Ethnicity, socioeconomic position and severity of problems as predictors of mental health care use in 5- to 8-year-old children with problem behaviour

Differences in Anxiety and Depression Among Migrant and Non-Migrant Primary School Children in The Netherlands

This is the first Dutch study investigating symptoms of five DSM-IV-classified anxiety disorders and depression in a large sample of pre-adolescent children with and without a migration background, adjusting for socioeconomic position (SEP) and social preference. Both are potential explanatory factors for differences in mental health among migrant children. We measured anxiety and depression scores with the self-report Revised Child Anxiety and Depression Scale (RCADS) in 2063 children (aged 8-13 years, 55% girls) in the Netherlands. Surinamese/Antillean, Turkish, and Moroccan children reported significantly higher anxiety scores than Dutch children. SEP and peer rejection partly explained higher anxiety scores. Surinamese/Antillean and Turkish children reported comparable depression scores to Dutch children, but Moroccan children reported lower depression scores after adjusting for SEP and peer rejection. Girls reported higher anxiety and depression levels across all four subgroups. Although differences between children with or without a migration background were small, these may increase in later life as the prevalence of anxiety and depression increases with age.

The Role of Leadership and Digital Transformation in Higher Education Students' Work Engagement

Teaching and learning processes should be subject to continuous change due to the constant evolution of social, educational and technological environments, which ultimately results in higher levels of student engagement. The current paper describes the technological changes faced by higher education institutions as a result of digital transformation challenges. Further, transformational and transactional leadership styles' effectiveness is regarded within the context of higher education institutions' digital enhancements. Over time, these factors have led to contextual shifts that have disengaged students from learning and thus self-development. The current research aimed to examine how higher education institutions should apply different leadership styles within digitally transformed contexts so as to increase students' learning engagement and reduce the risk of failure in their future developments within (inter)national labor markets. Data gathering and analysis involved a qualitative approach: an online survey was distributed, resulting in 856 responses. Through structural equation modeling, the data revealed a valid higher education digital transformation assessment tool; the results also emphasize the increased role of transactional leadership, as opposed to the traditional transformational style, within a highly digitized higher education institutional framework. Consequently, the linear relationship of students' work engagement with leadership proved to also be enhanced by quadratic effects. The current study stresses the importance of internal and external peers in higher education performance through high levels of student learning (work) engagement through leadership and a uniformly developed digitally transformed higher education environment.

Residential green space associated with the use of attention deficit hyperactivity disorder medication among Dutch children

Several studies have observed an inverse relationship between attention deficit hyperactivity disorder (ADHD)-related behavior of children, as reported by parents or teachers, and the amount of green space in their residential environment. Research using other, more objective measures to determine ADHD prevalence is scarce and could strengthen the evidence base considerably. In this study, it is investigated whether a similar beneficial association will be observed if the use of ADHD-related medication is selected as an outcome measure. More specifically, registry data from a health insurance company on the reimbursement of ADHD-related medication in 2011 were available for 248,270 children between 5 and 12 years of age. Amounts of green space within 250 and 500 m of the home address were calculated. Multilevel logistic regression analyses for the prevalence of use were conducted, including the following covariates: sex, age, urbanity of the neighborhood, neighborhood socioeconomic status (SES), and percentage of people with a non-Western migration background in the neighborhood population. Results showed that the amount of green space was inversely related to the prevalence of use of ADHD medication. Moreover, the relationship was strongest among children living in the least wealthy neighborhoods and absent among those living in the wealthiest neighborhoods. Results also show that in less wealthy neighborhoods, there is, on average, less green space available nearby: children who are likely to benefit most from nearby green space tend to have the least of it.

Changes in youth care use after the implementation of community-based support teams: repeated measurement study using registry data and data on team characteristics

OBJECTIVES

New legislation on youth care in the Netherlands led to the implementation of community-based support teams, providing integrated primary youth care. Important aims of the new Youth Act were more integrated, timely care and less use of intensive forms of care. Our aim was to study changes in youth care use in time and the role of newly introduced community-based support teams herein.

