Highlights in child mental health research: November 2022

Highlights

• Siblings of children with chronic conditions can have specific experiences including assuming supportive or caregiving roles, having less parental attention leading to feelings of isolation or loneliness, internalising struggles to avoid burdening parents further, and experiences of concern, sadness, and/or heightened stress.
• This study reviewed the evidence on the mental health of siblings of children with chronic conditions.

Key findings

• 34 studies were included in the systematic review, from UK, England, England and Wales, Turkey, USA, Sweden, The Netherlands, Finland, Canada, Greece, Denmark, India, Taiwan.
• Studies included in this review focus on chronic conditions such as: Type 1 diabetes, cancer, physical, mental and developmental disability.
• The review found that siblings of children with chronic conditions had increased risk of symptoms suggestive of depression, compared to children without a sibling with a chronic condition, but did not find a difference with respect to symptoms of anxiety.
• The findings of this study are consistent with most previous reviews on the topic.

Implications

• Findings of this study suggest the need for targeted interventions to support the psychological well-being of siblings of children with chronic health conditions.
• The findings could inform the development of screening measures for timely identification of siblings with mental health concerns.
• Sibling-oriented targeted interventions, such as camps and support groups could benefit siblings of children with a chronic condition.

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Highlights

• This systematic review found anxiety, depression, drug abuse, sleep and appetite disorders, as well as impaired social interactions, to be the most common presentations of mental health and wellbeing concerns amongst children and adolescents during the SARS-CoV-2 pandemic (from 2021 to 2022).
• Factors associated with poor mental health outcomes in children and adolescents during COVID-19 included: worsening parent’s mental health, belonging to urban racial and ethnical minorities, inclusion in other vulnerable and special population groups, and physical inactivity.

Key findings

• 24 articles were included in the systematic review. They included studies focusing on psychiatric interventions in children and adolescents, aged 3 to 19, from 2021 to 2022
• The review included studies of populations from: Brazil, Japan, Italy, Saudi Arabia, Canada, Pakistan, Australia, Sweden, the US, China, South Korea, The Netherlands, and the UK.
• Prevalence of depression ranged from 13.5% to 81.0%, with higher prevalence among ages 5-9 and 12-18, and prevalence was higher in females than males.
• Prevalence of anxiety among children and adolescents was 45.6%. Parental anxiety had the greatest influence on children’s symptoms. Children less exposed to parental concerns (e.g., about finances, health and education) were less likely to have internalizing and externalising problems.
• Prevalence of post-traumatic stress symptoms were statistically higher in vulnerable and/or socially at-risk children and adolescents.
• LGBTQ adolescents showed higher rates of psychological distress. Conflict with parents regarding gender issues was observed as a factor worsening mental health in this population.
• Most studies indicated the following key negative influences arising during the COVID-19 pandemic in 2021-2022: excessive contact with family members, missing school, interruption in daily routine, and reduced social contact.
• Frequent mask use, physical activity, and time spent on schoolwork were factors associated with good mental health.

Implications

• Findings from this analysis highlight that promotion of family well-being (including providing financial and care assistance and supporting the mental health of families) is crucial to support child and adolescent’s mental health.
• The authors suggest a focus on support aimed at the parent-child relationship (in addition to symptom management).
• The authors suggest that promotion of coping strategies for children and adolescents to deal with extreme situations, building resilience and managing negative feelings is fundamental.
• Vulnerable and special population groups require more support.

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Highlights

• This study compared psychological distress and child emotional and behavioural problems (EBPs) in children with diagnosed conditions such as autism spectrum disorder (ASD) or attention-deficit/hyperactivity disorder (ADHD) and in children without these diagnoses. It also explored changes in EBPs over time.
• The authors found that children with ASD and/or ADHD had higher EBPs than those without. However, mothers of children with ASD showed increasing distress over time, while mothers of children with ADHD showed reducing distress over time.

Key findings

• This study used the Longitudinal Study of Australian Children (LSAC) to investigate child mental health trajectories 0-14 years for children with ASD, ADHD, or ASD + ADHD.
• The study found children with ASD and/or ADHD diagnoses had higher emotional and behavioural problems than children without these diagnoses.
• The rates of behavioural problem over time showed a peak in child behavioural problems at age 8 years in ASD + ADHD, and a slightly later peak at 10 years in children with ASD or ADHD alone. Children without these diagnoses showed a gradual linear decline in emotional and behavioural problems from age 4 to 14 years.
• Mothers of children with ASD, ADHD and ASD+ASD had significantly higher psychological distress than mothers of children without these diagnoses and experienced peak psychological distress when the child was around 6 years of age.
• Mothers of children with ASD showed increasing distress over time while mothers of children with ADHD showed reduced distress over time. The authors speculated that this could be due to children with ADHD having more severe symptoms earlier in their development.
• Mother’s pre-existing distress levels had a lower and later effect on children with ASD and/or ADHD EBP levels than on children without these diagnoses.

Implications

• This research highlights key times where EBPs may be particularly elevated in children with ASD/ADHD. These may be suitable times to plan intervention.
• The child age of 6 years of age is a critical time to support parent mental health and child age 8–10 is a critical time to intervene regarding child EBPs. Intervention for parents at this point may reduce exacerbation of later child behaviour problems.
• These findings suggest that mothers of children with ASD (with or without ADHD) already had higher psychological distress in the first year of their children’s life, well before their children were formally diagnosed with ASD.

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Highlights

• This systematic review investigated the relationship between maternal depression on child mental health outcomes, and the effect that treatment of maternal depression has on help-seeking for child mental health concerns . It also looked at emerging models in primary care that address maternal depression in child mental health paediatric settings.
• The authors found mental health treatment for mothers has a positive effect on mental health outcomes on children and for help-seeking for children’s mental health.

Key findings

• 29 papers were included in this systematic review; these were found to be of variable quality.
• Effective treatment for maternal depression was found to improve child mental health outcomes from pre-school to adolescence.
• Mothers of psychiatrically ill children were found likely to have undiagnosed or untreated mental health conditions.
• Maternal depression was found to potentially interfere with treatment of child mental health difficulties. Mothers who have depression had higher perceived barriers, reduced compliance of mental health treatment for their teen children and were more likely to miss mental health appointments.
• Only three of the included studies screened maternal depression in a paediatric setting. The most common barriers to treating maternal depression and child psychosocial problems were lack of time, lack of training, and long waiting periods to receive mental health support.
• Providing psychotherapy interventions to depressed mothers with children with mental health difficulties was found to improve mental health outcomes in both mothers and children.

Implications

• Maternal depression is a significant modifiable risk factor for child mental health difficulties.
• Screening for maternal depression is becoming increasingly common but is often confined to the perinatal period. This could be considered more broadly across child and adolescent mental health services. However, this screening must be supported with the relevant support services for mothers who are at risk or diagnosed with depression
• Integrated care, and family-based preventative intervention may be beneficial when working with children and parents with mental health concerns.

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