Highlights in child mental health research: October 2020
Various, Australia, October 2020
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
- Benefits of healthy lifestyle behaviours for the wellbeing of Australian children
- Latest evidence on the treatment of anxiety in children
- Supporting the emotional wellbeing of children exposed to domestic violence
- Prolonged grief in caregivers who are refugees: Impacts on parenting and child wellbeing
What's new this month in child mental health research?
This month’s highlights include:
Check out recently released reports and journal articles on the COVID-19 pandemic and how it might affect children and families. This includes a research article on a new framework to support practitioners to deliver virtual mental healthcare (Doan et al., 2020), which has been summarised to provide key highlights.
Using data from over 2,500 participants, Thomas and colleagues (2020) found that children with healthy lifestyle behaviours (e.g. appropriate levels of screen-time, eating recommended intakes of fruit/vegetables) were more likely to have better psychological wellbeing.
This article by Walter and colleagues (2020) presents a new evidence-based clinical practice guideline to support practitioners in the assessment, diagnosis and treatment of anxiety in children.
This review of 12 studies identified multiple factors that increased a child’s risk of emotional difficulties after exposure to domestic violence (DV), including low levels of social support for the family and parenting stress (Carter et al., 2020). Importantly, children’s emotional intelligence was a protective factor that buffered the negative effect of DV on children’s emotional symptoms This lends support to interventions promoting children’s emotional awareness and regulation.
This study of refugee families who had resettled in Australia and who had experienced bereavement found that prolonged grief in caregivers/parents was associated with emotional difficulties in their children (Bryant et al., 2020). The findings add to the importance of identifying and supporting the mental health of parents who are refugees, particularly in relation to grief reactions; this can have positive flow-on effects on child wellbeing.
Benefits of healthy lifestyle behaviours for the wellbeing of Australian children
Healthy lifestyle behaviours are associated with children’s psychological health: A cross-sectional study (Australia)
Authors: Thomas, M., Gugusheff, J., Baldwin, H., Gale, J., Boylan, S., & Mihrshahi, S.
Journal: International Journal of Environmental Research and Public Health
- This study used data from the New South Wales Child Population Health Survey (2013-2014) to explore the relationship between healthy lifestyle behaviours and children’s psychological wellbeing.
- 2,665 parents of children aged 5 to 15 years old were asked about their children’s diet, physical activity and screen-time Psychological outcomes were measured using the Strengths and Difficulties Questionnaire (SDQ).
- Healthy lifestyle behaviours were based on the Australian Dietary Guidelines (for diet) and Australia’s Physical Activity and Sedentary Behaviour Guidelines (for physical activity and screen-time).
- Key findings included:
- Engaging in recommended levels of screen-time was associated with better psychological health and a reduced risk of mental health problems.
- Excessive screen-time was most strongly associated with poor mental health for children and adolescents (compared to other healthy lifestyle behaviours in the study).
- Children who ate the recommended intake of fruit and vegetables had significantly better psychological health.
- Overall, children who engaged in healthy lifestyle behaviours (e.g. appropriate levels of screen-time, healthy diets) were more likely to have better psychological wellbeing. This highlights the need for policies and programs that target improvements in children’s diets and appropriate levels of screen-time.
- Through encouraging and supporting families to strive for healthy lifestyle behaviours, practitioners and services providers can promote the mental health and wellbeing of Australian children.
Latest evidence on the treatment of anxiety in children
Clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders (USA)
Authors: Walter, H., Bukstein, O., Abright, R., Keable, H., Ramtekkar, U., Ripperger-Suhler, J., & Rockhill, C.
Journal: Journal of the American Academy of Child & Adolescent Psychiatry
- The American Academy of Child and Adolescent Psychiatry has produced a new clinical practice guideline (CPG) for assessing and treating children with anxiety disorders, highlighting the current state of evidence.
- This guideline is based on a recent systematic review by the Mayo Clinic Evidence-based Practice Center with the Agency for Healthcare Research and Quality. It provides practitioners with evidence-based guidance on early intervention, diagnosis and treatment of children and young people presenting with symptoms of anxiety.
- The guideline describes diagnostic assessment of anxiety as an essential element of treating anxiety. It provides clinical guidance (including recommended screening instruments and interview schedules) regarding:
- Mental status examination
- Psychiatric comorbidities
- Medical comorbidities
- Clinical formulation
- Differential diagnosis
- Safety and treatment planning.
