Highlights in child mental health research: October 2022

Highlights

• This study examines the psychosocial adjustment of asylum seeker children (with insecure residency) living with their families in the community in Australia.
• The authors found that asylum seeker children reported significantly more psychosocial problems compared to children from immigrant or refugee families with temporary protection or secure residency.

Key findings

• The Reassure Child and Adolescent Project (CAP) study is a 24-month longitudinal cohort study of children and adolescents (aged 5–17) (n=195) and their primary caregiver (n=135) from Farsi-Dari speaking backgrounds, arrived in Australia since 2010. Primary caregivers completed questionnaires for themselves and their children on their wellbeing. Young people (aged 11–18 years) were invited to complete self-report questionnaires.
• The study included asylum seekers (n=47 caregivers, n=64 children); people on Temporary Protection Visas (n=20 caregivers, n=30 children); permanent refugee visas (n=27 caregivers, n=44 children); and immigrant visas (n=41 caregivers, n=57 children).
• Results showed asylum-seeking children reported elevated psychosocial problems compared to language matched children with similar lengths of stay in Australia on temporary protection visas or secure residency (refugee and immigrant families).
• Across all residency categories, higher parental PTSD symptoms were associated with significantly higher child psychosocial problems. The relationship between worse parental PTSD and child psychosocial problems was more marked families with insecure residency.
• Female asylum-seeking children and young people displayed significantly more conduct problems than girls with temporary protection or secure residency.

Implications

• Children and adolescents living with insecure residency report higher psychological challenges than age and language matched refugees or immigrants with secure residency.
• These symptoms are associated with their parents’ psychiatric symptoms. The authors indicate that restrictive asylum policies are associated with greater mental health problems across the whole family.
• Asylum seeker children have limited access to clinical services and the authors highlight that they may have unmet health needs.

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Highlights

• Perinatal emotional wellbeing encompasses a wide range of factors that contribute to emotional wellbeing. This study compares perinatal wellbeing between women living in metropolitan and rural regions.
• Overall, perinatal mental wellbeing was found to be similar for women living in metropolitan and rural regions. However, women in rural regions experienced higher parenting stress and lower access to parenting supports.

Key findings

• 806 women from Victoria and Western Australia were recruited before 20 weeks of pregnancy and followed up to 12 months postpartum. 578 women were from capital cities in Australia (Melbourne and Perth) and 228 women were from rural regions mostly in Western Australia.
• Researchers conducted interviews to assess mood disorders at recruitment. Self-report symptom measures of mental health outcomes (depression, anxiety and stressful life events); lifestyle outcomes (sleep quality, exercise frequency, eating and nutrition habits, social support); post-partum parenting outcomes (breastfeeding cessation, parenting stress); were assessed at early pregnancy, third trimester, and 6- and 12-month postpartum.
• Women living in rural regions had lower symptoms of both depression and anxiety over the perinatal period. However, women in rural regions with depression reported significantly higher parenting stress than metropolitan women with depression or non-depressed women across all areas.
• Women in rural regions also reported less access to parenting activities and supports.
• There was no difference across the perinatal period for most lifestyle outcomes in rural compared with metropolitan women whether depressed or not.

Implications

• Findings suggest the relationship between stressful life events and depression is stronger, and access to parenting activities is lower for women living rurally. However, women living rurally did report feeling supported by partners and family.
• The authors suggest that future support and interventions for rural communities need to be tailored to not only reducing mental health symptoms but also increasing support for parenting.

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Highlights

• Individuals with Fetal Alcohol Spectrum Disorder (FASD) are at risk of having adverse childhood experiences (ACEs).
• This study explored ACEs in individuals with FASD and their association with justice/child protection system involvement and other comorbid conditions such as mood disorders.

Key findings

• A total of 211 participants (72% males) with FASD in Western Australia with a mean age of 11 years (range = 2–21) were included. 70% had been involved with the child protection system and 40% had trouble with the law.
• Participant records including medical, psychosocial and developmental history and other documents such as allied health and educational reports were coded retrospectively.
• Exposure to drinking/substance misuse at home (70%) and domestic violence (52%) were the two most common ACEs. Across all participants, 39% had four or more ACEs, which indicates a higher risks of poor health outcomes.
• Higher numbers of ACEs were associated with child protection system involvement, with almost 50% of this subgroup having had four or more ACEs.
• Children were more likely to be involved with child protection if they experienced drinking/substance misuse at home, or emotional and physical neglect. Children who were exposed to domestic violence were more likely to be involved with the justice system.
• Disengagement from school (43%), transiency (19%), bullying (12%), traumatic brain injury (9%) and homelessness (5%) were identified as additional stressors.
• Higher rates of life adversity were associated with an increased number of comorbidities. Specifically, those with FASD who had comorbidities such as attachment disorder, substance use disorder, and PTSD also reported higher ACEs scores.

Implications

• Increased ACEs in children with FASD are associated with increased comorbidities and involvement with the child protection and justice systems.
• The authors highlight that prevention, intervention and early diagnosis of FASD are important for at risk children to reduce the negative effects of ACEs

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Highlights

• Obesity is a chronic disease that compromises the physical and mental health of an increasing proportion of children globally.
• This systematic review narratively summarised clinical practice guidelines published in English for treating child and adolescent obesity.

Key findings

• The authors identified nine high quality guidelines for review that considered how to treat obesity in children aged 0-18 years.
• Most guidelines identified the importance of education and training for health care providers on how to treat childhood obesity and the importance of reducing body stigma in families and healthcare settings due to adverse psychological effects such as depression and low self-esteem.
• Many guidelines advised professionals to use behaviour change approaches, however there was limited guidance on how they should be implemented in obesity treatments or supplemented with psychosocial therapeutic approaches.
• Interventions that involve family lifestyle modifications were found to be the most effective at sustaining behaviour changes. However, these interventions rely on the capacity of parents/guardians for implementation.
• All guidelines were consistent in focussing treatment on behaviour changes that subsequently impact on weight status rather than having a direct weight loss focus.
• Most guidelines included nutrition and physical activity Many guidelines acknowledged the need to be mindful of the social determinants of health (such as environment, nutrition education, food security) and the effects on the ability of families to adhere to nutrition recommendations, but there were no detailed guidelines on how to address social determinants.

Implications

• This study found a consensus that family-oriented behaviour change interventions should be provided as the primary treatment for obesity in children.
• The authors highlight that future guidelines should consider and provide recommendations that address the social determinants of childhood obesity, and how the effects of co-morbid diagnoses such as psychological issues affect obesity development and treatment.
• The authors highlight the need for further information and guidance on how to support meaningful improvements in health, function, wellbeing, and quality of life.

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