Highlights in child mental health research: September 2020

Highlights

• This review investigated the associations between child and adolescent engagement with screen-based technologies (i.e. “screen time”), their contact with nature (i.e. “green time”), and their psychological functioning.
• The review also explored how a combination of increased screen time and decreased green time might impact on children’s mental health.
• Data from 186 studies were analysed. Studies were largely conducted in Europe and the United States.
• Participants were aged 0 to 18 years. Early adolescents (i.e. aged 12-14 years) were the most common age group followed by school-aged children (i.e. aged 5-11 years).
• Key findings included:
  • An association between high levels of screen time and unfavourable psychological
  • An association between green time and favourable psychological
  • Greater neighbourhood greenspace appeared to buffer against perceived stress for early adolescents and was associated with higher emotional wellbeing.
  • Negative psychological effects of screen time and benefits of green time appeared stronger in children and adolescents from low socioeconomic
• Given these findings, practitioners should be mindful of the potential for screen time to negatively impact children’s wellbeing when supporting children and families. This may be particularly important in relation to families of low socioeconomic backgrounds.
• To support children who are negatively impacted by screen time, practitioners could provide support, guidance, and resources to parents/families regarding healthy screen time use. Examples of resources include those provided by the Raising Children Network. Practitioners may also wish to promote greater “green time” for children to optimise their wellbeing.

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Highlights

• This review synthesised evidence on interventions that aim to facilitate the discharge of children and adolescents from inpatient mental health services (i.e. CAMHS). In particular, the review focused on the elements and outcomes of interventions. Data from 19 studies were analysed.
• Discharge interventions were defined as “personal contact between the patient and their care team that aim(s) to prevent or solve anticipated problems in subsequent outpatient or post-discharge care [and] facilitate continuity of care” (p. 2). Interventions can be pre-discharge, post-discharge, or supporting a transition in care.
• The review identified elements of discharge interventions. These included (p. 8-12):
  • Risk screening and assessment (e.g. gathering patient information during admission to make necessary accommodations during the hospitalisation or post-discharge period).
  • Individualised care (i.e. tailoring the intervention to the individual needs of the patient).
  • Discharge preparation and planning (i.e. planning and coordinating the patient’s discharge into the community).
  • Community linkage (e.g. involving community services/agencies in the intervention; assisting the patient with referrals and resources in the community).
  • Psychoeducation (e.g. supporting patients to build their knowledge and skills, such as emotional regulation and coping skills).
  • Follow-up support (e.g. supporting patients post-discharge, such as through phone calls and follow-up meetings).
• Positive outcomes of discharge interventions were identified, including:
  • Positive patient and caregiver satisfaction
  • Improved patient health outcomes (e.g. reduced anxiety, decreased emergency department re-admissions)
  • Increased cost effectiveness.

• While the target populations, goals and outcomes of the interventions were diverse, the review nevertheless identified key intervention elements that can facilitate successful discharge processes and reduce likelihood of re-admissions.
• These findings will be of interest to practitioners and service providers who support children during their discharge from inpatient services, as well as those who work with children and their families post-discharge in the community.

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Highlights

• This study explored the associations between adverse childhood experiences (ACEs), positive childhood experiences (PCEs), and child and adolescent depression.
• Data of 40,302 children and adolescents (aged 8-17 years) from the US National Survey of Children’s Health were analysed.
• Positive childhood experiences were conceptualised as being “measures of resilience” by the researchers. Examples of PCEs included children’s competency in managing their emotions [i.e. “child resilience”], having constructive opportunities for social engagement, and developing in a safe and stable family environment (p. 2).
• Examples of ACEs included parental separation or divorce, parental death and witnessing household or neighbourhood violence.
• Key findings included:
  • Children with depression were more likely to have been exposed to ACEs than children who did not have depression.
  • A lack of specific PCEs (i.e. child resilience and development in a safe, stable family environment) were significantly associated with depression in children and adolescents.
  • Higher levels of specific PCEs (i.e. child resilience and development in a safe, stable family environment) may lessen the impact of ACEs on depression. That is, these factors appear to buffer the negative effects of ACEs.

• Overall, these findings suggest that strengthening children’s resilience (e.g. building their competency in managing emotions) and ensuring that children have a safe, stable and supportive environment can lessen the effects of ACEs on depression.
• Child and family-focused practitioners can have an important role in promoting PCEs and building children’s resilience (e.g. by promoting open and supportive parent-child communication to create shared goals; implementing evidence-based programs and approaches that aim to strengthen children’s resilience, such as their emotional regulation).

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Highlights

• This systematic review explored the associations between individual forms of victimisation or polyvictimisation, and indicators of psychopathology (i.e. mental health problems) in children and adolescents.
• Data from 22 studies were analysed (participants aged 0 to 17 years). All studies were required to have used the same victimization assessment tool (the Juvenile Victimization Questionnaire).
• While polyvictimisation has varying definitions, this review defined polyvictimisation as “multiple and distinct types of child victimisations (e.g. sexual abuse, bullying, physical violence)” (Haahr-Pedersen et al., p. 2)
• The review identified a significant positive association between polyvictimisation and a range of child mental health indicators, including:
  • Externalising problems (e.g. anger, hyperactivity, delinquent behaviours)
  • Internalising problems (e.g. anxiety, depression, emotional control)
  • Psychological distress.
• The findings also suggested that polyvictimisation may be a stronger risk factor for psychopathology than individual types of victimisation.
• Prevention, assessment and intervention approaches for children who have experienced victimisation are often “siloed” in their approach whereby distinct types of victimisations are targeted. Hence the researchers highlight the importance of further developing clinical approaches that account for and address polyvictimisation; this may help optimise the care and wellbeing of children who have experienced multiple forms of victimisation.
• Practitioners working with victimised children may wish to reflect on an individual child’s risk of polyvictimisation, and to consider that this may place them at an increased risk of mental health difficulties.
• When working with polyvictimised children, practitioners should ensure that interventions address all dimensions of mental health problems (e.g. both inner and outer-directed difficulties).

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