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Panagi L, White SR, Howdle C, Bennett S, Heyman I, Shafran R, Ford T. Predictors of contact with services for mental health problems among children with comorbid long-term physical health conditions: a follow-up study. Eur Child Adolesc Psychiatry 2024; 33:21-31. [PMID: 36357554 PMCID: PMC10807016 DOI: 10.1007/s00787-022-02105-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 10/26/2022] [Indexed: 11/12/2022]
Abstract
Children with long-term physical health conditions (pLTCs) are at increased risk of developing mental health comorbidities, although most do not access services for their mental health. No previous studies have examined the determinants of contact with services for mental health concerns among this group of children. This 3-year longitudinal study involved a population-based sample of children aged 5-16 years from the British Child and Adolescent Mental Health Surveys conducted in 1999 and 2004. In children with comorbid pLTCs and mental health disorders at baseline (N = 397), we examined associations between several child-, family- and service-related factors and (a) contact with primary health care, (b) contact with paediatrics and (c) contact with child and adolescent mental health services over 3-year follow-up (2002 and 2007). Separate multivariable binary logistic regressions were conducted for each service. The impact of mental health difficulties on the child and contact with the teacher predicted contact with all three services. Adolescent age, female gender, larger family size, some or marked academic difficulties, and having parents with educational qualification(s) were specific predictors of contact with primary health care. Male gender, stressful life events, and contact with primary health care were specific predictors of contact with child and adolescent mental health services. No other factors predicted contact with paediatrics. Our findings highlight the role of child-, family-, and service-related factors in accessing mental health care in children with comorbid pLTCs and mental health disorders which could inform planning and provision of services to reduce unmet mental health needs.
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Affiliation(s)
- Laura Panagi
- Department of Psychiatry, University of Cambridge, The Clifford Allbutt Building, Biomedical Innovation Hub/Bay 13, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 OAH, UK.
| | - Simon R White
- Department of Psychiatry, University of Cambridge, The Clifford Allbutt Building, Biomedical Innovation Hub/Bay 13, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 OAH, UK
| | - Charlotte Howdle
- School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0SP, UK
| | - Sophie Bennett
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Isobel Heyman
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, The Clifford Allbutt Building, Biomedical Innovation Hub/Bay 13, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 OAH, UK
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2
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Panayiotou M, Finning K, Hennessey A, Ford T, Humphrey N. Longitudinal pathways between emotional difficulties and school absenteeism in middle childhood: Evidence from developmental cascades. Dev Psychopathol 2023; 35:1323-1334. [PMID: 34955109 DOI: 10.1017/s095457942100122x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Emotional difficulties are associated with both authorized and unauthorized school absence, but there has been little longitudinal research and the temporal nature of these associations remains unclear. This study presents three-wave random-intercepts panel models of longitudinal reciprocal relationships between teacher-reported emotional difficulties and authorized and unauthorized school absence in 2,542 English children aged 6 to 9 years old at baseline, who were followed-up annually. Minor differences in the stability effects were observed between genders but only for the authorized absence model. Across all time points, children with greater emotional difficulties had more absences, and vice versa (authorized: ρ = .23-.29, p < .01; unauthorized: ρ = .28, p < .01). At the within-person level, concurrent associations showed that emotional difficulties were associated with greater authorized (β = .15-.17, p < .01) absence at Time 3 only, but with less unauthorized (β = -.08-.13, p < .05) absence at Times 1 and 2. In cross-lagged pathways, neither authorized nor unauthorized absence predicted later emotional difficulties, and emotional difficulties did not predict later authorized absence at any time point. However, greater emotional difficulties were associated with fewer unauthorized absences across time (β = -13-.22, p < .001). The implications of these findings are discussed.
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Affiliation(s)
| | | | | | | | - Neil Humphrey
- University of Manchester, Manchester Institute of Education, Manchester, UK
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3
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Johnson CL, Gross MA, Jorm AF, Hart LM. Mental Health Literacy for Supporting Children: A Systematic Review of Teacher and Parent/Carer Knowledge and Recognition of Mental Health Problems in Childhood. Clin Child Fam Psychol Rev 2023; 26:569-591. [PMID: 36763174 PMCID: PMC10123050 DOI: 10.1007/s10567-023-00426-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2023] [Indexed: 02/11/2023]
Abstract
The level of mental health literacy (MHL) in adults who work with or care for children is likely to influence the timeliness and adequacy of support that children receive for mental health problems. The aim of this study was to systematically review the literature on mental health literacy for supporting children (MHLSC, recognition/knowledge) among parents and teachers of school aged children (5 to 12 years old). A systematic search was conducted for quantitative studies published between 2000 and June 2021 using three databases (MEDLINE, PsycINFO and ERIC) and relevant citations reviewed in Scopus. To be included, studies needed to measure at least either 'mental health knowledge' or 'recognition'. Synthesis proceeded according to study design, adult population, child MHP, then MHL outcome. Study quality was assessed using AXIS. 3322 documents were screened, 39 studies met inclusion criteria. 49% of studies examined teachers' knowledge or recognition of ADHD; only five studies reported on parent samples. Synthesis found a nascent field that was disparate in definitions, methods and measures. Little research focussed on knowledge and recognition for internalizing problems, or on parents. Methods used for measuring knowledge/recognition (vignette vs screening) were associated with different outcomes and the quality of studies was most often low to moderate. Adults appear to have good recognition of childhood ADHD but their knowledge of internalizing disorders is less clear. Further research is required to develop standard definitions and validated measures so gaps in MHLSC can be better identified across populations who have a role in supporting children with their mental health.
