Highlights in child mental health research: November 2019

Highlights

• Many Australian children with mental health problems do not access mental health services. This study sought to contribute to understandings of why this occurs through determining the level of parents’ under-recognition of children’s mental health problems across different income quintiles (a quintile comprises one-fifth of a sample).
• The study data was drawn from the Longitudinal Study of Australian Children (LSAC).
• The Strengths and Difficulties Questionnaire (parent version) was used to measure children’s mental health problems.
• Parents’ perceptions of their children’s mental health problems were measured using parent responses to an LSAC question of emotional, behavioural and developmental problems.
• Key findings included that under-recognition was:
  • “Highest in the lowest income quintile” with approximately 11% of these children having mental health needs not recognised by parents. In contrast, under-recognition for the highest income quintile was approximately 2.4%.
  • Greater for boys than girls.
  • Greater for younger children than older children. Under-recognition tended to lessen as children became older.
  • Given that parents from the lowest income quintiles were less likely to recognise their children’s difficulties as a mental health problem, the researchers suggest that practitioners, researchers and policymakers who wish to improve “parent’s mental health literacy [should] prioritise low-income groups” (p. 1104). This occurs against the background of a more-generalised need for wider strategies to increase parents’ child mental health literacy.
  • Improving the child mental health literacy of parents will be critical for improving the mental health of Australian children given that children’s access to mental health care is predominantly influenced by parents and caregivers (Huang, Hiscock & Dalziel, 2019).

• These findings have important implications for practitioners who work with children and families to support children’s social-emotional wellbeing. The results suggest that practitioners should be mindful that parents may require psycho-education to help contextualise their child’s difficulties and to understand how children’s mental health difficulties may manifest.  This would appear especially important for low-income families, as well as for boys or younger children, given higher levels of under-recognition.

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Highlights:

• This Australian study investigated the associations between being the subject of child protection reports during early childhood (0 to 6 years old) and subsequent mental health diagnoses in middle childhood (6 to 14 years old).
• These associations were explored for any kind of child protection report, as well as for level of response by child protection.
• Linked data was used from the New South Wales Child Development Study (NSW-CDS).

• 5% of the children in the cohort (i.e. 13,796 of 74,462 children) were subjects of child protection reports in early childhood.

• Children who had contact with child protective services in early childhood were more likely to receive a mental disorder diagnosis in middle childhood. The odds of being diagnosed with a mental disorder were almost three times as high for these children (compared to children without reports). This finding was interpreted as reflecting maltreatment consequences, which also leads to contact with child protection.

• The above finding of increased frequency of mental health diagnosis was highest for children placed in out-of-home-care; the odds of being diagnosed with a mental disorder were more than five times as high for these children. The researchers suggest that out-of-home-care “may not always provide optimal protection,” but nevertheless acknowledge that “leaving a mistreated child with their family may risk further harm” even with child protection involvement (p. 5).

• An “increasing level of child protection response” was associated with an “increased prevalence of mental disorder diagnoses,” suggesting that “severity of trauma experienced during early childhood may be important” (p. 5). The researchers also propose that the point in a child’s development at which they are placed in care, as well as their “psychological response” to placement, are also likely to be key factors (p. 5).

• The researchers emphasise the need for strategies that increase early detection of children at risk of harm so that their families can be adequately supported. This will be critical for avoiding child maltreatment and its associated detrimental effects.

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Highlights:

• Are online parenting programs effective for improving child outcomes and parenting outcomes? This was the question explored in a meta-analysis of 28 research studies (comprising 3, 979 participants).  The review investigated 15 different outcomes.
• Overall, the study found a range of significant effects of online parenting programs. These effects were similar to those observed in meta-analyses of in-person programs.  Benefits were observed across parenting skills, parent wellness and child wellness.
• “Online parenting programs had the strongest effects on increasing positive parenting and parents’ encouragement” (p. 1).
• Online parenting programs also led to reductions in:
  • negative parent child-interactions and negative discipline strategies
  • child problem behaviours and anxiety
  • parent stress, depression, anxiety and anger
  • parenting conflicts between parents
• Online parenting programs led to improvements in:
  • Positive child behaviour
  • Parent confidence
  • Parenting satisfaction
• Particularly important for practitioners and service-providers is that there was no significant difference in the strength of effects between online parenting programs that had clinical support versus no clinical support. A “clinically supported program” refers to parents having contact with “researchers, therapists, or content specialists” (in conjunction with the online program) (p. 3).
• The above finding has important implications, suggesting that families who cannot access clinical support due to financial reasons (e.g. a lack of program funding, parents being unable to make payments) can still benefit from free online parenting programs.
• There was no significant difference in the strength of the program effects for programs provided to targeted populations (i.e. high-risk populations) versus the general population. This has important implications for service providers and policy-makers, suggesting “that both targeted populations and general populations can benefit” from online parenting programs (p. 8).
• Additional research is still needed to compare differences in outcomes between online parenting programs versus face-to-face parenting programs.

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Highlights:

• This systematic review and meta-analysis explored the prevalence of problematic smartphone use in children and young people (CYP). It also explored associations between problematic smartphone usage and:
  • mental health outcomes (i.e. depression, anxiety and perceived stress)
  • sleep
  • school performance
• 41 studies involving 41, 871 CYP met criteria for inclusion.
• The study used a broader definition of children and young people that required included studies to have a mean population age of no older than 25 years. This allowed the use of important paediatric data and was more inclusive of CYP who are “developmentally vulnerable to PSU” (p. 2). The youngest participants were aged 10 years.
• Problematic smartphone usage was defined as “smart phone use associated with at least some element of dysfunctional use” (p. 3). Examples included neglecting other activities and experiencing anxiety when the smartphone is unavailable.
• The prevalence of problematic smartphone use in children and young people ranged from 10% to 30%. That is, approximately 1 in 4 demonstrated problematic use.
• “Problematic smartphone use was accompanied by increased odds of poorer mental health” across the outcomes investigated, including for:
  • depression
  • anxiety
  • perceived stress
• Problematic smartphone use was consistently associated with poor sleep quality and poor educational attainment.
• The researchers suggest that practitioners should be aware of the association between problematic smartphone use and mental health, including that excessive or night-time use might be contributing to poorer mental health and wellbeing.
• The researchers acknowledge that in reality the “primary prevention of problematic smartphone use” is difficult given that use is now a normal part of society. But they nevertheless suggest that increasing awareness of the wellbeing/mental health risks in parents, children/young people, practitioners and teachers may help limit use (p. 7).
• The authors suggest that research is urgently required to create assessment tools for problematic smartphone usage, as well to explore prevention and risk factors related to mental health and wellbeing. Given the wide age range of this study, future research could also explore the impacts in younger children specifically.

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