Highlights in child mental health research: March 2024

This month’s highlights include:

Supporting CALD young people with their mental health and wellbeing in Australia

This paper explored interventions and common elements of practice for improving the mental health of CALD youth (12–25 years) and main challenges related to service access. Common elements of practice emerged:

• personalisation, identity and acknowledgment of trauma
• creative expression
• cultural competence
• self-efficacy and empowerment
• social connections and relationships; and
• information and content delivery.

Group interventions in a community-based mental health service for self-harming and suicidal youth

This paper described the implementation of two community-based group interventions for young people (16–18 years): the dialectical behaviour therapy-adolescent [DBT-A] and cognitive behavioural Self and Strength [S&S]. The authors provided insights into the practical aspects of delivery, they assessed program reach, effectiveness, adoption, implementation and maintenance. In both groups, there was a reduction in self-harm, suicidal behaviours and emotional dysregulation among participants compared to prior to the start of both programs, however, these changes were not statistically significant for the S&S group.

The impact of maternal health on child’s health outcomes during the first five years

This systematic review investigated the relationship between physical and mental health of mothers and the health and quality of life of their children (0-5 years). The review found an association between maternal health and child health (including physical health, e.g. infections; and mental health, e.g. internalising or externalising behaviours) and health service usage. However, findings from individual studies were primarily related to a specific maternal or child’s health condition or overall health and there was limited consistency in the health conditions and child outcomes measured.

Positive and adverse childhood experiences and mental health of children

This quantitative study explored the relationship between adverse childhood experiences (ACE), positive childhood experiences (PCE) and mental health of children (6–17 years) in the US. Results showed that having more ACEs was linked to a higher chance of developing a mental health (MH) condition; having more PCEs was associated with a lower chance of having a MH condition. However, PCEs have a smaller (yet still positive) influence on the likelihood of developing mental health problems when there are multiple ACEs present.

Why is this important?

• There is limited research about mental health programs and interventions that are offered for young people from Culturally and Linguistically Diverse (CALD) backgrounds in Australia.
• This paper explored interventions and common elements of practice for improving the mental health of CALD young people and main challenges that prevent them from accessing mental health services.

What did they do?

• This paper systematically reviewed 19 studies from 2010-2022 where the primary recipient of the program or intervention was a young person aged 12–25 years living in Australia who identified as CALD and exhibited signs of mental distress.
• The authors included a range of interventions and study designs including 10 qualitative, seven quantitative and two mixed-methods approaches.
• The study used a ‘common elements’ approach to evaluate evidence and identify discrete practices or techniques for engaging clients and eliciting behaviour change.

What did they find?

• The study identified a broad range of treatment approaches: creative and arts-based counselling, cognitive-behavioural groupwork, psychoeducational groups, non-specified counselling, grief and loss counselling, resilience-based interventions, trauma informed counselling, and non-specified targeted interventions for health risk behaviours.
• Six common elements of practice or programs emerged:
  • personalisation, identity and acknowledgment of trauma (including intersectionality of e.g., sexuality, culture and disability)
  • creative expression
  • cultural competence
  • self-efficacy and empowerment
  • social connections and relationships; and
  • information and content delivery.
• Barriers that affected CALD young people’s participation in mental health programs included access to services, language and literacy difficulties, stigma and shame, limited cultural competency of service providers and Western-centric ideas about mental health and wellbeing.

What does this mean for practice?

• Consider how intersectionality (i.e., other aspects of a CALD young persons’ identity including gender, sexuality) may be influencing their experience of mental health and wellbeing, as well as services.
• Mental health and wellbeing interventions should be tailored to ensure they are culturally safe and accessible to CALD young people. For example, programs should address the link between cultural identity and connection to wellbeing.
• Programs can be improved by enhancing service providers’ cultural competence, improving information and content delivery, and fostering self-efficacy and empowerment among CALD young people.

Why is this important?

• Self-harm and suicide are major public health concerns with high individual, economic and social costs.
• Group-based interventions that support emotion regulation and promote connectedness could be a potentially cost-effective solution to support the mental health of young people.
• The article describes the implementation of two separate group-based interventions: the dialectical behaviour therapy-adolescent [DBT-A] and cognitive behavioural Self and Strength [S&S] programs within a community-based youth mental health service in Australia, providing insights into the practical aspects of delivery.

What did they do?

• The authors used the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework to assess the feasibility and implementation of DBT-A and S&S group therapy programs delivered over 12 months.
• The authors assessed program reach (patient flow, group uptake, treatment completion), effectiveness (youth and care clinical outcomes), adoption (staff perception), implementation (barriers), and maintenance (service commitment and acceptability).
• Participants were young people with previous episodes of self-harm aged 16-18 years, including 13 young person-parent pairs (DBT-A group, 92% female young people) and 9 young people (S&S group, 100% female). They were recruited from the Southern Youth Mental Health Service, South Australia, between 2020-2021.

What did they find?

• The study found that the interventions were both feasible to implement and acceptable to the youth, indicating their potential for wider adoption. The clinicians also reported that their experiences in supporting the groups as facilitators were positive overall and they observed young people benefitting from participation.
• The paper reported that the implementation of both group interventions led to reductions in self-harm, suicidal behaviours and emotional dysregulation among participants compared to before the programs started. However, these changes were not statistically significant for the S&S group.
• Barriers to uptake of the programs included reach, staffing continuity, disruptions related to COVID, and some recruitment issues attributed to preferences around individual or group service models.

