Highlights in child mental heath research: May 2023

This month’s highlights include:

• Review of mental health service access for young children

This scoping review analysed literature regarding access to infant mental health services by parents. Accessibility and engagement barriers for at risk populations, the benefits of early detection, the promotion of cultural responsiveness, ensuing service sustainability, and the use of innovated interventions and tools to improve existing practices were key themes. The review found that evidence that addresses how access to infant mental health services can be improved is lacking.

• Associations between health behaviours and mental health in adolescence

This study analysed the relationship between self-reported experiences of six lifestyle behaviours (sleep; physical activity; diet; screen time; alcohol use; tobacco use) and levels of psychological distress, anxiety, and depression. Longer sleep, greater physical activity, higher fruit and vegetable consumption, and low intake of sugar sweetened beverages, tobacco and alcohol were associated with better mental health outcomes.

• Parent’s professional help-seeking for their children with anxiety

This study investigated modifiable factors that affect parent’s help seeking for their children with anxiety. Lower personal stigma and more positive attitudes towards seeking professional support in parents were significantly associated with greater help-seeking behaviour. Conversely, parent knowledge of anxiety disorders and help-seeking self-efficacy were not significantly associated with help-seeking behaviour.

• Improving child mental health inequities

This study analysed the impact of socioeconomic disadvantage at age 0-1 year on children’s mental health problems at 10-11 years. A larger proportion of disadvantaged children had a parent experiencing high psychological distress than their non-disadvantaged peers, and fewer attended preschool. The findings suggest that improving parental mental health and preschool attendance could reduce, but not completely eliminate mental health inequities.

Why is this important? 

• Targeted and early infant mental health (IMH) interventions can help to mitigate the consequences of adverse early life experiences. However, barriers to accessing IMH interventions exist.

What did they do?

• The authors reviewed studies relating to infant mental health services access and models of care published between 2000 and 2021.
• 28 studies were included in the review, about half of which were from the United States.

What did they find?

• The authors identified common barriers to IMH access including a lack of integration and coordination between services, mental health related stigma, difficulties engaging at-risk families, and a lack of training in primary health professionals about how to identify and assess infant mental health challenge
• The review also identified solutions to improve access to IMH, maintain family engagement with IMH services, and ensure sustainability of IMH services. These solutions included integration of paediatric mental health services with physical health services, increased practitioner training on IMH and cultural sensitivity, and stigma reduction activities.

What does this mean for practice?

• The authors argue there is a need to address the barriers to IMH services by:  co-locating paediatric mental and physical health services, and adult and paediatric services, identifying and overcoming barriers for at-risk groups.
• The authors also recommend more training for practitioners in early detection of IMH needs through recognising and addressing emotional responses in infants and potential risk factors. The authors also suggest that holistic screening tools may support practitioners to consider a wider range of early life experiences that influence mental health.

Why is this important? 

• This study aimed to understand associations between mental health (MH) and key modifiable lifestyle behaviours among early adolescents in Australia.

What did they do?

• The study involved a cross-sectional survey of 6,640 Year 7 students in NSW, QLD and WA.
• It explored the relationship between mental health outcomes (psychological distress, anxiety, and depression) and six lifestyle behaviours: sleep duration, physical activity levels, diet (fruit, vegetable and sugar-sweetened beverage (SSB) consumption), screen time, alcohol and tobacco use.

What did they find?

• Female adolescents had significantly higher levels of psychological distress, anxiety and depression compared to males, as did culturally and linguistically diverse (CALD) students compared to non-CALD students. Students with higher socioeconomic status (SES) (e.g., those with higher family affluence and attending schools in higher SES neighbourhoods) had significantly lower levels of psychological distress and depression than students from low SES backgrounds.
• All six health behaviours were significantly associated with levels of psychological distress, anxiety and depression. Greater sleep duration, higher fruit and vegetable consumption and lower consumption of SSBs, greater physical activity and lower screen time were all associated with significantly lower levels of psychological distress, anxiety and depression. Finally, significantly lower scores of psychological distress, anxiety and depression were also observed in students who abstained from alcohol and tobacco use.
• The lowest MH symptom scores were found in students who slept more than nine hours a night; consumed three or more serves of fruit and two or more serves of vegetables daily; never or rarely drank SSBs; engaged in six days of moderate-to-vigorous physical activity each week; engaged in less than 60 minutes of screen time a day; and had not smoked cigarettes or consumed alcohol in the past six months.

