Highlights in child mental health research: October 2024

This month’s highlights include:

Social inequalities in child mental health trajectories

Social inequalities have been shown to impact children’s mental health. This study used data from eight birth cohorts from 12 different countries to understand the relationship between social inequalities and children’s mental health over time.

The study found that children who experience social inequalities are more likely to have internalising and externalising symptoms from an early age. It also showed that the mental health problems in children from disadvantaged social-economic circumstances remained consistent as they grew older.

Racial discrimination, mental health and sleep problems among Aboriginal and Torres Strait Islander children

Using data from two large-scale Australian population surveys (Speak Out Against Racism and Growing up in Australia: The Longitudinal Study of Australian Children), this study used a casual mediation analysis to implement a hypothetical intervention to understand what would happen to the mental health and sleep patterns of Aboriginal and Torres Strait Islander children if interpersonal racism was eliminated. The authors found that eliminating racial discrimination would reduce mental health and sleep problem inequities among Aboriginal and Torres Strait Islander children.

Responding to adverse childhood experiences in African-background refugee families in New South Wales

This qualitative study sought to understand the challenges that children and families from refugee backgrounds face in accessing support for adverse childhood experiences (ACEs) from child welfare services in New South Wales, Australia. The authors conducted interviews and focus groups with 12 African-background parents, 12 practitioners and 11 local African community leaders. The authors found that parents mostly relied on informal supports. The supports from formal support services also sometimes conflicted with parents’ cultural beliefs, particularly around discipline and family roles. Evidence suggests that supports that are sensitive to cultural differences and that are trauma-informed can be beneficial for addressing ACEs in refugee populations.

Screen time and the mental health of adolescents

This study examined the impact of screen time (e.g., video chat, texting and video games) on behavioural and mental health problems among 9,538 adolescents (ages 9–10). The authors used data from the Adolescent Brain Cognitive Development (ABCD) Study in the United States. Higher screen time was correlated with increased symptoms across depressive, conduct, somatic and attention-deficit/hyperactivity (ADHD) symptoms, however the effects were small overall. The symptoms varied by race and ethnicity, with negative associations more prominent among White adolescents for some mental health outcomes such as depressive symptoms.

Why is this important?

• Social inequalities have been shown to impact children’s mental health. Children born into disadvantaged socio-economic circumstances (SEC) are more likely to have worse mental health outcomes.
• Although there is research into the relationship between social inequalities and the impact on children’s mental health, much of this research does not track the impact over time or into the transition into adolescence.

What did they do?

• This study used data from eight birth cohorts from 12 different countries (Australia, Belgium, Denmark, France, Germany, Greece, Italy, Netherlands, Poland, Norway, Spain and the United Kingdom), with a total sample size of 149,604 children.
• The authors measured SEC through maternal education qualifications. Data was also considered if it contained data on maternal age at birth, the child’s sex and data on children’s internalising (e.g. emotional or peer problems) and externalising symptoms (e.g. behavioural problems, hyperactivity).
• This study used either the Strengths and Difficulties Questionnaire and the Child Behaviour Checklist to measure internalising and externalising problems.
• All data used in the selected birth cohort studies came from questionnaires filled in by the child’s parents (except for one wave of the Danish birth cohort study where the mean age was 18 years old).

What did they find?

• Children born into disadvantaged SECs were more likely to have internalising and externalising symptoms.
• Mental health challenges in children start from an early age. The authors found that children from disadvantaged SECs displayed externalising and internalising symptoms as young as two years of age.
• Children born to mothers of low education had more internalising and externalising symptoms.
• The patterns of inequalities varied across surveys, depending on gender and types of symptoms. However, for the most part, inequalities in internalising and externalising problems remained consistent as children got older.

What does this mean for practice?

• Healthcare inequalities are likely to have effects on children’s mental health and have effects throughout their lives.
• Children from families experiencing socio-economic disadvantage may require more support for mental health challenges.

Why is this important?

• Racism causes health inequalities for Aboriginal and Torres Strait Islander people, including children.
• Interpersonal racism (an everyday form of racism occurring between individuals) has been shown to have significant negative effects on Aboriginal and Torres Strait Islander children’s health, including mental health and sleep difficulties.

What did they do?

• The study used cross-sectional and longitudinal data from two large-scale Australian population surveys: Speak Out Against Racism (SOAR) and Growing up in Australia: The Longitudinal Study of Australian Children (LSAC).
• SOAR was a survey completed by 4664 primary and secondary students (10-15 years of age) from 23 schools across New South Wales and Victoria, Australia. The study focused on racism and mental health.
• LSAC is a nationally representative study of two cohorts: a birth cohort (n=5107 infants) and a kindergarten cohort (n=4983 four-year-olds).
• The authors used a type of analysis (casual mediation) that allows for researchers to implement a hypothetical intervention. In this case, hypothetically understanding what would happen to the mental health and sleep patterns of Aboriginal and Torres Strait Islander children if interpersonal racism was eliminated.

