Prevalence and correlates of probable adolescent mental health problems reported by parents in Vietnam

Purpose

The purpose of the present study was to estimate the prevalence of probable mental health problems in an epidemiologic study of Vietnamese adolescents. A secondary aim was to examine the correlates of probable mental health caseness.

Methods

Interviewers visited 1,914 households that were randomly selected to participate in a multi-agency study of mental health in select provinces of Vietnam. Semi-structured interviews assessed adolescent mental health problems using the Strengths and Difficulties Questionnaire (SDQ) parent informant version, and additionally the interviewers collected information on demographic variables (age, gender, ethnic group, religious affiliation, social capital). The final sample included data on 1,368 adolescents (aged 11?C18?years).

Results

The average score on the total problem composite of the SDQ scale was 6.66 (SD?=?4.89), and 9.1% of the sample was considered a case (n?=?124). Bivariate analyses were conducted to determine which demographic variables were related to the SDQ case/non-case score. All variables except gender were significant in bivariate analyses, and therefore were entered into a logistic regression. Results indicated that age, religion, and wealth remained significant predictors of probable caseness.

Conclusions

Overall, prevalence estimates of mental health problems generated by the SDQ were consistent with those reported in the US and other Western and non-Western samples. Results of the current study suggest some concordance of risk and protective factors between Western and Vietnamese youth (i.e., age and SES).     

Prevalence and comorbidity of psychiatric disorders among 6-year-old children: 2004 Pelotas Birth Cohort

Purpose

Most studies published on the prevalence of psychiatric disorders in children were conducted in high-income countries despite the fact that nearly 90 % of the world’s population aged under 18 live in low- and middle-income countries. The study aimed to assess the prevalence of psychiatric disorders among children of 6 years of age, to examine the distribution of psychiatric disorders by gender and socioeconomic status and to evaluate the occurrence of psychiatric comorbidities.

Methods

The 2004 Pelotas Birth Cohort originally comprised 4,231 live births from Pelotas, southern Brazil. A total of 3,585 (84.7 % of 4,231 births) children aged 6 years were assessed using the Development and Well-Being Assessment (DAWBA).

Results

Nearly 13 % of the children presented a psychiatric diagnosis according to DSM-IV, being more prevalent among males than females (14.7 and 11.7 %, respectively, p = 0.009). Anxiety disorders were the most prevalent of all disorders (8.8 %) and specific phobias (5.4 %) and separation anxiety disorder (3.2 %) were the most common subtypes. Attention deficit hyperactivity disorder (2.6 %), oppositional defiant disorder/conduct disorder (2.6 %), and depression (1.3 %) were also diagnosed. More than one psychiatric disorder was presented by 17 % of children. Socioeconomically disadvantaged children had a higher prevalence of psychiatric disorders.

Conclusion

Our findings underline the early onset of psychiatric disorders among children and the frequent occurrence of psychiatric comorbidity. Early prevention is needed in the field of mental health in Brazil and should start during infancy.     

Atomoxetine for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in children with ADHD and dyslexia

Background

There are conflicting results on whether immigrant children are at a heightened risk of mental health problems compared with native youth in the resettlement country.

The objective of the study

To compare the mental health of 94 Norwegian-born children from a community cohort of Vietnamese refugees, aged 4 - 18 years, with that of a Norwegian community sample.

Methods

The SDQ was completed by two types of informants; the children's self-reports, and the parents' reports, for comparison with Norwegian data from the Health Profiles for Children and Youth in the Akershus study.

Results

The self-perceived mental health of second-generation Vietnamese in Norway was better than that of their Norwegian compatriots, as assessed by the SDQ. In the Norwegian-Vietnamese group, both children and parents reported a higher level of functioning.

Conclusion

This surprising finding may result from the lower prevalence of mental distress in Norwegian-Vietnamese children compared with their Norwegian peers, or from biased reports and cultural differences in reporting emotional and behavioural problems. These findings may represent the positive results of the children's bi-cultural competencies.     

