Maternal mental health and child behaviour problems at 2 years: findings from the Pacific Islands Families Study

OBJECTIVE: The present study investigated associations between the timing and persistence of maternal psychological disorder and child behaviour problems in a cohort of Pacific 2-year-old children in New Zealand. METHOD: Mothers of a cohort of 1,398 Pacific infants born in South Auckland, New Zealand were interviewed when their children were 6 weeks, 12 and 24 months of age. Within the context of a wider interview, data regarding maternal mental health were obtained at these times and maternal reports of child behaviour were gathered when the children were 2 years old. RESULTS: Prevalence rates for internalizing problems were significantly higher in children of mothers who had self-reported symptoms of psychological disorder (11.9% in no symptoms, 27.8% in early symptoms of postnatal depression, 21.1% in late symptoms of psychological disorder and 42.9% in persistent or recurrent symptoms). The adjusted odds ratio (OR) of a child having internalizing problems was 1.38 (95% confidence interval (CI): 0.79-2.43) in those of mothers reporting early symptoms of postnatal depression, 1.45 (95%CI: 0.85-2.49) in late symptoms of psychological disorder, and 2.93 (95%CI: 1.54-5.57) in persistent or recurrent symptoms relative to the no symptoms group. For externalizing problems, the effects of maternal psychological disorder were not significant. CONCLUSIONS: Maternal persistent or recurrent symptoms of psychological disorder may contribute to the behaviour problems of children as young as 2 years old. However, the timing of disorder, whether it is infant or toddler exposure, does not appear to be as crucial. Improved understanding of the associations between maternal psychological disorder and early child behaviour problems may help maternal and child health professionals design appropriate and effective screening and intervention programs to help Pacific mothers and children.     

Urban-rural mental health differences in Great Britain: findings from the National Morbidity Survey

Studies of urban-rural differences in prevalence of non-psychotic mental disorder have not given consistent findings. Such differences have received relatively little study in Great Britain. Data from 9777 subjects in the Household Survey of the National Morbidity Survey of Great Britain were analysed for differences between urban, semi-rural, and rural areas. Psychiatric morbidity was assessed by scores on the Revised Clinical Interview Schedule (CIS-R), together with alcohol dependence, drug dependence, and receipt of treatment from general practitioners. Associations with other characteristics were examined by logistic regression. Urban subjects had higher rates than rural of CIS-R morbidity, alcohol dependence, and drug dependence, with semi-rural subjects intermediate. Urban subjects also tended to be members of more deprived social groups, with more adverse living circumstances and greater life stress--factors themselves associated with disorder. Urban-rural differences in alcohol and drug dependence were no longer significant after adjustment for these factors by logistic regression, and differences on CIS-R morbidity were considerably reduced. There were no differences in treatment. There are considerable British urban-rural differences in mental health, which may largely be attributable to more adverse urban social environments.     

Urban-rural mental health differences in Great Britain: findings from the National Morbidity Survey

Studies of urban-rural differences in prevalence of non-psychotic mental disorder have not given consistent findings. Such differences have received relatively little study in Great Britain. Data from 9777 subjects in the Household Survey of the National Morbidity Survey of Great Britain were analysed for differences between urban, semi-rural, and rural areas. Psychiatric morbidity was assessed by scores on the Revised Clinical Interview Schedule (CIS-R), together with alcohol dependence, drug dependence, and receipt of treatment from general practitioners. Associations with other characteristics were examined by logistic regression. Urban subjects had higher rates than rural of CIS-R morbidity, alcohol dependence, and drug dependence, with semi-rural subjects intermediate. Urban subjects also tended to be members of more deprived social groups, with more adverse living circumstances and greater life stress--factors themselves associated with disorder. Urban-rural differences in alcohol and drug dependence were no longer significant after adjustment for these factors by logistic regression, and differences on CIS-R morbidity were considerably reduced. There were no differences in treatment. There are considerable British urban-rural differences in mental health, which may largely be attributable to more adverse urban social environments.     

ECT: an assessment of mental health professionals' knowledge and attitudes

The attitudes of four groups of mental health professionals (psychiatrists, nurses, psychologists, and social workers) toward ECT were compared to their levels of clinical experience, knowledge about ECT, and professional background. In each of these four groups a more positive attitude about ECT correlated with increased levels of clinical experience and knowledge.     