What did they find?

• Aboriginal and Torres Strait Islander children were more likely to experience mental health problems than Anglo-European children.
• In the SOAR study, 40.1% of Aboriginal and Torres Strait Islander children experienced mental health problems compared to 13.5% of Anglo-European children.
• In the LSAC study, 25.3% of Aboriginal and Torres Strait Islander children experienced mental health problems compared to 7.6% of Anglo-European children.
• The authors found that through their analysis, eliminating racial discrimination would reduce mental health and sleep problem inequities among Aboriginal and Torres Strait Islander children.

What does this mean for practice

• Addressing racism and racial discrimination is a public health priority and requires targeted policy interventions.
• Aboriginal and Torres Strait Islander communities should be at the centre of changes to policy (such as healthcare) to address the impact of racism.

Why is this important?

• Research estimates that worldwide, nearly one billion children (ages 2-17) experience some form of adverse childhood experiences (ACEs) every year.
• Statistically, children from refugee backgrounds are more likely to face ACEs than the general population but are less likely to access support services.
• Understanding the unique challenges that children and families from refugee backgrounds face in accessing support can help in the design of more culturally responsive services to support them through ACEs.

What did they do?

• The study used a qualitative and ethnographic research design to capture the cultural and social nuances affecting the experiences of African-background refugee families when accessing and interacting with child welfare services in New South Wales.
• The authors interviewed 12 African-background parents and 12 practitioners, as well as two focus groups with 11 African community leaders to gather their perspectives.
• The results were analysed using reflexive thematic analysis, organising responses into key themes.

What did they find?

• ACEs in African-background refugee children were associated with a range of symptoms, including social withdrawal, substance misuse, suicidal thoughts, violence, and revenge fantasies, as well as physical and mental health problems. Parents primarily managed these issues at the family level, seeking professional help only when necessary.
• The authors found that refugee parents with African backgrounds rely heavily on informal support systems and often take on the role of ‘therapists’ for children affected by ACEs. They use cultural and spiritual practices to manage trauma, as formal support systems are often inaccessible or culturally unresponsive​.
• Parents experienced tensions interacting with child protection services, as the services’ practices sometimes clashed with family cultural norms, particularly around discipline and family roles. These differences can lead to misunderstandings and mistrust between refugee families and the child welfare services​.

What does this mean for practice?

• Practitioners need to be aware of the unique needs of refugee background families, particularly of the impact of racism and trauma.
• Evidence suggests that supports and services that are sensitive to cultural differences and that are trauma informed can be beneficial for addressing ACEs in refugee populations.

Why is this important?

• The prevalence of mental health problems and suicide among adolescents has increased significantly since the early 2000s. Because screen time has also grown exponentially during this time, there is widespread interest in any associations between these two trends.
• This study explores a previously under-researched area of the different effects of screen time on the mental health of adolescents according to race and ethnicity.

What did they do?

• The study explored how time spent on different types of screen usage (e.g., video chat, texting, video games) are related to behavioural and mental health symptoms in adolescents, specifically looking at how these associations may vary by race and ethnicity.
• The authors used data from the Adolescent Brain Cognitive Development (ABCD) Study conducted in the United States. Data was collected from 9,538 adolescents (ages 9–10 at baseline) over two years.
• The authors explored screen time self-reported by adolescents (based on the ABCD Youth Screen Time Survey) and parent-reported mental health symptoms using the Child Behaviour Checklist.
• The mental health outcomes explored included behavioural, emotional, and mental health symptoms: depressive, anxiety, somatic, attention-deficit/hyperactivity (ADHD), oppositional defiant, and conduct symptoms.

What did they find?

• The average total screen time at baseline was 4.0 ± 3.2 h per day (additional to school time), with most time spent watching television shows/movies (1.3 ± 1.1 h/day), watching/streaming videos (1.3 ± 1.2 h/day) and playing video games (1.2 ± 1.1 h/day).
• Overall, higher screen time was correlated with increased symptoms across mental health challenges, including depressive, conduct, somatic and ADHD symptoms. However, the effects were small overall.
• Video chat, texting, videos, and video games were the screen types most often linked to depressive symptoms. Interestingly, social media time was not statistically linked to any mental health problems, however the authors suggested this may because the participants were young and spent the least screen time on social media.
• Links between screen time and mental health symptoms varied by race and ethnicity, showing stronger associations for depressive, ADHD, and oppositional defiant symptoms in White adolescents compared to Black adolescents. Links between screen time and depressive symptoms were stronger among White compared to Asian adolescents.

What does this mean for practice?

• The study suggests the need for age-appropriate, tailored guidelines for screen use and early mental health interventions for adolescents to help reduce the impact of screen time on mental health later in life​.
• Since the effects of screen time can vary by race and ethnicity, mental health interventions can benefit from responses that address and respond to the specific needs of different adolescent populations.