Can standardized diagnostic assessment be a useful adjunct to clinical assessment in child mental health services? A randomized controlled trial of disclosure of the Development and Well-Being Assessment to practitioners

Purpose

While research demands standardized diagnostic assessments as an indication of sufficient methodological rigour, there is debate about their application to clinical practice. The Development and Well-Being Assessment (DAWBA) provides a structured assessment of psychiatric disorder. Since it can be completed on-line, it could be used by Child and Adolescent Mental Health Services with few additional demands on staff. Access to the standardized diagnostic information as an adjunct to clinical assessment could reduce the number of appointments spent on assessment, free up practitioner time to work on engagement and improve clinical outcomes by increasing the accuracy of assessment and thus access to the appropriate evidence-based treatment.

Method

Randomized controlled trial of the disclosure of the DAWBA to the assessing practitioner (n = 117) versus assessment at normal (n = 118) and analysed by “intention to disclose”.

Results

Exposure to the DAWBA may increase agreement between the DAWBA and practitioners about some anxiety disorders, but detected no other statistically significant increased agreement for other disorders, nor a reduced need for further assessment, the number of difficulties recognised or influence on outcomes.

Conclusions

The results may be explained by the inadequacy of the DAWBA, lack of statistical power to detect any effects that were present or a reluctance of some practitioners to use the DAWBA in their assessment. Future research might benefit from exploring the use of the DAWBA or similar assessments as a referral rather than an assessment tool, and exploring how practitioners and parents experience and use the DAWBA and what training might optimise the utility of the DAWBA to clinical practice.     

Profiling disordered eating patterns and body mass index (BMI) in the English general population

Purpose

Little national evidence exists on disordered eating patterns in the UK. This study examined the prevalence and nature of disordered eating patterns in the National Adult Psychiatric Morbidity Survey 2007.

Method

Responses to the screening tool for eating disorders (SCOFF) and body mass index (BMI) were analysed using latent class analysis (n = 7,001). Multinomial logistic regression explored the associations between latent classes and mental health comorbidities.

Results

The prevalence of possible eating disorders in England using the SCOFF was 6.3 %; this decreased to 1.6 % when accounting for the negative impact feelings about food had on the respondent’s life. Five latent classes were identified: classes 1 and 2 resembled known eating disorders (‘marginal anorexia’ relating to anorexia nervosa and ‘binge eaters’ relating to bulimia nervosa/binge eating disorder); class 3 consisted of people who were obese, but did not experience eating problems; class 4 was morbidly obese, with an elevated risk of anxiety disorders; class 5 was labelled as ‘normal eaters’, with a low probability of eating problems and a normal BMI.

Conclusions

Adults assigned to eating disorder type classes are at increased risk for mental health comorbidities and poorer social functioning. Information presented herein on clustering of disordered eating patterns may help clinicians identify those men and women risk for an eating disorder.     

Professional care seeking for mental health problems among women and men in Europe: the role of socioeconomic,family-related and mental health status factors in explaining gender differences

Purpose

This comparative study examines cross-national variation in gender differences in primary and specialized mental health care use in Europe. We investigate to what extent socioeconomic, family-related, and mental health factors explain the gender difference, and how the impact of these groups of determinants on gender differences in mental health care use varies between countries.

Methods

Data from the Eurobarometer 248 (2005–2006) for 29 European countries is used and country-specific logistic regression analyses are performed.

Results

Gender differences in professional care seeking are largely need based. In almost one-third of the countries examined, the gender difference is mainly attributable to women’s poorer mental health status. However, in some countries, family and socioeconomic characteristics also have an independent contribution to the gender difference in mental health care use. Women’s higher likelihood of a lower socioeconomic position, might partly explain their higher primary care use, while in some countries, it restricts their specialized care use. In addition, some social conditions, as having children and being widowed, seem to function in a few countries as suppressors of women’s care use.

