Highlights in child mental health research: March 2022

Highlights

• Mental health technologies such as smartphone applications (apps) with mood and/or anxiety monitoring functions (e.g., actively and/or passively tracking feelings, thoughts, and behaviours) are increasingly popular for managing depression and anxiety symptoms. However, the evidence for the advantages of these mental health technologies over existing preventative and therapeutic tools is unclear.
• This scoping review 1) systematically maps the extent of the current research on mood and/or anxiety monitoring apps; 2) identifies the purpose of monitoring functionalities; 3) evaluates the efficacy of monitoring apps in managing or treating depression and anxiety symptoms in children and young people aged 0 to 25 years and 4) suggests future directions to guide the development of apps.

Key findings

• Thirty-nine articles (23 primary studies, and 16 secondary studies) set in Europe, North America and Australia and Asia were included in the paper.
• The authors identified three purposes of the monitoring functionality: to assist interventions; to manage or assess anxiety and depression; and to collect data.
• Only two of the included primary studies were trials evaluating monitoring apps for treating anxiety and depression. Instead, primary research tended to focus on the feasibility (6 studies), acceptability, usability, or design of engaging apps (9 studies), and momentary awareness of mood fluctuations (5 studies).
• The authors suggest that by monitoring feelings, behaviours and thoughts within apps, children and young people increase awareness and generate knowledge and habits that inform and alter how they relate to anxiety and depression symptoms.
• Their analysis identifies that without acknowledging the social, cultural and environmental contexts that contribute to distress, monitoring apps may pose anxiety and depression as simply internal phenomena and place the responsibility of managing anxiety and depression symptoms on the individual alone.

Implications

• This scoping review highlights that there is currently little evidence to support smartphone monitoring apps as a therapeutic approach for managing anxiety and depression symptoms in children and young people.

Access the free full text

Highlights

• This systematic review found a small, but significant, effect of family or caregiver involvement in psychotherapy when compared to without family involvement on depression outcomes in children. Programs with full family involvement produced a larger effect size.
• The review identified a limited number of studies with some variability in study quality, reducing confidence in the findings.

Key findings

• A total of 8167 articles were screened, with 19 articles meeting inclusion criteria. All were published between 1990 and 2020, and were set in England, America, Norway, and Australia.
• Authors present a metanalysis of 17 of the included studies with post-intervention data for a total of 1208 children aged between three and 18 years.
• The evidence that family/caregiver involvement reduces depressive symptoms is limited and heterogeneity was present, partially due to study quality.
• The included studies also varied in the frequency, extent, and format of family involvement in the sessions. The most common formats were individual sessions (with child, and caregiver separately); family sessions (child meeting together with the caregivers, and/or siblings) or groups (sessions with groups of caregivers/family members).
• Six studies used a cognitive behavioural approach and one study each used a systemic approach and psychodynamic approach. The therapeutic approach used was not clearly described in 11 studies.

Implications

• There is evidence to support routine involvement of family/caregivers in psychotherapy for reducing depression symptoms in children, but the effect size was small.
• The authors suggest that further robust structured research based on guidelines is needed.
• To realise the hypothesised effects of family/caregiver involvement in psychotherapy on child and adolescent depression, it is important to further unpack which children with depression, under what circumstances and with what combinations of family members benefit most.

Access the free full text

Highlights

• This systematic review and meta-analysis examined whether screen time (e.g., television and video games) is associated with behaviour problems in children aged 12 years and under (mean age 6 years).
• Screen time was correlated with externalising (e.g., aggression, attention deficit/ hyperactivity disorder symptoms) and internalising (e.g., depression, anxiety) behaviours
• Effect sizes were small but likely to be meaningful and included studies varied in their methods

Key findings

• Eighty-seven articles (with 98 unique study populations) were included in the meta-analyses. Most articles were observational studies, and the rest were experimental studies (19 with and 21 without control for baseline outcome). The research was predominantly conducted in North America, Africa, Asia, Australia or New Zealand and the Middle East with individual studies from South America and Europe.
• The authors extracted data on child age, sex, and socioeconomic status, type of informants and measurements for screen time and behaviour problems, study publication year, and study design and quality.
• The articles included in this systematic review suggest that screen time may influence both internalising and externalising behaviour problems, especially aggression among children 12 years or younger. The authors caution against making inferences on the directionality of the findings because screens may be offered to children with behavioural problems to pacify or negotiate with them.
• Correlations between screen time and externalising behaviour were stronger in boys than girls. The magnitude of the correlations were reduced when study quality and year of publication were taken into account. Self-reported screen use may also bias results.

Implications

• Future research is needed to understand how cultural beliefs, content (exposure to violent content, or social media) and context (educational or entertainment) influence outcomes.
• Additionally, studies that use multiple informants (e.g., peers, child, teacher), objective methods (e.g., passive sensing apps or observer report), and longitudinal approaches to measure the association of screen time with child outcomes will strengthen research.

Read the abstract

Highlights

• Daily activities such as sleep, physical activity, and sedentary behaviour can have substantial impacts on the young people’s overall physical, academic and wellbeing.
• Identifying 24-hour optimal time-use can provide evidence for recommendations about the best allocation of time for health and well-being
• This study aims to identify the time-use composition for sleep, physical activity, and sedentary behaviour that best predicts physical, cognitive and wellbeing outcomes in a representative sample of 11–12-year-olds drawn from the Longitudinal Study of Australian Children (LSAC).
• The wellbeing measures were life satisfaction, psychosocial health, depressive symptoms and emotional problems. The cognitive measures were non-verbal IQ; vocabulary and academic performance. The physical measures were adiposity, fitness, blood pressure, inflammatory biomarkers and bone strength.

Key findings

• This study uses a new approach to the analysis of time-use data—compositional data analysis— to examine the interplay between daily activities and outcomes.
• Days with longer durations of sleep, shorter sedentary time with at least three hours of light physical activity and two hours of moderate to vigorous physical activity were best for wellbeing
• Days with more sedentary time (about 10.5 hours) and less physical activity (both light and moderate to vigorous) were best for academic performance
• Days with shorter sedentary time (about 9.3 hours) and longer moderate to vigorous physical activity (about 2.1 hours) were best for physical health
• A 24-hour day comprised of 10 hours and 21 minutes of sleep, 9 hours and 44 minutes of sedentary time, 2 hours and 26 minutes light physical activity and 1 hour and 29 minutes of moderate to vigorous physical activity is best for optimal physical, cognitive and wellbeing outcomes, treating all outcomes equally (i.e., a Goldilocks Day).

Implications

• The authors suggest that optimal durations of time use vary depending on the outcome of interest. Creating a personalised Goldilocks Day based on individual outcome priorities is possible via an interactive online tool: https://dotdumuid.shinyapps.io/Weighting_of_outcomes_for_optimal_time_use/

Access the free full text