Parenting and the development and prevention of child mental health problems

PURPOSE OF REVIEW: The government is recognizing the need to deal with the growing numbers of antisocial young people through investing in early preventive parenting support. It is important that the services provided are evidence-based and delivered effectively. This review briefly discusses the contribution of parenting to the development of child mental health difficulties, particularly externalizing problems, and reviews some effective early intervention preventive programmes. RECENT FINDINGS: Over 30 years of research have established both that parenting behaviours influence the development of childhood conduct disorders and that behavioural family interventions targeting specific parenting skills are the most effective way of preventing or reducing child behaviour problems. Until recently, however, those children at highest risk have often had the poorest outcomes from intervention. Recent research has identified the factors that make parenting interventions effective and how to engage the multi-stressed, hard-to-reach families whose children are most at risk. SUMMARY: Research has identified risk factors that are associated with the development of conduct disorder and affect the quality of parenting. This has made it possible to provide preventive interventions, targeting families that are most at risk. Evaluations have shown, however, that getting effective preventive services to those most at risk is not straightforward and programmes need to address the problem of recruiting parents who, by virtue of their multiple problems, have traditionally been hard to engage. Emphasis is placed on the importance of using evidenced-based programmes in service settings in ways that are effective.     

The mental health of young people in Australia: key findings from the child and adolescent component of the national survey of mental health and well-being

OBJECTIVE: To identify the prevalence of three mental disorders (Depressive Disorder, Conduct Disorder and Attention-Deficit/Hyperactivity Disorder), the prevalence of mental health problems, the health-related quality of life of those with problems, and patterns of service utilisation of those with and without mental health problems, among 4-17-year-olds in Australia. To identify rates of health-risk behaviours among adolescents with mental health problems. METHOD: The mental disorders were assessed using the parent-version of the Diagnostic Interview Schedule for Children Version IV. Parents completed the Child Behaviour Checklist to identify mental health problems and standard questionnaires to assess health-related quality of life and service use. The Youth Risk Behaviour Questionnaire completed by adolescents was employed to identify health-risk behaviours. RESULTS: Fourteen percent of children and adolescents were identified as having mental health problems. Many of those with mental health problems had problems in other areas of their lives and were at increased risk for suicidal behaviour. Only 25% of those with mental health problems had attended a professional service during the six months prior to the survey. CONCLUSION: Child and adolescent mental health problems are an important public health problem in Australia. The appropriate balance between funding provided for clinical interventions focusing on individual children and families and funding for interventions that focus on populations, requires careful study. The latter are an essential component of any strategy to reduce mental health problems as the high prevalence of problems makes it unlikely that individual care will ever be available for all those needing help. Clinical and population health interventions must take into account the comorbid problems experienced by children with mental disorders.     

Collaborative needs assessment for child mental health program development

A needs assessment for child mental health program development involving a collaboration between a state university clinical psychology training program and a coalition of publicly funded child-serving agencies is described. The benefits of the joint research effort for all partners are highlighted as well as the lessons learned about the processes of such a partnership. Application of the results included curricular modifications to the university's training program, the addition of new programming and the improvement of existing services to address child mental health needs, and interventions to increase community awareness of available services.     

Cost effectiveness of three child mental health assessment methods: computer-assisted assessment is effective and inexpensive

In order to survive severe funding reductions, community mental health centers (CMHCs) have implemented a number of systems-level interventions that attempt to minimize the impact of budget cuts on treatment effectiveness. The present study focused on ways to maintain the effectiveness of clinical assessment while lowering the assessment cost. The present study evaluated the relative cost effectiveness of three methods for collecting information and developing clinical assessment reports on children at a CMHC: (a) a traditional narrative clinical assessment report; (b) a form-style clinical assessment; and (c) a computer-assisted clinical assessment. The results revealed that the computer-assisted assessments was at least as effective as the two alternative assessment methods and only 20 percent to 45 percent as costly. The effect of using the computer-assisted assessments was reported to be favorable by therapists. While computer technology can be used to cut service delivery costs, the use of computers in CMHCs has generally been limited to administrative tasks, and clinical applications have been ignored.     

Service utilization by children with conduct disorders: findings from the 2004 Great Britain child mental health survey

Children with conduct disorders (CD) and their families are in contact with multiple agencies, but there is limited evidence on their patterns of service utilization. The aim of this study was to establish the patterns, barriers and correlates of service use by analysing the cohort of the 2004 Great Britain child mental health survey (N = 7,977). Use of social services was significantly higher by children with CD than emotional disorders (ED) in the absence of co-morbidity, while use of specialist child mental health and paediatric was significantly higher by children with hyperkinetic disorders (HD) than CD. Children who had comorbid physical disorders used more primary healthcare services compared to those without physical disorders. Utilization of specialist child mental heath and social services was significantly higher among children with unsocialized CD than socialized CD and oppositional defiant disorders. Services utilization and its correlates varied with the type of service. Overall, specialist services use was associated with co-morbidity with learning disabilities, physical and psychiatric disorders. Several correlates of services use in CD appeared non-specific, i.e. associated with use of different services indicating the possibility of indiscriminate use of different types of services. The findings led to the conclusion that there is the need for effective organization and co-ordination of services, and clear care pathways. Involvement of specialist child mental health services should be requested in the presence of mental health co-morbidity.     