Conclusions

Our study has shown that the gender difference in mental health care use, with women having a higher care use, is not a consistent European phenomenon and is dependent on the type of care provider, with greater gender inequity in the use of primary health care. The social roles adopted by men and women have in some countries on top of the mental health status a relevant influence on the greater tendency among women to contact a care provider. How the socioeconomic and family characteristics moderate the relation between gender and mental health care use is not straightforward and country dependent.     

A cross-sectional study of mental health and well-being and their associations in the UK veterinary profession

Background

Veterinary surgeons are at elevated risk of suicide, with a proportional mortality ratio around four times that of the general population and approximately twice that of other healthcare professions. There has been much speculation regarding possible mechanisms underlying increased suicide risk in the profession but little empirical research. We aimed to assess the contribution of mental health and well-being to the elevated risk, through a postal questionnaire survey of a large stratified random sample of veterinary surgeons practising within the UK.

Methods

A questionnaire was mailed twice to 3,200 veterinary surgeons. Anxiety and depressive symptoms, alcohol consumption, suicidal ideation, positive mental well-being, perceptions of psychosocial work characteristics, and work–home interaction were assessed using valid and reliable existing instruments and a series of bespoke questions previously developed through informal focus groups.

Results

Evaluable questionnaires were returned by 1,796 participants, a response rate of 56.1%. The demographic and occupational profile of respondents was representative of the UK veterinary profession. The prevalence of ‘caseness’ (i.e. HADS subscale score ≥8) for anxiety, depression, and co-morbid anxiety and depression was 26.3, 5.8 and 4.5%. 5.4% of respondents were non-drinkers, 32.0% low-risk drinkers, and 62.6% ‘at-risk’ drinkers (i.e. AUDIT-C score ≥4 for women, ≥5 for men). The 12-month prevalence of suicidal thoughts was 21.3%.

Conclusions

Compared to the general population, the sample reported high levels of anxiety and depressive symptoms; higher 12-month prevalence of suicidal thoughts; less favourable psychosocial work characteristics, especially in regard to demands and managerial support; lower levels of positive mental well-being; and higher levels of negative work–home interaction. The levels of psychological distress reported suggest ready access to and knowledge of lethal means is probably not operating in isolation to increase suicide risk within the profession.     

Diet quality and mental health problems in adolescents from East London: a prospective study

Purpose

In this study, we aimed to examine the relationship between diet quality and depression in a prospective study of adolescents from varied ethnic and cultural backgrounds.

Design

In this prospective cohort study, data were collected at two time points (2001 and 2003) from nearly 3,000 adolescents, aged either 11–12 years or 13–14 years, participating in RELACHS, a study of ethnically diverse and socially deprived young people from East London in the UK. Diet quality was measured from dietary questionnaires, and mental health assessed using the Strengths and Difficulties Questionnaire (SDQ) and the Short Mood and Feelings Questionnaire (SMFQ).

Results

In cross-sectional analyses, we found evidence for an association between an unhealthy diet and mental health problems. Compared to those in the lowest quintile of Unhealthy diet score, those in the highest quintile were more than twice as likely to be symptomatic on the SDQ (OR 2.10, 95 %CI 1.38–3.20) after taking all identified confounders into account. There was also some evidence for a cross-sectional inverse association between a measure of healthy diet and mental health problems. A prospective relationship between the highest quintiles of both Healthy (OR 0.63, 95 %CI 0.38–1.05) and Unhealthy (OR 1.75, 95 %CI 1.00–3.06) diet scores and SDQ scores at follow-up was also evident, but was attenuated by final adjustments for confounders.

Conclusion

This study is concordant with previous observational studies in describing relationships between measures of diet quality and mental health problems in adolescents.     

Sexual orientation disparities in mental health: the moderating role of educational attainment

Purpose

Mental health disparities between sexual minorities and heterosexuals remain inadequately understood, especially across levels of educational attainment. The purpose of the present study was to test whether education modifies the association between sexual orientation and mental disorder.

