Highlights in child mental health research: September 2023

This month’s highlights include:

• Sports participation and children’s psychosocial wellbeing

The study aimed to examine the long-term effects of sports participation on the psychosocial wellbeing of Australian children. Both team sports and individual sports were found to benefit quality-of-life and psychosocial wellbeing in girls and boys, though team sports participation had more significant benefits. Participating in both saw the strongest benefits Prolonged engagement with sports over several years is more impactful than one-off participation.

• The impact of shared and structured parenting practices on parent and child mental health

The study aimed to investigate the role of parenting practices on parent and child mental health. Higher levels of shared parenting responsibilities were associated with lower depressive symptoms in parents. In children aged 2-5 years, higher levels of structured parenting and shared parenting were significantly associated with fewer emotional and conduct problems. Findings across other age groups were mixed.

• Relationship between self-concept, anxiety and later depression in children

This study aimed to better understand the role that self-concept plays in the relationship between early anxiety symptoms and the subsequent appearance of depressive symptoms in children. The authors assessed self-concept in the domains of family, emotional, physical, social, and academic achievement. Children with higher levels of anxiety were more likely to present with lower self-concept. Academic self-concept was the only significant mediator between anxiety at baseline and presentations of depression after 12 months. This suggest that improving how children perceive themselves in an educational context may play a role in preventing depression, especially for children with existing anxiety.

• Effects of positive and poor prenatal mental health on child outcomes

This systematic review aimed to highlight the adverse effects of poor prenatal mental health on children’s outcomes and the impacts of positive prenatal mental health. 74 studies were included. Maternal psychological distress in pregnancy was found to be associated with adverse child outcomes and maternal psychological distress had a negative association with positive child outcomes. Positive maternal mental health during pregnancy was associated with positive child outcomes and was not significantly associated with adverse child outcomes.

Why is this important?

• The study aimed to examine the long-term effects of sports participation on the psychosocial wellbeing of Australian children. While the association between sports participation and children’s health and wellbeing is evidenced by existing research, this study aimed to understand this association across time.

What did they do?

• Data from five waves (between 2010-2018) of the Longitudinal Study of Australian Children were analysed. 4,242 children aged 6-7 years in 2010 were included.
• Tools used to assess outcomes included: the Strengths and Difficulties Questionnaire, the Paediatric Quality of Life (QOL) Inventory, and yes/no questions assessing for regular sports participation (at least once a week for three months or more) in a team (e.g., cricket or netball) or individually (e.g., tennis or gymnastics).

What did they find?

• Individual sports participation rates were similar for boys (53%) and girls (58%), though more boys participated in team sports than girls (59% and 26% respectively). There was an overall decline of sports participation over time.
• For team sport participation, boys who participated had 1.78 points lower difficulties scores and 4.72 points higher QOL scores compared to boys who did not participate. Girls who participated had difficulties scores 1.22 point lower and QOL scores 3.44 points higher.
• For individual sports, children still had reduction in difficulties and benefits to QOL, but to a lower extent than team sports.
• The greatest positive change was observed in children who participated in both team and individual sports.
• The benefits of sports participation were found to be cumulative, with improved outcomes found when children engaged with sport for multiple years in a dose-response relationship.

What does this mean for practice?

• Practitioners working can consider promoting consistent sports participation to children and their carers as a means of improving children’s quality of life and psychosocial wellbeing.
• Although team sports are found to be more beneficial than individual sports, individual participation is still beneficial. Participating in both provides the strongest benefits.
• Prolonged engagement with sports over several years between the ages of 6 and 15 is more beneficial than one-off participation for psychosocial wellbeing and quality-of-life. It is therefore important that children continue participation, especially into adolescence.

Why is this important?

• The Canadian study aimed to investigate the role of parenting practices on parent and child mental health over time, particularly in the COVID-19 pandemic period and transition phase.

What did they do?

• The authors used data from online surveys completed by parents about themselves and their children (aged 2-18 years) between 2020-2022. Parenting practices, shared parenting responsibilities, and symptoms of parent and child mental health and wellbeing were assessed repeatedly (median of four times, up to 14 times).
• Analysis was conducted separately for 4 age group categories. The age groups were defined prior to analysis, based how much limit-setting and instrumental caregiving was required at each developmental stage.
• Convenience sampling was used to recruit participants. 1027 parents in Canadian two-parent households completed the surveys. 85% were mothers.

What did they find?