Psychiatry and the need for mental health care in Australia: findings from the National Survey of Mental Health and Wellbeing

OBJECTIVE: This paper describes the pattern of consultations reported with psychiatrists and primary mental health care providers in the Australian adult population. It explores whether inequalities found in utilization of psychiatric services according to area are different in degree from inequalities in utilization of medical and surgical specialists,and describes the meeting of perceived needs for mental health care within those seen by psychiatrists. METHOD: The National Survey of Mental Health and Wellbeing (NSMHW) was a community survey employing clustered probability sampling, with a computerized field questionnaire which included sections of the composite international diagnostic interview (CIDI), as well as self-reported service utilization and perceived needs for care. RESULTS: By survey estimates, 1.8% of the Australian population consulted a psychiatrist in the last year. Among people with an ICD 10-diagnosed mental disorder, 7.3% consulted a psychiatrist.Only about one in five people seen by a psychiatrist report the psychiatrist as the only mental health care provider. Disadvantaged areas of the cities and remote areas, when compared with the least deprived areas of the cities, showed lower rates of utilization.This effect is stronger in psychiatry than in other specialties.Patients seeing psychiatrists seem to be a more satisfied group than those seeing only other providers; nonetheless, some needs are not well met, and the role of the psychiatrist cannot be isolated as the cause of this satisfaction. CONCLUSIONS: Most care delivered by psychiatrists is de facto shared care. Psychiatrists as clinical professionals need to be continually mindful of the need to communicate with others providing care. Psychiatric services in Australia are not delivered in an equitable manner,and the inequalities are greater for psychiatric services than for other medical specialties.     

Self-reported discriminatory and positive behaviours towards people with mental health problems: findings from an Australian national survey

Objective

The aim of the study was to explore self-reported avoidance, discrimination, and positive treatment by members of the public towards people with mental health problems.

Methods

In 2014, telephone interviews were carried out with 5220 Australians aged 18 +. Respondents were asked if they had known an adult with a mental health problem over the previous 12 months. If they had, they were asked further questions about the person’s age, gender, relationship to the respondent, and their mental health problem. Respondents were then asked if they had avoided, discriminated against or treated the person more positively and, if so, some details about what happened.

Results

19.9% of respondents reported avoiding someone with a mental health problem, with the most common reasons being difficulty tolerating the person’s behaviour and needing time out. However, respondents were more likely to report treating the person with mental health problems more positively (73.0%) than avoiding or discriminating against them (4.7%). The most common positive behaviours were non-specific support and maintaining or increasing contact. Avoidance was less likely from friends and those aged 60 +. Discrimination was more likely from family members and spouses and less likely from respondents aged 60 +. Positive treatment was more likely from people who had experienced a mental health problem.

Conclusions

This study provides insight into the reasons why people avoid others with mental health problems. The results can provide input into the design of anti-discrimination interventions and further empower people with mental health problems as they advocate for change in the area of discrimination.

     

The Recovery Knowledge Inventory: assessment of mental health staff knowledge and attitudes about recovery

In order to assess knowledge of and attitudes toward recovery-oriented practices among providers of mental health and substance abuse treatment and rehabilitation services throughout the state of Connecticut, an instrument named the Recovery Knowledge Inventory (RKI) was developed and administered. The items that comprise the instrument are based on the emerging literature on recovery in psychiatric and substance use disorders, and assess four different domains of understanding, namely: 1) roles and responsibilities in recovery, 2) non-linearity of the recovery process, 3) the roles of self-definition and peers in recovery, and 4) expectations regarding recovery. This paper describes the instrument and its preliminary psychometric properties, and provides an example of its utility in assessing the training needs of staff who increasingly are being expected to deliver recovery-oriented care.     

The Christchurch Health and Development Study: review of findings on child and adolescent mental health.

OBJECTIVE: This paper provides an overview of the Christchurch Health and Development Study (CHDS) and a summary of findings relating to child and adolescent mental health. METHOD: The CHDS is a longitudinal study of a birth cohort of 1265 children born in the Christchurch (New Zealand) urban region during mid 1977. This cohort has now been studied from birth to age 21. RESULTS: The paper examines the ways in which the study has been able to examine a wide range of issues. Key issues examined include: (i) measurement of disorder (respondent effects; dimensionality; scales vs categories); (ii) prevalence and treatment of disorder; (iii) stability and continuity of disorders; (iv) the contribution of risk and aetiological factors (e.g. lead exposure, parental divorce, child abuse, family adversity, sexual orientation) to psychosocial adjustment; and (v) the psychosocial consequences of mental health problems in adolescence. CONCLUSIONS: The study findings illustrate the many advantages of a longitudinal study, such as the CHDS, in providing methodologically sound, theoretically relevant and cost effective research that caters for the interests of multiple end-users including the scientific community, clinicians and applied policy makers.