What does this mean for practice?

• Evidence-based group interventions can be used by community-based mental health services to support young people with a history of self-harming and suicide attempts. However, the effectiveness of group programs may vary based on intervention characteristics.
• The lack of participation in group therapy is an area of research that needs more exploration, as it may help with improving the enrolment of people in group programs.

Why is this important?

• Parental health, particularly the primary carer’s health, is an important influence on the health of young children and can impact them throughout life.
• The article looked at the relationship between the physical and mental health of mothers and the health and quality of life of their children in the first five years of their life.

What did they do?

• A systematic review of literature from 2010-2022 was conducted on the associations between maternal health exposures (mental, physical and Health-Related Quality of Life [HRQoL]) and child health outcomes (physical health, mental health, HRQoL and health service use/cost).
• A total of 13 quantitative studies were included in the review from countries with health systems similar to Australia.
• The findings were summarised in a narrative approach, providing key themes from the studies, including the ways in which maternal health and child health outcomes vary between disadvantaged and non-disadvantaged populations.

What did they find?

• Out of 13 studies, 10 explored maternal mental health and 3 maternal physical health, 10 studies assessed child physical health, two explored health service use/cost and one was on child mental health. One study focused on socioeconomically disadvantaged populations but confirmed similar pattern of results compared to general population.
• The review found that overall, there is an association between maternal health and child health (including physical health, e.g. infections, and mental health, e.g. internalising or externalising behaviours) and health service usage from ages 0-5 years.
• However, findings from individual studies were primarily related to a specific maternal or child’s health condition or overall health and there was limited consistency in the health conditions and child outcomes measured. Therefore, the findings are not generalisable to all health conditions or child outcomes. There are also gaps in the current evidence investigating overall maternal health and child health, HRQoL or health service usage.
• The review found that mothers with depression use more primary health services for children (3 studies).

What does this mean for practice?

• There are some research gaps that limit our understanding particularly in how maternal health exposures and quality of life affect the quality of life of children.
• Professionals can be aware that the physical, mental and social health of mothers may influence the mental and physical health of young children.

Why is this important?

• Adverse childhood experiences (ACEs) are very stressful events or circumstances that can contribute to mental health problems in children. These include abuse, neglect and household dysfunction (e.g. parental substance use, family violence, parental separation).
• Positive childhood experiences (PCEs) can protect against the development of mental health problems in children. Examples of PCEs include open family communication styles; the ability to live and play in a safe, stable, and protective environment; having constructive opportunities for social engagement; and receiving mentorship from adults.
• This paper explored how ACEs and PCEs affect the mental health of children.

What did they do?

• The US National Survey of Children’s Health (2017–2020) data was used for this study. 22,628 children between ages 6–17 years were included. This annual nationally representative survey reports on the physical and emotional health of US children, including caregiver reports of child diagnoses of mental health conditions, adverse and positive childhood experiences.
• Parents reported whether their child experienced ACEs, including:
  • households with difficulties in meeting basic needs such as food or housing
  • being treated unfairly because of race
  • a parent divorce
  • the death of a parent
  • parent incarceration
  • witnessing adults being violent towards other adults
  • children being a victim of violence
  • having a mentally ill family member; and
  • living with a person with an alcohol or drug problem.
• Parents also reported PCEs in the study including children’s access to:
  • supportive relationships (good family communication, family resilience and having non-parent mentors)
  • opportunities for social engagement (children’s engagement in sports teams, sports lessons, organised activities, clubs or community service/volunteering); and
  • safe, stable environments (neighbourhood safety and social support).
• Data on child and parent demographic, socioeconomic and child health diagnoses were also collected.
• The authors conducted univariate and multivariate statistical analyses of the data. Multivariate logistic regression was used to predict the odds of a child reporting a mental health condition (controlling for ACEs, PCEs, sociodemographic and health characteristics of the child and family).

What did they find?

• Most children lived in metropolitan areas (88%), had two parent families (74%), and no mental health problems (78%).
• Most children (97%) had positive childhood experiences (12% – 1 PCE, 28% – 2 PCEs, 38% – 3 PCE’s, 17% – 4 or more PCE’s). Half the children (46%) were exposed to negative childhood experiences (24% had 1 ACE, 10% – 2 ACEs, 5% – 3 ACE’s, 7% – more than 4 ACE’s).
• The authors found that the odds of reporting a mental health condition were 24% lower for girls than for boys, 39% higher for children older than 12 years compared to younger, 944% higher for children with special health care needs compared to those without.
• Results showed that for every ACE reported, the odds of reporting a child mental health problem was 25% higher. Similarly, for every PCE reported, the odds of reporting a mental health problem was 24% lower.
• Results suggest that PCEs can have a moderate effect on the likelihood of having a mental health problem when the number of ACEs reported are low. However, PCEs have a smaller (yet still positive) influence on the likelihood of developing mental health problems when there are multiple ACEs present.

What does this mean for practice?

• Professionals can be aware that PCEs can mitigate the long-term effects of ACEs and offset some of the negative outcomes. However, once children are exposed to several ACEs, positive experiences can be insufficient to fully protect against mental health problems.
• It is important to identify children at risk of ACEs early and seek to prevent ACEs occurring. This may include a range of work to support parents, for example.