The surgeon general’s national action agenda on children’s mental health

The Surgeon General’s National Action Agenda highlighted key issues that challenge the public health system in appropriately meeting the mental health needs of children and their families. Among these issues included the need for screening and early identification, improving access to appropriate mental health care, strengthening the infrastructure, and expanding training for providers. Two key gate-keeping systems identified as critical in this reform of mental health care for children and their families are education and primary care. This paper focuses on these two systems to illustrate problems related to these issues. Central to the Surgeon General’s call for reform is also the pressing public health responsibility to improve and use the science base by strengthening the connection between what we know from the scientific evidence base and what we do in practice. The implications of this reform for specialty mental health are discussed.     

‘Recovery’: Does it fit for adolescent mental health?

The notion of ‘recovery’ in mental health has a long and diverse history in terms of definition, treatment processes and outcomes. Particularly with regard to definition, there has been much debate in the literature. The aim of this paper is to extend the discussion by exploring how the concept is used for two developmentally divergent populations—adults and adolescents. I argued that it is indeed appropriate and valid to use ‘recovery’ in the treatment process for adolescents. However, while adults share various facets of the recovery process with their adolescent counterparts, there are also significant differences such as physiological change, the impact of peers, identity development and the role of family. These crucial differences must guide any clinical services for the adolescent population.     

Predicting parents’ intentions to seek help for young children’s mental health

One in five school-age children has mental health problems, yet less than a quarter access professional help. Early childhood presents a window for prevention. This study implemented the ‘Theory of Planned Behaviour’ to explore parents’ intentions to seek professional help for young children’s behaviour and emotional problems. Participants were 442 parents of 6-year-old children, recruited as a population sample in infancy. The ‘Theory of Planned Behaviour’ measured parents’ personal intentions, attitudes and beliefs about seeking professional help for young children’s mental health. Although many parents (84%) had positive intentions to seek help if their young child were in need, a proportion (16%) was ambivalent/unlikely to do so. Specific beliefs distinguishing parents with positive intentions were that professionals would provide expert strategies with empathy and understanding, with appointments providing value for time and money. Community mental health initiatives could target these beliefs in facilitating better access for young children in need.     

Social context factors and refugee children’s emotional health

Social Psychiatry and Psychiatric Epidemiology - Refugee children face numerous challenges associated with pre-migration trauma and post-migration adaptation. Much research pertaining to refugee...     

Migration and common mental disorder: An improvement in mental health over time?

Abstract

Global migration is reaching record high levels and UK migrant groups comprise an increasing proportion of the total population. The migratory process causes stress that can affect mental health. There is limited consistent empirical evidence of a longitudinal nature to explain the association between migration and mental health. This review aims to examine the evidence of a relationship between migration and common mental disorder (CMD) amongst migrants over time. A comprehensive search of medical and psychiatric databases for global quantitative empirical studies investigating incidence of CMD amongst adult migrants from 1975 to July 2012 was conducted. Declines in rates of CMD amongst migrants over time were reported by two thirds of the 18 studies reviewed, less than one third of which were statistically significant. On the contrary, three studies showed an increased rate of CMD, one statistically significant. Individual psychological resources, social support, the acculturation process, cultural variations and time since relocation are identified as statistically significant protective factors against the development of CMD amongst migrants. New enlightening points include the significant impact of varying patterns of psychological distress, of which negative is the most adverse for CMD. Migration is an extremely complex process. Further clarification is needed to gain deeper understanding of the relationship between migration and CMD to address contradictions in the literature and health inequalities amongst migrants.     

Parents’ mental health and children’s cognitive and social development

Background  

The development of children of parents who are experiencing mental health difficulties is a continuing cause of concern for professionals working in health, social care and education as well as policy makers. In light of this interest our study investigates the interplay between the mental health of mothers and fathers and family socioeconomic resources, and the impact for children’s cognitive and social development.     

Explanatory variables for women’s increased risk for mental health problems in Vietnam

Social Psychiatry and Psychiatric Epidemiology - The United Nations Sustainable Development Goals include gender equality for women, including health, as one of seventeen targets. Within this broad...     

Improved investment in mental health services: value for money?

BACKGROUND: This paper examines what has been achieved in the specialist mental health services by the vastly increased health expenditures that the National Health Service (NHS) has enjoyed in the past 5 years. AIMS: To describe the way money has been spent in specialist mental health services and examine why problems remain after such admirable changes to already available resources. METHOD: Changes in staff employed by mental health services, where the extra staff are deployed, and patterns of expenditure within the whole service and within community mental health teams are examined. RESULTS: Some of the new expenditure has been well spent, and has produced improvements in the service. However, one must also take account of the costs of the greatly increased numbers of managers, who impose two sorts of costs: that of their own salaries, and the opportunity costs of front-line staff having to attend meetings and write reports rather than seeing patients. Throughout the rest of the NHS, money has been wasted on needless reorganisations, on consultant and general practitioner contracts, and on information technology that has so far failed to deliver tangible advantages. CONCLUSIONS: The emphasis on central control undermines local initiatives and wastes resources. Some central control is inevitable, but policies need to be developed in collaboration with clinicians. At local level, expenditure by primary care trusts and mental health trusts also needs to be scrutinised by committees that should include representatives of front-line mental health staff.     