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Affiliation(s)
- Catherine L Johnson
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Level 5, 207 Bouverie Street, Carlton, VIC, 3010, Australia.
| | - Maxine A Gross
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Level 5, 207 Bouverie Street, Carlton, VIC, 3010, Australia
- Telethon Kids Institute, Adelaide, SA, Australia
| | - Anthony F Jorm
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Level 5, 207 Bouverie Street, Carlton, VIC, 3010, Australia
| | - Laura M Hart
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Level 5, 207 Bouverie Street, Carlton, VIC, 3010, Australia
- School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
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4
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Sarmiento C, Reid GJ. Accessing and re-accessing mental health walk-in clinics for children and families. THE JOURNAL OF MEDICINE ACCESS 2023; 7:27550834231200617. [PMID: 37786838 PMCID: PMC10541731 DOI: 10.1177/27550834231200617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/22/2023] [Indexed: 10/04/2023]
Abstract
Background Many child and youth mental health (CYMH) agencies across Canada and in Ontario are using mental health walk-in clinics (MHWCs). Objectives (1) Explore how MHWCs are used by families (e.g. mean, mode, and median number of visits), and (2) document how often and how soon families returned for a second MHWC visit and identify correlates of time to a second MHWC visit. Design Administrative data from two CYMH agencies in Ontario were extracted, including demographics, visit data, and presenting concerns. Methods In this exploratory, descriptive study, analyses of administrative data were conducted to identify patterns and correlates of MHWC use before other agency services, compared to MHWC use exclusively. Results About a third of children and families using MHWCs had two or more visits. Child age, guardianship, and disposition at discharge emerged as correlates of time to a second MHWC visit. Conclusion MHWCs can save families' time, and both agencies' time and money by eliminating the need to complete a detailed assessment prior to treatment for cases that would go on to have a single visit within this service.
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Affiliation(s)
- Catalina Sarmiento
- Department of Psychology, The University of Western Ontario, London, ON, Canada
| | - Graham J. Reid
- Departments of Psychology, Family Medicine, and Paediatrics, The University of Western Ontario, London, ON, Canada
- Children’s Health Research Institute, London, ON, Canada
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5
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Ter-Minassian L, Viani N, Wickersham A, Cross L, Stewart R, Velupillai S, Downs J. Assessing machine learning for fair prediction of ADHD in school pupils using a retrospective cohort study of linked education and healthcare data. BMJ Open 2022; 12:e058058. [PMID: 36576182 PMCID: PMC9723859 DOI: 10.1136/bmjopen-2021-058058] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 08/08/2022] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Attention deficit hyperactivity disorder (ADHD) is a prevalent childhood disorder, but often goes unrecognised and untreated. To improve access to services, accurate predictions of populations at high risk of ADHD are needed for effective resource allocation. Using a unique linked health and education data resource, we examined how machine learning (ML) approaches can predict risk of ADHD. DESIGN Retrospective population cohort study. SETTING South London (2007-2013). PARTICIPANTS n=56 258 pupils with linked education and health data. PRIMARY OUTCOME MEASURES Using area under the curve (AUC), we compared the predictive accuracy of four ML models and one neural network for ADHD diagnosis. Ethnic group and language biases were weighted using a fair pre-processing algorithm. RESULTS Random forest and logistic regression prediction models provided the highest predictive accuracy for ADHD in population samples (AUC 0.86 and 0.86, respectively) and clinical samples (AUC 0.72 and 0.70). Precision-recall curve analyses were less favourable. Sociodemographic biases were effectively reduced by a fair pre-processing algorithm without loss of accuracy. CONCLUSIONS ML approaches using linked routinely collected education and health data offer accurate, low-cost and scalable prediction models of ADHD. These approaches could help identify areas of need and inform resource allocation. Introducing 'fairness weighting' attenuates some sociodemographic biases which would otherwise underestimate ADHD risk within minority groups.
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Affiliation(s)
| | - Natalia Viani
- Department of Psychological Medicine, King's College London, London, UK
| | - Alice Wickersham
- Department of Psychological Medicine, King's College London, London, UK
| | - Lauren Cross
- Department of Psychological Medicine, King's College London, London, UK
| | - Robert Stewart
- Department of Psychological Medicine, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Johnny Downs
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Child and Adolescent Psychiatry, King's College London, London, UK
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6
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Lange S, Gossmann E, Hofmann S, Fegert JM. Condemn or Treat? The Influence of Adults' Stigmatizing Attitudes on Mental Health Service Use for Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15951. [PMID: 36498023 PMCID: PMC9740034 DOI: 10.3390/ijerph192315951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/24/2022] [Accepted: 11/25/2022] [Indexed: 06/17/2023]
Abstract
Stigmatizing attitudes towards mental disorders influence parents’ help-seeking behavior for their child’s mental health problems. As untreated mental disorders can cause morbidity and mortality, such parental attitudes are a serious barrier for public health promotion. Therefore, the help-seeking readiness in a distressed child’s broad social environment is essential. However, the role of stigma was unexplored in this context. This study empirically investigated the influence of adults’ stigmatizing attitudes towards mentally disabled people on their readiness to seek professional help for children’s mental health issues. Data from a representative German sample (N = 1906; 52% female) were collected between July and October 2021. A heteroscedastic ordered probit model was used for estimation. An empirical analysis provides evidence for a significant negative relationship between adults’ stigmatizing attitudes and their readiness to initiate mental health support for children (ß = −0.01; p < 0.001). Support acceptance seems to be independent of having children. To tackle stigmatizing attitudes and to promote public health, mental health literacy should be fostered through broad-based approaches. Awareness should be raised that children are also entitled to mental health care, just as they are in other health areas. Policy makers need to promote comprehensive information about mental illnesses and create incentives for acute and preventive service use.