Methods

We compared the odds of past 12-month and lifetime psychiatric disorder prevalence (any Axis-I, any mood, any anxiety, any substance use, and comorbidity) between lesbian, gay, and bisexual (LGB) and heterosexual individuals by educational attainment (those with and without a bachelor’s degree), adjusting for covariates, and tested for interaction between sexual orientation and educational attainment. Data are drawn from the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative survey of non-institutionalized US adults (N = 34,653; 577 LGB).

Results

Sexual orientation disparities in mental health are smaller among those with a college education. Specifically, the disparity in those with versus those without a bachelor’s degree was attenuated by 100 % for any current mood disorder, 82 % for any current Axis-I disorder, 76 % for any current anxiety disorder, and 67 % for both any current substance use disorder and any current comorbidity. Further, the interaction between sexual orientation and education was statistically significant for any current Axis-I disorder, any current mood disorder, and any current anxiety disorder. Our findings for lifetime outcomes were similar.

Conclusions

The attenuated mental health disparity at higher education levels underscores the particular risk for disorder among LGBs with less education. Future studies should consider selection versus causal factors to explain the attenuated disparity we found at higher education levels.     

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.     

A systematic review on the prevalence of conduct disorder in the Middle East

Objective

Several epidemiological studies have been done on conduct disorder in the Middle East, but no systematic review has been conducted on this topic. Thus, we aimed at investigating the prevalence of conduct disorder in the Middle East in this systematic review of the literature.

Methods

We searched all the cross-sectional studies in the scientific databases of PubMed, Scopus, Google Scholar, Index Medicus for the Eastern Mediterranean Region, Islamic World Science Citation Center, and Grey Literature including conference proceedings, and hand searching of key journals from 1995 to the end of 2014. Included studies described the prevalence of conduct disorder prior to age of 18, with any type of random or non-random sampling for at least one gender in the general or school-based populations who resided in Middle Eastern countries. Two reviewers assessed the quality of the included studies independently and extracted the relevant data.

Results

Twenty-four studies were included in this review. Sample sizes varied from 136 to 9636 with the age range of 6–18 years. These studies were conducted in Iran, Turkey, Israel, Cyprus, Egypt, United Arab Emirates, Iraq, Afghanistan, Yemen, and Palestine. Strengths and Difficulties Questionnaire (SDQ) was used in most of the included studies. The prevalence of conduct disorder was reported from 2.4% by diagnostic criteria taken from DSM-IV-TR in Iraq to 32.9% by SDQ in Iran; the prevalence rates ranged from 1 to 29.9% for females and from 3.3 to 34.6% for males. However, the prevalence of conduct disorder was reported 0.34% by the diagnostic instrument of Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children—Present and Lifetime in Iranian children and adolescents.

Conclusions

The prevalence of conduct disorder in this study was higher than the worldwide prevalence, thus, it seems essential to design preventive and treatment programs for children and adolescents with conduct disorder.

     

Normative data and psychometric properties of the strengths and difficulties questionnaire among Japanese school-aged children

Background

Although child mental health problems are among the most important worldwide issues, development of culturally acceptable mental health services to serve the clinical needs of children and their families is especially lacking in regions outside Europe and North America. The Strengths and Difficulties Questionnaire (SDQ), which was developed in the United Kingdom and is now one of the most widely used measurement tools for screening child psychiatric symptoms, has been translated into Japanese, but culturally calibrated norms for Japanese schoolchildren have yet to be established. To this end, we examined the applicability of the Japanese versions of the parent and teacher SDQs by establishing norms and extending validation of its psychometric properties to a large nationwide sample, as well as to a smaller clinical sample.

Methods

The Japanese versions of the SDQ were completed by parents and teachers of schoolchildren aged 7 to 15 years attending mainstream classes in primary or secondary schools in Japan. Data were analyzed to describe the population distribution and gender/age effects by informant, cut-off scores according to banding, factor structure, cross-scale correlations, and internal consistency for 24,519 parent ratings and 7,977 teacher ratings from a large nationwide sample. Inter-rater and test-retest reliabilities and convergent and divergent validities were confirmed for a smaller validation sample (total n?=?128) consisting of a clinical sample with any mental disorder and community children without any diagnoses.