Socioeconomic status and children’s mental health: results from the Bergen Child Study

Purpose

It is generally accepted that mental health problems are unequally distributed across population strata defined by socioeconomic status (SES), with more problems for those with lower SES. However, studies of this association in children and adolescents are often restricted by the use of global measures of mental health problems and aggregation of SES-indicators. We aim to further elucidate the relationship between childhood mental health problems and SES by including more detailed information about mental health and individual SES-indicators.

Methods

The participants (N?=?5,781, age 11–13) were part of the Bergen Child Study (BCS). Mental health was assessed using the teacher, parent and self-report versions of the Strengths and Difficulties Questionnaire (SDQ), including an impact section, used to measure symptom dimensions and probability of psychiatric disorders. Parent reports of family economy and parental education were used as SES measures.

Results

For each SES indicator we confirmed an inverse relationship across all the symptom dimensions. Poor family economy consistently predicted mental health problems, while parental education level predicted externalizing disorders stronger than internalizing disorders.

Conclusion

In this Norwegian sample of children, family economy was a significant predictor of mental health problems as measured across a wide range of symptom dimensions and poor economy predicted a high probability of a psychiatric disorder. Longitudinal studies of the impact of low family income as well as other SES factors on externalizing and internalizing symptom dimensions and disorders are called for.     

Debate: Child and adolescent mental health services in Pakistan; Do we need in-patient mental health facilities for children and young people?

Depression and anxiety are leading causes of morbidity in children and adolescents worldwide. In Pakistan, young people are exposed to many chronic adversities including violence, social and economic inequalities, and are at greater risk of developing mental health problems. Yet there is a lack of trained human resources, in-patient child and adolescent mental healthcare facilities, and training opportunities in child and adolescent psychiatry and mental health in Pakistan. Given the poor economic condition of the country, which has been made even worse by the COVID-19 pandemic, it is very unlikely that dedicated resources will be made available in near future to develop specialist child and adolescent mental health services in Pakistan. To bridge this treatment gap, we propose a multitiered, transdiagnostic, task-shifting strategy-based model for child and adolescent mental health services in Pakistan.     

Social services day care and health services day care in mental health: do they differ?

BACKGROUND: The difference between the services provided by day hospitals and day centres is far from clear. The supposition that day hospitals would provide an acute service, while day centres would offer social support for a more chronic population has been contentious and there is little evidence of how they are currently used. AIMS: We aimed to ascertain the differences between day hospitals (partial hospitalisation) and social service day centres in functions and roles, as perceived by staff, service users and referrers. METHODS: The views of service users and staff at two day hospitals and four day centres were ascertained through questionnaires and interviews, along with those of staff of eight Community Mental Health Teams, who constitute the sole pathway to the two services. RESULTS: Day hospitals were perceived by both referrers and clients to offer short-term, more intensive 'treatment' to more acutely ill people in need of mental health monitoring. Day centres were perceived to offer longer-term support, particularly social support, to people more likely to have longer-term and psychotic illnesses. CONCLUSION: There is currently a clear distinction between day centres and day hospitals, in key features of their services and client groups. It would be unwise to treat them as interchangeable.     

Does paternal mental health in pregnancy predict physically aggressive behavior in children?

The aim was to study the association between paternal mental health and physically aggressive behavior in children. This study is based on 19,580 father–child dyads from the Norwegian Mother and Child Cohort Study (MoBa). Fathers’ mental health was assessed by self-report (Symptom Checklist-5, SCL-5) in week 17 or 18 of gestation. Children’s behavior (hitting others) was obtained by mothers’ reports. A multinomial logistic regression model was performed. Expectant fathers’ high level of psychological distress was found to be a significant risk factor only for girls hitting, adjusted OR = 1.46 (1.01–2.12), p = 0.043, but not for boys. High levels of mental distress in fathers predict their daughters’ hitting at 5 years of age.     

The cost of fragmented mental health financing: Is it worth it?

Three major aspects of mental health systems—the way they are financed, the configuration of services, and the outcome of services—are discussed. Problems of resource consumption, fragmentation of goals, and deleterious impacts due to financing systems per se, are described. Levels of staff involvement in the financing system (as distinct from direct services) influence staff attitudes toward financing, services, and clients. Financing schemes appear to both influence the effectiveness of mental health systems and provide the dubious advantage of costing more. Studies are suggested that will compare comprehensive systems with an eye toward reform.This work has been partially supported by NIMH Grant #5P50-MH43458. The Western Mental Health Research Center is affiliated with Oregon Health Sciences University, Department of Psychiatry, where Dr. Cutler is Professor and Director of the Public Psychiatry Training Program.     