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Affiliation(s)
- Stephanie Lange
- Clinic for Child and Adolescent Psychiatry/Psychotherapy, University Hospital of Ulm, Steinhövelstraße 5, 89075 Ulm, Germany
- Competence Area Mental Health Prevention in the Competence Network Preventive Medicine Baden-Württemberg, Clinic for Child and Adolescent Psychiatry/Psychotherapy, University Hospital of Ulm, Steinhövelstraße 5, 89075 Ulm, Germany
| | - Emily Gossmann
- Clinic for Child and Adolescent Psychiatry/Psychotherapy, University Hospital of Ulm, Steinhövelstraße 5, 89075 Ulm, Germany
- Competence Area Mental Health Prevention in the Competence Network Preventive Medicine Baden-Württemberg, Clinic for Child and Adolescent Psychiatry/Psychotherapy, University Hospital of Ulm, Steinhövelstraße 5, 89075 Ulm, Germany
| | - Sophie Hofmann
- Clinic for Child and Adolescent Psychiatry/Psychotherapy, University Hospital of Ulm, Steinhövelstraße 5, 89075 Ulm, Germany
- Competence Area Mental Health Prevention in the Competence Network Preventive Medicine Baden-Württemberg, Clinic for Child and Adolescent Psychiatry/Psychotherapy, University Hospital of Ulm, Steinhövelstraße 5, 89075 Ulm, Germany
- Leadership Personality Center Ulm (LPCU), University Ulm, Kornhausgasse 9, 89073 Ulm, Germany
| | - Jörg M. Fegert
- Clinic for Child and Adolescent Psychiatry/Psychotherapy, University Hospital of Ulm, Steinhövelstraße 5, 89075 Ulm, Germany
- Competence Area Mental Health Prevention in the Competence Network Preventive Medicine Baden-Württemberg, Clinic for Child and Adolescent Psychiatry/Psychotherapy, University Hospital of Ulm, Steinhövelstraße 5, 89075 Ulm, Germany
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7
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Edwards J, Wang L, Duncan L, Comeau J, Anderson KK, Georgiades K. Characterizing mental health related service contacts in children and youth: a linkage study of health survey and administrative data. Child Adolesc Psychiatry Ment Health 2022; 16:48. [PMID: 35729646 PMCID: PMC9215063 DOI: 10.1186/s13034-022-00483-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 06/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To inform the provision and organization of care, and to improve equitable access to mental health services for children and youth, we must first characterize the children and youth being served, taking into consideration factors related to mental health need. Our objective was to use a population-based survey linked with health administrative data to estimate mental health related contacts and determine socio-demographic correlates, after adjusting for factors related to mental health need. METHODS Data from the 2014 Ontario Child Health Study (OCHS) were linked at the individual level to health administrative databases from Ontario's Ministry of Health and Long-Term Care (MOHLTC). Mental health related service contacts were identified in the 6-months prior to the OCHS survey date. Service contacts with physicians were obtained from health administrative data, and non-physician service contacts from survey data (parent-report). RESULTS 21.7% of Ontarian children (4-11 years) and youth (12-17 years) had at least one mental health related contact in the 6-months prior to their OCHS survey date (18.8% non-physician, 8.0% physician, 5.2% both). Children and youth contacting both physician and non-physician services (ref. contact with physician or non-physician services alone) had higher mean symptom ratings of mental disorders across all classes of disorder. After adjusting for total symptom ratings, children and youth with immigrant parent(s) (ref. non-immigrant) (Prevalence Ratio: 0.65, 95% CI 0.55, 0.75) were less likely to have any mental health related service contact. CONCLUSIONS Results indicate that children and youth with the highest mental health symptom ratings are more likely to have contact with multiple providers across sectors. As such, the coordination of care across and within sectors are critical components of mental health related services for children and youth. Our results indicate that the greatest disparities in mental health related service contacts may exist for children and youth with immigrant parent(s) and that targeted outreach efforts are required to reduce barriers to care and improve equitable access to mental health related services for children and youth in Ontario.
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Affiliation(s)
- Jordan Edwards
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada. .,Offord Centre for Child Studies, McMaster University, Hamilton, ON, Canada.
| | - Li Wang
- grid.25073.330000 0004 1936 8227Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON Canada
| | - Laura Duncan
- grid.25073.330000 0004 1936 8227Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON Canada ,grid.25073.330000 0004 1936 8227Offord Centre for Child Studies, McMaster University, Hamilton, ON Canada
| | - Jinette Comeau
- grid.39381.300000 0004 1936 8884Department of Sociology, King’s University College, Western University, London, ON Canada
| | - Kelly K. Anderson
- grid.39381.300000 0004 1936 8884Department of Epidemiology & Biostatistics, Western University, London, ON Canada ,grid.39381.300000 0004 1936 8884Department of Psychiatry, Schulich School of Medicine, Western University, London, ON Canada ,grid.415847.b0000 0001 0556 2414Lawson Health Research Institute, London, ON Canada
| | - Katholiki Georgiades
- grid.25073.330000 0004 1936 8227Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON Canada ,grid.25073.330000 0004 1936 8227Offord Centre for Child Studies, McMaster University, Hamilton, ON Canada
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8
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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. Eur Child Adolesc Psychiatry 2022; 31:1-11. [PMID: 33656617 PMCID: PMC9343259 DOI: 10.1007/s00787-021-01737-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 02/05/2021] [Indexed: 10/24/2022]
Abstract
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.