Results

Means, standard deviations, and banding of normative data for this Japanese child population were obtained. Gender/age effects were significant for both parent and teacher ratings. The original five-factor structure was replicated, and strong cross-scale correlations and internal reliability were shown across all SDQ subscales for this population. Inter-rater agreement was satisfactory, test-retest reliability was excellent, and convergent and divergent validities were satisfactory for the validation sample, with some differences between informants.

Conclusions

This study provides evidence that the Japanese version of the SDQ is a useful instrument for parents and teachers as well as for research purposes. Our findings also emphasize the importance of establishing culturally calibrated norms and boundaries for the instrument’s use.     

Prevalence of mental health disorders among low-income African American adolescents

Purpose

Data on the prevalence of mental health disorders for low-income, urban African American adolescents are scarce. This study presents data about the burden of mental disorders for this understudied population.

Methods

Mental disorders were assessed using the Diagnostic Interview Schedule for Children (C-DISC), Youth Self-Report (YSR), and Child Behavior Checklist (CBCL) among a sample of adolescents and their caregivers from very impoverished neighborhoods in a Southern city.

Results

Based on the C-DISC, 3.8, 5.1 and 7.7 % of adolescents met diagnostic criteria for major depression, post-traumatic stress disorder, and conduct disorder, respectively. There were significant differences among some of the mental health disorders based on adolescent and caregiver characteristics such as sex, school status, caregiver work status, and income level. We found a low prevalence of alcohol, marijuana, and substance abuse and dependence disorders.

Conclusions

Information about the prevalence of mental health disorders in specific communities and populations can assist in addressing unmet needs, planning for services and treatment, and reducing health disparities.     

Epidemiology of childhood conduct problems in Brazil: systematic review and meta-analysis

Purpose

This study aimed to review evidence on the prevalence of and risk factors for conduct problems in Brazil.

Methods

We searched electronic databases and contacted Brazilian researchers up to 05/2012. Studies were included in the review if they reported the prevalence of or risk factors for conduct problems, conduct disorder, or oppositional defiant disorder for 100 + Brazilian children aged ≤18 years, systematically sampled in schools or the community. Prevalence rates and sex differences were meta-analysed. Risk factor studies were reviewed one by one.

Results

The average prevalence of conduct problems in screening questionnaires was 20.8 %, and the average prevalence of conduct disorder/oppositional defiant disorder was 4.1 %. There was systematic variation in the results of screening studies according to methodology: recruitment location, informants, instruments, impairment criterion for case definition, and response rates. Risk factors previously identified in high-income countries were mainly replicated in Brazil, including comorbid mental health problems, educational failure, low religiosity, harsh physical punishment and abuse, parental mental health problems, single parent family, and low socioeconomic status. However, boys did not always have higher risk for conduct problems than girls.

Conclusions

Studies using screening questionnaires suggest that Brazilian children have higher rates of conduct problems than children in other countries, but diagnostic studies do not show this difference. Risk factors in Brazil were similar to those in high-income countries, apart from child sex. Future research should investigate developmental patterns of antisocial behaviour, employ a variety of research designs to identify causal risk mechanisms, and examine a broader range of risk factors.     

Adjustment disorders: prevalence in a representative nationwide survey in Germany

Objectives

This is the first study to estimate the prevalence of adjustment disorder (AjD) in the general population. A new conceptualisation of AjD as a stress response syndrome was applied, which allowed AjD to be assessed directly from its symptom profile, including intrusive, avoidance and failure-to-adapt symptoms (Maercker et al., Psychopathology 40:135–146, 2007).

