Highlights in child mental health research: April 2020

Highlights:

• Research is only just beginning to emerge into the potential effects of the COVID-19 pandemic on children’s mental health.

• This study conducted in Hubei province, China investigated levels of anxiety and depressive symptoms in 1,784 primary school students.

• Students were from Grades 2 to 6 and completed an online survey. Information collected by the survey included:
  • School grade
  • Sex
  • Optimism regarding the epidemic
  • If they worried about becoming infected with COVID-19
  • Anxiety and depressive symptoms (measured using the Screen for Child Anxiety Related Emotional Disorders and Children’s Depression Inventory – Short Form).

• Key findings included:
  • Around 22% of students reported depressive symptoms. This rate was higher than in other studies conducted in Chinese primary schools.
  • Around 18% of students reported anxiety symptoms. Similar to above, this rate was also noted to be higher than in other prevalence surveys.
  • Children who were not worried or who were slightly worried about becoming infected with COVID-19 had significantly lower levels of depressive symptoms and were at a lower risk of depressive symptoms (compared to children who were quite worried).
  • Children that were not optimistic regarding the epidemic had significantly higher levels of depressive symptoms and were at a higher risk for depressive symptoms.

• The researchers suggested that “the reduction of outdoor activities and social interaction may have been associated” with the observed increase in depressive symptoms (Xie et al., 2020, p. 1).
• Xie and colleagues (2020) highlight that their findings are consistent with past research that found that the SARS (severe acute respiratory syndrome) epidemic in 2003 was also associated with psychological symptoms in Chinese students.
• These “findings suggest that serious infectious diseases may influence the mental health of children as other traumatic experiences do” (Xie et al., 2020, p. 1).
• Importantly, this study only examined the short-term effects of the pandemic on children’s mental health. Hence further research is needed into longer-term outcomes.
• These findings offer early, emerging evidence to suggest that the COVID-19 pandemic has the potential to negatively impact children’s mental health. Practitioners, policy-makers, and governments should carefully consider the pandemic’s potential effects on children’s well-being.
• The researchers suggest that their findings may help stakeholders (e.g., organisations, policy-makers, governments) to optimise child mental health interventions in countries impacted by the COVID-19 pandemic.

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Highlights:

• Transdiagnostic approaches aim to identify the “core mechanisms” that underlie multiple kinds of psychopathology (i.e. mental health problems) (p.2).
• Transdiagnostic approaches can offer advantages compared to approaches that are disorder-specific, such as helping to identify key mechanisms that could be targeted by interventions to treat or prevent multiple kinds of mental health problems (p. 2).
• “Childhood trauma exposure is associated with elevated risk for virtually all commonly occurring forms of psychopathology” (p. 1).
• This opinion piece published by researchers in BMC Medicine proposes a model of transdiagnostic mechanisms to “explain the strong links between childhood trauma and psychopathology” (p. 1). The mechanisms proposed to link childhood trauma to psychopathology (p. 2) are:
  • Biases and changes in how social information is processed (i.e., “social information processing”) – Examples include incorrectly classifying neutral and negative emotions as anger and being biased to attend to cues that are threat-related.
  • Changes in the way that emotions are processed (i.e. “emotional processing”) – Examples include reduced awareness, learning, and regulation of emotions.
  • Accelerations in biological ageing – Examples include accelerations in the ageing of cells (i.e. “cellular ageing”) and the timing of puberty.
• Social support, especially from caregivers, is a protective factor for multiple kinds of trauma-related mental health problems and encourages
• This article contributes to the identification and understanding of transdiagnostic mechanisms that have a role in multiple kinds of psychopathology. Knowledge about these mechanisms can contribute to developing early interventions and treatments through identifying key targets.
• “In contrast to disorder-specific approaches that have historically been common, altering these transdiagnostic mechanisms through intervention provides the opportunity to more broadly reduce…[the] risk” of child mental health problems (p. 6).

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Highlights

• This study investigated the association between infant temperament and subsequent psychopathology in childhood and adolescence. This was done via a systematic review and meta-analysis of prospective longitudinal research studies.
• 25 research studies met inclusion criteria for the review.
• The measures of infant temperament explored (grouped into five constructs) were (p. 402):
  • negative emotionality (i.e. the intensity and frequency that negative emotions are experienced. Examples of such emotions include fear, sadness, and discomfort).
  • self-regulation (i.e. regulating oneself and one’s emotions, such as by orienting to “sources of comfort” like touch or sound)
  • behavioural inhibition (e.g., being shy; being fearful; withdrawing from social or new situations).
  • surgency/extraversion (e.g., sociability; seeking pleasure; positive affect/emotions).
  • activity level (i.e. the amount that a child physically moves)