- Treatment statements based on evidence and best practice are also provided, including regarding the use of various medications. Treatment statements were only developed when there was sufficient evidence to support a recommendation.
- Lastly, the guidelines emphasise the importance of accurate assessment and diagnosis of anxiety disorders to achieve effective treatment.
Supporting the emotional wellbeing of children exposed to domestic violence
Mediators and effect modifiers of the causal pathway between child exposure to domestic violence and internalizing behaviors among children and adolescents: A systematic literature review
Authors: Carter, B., Paranjothy, S., Davies, A., & Kemp, A.
Journal: Trauma, Violence & Abuse
- This review investigated the “effect of exposure to domestic violence (DV) on internalising symptoms” (such as anxiety, depression, emotional control) in children and adolescents (Carter et al., 2020, p. 1).
- The researchers also explored additional factors that might influence this effect (i.e. mediators and modifiers). That is, factors that might influence the likelihood of a child experiencing internalising problems following DV. Factors could be related to the individual, the family, or the community.
- Data from 12 studies conducted in the United States were analysed.
- All included studies focused on primary school-aged children (age 5-11 years), with four additional studies including adolescents (age 12-18 years).
- The review identified multiple factors that increased a child’s risk of internalising problems after exposure to DV. These included:
- low levels of social support for the family
- emotional dysregulation in the child (e.g. difficulties with regulating emotions, reduced awareness of one’s own emotions)
- negative parenting behaviours (e.g. harsh parenting, poor child-parent communication)
- parenting stress (e.g. stress related to fulfilling their role as a parent).
- Children’s emotional intelligence was found to be a protective (mediating) factor that influenced the relationship between exposure to DV and internalising problems. This refers to a child’s ability to identify, manage, and regulate their emotions.
- These findings have implications for practitioners who support children or families exposed to domestic violence. Examples include:
- Providing interventions that target children’s emotional awareness and regulation may act as a buffer to help protect children from developing internalising problems
- Supporting parents/caregivers to increase positive parenting behaviours and refrain from negative parenting behaviours (e.g. harsh discipline) can promote child wellbeing
- Encouraging children to participate in extracurricular activities, such as groups or classes, can be a protective factor.
Prolonged grief in caregivers who are refugees: Impacts on parenting and child wellbeing
Prolonged grief in refugees, parenting behaviour and children’s mental health (Australia)
Authors: Bryant, R.A., Edwards, B., Creamer, M., O’Donnell, M., Forbes, D., Felmingham, K.L., Silove, D., Steel, Z., McFarlane, A.C., Van Hoof, M., Nickerson, A., Hadzi-Pavlovic, D.
Journal: The Australian and New Zealand Journal of Psychiatry
- This study explored the impact of prolonged grief disorders in refugees on parenting behaviours and, in turn, child mental health.
- Prolonged grief disorder was defined as “persistent yearning for the deceased together with associated emotional pain, difficulty in accepting the death, a sense of meaningless, bitterness about the death, and difficulty engaging in new activities” (Bryant et al., 2020, p.2)
- 178 children and 110 parents from the Building a New Life in Australia (BNLA) study participated (BNLA is a nationally representative cohort study of refugees resettled in Australia). All families included in the analysis had experienced bereavement (i.e. the death of someone close to them).
- The psychological wellbeing of children was assessed using the Strengths and Difficulties Questionnaire. Adults were assessed for trauma history, post-migration difficulties, parenting style, and grief and post-traumatic stress disorders.
- Key findings included:
- Approximately one-third (37%) of parents/caregivers reported having probable prolonged grief disorder.
- Prolonged grief disorder in parents/caregivers was associated with emotional difficulties in their children. Prolonged grief disorder may impact on children through a variety of mechanisms, including a parent’s mood, social withdrawal and shifts in focus from family functioning to the deceased person.
- Harsher parenting (e.g. negativity, discipline that is physical, rigidly enforcing rules) was associated with greater problems in child wellbeing, particularly behavioural problems.
- These findings will be of interest to practitioners who support families from a refugee background who have experienced bereavement. In particular, they highlight the importance of identifying and supporting parental mental health (including grief reactions), as this can also have positive flow-on effects for children’s wellbeing.