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9
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Bøe T, Hysing M, Askeland KG, Skogen JC, Heradstveit O. Do Parental Education-Related Inequality Matter in Child and Adolescent Utilization of Mental Health Services: Results From a Norwegian Register Linkage Study. Health Serv Insights 2021; 14:11786329211055302. [PMID: 34916801 PMCID: PMC8669118 DOI: 10.1177/11786329211055302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/30/2021] [Indexed: 11/17/2022] Open
Abstract
Equitable access to health care point to equal access to care for those with equal needs, but pro-rich and pro-educated inequities have been documented in specialized mental health care utilization. This study aimed to investigate equity in Norwegian adolescents’ use of child and adolescent mental health services (CAMHS) with regards to parental education levels, using a survey of 10 257 Norwegian 16- to 19-year-olds subsequently linked to CAMHS data from the Norwegian Patient Registry (n = 970 had been in contact with CAMHS). Analyses using concentration indices (C) suggested adolescents with parents with lower education levels had more mental health problems (ie, larger need; C = −0.032, P < .001) and were more in contact with CAMHS (C = −0.025, P < .001). Regression analysis suggested that CAMHS contact, and number of unique admissions was largely distributed according to need, but participants whose parents had basic education levels were in contact with CAMHS for slightly longer than predicted from their self-reported mental health problems, age, and sex. Results from this study suggested that contact with CAMHS was largely equitable and mostly influenced by need. There was little evidence of parental education-related inequity in access to, and use of, specialized mental health services.
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Affiliation(s)
- Tormod Bøe
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway.,Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
| | - Mari Hysing
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway.,Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
| | - Kristin G Askeland
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
| | - Jens Christoffer Skogen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway.,Centre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
| | - Ove Heradstveit
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway.,Centre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
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10
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Wickersham A, Ford T, Stewart R, Downs J. Estimating the impact of child and early adolescent depression on subsequent educational attainment: secondary analysis of an existing data linkage. Epidemiol Psychiatr Sci 2021; 30:e76. [PMID: 35502824 PMCID: PMC8679834 DOI: 10.1017/s2045796021000603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 10/11/2021] [Accepted: 10/11/2021] [Indexed: 01/13/2023] Open
Abstract
AIMS Depression is thought to be associated with lower subsequent educational attainment during school. But, without longitudinal studies which take account of prior attainment and other potential confounders, estimates of the impact of clinically recognised depression in childhood and early adolescence are unknown. We investigated whether a clinical diagnosis of depression is associated with lower subsequent educational attainment, and whether the association is modified by gender, ethnicity and socioeconomic status. METHODS We conducted a secondary analysis of an existing administrative data linkage between national educational data and a large mental healthcare provider in London, UK (2007-2013). Depression diagnosis before age 15 (exposure) was measured from electronic health records, and subsequent educational attainment at age 15-16 (outcome) was measured from educational records. We fitted logistic regression models and adjusted for gender, ethnicity, socioeconomic status, relative age in school year, neurodevelopmental disorder diagnosis and prior attainment. We investigated effect modifiers using interaction terms. RESULTS In total, n = 63 623 were included in analysis, of whom n = 242 had record of a depression diagnosis before age 15. Depression was associated with lower odds of subsequently achieving expected attainment levels in national exams, after adjustment for all covariates (odds ratio = 0.60, 95% confidence interval = 0.43 to 0.84, p = 0.003). There was no evidence that gender, ethnicity or socioeconomic status modified this association. CONCLUSIONS These findings support a relationship between depression and lower subsequent educational attainment. This highlights the need for tailored educational interventions to support children and adolescents with depression, particularly in the lead up to key educational milestones.
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Affiliation(s)
- A. Wickersham
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - T. Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - R. Stewart
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - J. Downs
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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11
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Oh E, Mathers M, Hiscock H, Wake M, Bayer J. Professional help seeking for young children with mental health problems. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1111/ajpy.12072] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Elizabeth Oh
- Department of Psychology and Psychiatry, Monash University, Melbourne, Victoria, Australia,
| | - Megan Mathers
- Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia,
| | - Harriet Hiscock
- Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia,
- Centre for Community Child Health, Royal Children's Hospital, Melbourne, Victoria, Australia,
- Department of Pediatrics, Royal Children's Hospital, Melbourne, Victoria, Australia,
| | - Melissa Wake
- Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia,
- Centre for Community Child Health, Royal Children's Hospital, Melbourne, Victoria, Australia,
- Department of Pediatrics, Royal Children's Hospital, Melbourne, Victoria, Australia,
| | - Jordana Bayer
- Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia,
- School of Psychological Science, La Trobe University, Melbourne, Victoria, Australia,
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12
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Bryant A, Guy J, Holmes J. The Strengths and Difficulties Questionnaire Predicts Concurrent Mental Health Difficulties in a Transdiagnostic Sample of Struggling Learners. Front Psychol 2020; 11:587821. [PMID: 33329246 PMCID: PMC7717974 DOI: 10.3389/fpsyg.2020.587821] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/20/2020] [Indexed: 11/17/2022] Open
Abstract
Children and adolescents with developmental problems are at increased risk of experiencing mental health problems. The Strengths and Difficulties Questionnaire (SDQ) is widely used as a screener for detecting mental health difficulties in these populations, but its use thus far has been restricted to groups of children with diagnosed disorders (e.g., ADHD). Transdiagnostic approaches, which focus on symptoms and soften or remove the boundaries between traditional categorical disorders, are increasingly adopted in research and practice. The aim of this study was to assess the potential of the SDQ to detect concurrent mental health problems in a transdiagnostic sample of children. The sample were referred by health and educational professionals for difficulties related to learning (N = 389). Some had one diagnosis, others had multiple, but many had no diagnoses. Parent-rated SDQ scores were significantly positively correlated with parent ratings of mental health difficulties on the Revised Child Anxiety and Depression Scale (RCADS). Ratings on the SDQ Emotion subscale significantly predicted the likelihood of having concurrent clinical anxiety and depression scores. Ratings on the Hyperactivity subscale predicted concurrent anxiety levels. These findings suggest the SDQ could be a valuable screening tool for identifying existing mental health difficulties in children recognized as struggling, as it can be in typically developing children and those with specific diagnoses.