SETTING

Register data (2015-2018) on youth of a large city were linked and combined with administrative and aggregated data on team characteristics.

PARTICIPANTS

Data on 126 095 youth (0-18 years) were available for analyses.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary, specialised and residential youth care use were the primary outcomes.

RESULTS

Generalised estimating equations analyses adjusted for individual characteristics demonstrated that over 4 years, use of primary youth care increased from 2.2% to 8.5% (OR 1.70; 99% CI 1.67 to 1.73), specialised youth care decreased from 7.2% to 6.4% (OR 0.98; 99% CI 0.97 to 1.00) and residential youth care increased slightly (OR 1.04; 99% CI 1.01 to 1.06). Gender, age, family status, migrant background and educational level were all associated with the types of youth care use and also with some trends in time. Likelihood to receive care increased in time for preschool and younger children but did not improve for migrant children.Case load, team size, team turnover, team performance and transformational leadership showed significant associations with different types of youth care use but hardly with trends in time.

CONCLUSION

Patterns of youth care use changed towards more locally provided primary youth care, slightly less specialised and slightly more residential youth care. Furthermore, youth care use among younger children increased in time. These trends are partly in line with the trends intended by the Youth Act. Little evidence was found for the role of specific team characteristics on changes in youth care use in time.

Teacher-reported emotional and behavioural problems and ethnic background associated with children's psychosocial care use: a longitudinal population-based study

Approximately, 15% of children in Western countries suffer from emotional and behavioural problems. However, not all children receive the psychosocial care they need, especially children with a non-Western background experience an unmet need for care. This might be because parents of non-Western children report a lower need for care than parents of Western children, unrelated to the actual need. This study examined the association between teacher-reported problems and psychosocial care use, independent of mother-reported problems. Further, the role of ethnic background in this association was investigated. The study sample of 9-year-old children was retrieved from the Generation R Study (N = 3084), a prospective, population-based cohort of children born in Rotterdam, the Netherlands. Teacher- and mother-reported problems were measured via questionnaire when the children were  6/7 years old. Psychosocial care use was mother-reported at the research centre when children were 9 years old (8.1%). Hierarchical logistic regressions showed significant positive associations between teacher-reported total, externalising and internalising problems and later psychosocial care use. These associations were independent of mother-reported problems. Children with a non-Western background used less care, but ethnic background did not moderate the association between teacher-reported problems and care use. Our findings suggest that teachers might have an important role, next to parents, in the identification of problems and children's access to care. This may be particularly important for non-Western children, as they use less psychosocial care than Western children, despite other research showing that they generally display higher levels of problems. Directions for future research and implications are discussed.

Children's use of psychosocial care in a population-based longitudinal study: less likely for girls, children with a non-Western background and children with a high quality of life

Knowledge on determinants of children's psychosocial care use is important to improve their access to care. This study examined the independent contributions of need and predisposing factors to psychosocial care use in 9-year-old children, guided by the Gateway Provider Model. Data of the Generation R Study, a prospective cohort of children born in Rotterdam, the Netherlands, were analysed using multivariable logistic regression (n = 4714). Need (quality of life, presence and type of emotional/behavioural problems) and predisposing factors (sex, ethnic background and maternal educational level) were measured using parent questionnaires at multiple time points between ages 1.5 and 9 years. Psychosocial care use was parent-reported at 9 years old (9.6% among children with Western background, 7.3% among children with non-Western background). Having emotional/behavioural problems at 5 and 9 years old was associated with more care use, while having a higher quality of life, being a girl and having a Moroccan/Turkish or other non-Western background were associated with less care use. Externalising and internalising problems, as well as several types of problems, at 5 and 9 years old were associated with psychosocial care use. Stratified analyses revealed that, in children with non-Western backgrounds, only a poorer psychosocial quality of life was associated with psychosocial care use. To conclude, girls with a Western background and children with a non-Western background were less likely to receive care compared to their peers. Children with parent-reported emotional/behavioural problems at 5 and 9 years old and decreased quality of life at 5 years old were more likely to receive psychosocial care use at 9 years old. Our findings hold relevance for preventive policies.