• Examples of subsequent psychopathology explored included internalising problems, externalising problems, and neurodevelopmental problems (e.g. Autism Spectrum Disorder, Attention-Deficit/Hyperactivity Disorder).
• The review found a “small but significant association between infant temperament and later psychopathology suggesting that such measures can play a limited role in infant risk indices to help target children at risk” (p. 412).
• In particular, “high negative emotionality and [low] self-regulation in infancy may be transdiagnostic” markers of early risk for “psychopathology in general” (p. 412).
• Given that the association found was small (albeit significant) and the “predictive power of questionnaire-measured infant temperament” was found to be weak, the researchers conclude these questionnaires “can play only a limited role as indices of early risk for later psychopathology” (p. 411).
• While the researchers acknowledge that the above finding is disappointing, they highlight that this is not inconsistent with other more-general attempts that have been limited in this quest to identify markers of early risk for subsequent psychopathology.

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Highlights:

• This study explored the associations between family financial difficulty (i.e. socioeconomic disadvantage) and child mental health outcomes at age 4 to 5 years. Importantly, the researchers also investigated potential factors that might help promote resilience in children exposed to family financial difficulty.

• The study used data of 636 children from the larger Born in Bradford study, which is an ongoing multi-ethnic prospective cohort study in the United Kingdom.
• Key findings included:
  • Family financial difficulty was associated with poorer child mental health outcomes. This finding is consistent with past research.
  • Factors that were associated with positive mental health outcomes in children included high levels of parental warmth, high scores in child literacy, and stronger child physical development scores.
  • Maternal warmth was a protective factor that affected the association between family financial difficulty and later child mental health problems.
• This study supports “warm parenting, child literacy and child physical development” as protective factors for children’s mental health. Warm and nurturing parenting may be especially important for children exposed to socioeconomic disadvantage given that maternal warmth appeared to buffer the effects of family financial difficulty on children’s mental health.

• “The importance of warm and supportive parenting has been established as being crucial in enabling children to develop intrinsic skills and resources important in coping with adversity, including: emotional security; self-belief; self-efficacy; capacity for problem solving; social competence, and a sense of purpose.” (p. 474).

• These findings are relevant to practitioners and service providers who work to optimise children’s well-being. It highlights the importance of parental warmth and suggests that interventions and supports that target this facet of parenting may help promote the emotional well-being of young children. Such interventions may be of “particular benefit to children growing up” with socioeconomic disadvantage (p. 475).

• The researchers recommend that future research should further explore the potential of parental warmth as a protective factor, including supportive interventions, especially in sub-groups with socioeconomic disadvantage.

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Highlights:

• “Shared decision-making (SDM) is the communication process that allows service users and service providers to collaborate when making care and treatment decisions” (p. 2).
• In the delivery of child and adolescent mental health care, these SDM processes can involve practitioners, parents/caregivers, and children.
• This scoping review identified and examined interventions that aim to support shared decision-making with parents in child and adolescent mental health.
• A total of 23 interventions from 31 records were identified and included.
• The parent-interventions were broad with regard to the kinds of child mental health difficulties involved. For example, child mental health difficulties ranged from specific disorders (e.g., Attention-Deficit/Hyperactivity Disorder, Autism Spectrum Disorder) to broader mental health presentations (e.g., universal mental health care).
• It was found that “SDM interventions involving parents have been implemented differently across various presenting mental health difficulties” (p. 1). Nevertheless, some commonalities between interventions were identified.  For example, the majority of interventions included the SDM elements of presenting options to parents (87%) and discussing treatment advantages and disadvantages (83%).

• The review also identified factors that impacted the use and implementation of parent-targeted SDM interventions. These factors were grouped into three over-arching themes:
  • Time (e.g., if the intervention was time-efficient; if the intervention did not place an additional burden on practitioners in terms of time; if the intervention allowed parents to make use of lengthy waiting times by preparing for future appointments).
  • Accessibility (e.g., if the intervention was easily accessible to practitioners and/or parents, such as via the internet; if the required training for the intervention was minimal for practitioners and parents).
  • Appropriateness (e.g., if the intervention was easily understood and used; if the language used was clear, appropriate, and jargon-free for parents).
• These findings will help to increase practitioners’ awareness of what interventions are available for supporting shared-decision making with parents. This will assist clinicians who wish to incorporate parent-targeted shared-decision making approaches in their delivery of child mental health services.
• These findings will also help to develop and implement new tools to support SDM with parents.

• Additional research is still needed to evaluate the effectiveness of parent-targeted interventions that seek to promote shared-decision making.

Read the Abstract here