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Affiliation(s)
- Annie Bryant
- Department of Clinical Psychology, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Jacalyn Guy
- Medical Research Council (MRC) Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
| | - Joni Holmes
- Medical Research Council (MRC) Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
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Abstract
A substantial number of children experience persistent or recurrent problems and may need more than one episode of care. However, there is a paucity of research on recurrent service use. The present study examined the rates and predictors of re-accessing community-based care. Secondary data analyses were conducted on administrative data from 5 mental health agencies in Ontario (N = 1802). Approximately a third (29.6%) of children who had an episode of care re-accessed services again within 4 years; the median time to re-access was 386 days or 12.68 months. Social content (e.g., age, parental marital status) and treatment system (e.g., spacing of visits) variables predicted re-accessing services, although predictors varied based on how services were re-accessed. A better understanding of the factors that influence recurrent service use may help mental health agencies better prepare for and facilitate this process for families.
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Affiliation(s)
- David Saunders
- Clinical and Research Fellow, Child and Adult Psychiatry, Yale Child Study Center
| | - Hedy Kober
- Associate Professor, Department of Psychiatry, Department of Psychology, Cognitive Science Program, Interdepartmental Neuroscience Program, Yale University School of Medicine
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Reardon T, Harvey K, Creswell C. Seeking and accessing professional support for child anxiety in a community sample. Eur Child Adolesc Psychiatry 2020; 29:649-664. [PMID: 31410579 PMCID: PMC7250799 DOI: 10.1007/s00787-019-01388-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 08/05/2019] [Indexed: 11/17/2022]
Abstract
There is a lack of current data on help-seeking, and barriers to accessing professional support for child anxiety disorders. This study aimed to provide current data on the frequency and type of parental help-seeking, professional support received, and parent-reported barriers/facilitators in the context of child anxiety, and to explore factors associated with help-seeking, and parent-reported barriers among help-seekers and non help-seekers. We conducted a survey of help-seeking in parents of 222 children (aged 7-11) with elevated anxiety symptoms identified through screening in schools, 138 children of whom met diagnostic criteria for an anxiety disorder. Almost two-thirds (64.5%) of parents of children with an anxiety disorder reported seeking help from a professional; in 38.4% of cases parents reported that their child had received support from a professional to help manage and overcome their anxiety difficulties, and < 3% had received evidence-based treatment (CBT). Frequently reported parental barriers related to difficulties differentiating between developmentally appropriate and clinically significant anxiety, a lack of help-seeking knowledge, perceived negative consequences of help-seeking, and limited service provision. Non-help seekers were more likely than help seekers to report barriers related to thinking a child's anxiety may improve without professional support, and the absence of professional recognition. Findings identify the need for (i) tools for parents and primary school staff to help identify children who may benefit from professional support to overcome difficulties with anxiety; and (ii) increased evidence-based provision for child anxiety disorders, including delivery within schools and direct support for parents.
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Affiliation(s)
- Tessa Reardon
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Kate Harvey
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK.
| | - Cathy Creswell
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
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Parker C, Tejerina-Arreal M, Henley W, Goodman R, Logan S, Ford T. Are children with unrecognised psychiatric disorders being excluded from school? A secondary analysis of the British Child and Adolescent Mental Health Surveys 2004 and 2007. Psychol Med 2019; 49:2561-2572. [PMID: 30572975 DOI: 10.1017/s0033291718003513] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is limited research that explores the association between exclusion from school and mental health, but it seems intuitively plausible that the recognition of mental difficulties by key teachers and parents would influence the likelihood of exclusion from school. METHODS A secondary analysis of the British Child and Adolescent Mental Health survey 2004, (n = 7997) and the 2007 follow-up (n = 5326) was conducted. Recognition of difficulty was assessed via a derived variable that combined the first item of the Impact supplement of the Strengths and Difficulties Questionnaire which asked parents and teachers if they thought that the child has difficulties with emotions, behaviour and concentration, and the presence/absence of psychiatric disorder measured by the Development and Well-being Assessment. RESULTS Adjusted logistic regression models demonstrated that children with recognised difficulties were more likely to be excluded [adjusted odds ratio (OR) 5.78, confidence interval 3.45-9.64, p < 0.001], but children with unrecognised difficulties [adjusted OR 3.58 (1.46-8.81) p < 0.005] or recognised subclinical difficulties [adjusted OR 3.42 (2.04-5.73) p < 0.001] were also more likely to be excluded than children with no difficulties. Children with conduct disorder and attention deficit hyperactivity disorder were most likely to be excluded compared with other types of disorder. CONCLUSION Exclusion from school may result from a failure to provide timely and effective support rather than a failure to recognise psychopathology.
