Highlights in child mental health research: June 2022

Highlights

• Neighbourhood-level interventions offer a promising opportunity to promote child mental health at a population level. However, a better understanding of the specific design elements, such as public open space, is needed to inform actionable policy interventions.
• This research investigates the inequalities in access to quality neighbourhood spaces, the relationship between neighbourhood places and child mental health and whether the relationship differs based on socio-economic disadvantage.

Key findings

• This study used data from a population linked dataset, the Australian Early Development Census (which includes questions relating to internalising and externalising difficulties) with geospatial data.
• Associations between access to and quality of public open space and mental health outcomes were assessed taking into account demographic and contextual factors.
• The results show inequalities in access child friendly open spaces based such that lower maternal education levels (weak-moderate evidence) and greater neighbourhood disadvantage (strong evidence) was associated with lower access to public open spaces.
• Children with access to any type of public space had lower levels of mental health difficulty and higher levels of mental health competence (positive mental health). This was even more so if the public open space had child friendly features such as a playground and a toilet nearby.
• Aboriginal and Torres Strait Islander children were over-represented in the group without access to child friendly public open space within 800 m.

Implications

• Improving access to neighbourhood public open space appears to be a promising strategy for preventing mental health difficulties and promoting competence in early childhood.
• Access to child friendly public open space with features that support extended use by families provides a key neighbourhood opportunity for skill-building and socialisation during early years.

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Highlights

• Children who face adversity have higher prevalence of mental health disorders. However, children and families experiencing adversity often do not access evidence-based services in a timely, effective manner. This can be due, in part, to fragmented services and a workforce without adequate knowledge of child mental health.
• This review assesses the effectiveness of integrated primary health and social care hubs on mental health outcomes for children experiencing adversity and describes common integration dimensions of effective hubs.

Key findings

• A systematic review was undertaken looking at interventional studies that used some form of integrated approach to mental health within a primary health care setting. The studies included needed to have used validated mental health outcome measures.
• Of 5961 retrieved references, four studies involving children aged 0–12 years experiencing one or more adversities were included. None of these were Australian studies. There was limited high-quality evidence, with only one RCT, which did not show significant improvements.
• Despite differences in study methodology, level of integration and mental health outcome measures, the review identified three studies of integrated health and social care Hubs that were associated with improved mental health outcomes.
• The most common dimensions of effective hubs were clinician integration (such as case management, patient-centred care and continuity of care), professional integration and organisational integration (including co-location of services).

Implications

• This review suggests that integrated hubs, based in primary care settings, may be an appropriate model of care to improve child mental health outcomes in children experiencing adversity.
• Effective components of integrated hubs likely include clinical integration (including case management, patient-centred care, patient education, and continuity of care), professional integration, and organisational integration including co-location.
• The results suggest hubs incorporating effective integration dimensions could improve mental health outcomes for children experiencing adversity; however, further robust studies are required.

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Highlights

• Numerous evidence-based trauma therapies for children and adolescents have been developed over several decades to minimize the negative outcomes of post-traumatic stress disorder (PTSD).
• This paper derives the common elements (such as techniques or mechanisms that are similar) from evidence-based trauma therapies for children and adolescents.

Key findings

• Studies included in this review investigate PTSD with a focus on children and adolescents 7-18 years of age, and used randomised control trials (RCT) to measure effectiveness. Five evidence-based trauma therapies were identified in this way.
• The common elements were determined using a Delphi method (which a structured consultation process) with key Dutch trauma therapists. An element was deemed common when it appeared in three or more of the therapies. The final list was presented to international experts on the included trauma therapies.
• A substantial number of common techniques and mechanisms were found across the five evidence-based trauma therapies for children and adolescents, showing a strong overlap between therapies.
• Some of the common techniques included psychoeducation, relaxation, cognitive shifting. Some of the common mechanisms included consolidation, trauma processing, sharing. Details can be found in table 2 and 3 of the paper.

Implications

• When there are multiple evidence-based programs available, understanding the common elements help promote therapy that is flexible and accessible for both therapists and clients whilst also maintaining program fidelity.
• The importance of a therapeutic relationship, or therapeutic alliance was highlighted as a key mechanism in the evidence-based programs and is critical in psychotherapy in general.
• The results show a broad range of parameters, suggesting the need for a tailor-made approach by the trauma therapist.

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Highlights

• Youth growing up in disadvantaged neighbourhoods are more likely than their advantaged peers to face negative behavioural and mental health outcomes.
• Although studies have shown that adversity can undermine positive development via its impact on the developing brain, few studies have examined the association between neighbourhood disadvantage and neural function, and no study has investigated potential social mechanisms within the neighbourhood that might link neighbourhood disadvantage to altered neural function.
• The amygdala is a part of the brain responsible for our flight or fight response sensitive to emotional facial expressions especially related to threats. Having a hyperactive amygdala can have negative effects on mental health.

Key findings

• This study examined socio-emotional face processing through fMRI of a sample of twins 7-19 years in conjunction with information on neighbourhood disadvantage and perceived social processes.
• It found that neighbourhood disadvantage was associated with greater right amygdala reactivity to threat, where children from these neighbourhoods were more reactive to facial expressions of anger and fear. This was also the case if the neighbourhood was perceived to have low social processes (e.g. neighbours don’t look out for each other).
• However, researchers also found positive neighbourhood social processes could mediate, or lessen, the relationship between neighbourhood disadvantage and amygdala reactivity.

Implications

• Supportive social processes in a neighbourhood for example community support such as how willing people are to help neighbours, and behavioural norms such as intervening if a child was unsafe, has an effect on a child’s flight or fight response to negative facial expressions.
• Supportive neighbourhoods can have a role in mitigating the effect of disadvantage when it comes to adverse impacts on brain functioning in children.

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