Distinct influence of parental occupation on cortical thickness and surface area in children and adolescents: Relation to self-esteem

Studies of socioeconomic disparities have largely focused on correlating brain measures with either composite measure of socioeconomic status (SES), or its components-family income or parental education, giving little attention to the component of parental occupation. Emerging evidence suggests that parental occupation may be an important and neglected indicator of childhood and adolescent SES compared to absolute measures of material resources or academic attainment because, while related, it may more precisely capture position in social hierarchy and related health outcomes. On the other hand, although cortical thickness and surface area are brain measures with distinct genetic and developmental origins, large-scale neuroimaging studies investigating regional differences in interaction of the composite measure of SES or its components with cortical thickness and surface area are missing. We set out to fill this gap, focusing specifically on the role of parental occupation on cortical thickness and surface area by analyzing magnetic resonance imaging scans from 704 healthy individuals (age = 3-21 years). We observed spatially distributed patterns of (parental occupation × age2 ) interaction with cortical thickness (localized at the left caudal middle frontal, the left inferior parietal and the right superior parietal) and surface area (localized at the left orbitofrontal cortex), indicating independent sources of variability. Further, with decreased cortical thickness, children from families with lower parental occupation exhibited lower self-esteem. Our findings demonstrate distinct influence of parental occupation on cortical thickness and surface area in children and adolescents, potentially reflecting different neurobiological mechanisms by which parental occupation may impact brain development.

Association of maternal ethnicity and urbanicity on severe pediatric disease: a nationwide cohort study

BACKGROUND

A healthy migrant effect on birth outcomes has been reported, however, whether this protective effect persists throughout childhood is unknown. The effect of urbanicity on child health among an immigrant population is unclear. The objective of this study was to compare the incidence rate and cumulative incidence of severe diseases among urban children of Taiwan-born mothers, rural children of Taiwan-born mothers, urban children of foreign-born mothers, and rural children of foreign-born mothers.

METHODS

A nationwide cohort study was conducted for children born in Taiwan during 2004-2011 and follow-up till age 4 to 11 years old by linkage the Taiwan Birth Registry 2004-2011, Taiwan Death Registry 2004-2015, and National Health Insurance Research Database 2004-2015. Cox proportional hazards model (multivariable) was used to examine differences among the four study groups.

RESULTS

There were 682,982 urban children of Taiwan-born mothers, 662,818 rural children of Taiwan-born mothers, 61,570 urban children of foreign-born mothers, 87,473 rural children of foreign-born mothers. Children of foreign-born mothers had a lower incidence of vasculitis, mainly Kawasaki disease. The incidences of congenital disorders did not differ between children of foreign-born mothers and children of Taiwan-born mothers. The incidence of psychotic disorders was higher in urban children. However, children in rural areas had a higher incidence of major trauma/burn and a higher mortality rate.

CONCLUSIONS

A healthy migrant effect was only seen for Kawasaki disease. The mental health of urban children born to immigrant mothers warrants concern.

The role of adverse childhood experiences and mental health care use in psychological dysfunction of male multi-problem young adults

Adverse childhood experiences (ACEs) are associated with severe problems later in life. This study examines how eleven types of ACEs and mental health care use history are related to current psychological dysfunction among multi-problem young adults. A sample of 643 multi-problem young adult men (age 18-27) gave informed consent for us to collect retrospective regional psychiatric case register data and filled out questionnaires. ACEs were highly prevalent (mean 3.6, SD 2.0). Logistic regression analysis showed that compared with participants who experienced other ACEs, participants who experienced psychological problems in their family and grew up in a single-parent family were more likely to have used mental health care, and physically abused participants were less likely to have used mental health care. Linear regression analyses showed a dose-response relationship between ACEs and internalizing and externalizing problems. Linear regression analyses on the single ACE items showed that emotional abuse and emotional neglect were positively related to internalizing problems. Emotional and physical abuse and police contact of family members were positively related to externalizing problems. While multi-problem young adults experienced many ACEs, only a few ACEs were related to mental health care use in childhood and adolescence. Long-term negative effects of ACEs on psychological functioning were demonstrated; specifically, emotional abuse and emotional neglect showed detrimental consequences. Since emotional abuse and emotional neglect are not easily identified and often chronic, child health professionals should be sensitive to such problems.