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Affiliation(s)
- Claire Parker
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - María Tejerina-Arreal
- College of Medicine and Health, University of Exeter, Exeter, UK
- Personality, Evaluation and Psychological Treatments Department, Faculty of Psychology, University of Murcia, Murcia, Spain
| | - William Henley
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Robert Goodman
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Stuart Logan
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Tamsin Ford
- College of Medicine and Health, University of Exeter, Exeter, UK
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Shelemy L, Harvey K, Waite P. Supporting students’ mental health in schools: what do teachers want and need? EMOTIONAL AND BEHAVIOURAL DIFFICULTIES 2019. [DOI: 10.1080/13632752.2019.1582742] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Lucas Shelemy
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Kate Harvey
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Polly Waite
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
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Anderson JK, Ford T, Soneson E, Coon JT, Humphrey A, Rogers M, Moore D, Jones PB, Clarke E, Howarth E. A systematic review of effectiveness and cost-effectiveness of school-based identification of children and young people at risk of, or currently experiencing mental health difficulties. Psychol Med 2019; 49:9-19. [PMID: 30208985 DOI: 10.1017/s0033291718002490] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Although school-based programmes for the identification of children and young people (CYP) with mental health difficulties (MHD) have the potential to improve short- and long-term outcomes across a range of mental disorders, the evidence-base on the effectiveness of these programmes is underdeveloped. In this systematic review, we sought to identify and synthesise evidence on the effectiveness and cost-effectiveness of school-based methods to identify students experiencing MHD, as measured by accurate identification, referral rates, and service uptake. METHOD Electronic bibliographic databases: MEDLINE, Embase, PsycINFO, ERIC, British Education Index and ASSIA were searched. Comparative studies were included if they assessed the effectiveness or cost-effectiveness of strategies to identify students in formal education aged 3-18 years with MHD, presenting symptoms of mental ill health, or exposed to psychosocial risks that increase the likelihood of developing a MHD. RESULTS We identified 27 studies describing 44 unique identification programmes. Only one study was a randomised controlled trial. Most studies evaluated the utility of universal screening programmes; where comparison of identification rates was made, the comparator test varied across studies. The heterogeneity of studies, the absence of randomised studies and poor outcome reporting make for a weak evidence-base that only generate tentative conclusions about the effectiveness of school-based identification programmes. CONCLUSIONS Well-designed pragmatic trials that include the evaluation of cost-effectiveness and detailed process evaluations are necessary to establish the accuracy of different identification models, as well as their effectiveness in connecting students to appropriate support in real-world settings.
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Affiliation(s)
- Joanna K Anderson
- NIHR CLAHRC East of England, University of Cambridge, Institute of Public Health,Douglas House,18 Trumpington Road,Cambridge CB2 8AH,UK
| | - Tamsin Ford
- University of Exeter Medical School,South Cloisters,St Luke's Campus,Exeter EX1 2LU,UK
| | - Emma Soneson
- Department of Psychiatry,University of Cambridge,Herschel Smith Building,Forvie Site,Robinson Way,Cambridge CB2 0SZ,UK
| | - Jo Thompson Coon
- University of Exeter Medical School,South Cloisters,St Luke's Campus,Exeter EX1 2LU,UK
| | - Ayla Humphrey
- Department of Psychiatry,University of Cambridge,Herschel Smith Building,Forvie Site,Robinson Way,Cambridge CB2 0SZ,UK
| | - Morwenna Rogers
- University of Exeter Medical School,South Cloisters,St Luke's Campus,Exeter EX1 2LU,UK
| | - Darren Moore
- Graduate School of Education,St Luke's Campus,Exeter EX1 2LU,UK
| | - Peter B Jones
- Department of Psychiatry,University of Cambridge,Herschel Smith Building,Forvie Site,Robinson Way,Cambridge CB2 0SZ,UK
| | - Emmet Clarke
- Norfolk and Suffolk NHS Foundation Trust,80 St Stephens Rd,Norwich NR1 3RE,UK
| | - Emma Howarth
- NIHR CLAHRC East of England, University of Cambridge, Institute of Public Health,Douglas House,18 Trumpington Road,Cambridge CB2 8AH,UK
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Hart T, O'Reilly M. 'The challenges of sharing information when a young person is experiencing severe emotional difficulties': implications for schools and CAMHS. Child Adolesc Ment Health 2018; 23:235-242. [PMID: 32677306 DOI: 10.1111/camh.12245] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Supporting the education of children and young people with complex emotional mental health difficulties requires schools to have knowledge of their needs. Exchanging information about less visible mental health difficulties is, however, known to be complex. Exploring the perceptions of young people experiencing problems can explicate some of this complexity and identify solutions. Yet their views are rarely given credence in this context. METHODS The findings were derived from a broader qualitative study exploring the school experiences of young people, aged 14-16 years, identified by CAMHS as having severe emotional difficulties. Their parents' and teachers' perceptions were also explored. Data were collected via semistructured interviews and analysed using thematic analysis. RESULTS Findings demonstrated that young people experiencing emotional difficulties need to feel safe about exchanging private information pertaining to their mental health. Teachers having a basic knowledge of mental health promoted their safety as this ensured confidentiality. Participants reported that CAMHS practitioners needed to be more proactive regarding the practicalities of exchanging information. CONCLUSIONS Arguably, teachers need to have basic knowledge of mental health and schools need clearer mental health confidentiality guidance. CAMHS also have responsibility in identifying more information exchange mechanisms and young service users and parents can play a part in this.
