Highlights in child mental health research: September 2019

Highlights:

• Mental health literacy is defined as “knowledge, attitudes, and beliefs about mental health disorders, help-seeking and treatment options that aid in the recognition, management, and prevention of such disorders” (Hurley et al., p. 1).
• Very little is known about the mental health literacy of parents and caregivers who are directly responsible for children and adolescents. This systematic review, led by Australian researchers, aimed to explore this research gap.
• The review synthesised 21 studies on the mental health literacy of parents and caregivers pertaining to child and adolescent mental health.
• “Findings across studies suggest that parents/caregivers had limited mental health knowledge” (p. 1). A key factor associated with increased knowledge of mental health disorders was “previous experience of mental health disorders and help-seeking” (p. 13).
• Both informal (e.g. family, friends) and formal support sources (e.g. general practitioners, mental health professionals) played key roles in parents’ knowledge, beliefs and help-seeking regarding child mental health.
• Factors related to help-seeking by parents/caregivers:
  • The “most prominent” barriers to help-seeking were “financial difficulties, inadequate mental health knowledge, and availability of services.” (p. 15).
  • “Cultural and religious beliefs” (p. 1) were associated with perceptions of which help-seeking strategies were appropriate.
  • The “nature of the mental health problem” (p. 15) – For example, one Australian study found that a greater impact on daily functioning was associated with a greater perceived need for help.
  • “Fear and mistrust of treatment services” (p. 1).
  • “Stigma” (p. 13)

• The implications of this research for prevention and intervention initiatives are discussed, including that “parents and caregivers appear receptive to receiving mental health related information” and recognise their important role in child mental health.
• Hurley and colleagues (2019) propose that mental health literacy initiatives should be:
  • “accessible” to parents (p. 17).
  • considerate of parent/caregiver “preferences for content and delivery” (p. 17)
  • tailored to the “target audience” (p. 17 – 18). For example, initiatives should be adapted to “mental health status and experience of participants” given the different needs of different settings (e.g., prevention versus help-seeking versus intervention/treatment).
• The researchers note that their review was limited by a lack of studies in this area, as well as the limitations of the included studies themselves (e.g. samples that are not representative). Further research is needed to address these issues.
• Hurley and colleagues (2019) also highlight the need for research into the preventative potential of mental health literacy initiatives, including educational programs.

Read the Abstract here

Highlights:

Which protective factors most strongly predict resilience in children who have been exposed to violence?

This was the question that the researchers aimed to answer in their meta-analysis of 118 studies involving 101,592 children (aged 18 years or younger).

Over two-thirds of the studies assessed resilience using measures of psychopathology (i.e. measures of mental health symptoms).  Only around one-third of the studies included measures of healthy or positive functioning (either alone or with psychopathology measures).

Four strong protective factors for resilience were identified in children exposed to violence (i.e. child maltreatment, intimate partner violence, community violence):

• Self-regulation – The ability to regulate one’s own emotions and behaviour in a way that is adaptive and achieves goals. Examples include emotional regulation and impulse control (see p. 408).
• Family support – Examples include family structure, family cohesion, parental warmth, parental acceptance and perceptions of family support (see p. 408).
• School support – Examples include feeling secure at school and feeling supported/valued by school staff (see p. 408).
• Peer support – Examples include attachment levels with peers, level of satisfaction with relationships, social support and emotional support (see p. 408).

Importantly, these protective factors were consistently noted for different types of violence.

The study identified four critical and potentially-modifiable protective factors that can inform the development of prevention and intervention strategies to promote resilience in children exposed to violence.

These protective factors also offer clear intervention targets for practitioners and services supporting this sub-group of children and their families.

Read the Abstract here

Highlights:

This review synthesised research exploring the views of children and young people (CYP) who had used mental health services after suicidal behaviour.

The researchers used a method of synthesising qualitative research (called meta-ethnography) to analyse four studies involving 44 participants aged 11 to 24 years.  Studies were conducted in the UK, Canada and Sweden.

The review was limited by a small number of eligible studies, which reduces the generalisability of the findings.  Given this is an under-researched but critical area, however, the study findings have been outlined below.

The synthesis found that children and young people who had used mental health services following suicidal behaviour:

• did not know “what mental health support services are available to them, or how to access them”.
• did not feel listened to by mental health practitioners.

Other key findings included:

• There may be a “potential silence around suicide in conversations between CYP and mental health practitioners” (p. 217).
• Using the term “self-harm” to include suicidal behaviour may be contributing to this silence through avoiding the use of the term “suicide.” This may also be contributing to CYP’s feelings of not being listened to (p. 217).

Potential implications of the findings for mental health practitioners, service providers and policy-makers are considered, including that:

• Strategies appear warranted to increase awareness of, and accessibility to, mental health services for children and young people with suicidal ideation and behaviour.
• It may be helpful for practitioners to consider whether clearly referring to and discussing suicide may be appropriate (rather than only referring to self-harm). This may help practitioners to reduce missed opportunities to address suicide risk.
• Practitioners may wish to keep in mind the potential barriers that may arise when working therapeutically with this sub-group of children and young people (e.g.,  feelings of not being treated with respect, feelings of not being listened to.  Practitioners may be able to reduce these barriers by making sure that young people feel acknowledged, respected and heard.

Given that this review included studies with participants aged 11 to 24 years, further research is needed with younger aged children.  Further, the small number of studies and participants available for review limit its generalisability.  Additional studies with larger sample sizes are required, as well as exploration of marginalised or vulnerable groups.  Despite the limitations, this review offered potentially useful findings in a critical but under-researched area.

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Highlights:

• This study investigated the pathways of depressive symptoms across childhood and adolescence in a sample of 4,983 children drawn from the Longitudinal Study of Australian Children (LSAC).
• Depressive symptoms were assessed using a parent questionnaire (i.e. the emotional symptoms sub-scale of the Strengths and Difficulties Questionnaire). Symptoms were measured across a 10-year period from age 4 to 14 years (six time-points in total).
• The study found four trajectories of depressive symptoms (p. 463):
  • Low-stable – Most of the sample (75%) showed levels of depressive symptoms that were low and stable over time.
  • Decreasing – 11% initially showed clinical levels of depressive symptoms, but these decreased across time to below clinical levels.
  • Increasing – 9% initially had depressive symptom levels that were below clinical levels, but these increased over time to above clinical levels. Females were 80% more likely than males to follow this trajectory.
  • High and rising – 6% of the sample demonstrated depressive symptoms that were high and rising.
• Reactive child temperament and maternal depression were early risk factors for children exhibiting an “increasing” trajectory or a “high and rising trajectory” of depressive symptoms (p. 463). Children with a reactive child temperament tend to react to things strongly (e.g. events) and are prone to strong feelings.
• Females who showed an early persistent temperament were less likely to demonstrate a worsening trajectory of depressive symptoms. Children with a persistent temperament tend to persist with tasks for longer, even if they are difficult.
• These findings add to existing evidence of the importance of parental mental health in children’s social-emotional well-being.
• It is important for practitioners and service providers to be mindful that children whose mothers are experiencing depression may be at a heightened risk for increasing depressive symptoms themselves. Ensuring that mothers are adequately supported in their mental health is likely to have positive effects for child mental health.
• The authors also propose a need for “further development and evaluation of prevention interventions that target…children with temperamental difficulties” (p. 470).

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