Methods

Prevalence rates of distressing life events and AjD were estimated from a representative sample of the German general population (n?=?2,512) with a broad age range (14–93?years). A questionnaire including a life events checklist and self-rating questions that assessed AjD symptoms and symptom duration were personally handed out by an interviewer.

Results

The prevalence of AjD fulfilling the criterion of clinically significant impairment was 0.9%; a further 1.4% of the sample was diagnosed with AjD without fulfilling the impairment criterion. In ~72.5% of AjD cases, symptoms had developed 6–24?months prior to assessment. AjD was most often associated with acute events such as moving or chronic stressors such as serious illness, conflicts at the respondent’s job or with friends or neighbours (with ~5% conditional probability each).

Conclusions

The results correspond with the few other studies that have examined the prevalence of AjD, even though a new conceptualisation of the disorder was used. Explorative results regarding the duration of AjD syndromes and symptoms call for further redefinition and empirical investigation of this under-researched mental condition.     

Psychiatric staff perceptions of patient attachments: a pilot study to investigate differences in and predictors of psychiatric staff perceptions of patient attachments

Objectives

We explored the extent to which a group of psychiatric staff differed in their ratings of patients’ attachment styles and whether deviations in mean ratings were related to education, clinical experience, familiarity with patients, or staff attachment styles.

Method

Fifteen mental healthcare workers assessed the attachment styles of nine patients with schizophrenia or schizoaffective disorder using the Psychosis Attachment Measure. Staff also reported on their own attachment styles. Similarity in ratings was investigated using two-way random interclass correlation coefficients (ICCs). An index showing how much each rater’s assessments of attachment style deviated from the mean attachment style rating for each of the patients was used to investigate possible predictors of deviations from mean ratings.

Results

Average staff ICCs for attachment anxiety and avoidance suggested reasonable levels of convergence between staff perceptions. Deviations from mean ratings were unrelated to staff qualifications or years of experience in mental health. However, staff who had known patients for longer periods tended to rate patients more similarly, whereas staff who had higher levels of attachment anxiety and avoidance tended to deviate from colleagues’ ratings.

Conclusions

Attachment styles in psychosis are observable characteristics that can be rated by mental health professionals, although length of time staff have known patients, as well as their own attachment styles are likely to influence perceptions.     

Mental disorders in primary care in Israel: prevalence and risk factors

Objective

Psychiatric morbidity is common among patients in primary care services and leads to disability and increased use of medical services. Comparison of primary care and community prevalence data is of interest in relation to the health services planning for mental disorders. The aim of the present study was to measure prevalence of mental disorders in six primary care clinics in Israel and to assess risk factors for these disorders.

Method

Prevalence of mental disorders was measured in a sample of 2,948 primary care consecutive attendees, using two-stage stratified sampling with the General Health Questionnaire 12 (GHQ-12) and the Composite International Diagnostic Interview (CIDI).

Results

A high rate (46.3 %) of current mental disorders was found, with rates of current depressive episode, generalized anxiety disorder, somatization disorder, and neurasthenia being relatively high in comparison with rates in other countries. Low education was a risk factor for all categories of disorders, unemployment a risk factor for depressive disorders, and parenthood was protective for most categories of disorders.

Conclusions

High rates of mental disorders were found in this Israeli primary care sample as compared to other countries, while in the community the rates were midrange as compared to other countries, pointing to a relatively higher use of primary care services by patients with mental disorders in Israel than in other countries.     

Social inequalities in mental health: results from the EU contribution to the World Mental Health Surveys Initiative

Purpose

The objective of the present study was to provide updated data from nine European countries about the impact of social inequalities in the prevalence of common mental disorders.

Methods

Cross-sectional household survey of a representative sample of the adult general population of Belgium, Bulgaria, Germany, Italy, The Netherlands, Northern Ireland, Portugal, Romania and Spain. In total, 34,395 individuals were included. Social inequalities in 12-month mood, anxiety and alcohol-related disorders were evaluated.