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Affiliation(s)
- Tania Hart
- Faculty of Health and Society, The University of Northampton, Northampton, UK
| | - Michelle O'Reilly
- School of Media, Communication and Sociology and School of Psychology, University of Leicester, Leicester, UK
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Kit PL, Teo CT, Tan M, Park Y. Singapore children’s online counselling experiences on a live chat portal. BRITISH JOURNAL OF GUIDANCE & COUNSELLING 2018. [DOI: 10.1080/03069885.2018.1485871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Phey Ling Kit
- Psychological Studies Academic Group, National Institute of Education, Nanyang Technological University, Singapore, Singapore
| | - Chua Tee Teo
- Psychological Studies Academic Group, National Institute of Education, Nanyang Technological University, Singapore, Singapore
| | - Meilinda Tan
- Psychological Studies Academic Group, National Institute of Education, Nanyang Technological University, Singapore, Singapore
| | - Yuhyun Park
- Psychological Studies Academic Group, National Institute of Education, Nanyang Technological University, Singapore, Singapore
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Mental Health Service Use Among Youth with Autism Spectrum Disorder: A Comparison of Two Age Groups. J Dev Behav Pediatr 2018; 39:20-27. [PMID: 29286984 DOI: 10.1097/dbp.0000000000000500] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Although youth with autism have elevated rates of mental health problems compared to typically developing youth, little is known about the mental health services that they receive. The current study examines predisposing, enabling, and clinical need factors as they relate to mental health service use in youth with autism. METHODS The current study surveyed parents of 2337 children and adolescents with autism, compared their access to behavioral management and mental health treatment (MHT), and isolated the correlates of such receipt. RESULTS Children used behavioral management more than adolescents, whereas the opposite was true for MHT. Mental health treatment receipt was associated with caregiver-related and mental health problems in both age groups, with routine health service use in children and with behavioral problems in adolescents. Behavioral management was correlated with caregiver-related services and behavioral problems in both age groups, and with sex and intellectual disability in adolescents. CONCLUSION Clinical needs and caregiver service use are consistently associated with mental health care across ages, whereas the role of youth characteristics is particularly relevant when considering service use for adolescents.
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Brimblecombe N, Knapp M, Murguia S, Mbeah-Bankas H, Crane S, Harris A, Evans-Lacko S, Ardino V, Iemmi V, King D. The role of youth mental health services in the treatment of young people with serious mental illness: 2-year outcomes and economic implications. Early Interv Psychiatry 2017; 11:393-400. [PMID: 26332590 DOI: 10.1111/eip.12261] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 07/12/2015] [Indexed: 11/30/2022]
Abstract
AIM This study aims to evaluate the outcomes and economic case for a UK innovative youth-specific mental health service for 16-25 year olds. METHODS A pre-, during- and post-treatment comparative design for 20 young people at high risk of developing psychosis who received 2 years' treatment with the service, using outcomes that concurred with the service aims: changes in mental health, employment rates and service use. RESULTS Forty-five percent of those at risk and with symptoms of serious mental illness commencing treatment were not receiving mental health services at baseline. Compared with service use prior to treatment at the youth-specific service, hospital admissions, Accident and Emergency, and criminal justice system use appear to decrease over the 2 years of treatment and the year after treatment, with potential cost differences of £473 000. Mental health improved or stayed the same, compared with baseline. Employment rates improved, although the sample size for this is very small. Potential cost differences associated with service users moving into employment over the 2 years are £148 000. The estimated cost over 2 years of providing the youth-specific mental health service to these young people was £106 000. CONCLUSIONS Given the extensive long-term negative consequences and high costs of untreated mental illness in the 16-25 age group and the documented problems young people have in receiving appropriate services, this youth-specific, age-appropriate service model appears to be successful, with improved outcomes and cost differences in the short-term, and with encouraging implications for the longer term.
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Affiliation(s)
- Nicola Brimblecombe
- Personal Social Services Research Unit, London School of Economics & Political Science, London, UK
| | - Martin Knapp
- Personal Social Services Research Unit, London School of Economics & Political Science, London, UK
| | | | | | - Steve Crane
- Tower Hamlets Early Detection Service, London, UK
| | - Abi Harris
- Tower Hamlets Early Detection Service, London, UK
| | | | - Vittoria Ardino
- Personal Social Services Research Unit, London School of Economics & Political Science, London, UK
| | - Valentina Iemmi
- Personal Social Services Research Unit, London School of Economics & Political Science, London, UK
| | - Derek King
- Personal Social Services Research Unit, London School of Economics & Political Science, London, UK
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O’Toole C. Towards dynamic and interdisciplinary frameworks for school-based mental health promotion. HEALTH EDUCATION 2017. [DOI: 10.1108/he-11-2016-0058] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to scrutinise two ostensibly disparate approaches to school-based mental health promotion and offer a conceptual foundation for considering possible synergies between them.
Design/methodology/approach
The paper examines current conceptualisations of child and youth mental health and explores how these inform school-based prevention and intervention approaches. The dominance of discrete, “expert-driven” psychosocial programmes as well as the potential of critical pedagogy is explored using frameworks provided by contemporary dynamic systems theories. These theories call for a situated and holistic understanding of children’s development; and they look beyond static characteristics within individuals, to view well-being in relation to the dynamic social and historical contexts in which children develop.