• The authors found different that structured and shared parenting were associated with different outcomes for children at different developmental stages.
• In children aged 2-5 years, higher levels of structured parenting (e.g., providing predictability and reliable routines, reasonable limits) were positively associated with decreased irritability, but was not associated with hyperactivity/inattention symptoms, or emotional problems.
• In children aged 2-5 years, higher levels of shared parenting responsibilities (e.g., satisfactory sharing of household and caregiving labour, joint decision-making, coordination) were also associated with decreased irritability and fewer emotional problems. Shared parenting responsibilities were not associated with hyperactivity/inattention symptoms in this age group.
• In children aged 6-9 years, neither structured nor shared parenting impacted on emotional problems, irritability, hyperactivity/inattention symptoms.
• Among children aged 10- 12 years, no associations were found between parenting styles and any child outcomes studied.
• Among children aged 13-18 years, structured parenting was not associated with any of the child outcomes studies. Shared parenting was associated with lower irritability in this age group, but not with other outcomes studied.
• Shared parenting responsibilities were associated with better parental mental health, but structured parenting was not associated with parental mental health outcomes.

What does this mean for practice?

• The study suggests that shared parenting is beneficial for parent and child mental health, even under chaotic or stressful life conditions such as COVID-19. Practitioners working with families can consider promoting shared parenting, particularly as a strategy beneficial to families who are struggling with mental health challenges in parents and/or emotion and conduct concerns in children aged 2-5 years.
• Structured parenting can also be encouraged by practitioners working with families, to help support emotion and conduct concerns in children aged 2-5 years.

Why is this important?

• This study aimed to better understand the role that self-concept plays in the relationship between early anxiety symptoms and the subsequent appearance of depressive symptoms in children from Spain
• Self-concept refers to the child’s perception of themselves.

What did they do?

• The authors conducted a longitudinal study of 217 children aged 8–12 years in Spain.
• Data was gathered on participant’s depressive symptoms, anxiety symptoms and self-concept in the domains of family, emotional, physical, social, and academic.
• Data was collected at three points; (1) baseline, (2) two months, and (3) 12 months after baseline.

What did they find?

• Anxiety at baseline was directly related to higher levels of depression and anxiety after 12 months.
• Children with higher levels of anxiety at baseline were more likely to present with lower self-concept across all areas after 6 months.
• When controlling for relevant variables (e.g., age, sex and anxiety and depressive symptoms at different time points), academic self-concept was the only significant mediator between anxiety at baseline and depression after 12 months. That is, children with anxiety symptoms were more likely to develop depressive symptoms after 12 months if they felt they did not perform well at school. Other domains of self-concept were not found to mediate the relationship between anxiety and later depressive symptoms.

What does this mean for practice?

• Practitioners can be aware of the impact of lower levels of self-concept on anxiety and depressive symptoms, and support children and their families to improve self-concept as a strategy to support positive mental health.
• Strategies to improve educational self-concept could contribute to preventing depression in children, especially those with existing anxiety.
• Children who feel competent academically may be more likely to have positive perceptions of family, as well as positive understandings of their physical appearance and aptitude. The authors hypothesised that this relationship may be, in part, due to positive reinforcement from family for academic achievement (e.g., praise or validation for good grades).

Why is this important?

• This study aimed to understand the impact of maternal mental health in pregnancy on child outcomes, including not only the adverse effects of poor mental health, but also exploring the impacts of positive maternal mental health.

What did they do?

• The authors conducted a systematic literature review and analysis of studies investigating associations of prenatal maternal mental health with child socioemotional development.
• 74 studies totalling 321,966 mother-child dyads across 21 countries were included. Of these, 68 studies involved the developmental stages of: infancy, toddler, preschool and/or mid childhood. Eight involved teenagers aged 12-16.

What did they find?

• In the studies reviewed, adverse child outcomes described in the studies were: emotional dysregulation, aggressive behaviour, internalising and externalising problems, negative mood, reactivity, mental health disorders, inattention, hyperactivity, fearfulness, peer problems. Positive outcomes included in the studies were adaptive skills, prosocial behaviours, positive mood, empathy, positive reactivity.
• Maternal psychological distress in pregnancy (e.g., depression, anxiety, stress) was found to have a significant association with adverse child outcomes (71 studies) and a negative association with positive child outcomes (15 studies).
• Positive maternal mental health during pregnancy was associated with positive child outcomes and was not significantly associated with adverse child outcomes, but this relationship was only explored in 6 and 2 studies respectively.
• Positive prenatal mental health was more strongly associated with positive child outcomes, and psychological distress was more strongly associated with adverse child outcomes. This finding supports the idea that positive and negative mental health are independent constructs that can influence different outcomes, and that positive mental health is more than the absence of symptoms of psychological distress.

What does this mean for practice?

• Positive child outcomes can be supported by understanding the spectrum of maternal mental health and its different impacts on child development.
• Practitioners can provide support to mothers who experience psychological distress during pregnancy as a means of enhancing child socioemotional development and mitigating against adverse effects.
• Assessing the mental health of pregnant people and developing interventions that target both negative and positive aspects of maternal mental health can help to optimize child socioemotional outcomes. Importantly, these interventions should begin in pregnancy (or earlier).
• The impact of positive maternal mental health is not as extensively researched as negative maternal mental health.