Results

In Europe, income seems not to be related to the prevalence of mental disorders. Unemployment and disablement are associated with mental disorders. Lower educational level augments the risk for mood disorders. Living in small (rural) areas decreases the risk for mood disorders and living in urban settings increases it. Northern Ireland, Portugal and Belgium are the countries with the highest risks for mental disorders.

Conclusions

Despite some contradictions with previous literature, in Europe there are social inequalities in the prevalence of mental disorders. However, income showed not to be associated with inequalities in mental health. Being younger, unemployed or disabled, with no education or incomplete primary studies, living in urban settings, and in Northern Ireland, Portugal or Belgium were associated to an augmented prevalence of mental disorders. Policy makers could focus on mental health promotion and mental disorders prevention programmes for risk groups such as unemployed/disabled individuals. Support to vulnerable groups (unemployed or those with less education) and mental health literacy can improve European citizens’ mental health.     

Ethnicity,socioeconomic position and severity of problems as predictors of mental health care use in 5- to 8-year-old children with problem behaviour

Background

Empirical research on mental health care use and its determinants in young school-aged children is still scarce. In this study, we investigated the role of ethnicity, socioeconomic position (SEP) and perceived severity by both parents and teachers on mental health care use in 5- to 8-year-old children with emotional and/or behavioural problems.

Methods

Data from 1,269 children with a high score (>P90) on the Strengths and Difficulties Questionnaire (SDQ) in the school year 2008–2009 were linked to psychiatric case register data over the years 2010–2011. Cox proportional hazards models were used to predict mental health care use from ethnicity, SEP and perceived severity of the child’s problems.

Results

During the follow-up period, 117 children with high SDQ scores (9.2 %) had used mental health care for the first time. Ethnic minority children were less likely to receive care than Dutch children (HR Moroccan/Turkish: 0.26; 95 % CI 0.13–0.54, HR other ethnicity: 0.26; 95 % CI 0.12–0.58). No socioeconomic differences were found. After correction for previous care use, ethnicity and parental perceived severity, impact score as reported by teachers was significantly associated with mental health care use (HR 1.58; 95 % CI 1.01–2.46).

Conclusions

Ethnicity is an important predictor of mental health care use in young children. Already in the youngest school-aged children, ethnic differences in the use of mental health care are present. A distinct predictor of care use in this age group is severity of emotional and behavioural problems as perceived by teachers. Therefore, teachers may be especially helpful in the process of identifying young children who need specialist mental health care.     

Association of childhood adversities with the first onset of mental disorders in Spain: results from the ESEMeD project

Purpose

Childhood adversities (CAs) have consistently been associated with mental health problems in childhood and adulthood. However, few studies have employed appropriate statistical methods that take into account overlap among CAs, and many of the ones that did so were based on insufficiently complex models. The present paper studies the prevalence of a wide variety of CAs, as well as their relationship to the onset of mental disorders in a representative sample of a Spanish population.

Methods

The study is part of the ESEMeD-Spain project, a cross-sectional household survey, which included a nationally representative sample of the Spanish adult population. CAs’ associations with lifetime prevalence of mental disorders were estimated using discrete-time survival analysis with person-years as the unit of analysis.

Results

Of our sample, 20.6 % reported at least one CA, of whom 24 % reported more than one CA. Parental death, parental mental disorder, family violence, economic adversity, physical and sexual abuse were associated with different groups of mental disorders. CAs were associated with the onset of mental disorders during several stages of life. Simulations suggest that CAs were associated with 12.6 % of all disorders, 10.8 % of mood disorders, 5.8 % of anxiety disorders, 27 % of substance disorders and 29.7 % of externalising disorders.

Conclusions

Prevalences of CAs in the Spanish population are lower than those found in other high-income countries, especially when compared to the USA. In Spain, different CAs were associated with the onset of a number of mental disorders, although these associations were not as frequent as in other countries. Although lower than in other countries, the association between CAs and mental health in Spain should be considered relevant. Specific health policies and prevention programmes are needed in order to decrease this burden.