What does this mean for practice?

• The directionality of associations between the lifestyle behaviours and MH outcomes is not yet clear. However, interventions targeting lifestyle behaviours could prove beneficial for both physical health and mental health outcomes.
• The authors suggest services can help support adolescents with mental health challenges, and their families, with tools to promote beneficial lifestyle behaviours. They also suggest interventions should work to engage the adolescent cohorts more likely to have poor mental health, including CALD young people, and those from lower socioeconomic backgrounds.

Why is this important? 

• This study aimed to better understand the modifiable factors (e.g., knowledge of anxiety, attitudes and self-efficacy towards help-seeking) in parents that affect professional help-seeking for their children.

What did they do?

• 257 Australian parents of children (5-12 years) with elevated anxiety symptoms were surveyed, about their help seeking from medical professionals (general practitioners (GP), psychologists, and paediatricians), knowledge of anxiety, help-seeking attitudes, personal stigma and self-efficacy.

What did they find?

• Two-thirds of parents had sought help from a GP (66.9%) or a psychologist (61.1%), but only a third had sought help from a paediatrician (33.9%).
• Parents with lower levels of anxiety-stigma (e.g., negative, avoidant or rejecting beliefs about anxiety disorders) and who held more positive attitudes towards seeking professional support were more likely to have sought help for their child compared to parents with stigmatising views on anxiety, and negative attitudes towards help-seeking.
• There was not a significant effect of parental knowledge of anxiety disorders or self-efficacy around seeking help on actual help-seeking behaviour.

What does this mean for practice?

• The study found parents are most likely to access GPs and psychologists for support with their child’s mental health; this highlights the importance of these practitioners for onwards referral to other professionals.
• The authors argue that primary healthcare providers can facilitate a positive environment for help-seeking and help parents know how to engage with mental health services, especially for the first time.
• The authors further propose that stigma reduction and improving attitudes towards help-seeking in parents, may be more influential on behaviour than providing them with general education on anxiety.

Why is this important? 

• This study investigated whether improving parental mental health and preschool attendance has the potential to reduce mental health inequities for disadvantaged children.

What did they do?

• This study used data from the nationally representative Longitudinal Study of Australian Children (LSAC) (n=5,107).
• The authors examined the relationship between child, parent, and environmental factors on child mental health problems (at 10-11 years). Child mental health outcomes were captured using the parent version of the Strengths and Difficulties Questionnaire (SDQ). Socioeconomic advantage was captured from parental reported income, education and occupation data. Families in the lowest 25% socioeconomically advantaged categories were classified as ‘disadvantaged’.

What did they find?

• Elevated mental health symptoms were found to be more prevalent in disadvantaged children (32.8%) compared to their non-disadvantaged peers (18.7%).
• At 4-5 years, a larger proportion of disadvantaged children had a parent experiencing high psychological distress (14.8%) than their non-disadvantaged peers (8.5%), and fewer attended preschool (60.9% vs 69.3%).
• At 4-5 years, low parental psychological distress and attending preschool were significantly associated with reduced odds of mental health symptoms in children at 10-11 years.

What does this mean for practice?

• The authors posit that supporting parental mental health and encouraging preschool attendance have the potential to improve child mental health, particularly in socioeconomically disadvantaged families.
• Improving preschool attendance of disadvantaged children and minimising the psychological distress of their parents could help to minimise children’s mental health inequities.
• The authors note that individual approaches (e.g., pre-school readiness programs) are unlikely to eliminate disparity entirely if delivered in isolation. Rather, approaches that combine multiple, diverse interventions across multiple sectors (e.g., addressing systemic factors that contribute to inequity, improving parental support, etc.) are needed.