoms (around 16%) – Those that initially demonstrated a moderate level of mental health symptoms that increased across time.
4. High-increasing symptoms (around 4%) – Those that initially demonstrated a high level of mental health symptoms that increased across time.

• Other key findings included:
  • “Most children with mental health symptoms had few [or no] MBS mental health attendances” (p. 364).
  • Only a minority of children with mental health symptoms received minimally adequate mental health treatment.
  • Consistent with past research, children in the moderate-increasing and high-increasing trajectories were more likely to have accessed mental health care. But there was no evidence to suggest an improvement in their symptoms.

• The researchers conclude that “a large proportion of Australian children with persisting, and worsening, high levels of mental health problems do not receive care meeting minimal treatment guidelines” (p. 368).
• There is a need to provide increased access to services for these children, including through increased financial support and strengthening parents’ awareness of the services available.

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Highlights

• This study explored the perspectives of parents and caregivers on the factors that contribute to the health and wellbeing of Aboriginal children.
• 425 parents and caregivers of Aboriginal children were asked for their views on the “single most important factor that would help their children to be healthy and well” (p. 1).
• Participants were from the Study of Environment on Aboriginal Resilience and Child Health (SEARCH).
• Parents and caregivers identified a wide range of factors (child, family, and environmental) as promoting the health and well-being of Aboriginal children. The 13 factors were:
  • Family relationships that are secure and loving
  • Access to, and availability of, healthcare that is culturally-competent
  • Adequate food and nutrition
  • Having an active lifestyle
  • Community services (e.g., parks, sporting facilities, youth services) and community engagement
  • Connectedness (social and emotional)
  • Feeling safe (emotionally, culturally, and physically)
  • Supports to break the pattern of inter-generational disadvantage
  • Housing that is available and affordable
  • Presence of Aboriginal role models
  • Strong access and connection to culture
  • Parent/caregiver health and well-being (including mental health).
• These findings will be of interest to service providers and policy-makers. They highlight the importance of public health initiatives that promote access to the “social determinants of health” for Aboriginal children and their parents/caregivers (p. 1).  Examples of social determinants include access to food, housing, and healthcare that is culturally-appropriate (including mental health care).

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Highlights

• Using data of over 18,000 children and adolescents who had been hospitalised for a mental health disorder, this study explored the risk factors for suicide attempt in three specific age-groups. Participants were from the USA.
• The age groups investigated were pre-adolescent (aged 12 years and under), adolescent (13 to 17 years old), and young adult (age 18 to 25 years old).
• The risk factors for suicide attempt that were common across all three age groups were:
  • Being of female sex
  • Having a depressive disorder
  • Having a previous history of suicide attempt
  • Having been bullied.
• The risk factors for suicide attempt that were specific to pre-adolescent children were:
  • Having a home or school setting that was unsafe
  • Not having health insurance (Note: Please refer to the full text for details of what this entails given the USA context).
• The researchers conclude that providing children with adequate mental health treatment and home/school environments that are supportive are critical to suicide prevention.
• The findings of this study are important for practitioners, service providers, and policy-makers to consider; developing effective suicide prevention strategies that target different age groups (including children) requires careful attention to age-specific risk factors.

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Highlights

• This systematic review investigated the “effectiveness of unstructured play interventions on young children’s physical, emotional and social wellbeing in various community settings” (p. 184).
• 8 studies were included, which were performed with young children aged 3 to 7 years old.
• Unstructured play refers to children being provided with moveable or fixed materials/areas/equipment to support play, but with no specified purpose or structure.
• The review found that “all studies reported positive impacts on children’s physical activity level, social engagement and emotional well-being” (p. 184).
• The researchers also highlight that unstructured play may help to support well-being during stressful periods through offering young children the “time, space, equipment, opportunities, and strategies” to help them cope (p. 194).
• The researchers encourage practitioners, teachers, service providers, and policy-makers to promote the implementation of unstructured play to optimise young children’s health and well-being (e.g. allocation of time; provision of materials/equipment/space; policies that support children’s play).

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Highlights

• This article reviews practices and research about the co-design of digital mental health technologies with children and young people. That is, the process of actively involving children and young people (YP) themselves in the design of technologies that aim to support them.
• Co-design with children and YP can occur at all stages, including “development, evaluation and implementation” (p. 12).
• It is hoped that co-design will help foster digital mental health technologies that are “more engaging, feasible, acceptable, and effective” for children and young people (p. 12).
• The article presents key issues for practitioners and researchers to consider when using co-design in this specific context, including a checklist and practice points. Issues discussed include techniques for engaging and involving children/YP and the importance of ensuring that the diversity of children/YP is addressed.
• The researchers also discuss the challenges that can arise when using co-design to develop digital mental health technologies, including ensuring sufficient resources, balancing the input of various stakeholders/users, and evaluating the impact of the resulting technology.
• The researchers emphasise the importance of ensuring that the co-design activities are carefully aligned with the unique context (i.e. the specific target users; the technology that is to be created; the specific setting).
• Future research is still needed to evaluate the effectiveness and impact of this co-design process.

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