Measuring the effects of socioeconomic factors on mental health among migrants in urban China: a multiple indicators multiple causes model

Objectives

Since 1978, rural–urban migrants mainly contribute Chinese urbanization. The purpose of this paper is to examine the effects of socioeconomic factors on mental health of them. Their mental health was measured by 12-item general health questionnaire (GHQ-12).

Methods

The study sample comprised 5925 migrants obtained from the 2009 rural-to-urban migrants survey (RUMiC). The relationships among the instruments were assessed by the correlation analysis. The one-factor (overall items), two-factor (positive vs. negative items), and model conducted by principal component analysis were tested in the confirmatory factor analysis (CFA). On the basis of three CFA models, the three multiple indicators multiple causes (MIMIC) models with age, gender, marriage, ethnicity, and employment were constructed to investigate the concurrent associations between socioeconomic factors and GHQ-12.

Results

Of the sample, only 1.94% were of ethnic origin and mean age was 31.63 (SD = ±10.43) years. The one-factor, two-factor, and three-factor structure (i.e. semi-positive/negative/independent usefulness) had good model fits in the CFA analysis and gave order (i.e. 2 factor>3 factor>1 factor), which suggests that the three models can be used to assess psychological symptoms of migrants in urban China. All MIMIC models had acceptable fit and gave order (i.e. one-dimensional model>two-dimensional model>three-dimensional model).

Conclusions

There were weak associations of socioeconomic factors with mental health among migrants in urban China. Policy discussion suggested that improvement of socioeconomic status of rural–urban migrants and mental health systems in urban China should be highlighted and strengthened.

Electronic supplementary material

The online version of this article (doi:10.1186/s13033-016-0118-y) contains supplementary material, which is available to authorized users.

Factors associated with high use of general practitioner and psychiatrist services among patients attending an addiction rehabilitation center

BACKGROUND

This study aimed to 1) identify the characteristics of individuals with substance use disorders (SUDs) who make high use of services provided by general practitioners (GP) and psychiatrists while receiving services concurrently from an addiction rehabilitation center (ARC), and 2) to compare high service users to moderate and low service users.

METHODS

Data were compiled for 4,407 individuals with SUDs who were receiving services from an ARC in 2004. The data came from the merging of four databases: the ARC data registry (January 1(st), 2004-December 31, 2004), the Quebec Health Insurance Board database (March 31, 2003-April 1st, 2005), the Quebec provincial database for hospitalizations (March 31, 2003-April 1st, 2005), and the Quebec National Institute of Public Health database (2004). Independent variables were grouped according to the Andersen Behavioral Model of Health Services Use: predisposing, enabling and need factors. Generalized estimating equations analyses were performed to assess the influence of individual and neighborhood-level characteristics on high use of services outside the ARC provided by GPs and psychiatrists. Benjamini-Hochberg's procedure was applied to correct for multiple comparisons.

RESULTS

About 97 % of individuals attending the ARC consulted a GP or a psychiatrist during the two-year study period, for a mean of 1.5 consultations per month. Findings revealed that 5 % of the sample made 26 % of all consultations over the two years, and they were defined as high users. No single predisposing factor was associated with high use. One enabling factor significantly increased the risk of being a high user of services from general practitioners and psychiatrists: receiving services at the ARC for three years prior to 2004. Four needs factors, all related to mental health diagnoses (schizophrenia, mood disorder, anxiety disorder, personality disorder), predicted high use of general practitioner and psychiatrist services.

CONCLUSIONS

This study found that nearly all individuals with SUDs receiving services from an ARC were users of health services from GPs and psychiatrists outside the ARC. High users most probably accessed them in inpatient settings. No previous study has compared high service users with low and moderate users among individuals with SUDs. Considering that ARCs are treating individuals with complex needs, some of whom make high use of medical professionals, both ARCs and their clients could benefit from increased collaboration and integration between the addictions and mental healthcare sectors.