Does educational background explain inequalities in care service use for mental health problems in the Dutch general population?

OBJECTIVE: To investigate whether (1) education predicts the use of care services for mental health problems, independently of mental disorder and functional impairment and (2) education modifies the association between mental disorder and service use. METHOD: Predictors of service use were recorded at baseline, and service use itself at 12-month follow-up, in a representative sample (N=7076) of the Dutch population, using the Composite International Diagnostic Interview. RESULTS: People with more education were less likely to use primary care but more likely to use mental health care. The effects on both types of care remained significant after adjustment for mental disorder and functional impairment. Lower education tended to strengthen the association between mood or anxiety disorder and primary care use. CONCLUSION: Further research on inequalities in service use will benefit from additional explanatory analyses and from the inclusion of sociopsychological variables, like cost-benefit considerations in decisions to use services.     

Australian parents’ work–family conflict: accumulated effects on children’s family environment and mental health

Purpose

Many parents struggle to balance their work and family responsibilities. Yet, little research in the field of social psychiatry has explored the emergence of work–family conflict (WFC) as an important social determinant of mental health, particularly for children. The current study used longitudinal Australian population-based data to investigate the impact of parents’ accumulated experiences of work–family conflict on children’s mental health. Levels of parent psychological distress, marital satisfaction and parenting irritability were examined as potential explanatory factors within the family environment.

Methods

The study used five waves of data from the Australian Longitudinal Study of Australian Children (LSAC), a representative community sample of Australian children and their parents. Analyses were restricted to coupled, employed mothers (1903) and fathers (1584) who reported their WFC levels in all five waves. Structural Equation Modelling (SEM) was used to examine the association between accumulated experiences of work–family conflict across all time-points (AWFC) and children’s mental health at wave 5. Family environment factors were assessed as possible explanatory mediators.

Results

There was a significant association between AWFC and children’s mental health at wave 5. Parent psychological distress, marital satisfaction and parenting irritability were all found to significantly explain this association (accounting for 66% of the total effect).

Conclusions

Children whose parents have ongoing or accumulated difficulties managing their work and family responsibilities are more likely to have poorer mental health. This has important implications for family-friendly work arrangements and demonstrates the need to further understand the intergenerational impacts of parents’ jobs on their children’s psychological wellbeing.

     

Predictors of immigrant children’s mental health in Canada: selection,settlement contingencies,culture, or all of the above?

Background and study aims

A previous publication from the New Canadian Children and Youth Study, a national study of immigrant children and youth in Canada, showed a gradient of levels of emotional distress with children from Hong Kong (HK) at the most severe end, Filipino children at the least severe, and children from the People’s Republic of China (PRC) in between. Based on the premise that country of origin can be regarded as an index for differing immigration trajectories, the current study examines the extent to which arrival characteristics, resettlement contingencies and cultural factors account for country of origin variations in immigrant children’s mental health. Arrival characteristics included child’s age at arrival, parental education, parental fluency in English or French, and assistance from family at arrival. Resettlement contingencies included parental mental health, intra-familial conflict, settlement stress, separations from parents and child’s age when mother started working outside the home. Cultural factors included one-child family composition and parenting styles.

Methods

A national survey of 2,031 families with at least one child between the ages of 4 and 6 or 11 and 13 from HK, the PRC and the Philippines was conducted with the Person Most Knowledgeable (PMK) in snowball-generated samples in 6 different cities across Canada. Predictors of the dependent variable, emotional problems (EP), were examined in a hierarchical block regression analysis. EP was regressed on ethnic and country of origin group in model 1; arrival characteristics were added in model 2; resettlement contingencies in model 3 and cultural factors in model 4.

Results

The final set of predictor variables accounted for 19.3 % of the variance in EP scores among the younger cohort and 23.2 % in the older. Parental human and social capital variables accounted for only a small amount of the overall variance in EP, but there were statistically significant inverse relationships between EP and PMK fluency in English or French. Settlement contingencies accounted for a significant increase in the explanatory power of the regression equation, net of the effects of country of origin and selection characteristics. This block of variables also accounted for the Filipino mental health advantage. Levels of parent’s depression and somatization, harsh parenting, intrafamilial conflict, and resettlement stress each varied directly with levels of children’s EP. Cultural variables made a significant contribution to explaining the variance in EP scores. Harsh parenting was significantly associated with increased levels of EP in both age groups, and supportive parenting was a mental health protective factor for younger children.

Conclusions

Immigrant family human and social capital, according to which immigrants are selected for admission to Canada, play a relatively small role in determining children’s mental health. These effects are overshadowed by resettlement contingencies and cultural influences. Concentrating on trying to find a formula to select the “right” immigrants while neglecting settlement and culture is likely to pay limited dividends for ensuring the mental health of children.