Findings
Psychosocial interventions and critical pedagogies have strengths but also a number of limitations. Traditional psychosocial interventions teach important skill sets, but they take little account of children’s dynamic socio-cultural contexts, nor acknowledge the broader inequalities that are frequently a root cause of children’s distress. Critical pedagogies, in turn, are committed to social justice goals, but these goals can be elusive or seem unworkable in practice. By bringing these seemingly disparate approaches into conversation, it may be possible to harness their respective strengths, in ways that are faithful to the complex, emergent nature of children’s development, as well as committed to correcting inequalities.
Originality/value
The current paper is unique in bringing together contemporary psychological theory with critical pedagogy perspectives to explore the future of school-based mental health promotion.
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Ford T, Macdiarmid F, Russell AE, Racey D, Goodman R. The predictors of persistent DSM-IV disorders in 3-year follow-ups of the British Child and Adolescent Mental Health Surveys 1999 and 2004. Psychol Med 2017; 47:1126-1137. [PMID: 27995813 DOI: 10.1017/s0033291716003214] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND The identification of the factors that influence the persistence of psychiatric disorder may assist practitioners to focus on young people who are particularly prone to poor outcomes, but population-based samples of sufficient size are rare. METHOD This secondary analysis combined data from two large, population-based cross-sectional surveys in Great Britain (1999 and 2004) and their respective follow-ups (2002 and 2007), to study homotypic persistence among the 998 school-age children with psychiatric disorder at baseline. Psychiatric disorder was measured using the Development and Well-Being Assessment applying DSM-IV criteria. Factors relating to the child, family, and the severity and type of psychopathology at baseline were analysed using logistic regression. RESULTS Approximately 50% of children with at least one psychiatric disorder were assigned the same diagnostic grouping at 3-year follow-up. Persistent attention-deficit/hyperactivity disorder and anxiety were predicted by poor peer relationship scores. Persistent conduct disorder was predicted by intellectual disability, rented housing, large family size, poor family function and by severer baseline psychopathology scores. CONCLUSIONS Homotypic persistence was predicted by different factors for different groups of psychiatric disorders. Experimental research in clinical samples should explore whether these factors also influence response to interventions.
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Affiliation(s)
- T Ford
- University of Exeter Medical School,Exeter,Devon,UK
| | - F Macdiarmid
- King's College London,Institute of Psychiatry,London,UK
| | - A E Russell
- University of Exeter Medical School,Exeter,Devon,UK
| | - D Racey
- University of Exeter Medical School,Exeter,Devon,UK
| | - R Goodman
- King's College London,Institute of Psychiatry,London,UK
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O’Toole CA, Furlong M, McGilloway S, Bjørndal A. Preschool and school-based mindfulness programmes for improving mental health and cognitive functioning in young people aged 3 to 18 years. Hippokratia 2017. [DOI: 10.1002/14651858.cd012518] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Mairead Furlong
- Maynooth University Department of Psychology; National University of Ireland Maynooth; Maynooth Ireland
| | - Sinead McGilloway
- Maynooth University Department of Psychology (Mental Health and Social Research Unit); National University of Ireland Maynooth; Maynooth Ireland
| | - Arild Bjørndal
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP); Oslo Norway
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Fuggle P, McHugh A, Gore L, Dixon E, Curran D, Cutinha D. Can we improve service efficiency in CAMHS using the CAPA approach without reducing treatment effectiveness? J Child Health Care 2016; 20:195-204. [PMID: 25573900 DOI: 10.1177/1367493514563856] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Health-care systems are under increasing pressure to deliver more care with similar or even less resources and there is concern that this may be achieved at the cost of reduced clinical effectiveness. In Child and Adolescent Mental Health Services (CAMHS), the Choice and Partnership Approach (CAPA) has been widely adopted as a way of increasing the efficient use of limited service resources. Some evaluations have reported increased patient flow and reduced waiting times, but it remains unknown whether such changes have been achieved at a cost of clinical effectiveness. This article describes a pragmatic multi-method evaluation of a CAMHS service reporting service outcomes (client satisfaction, waiting times, and patient flow) and clinical outcomes (clinician-rated clinical outcomes and goals achieved by families). Results showed improved service outcomes (high levels of client satisfaction and reduced waiting times) and an increase in patient flow (49 cases increased to 72 cases over an equivalent time period). Clinical outcomes showed no reduction in effectiveness and a significant improvement against the agreed goals of the intervention. The evaluation suggested that a well-structured goal-focused patient flow system may improve services by increasing patient flow while maintaining high satisfaction levels, without negatively impacting clinical effectiveness.
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Affiliation(s)
- Peter Fuggle
- Islington CAMHS, Whittington Health NHS Trust, Northern Health Centre, London, UK
| | - Annie McHugh
- Islington CAMHS, Whittington Health NHS Trust, Northern Health Centre, London, UK
| | - Lucy Gore
- Islington CAMHS, Whittington Health NHS Trust, Northern Health Centre, London, UK
| | - Emily Dixon
- Islington CAMHS, Whittington Health NHS Trust, Northern Health Centre, London, UK
| | - Daniel Curran
- Islington CAMHS, Whittington Health NHS Trust, Northern Health Centre, London, UK
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New evidence of factor structure and measurement invariance of the SDQ across five European nations. Eur Child Adolesc Psychiatry 2015; 24:1523-34. [PMID: 26036862 DOI: 10.1007/s00787-015-0729-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 05/23/2015] [Indexed: 12/22/2022]
Abstract
The main purpose of the present study was to analyse the internal structure and to test the measurement invariance of the Strengths and Difficulties Questionnaire (SDQ), self-reported version, in five European countries. The sample consisted of 3012 adolescents aged between 12 and 17 years (M = 14.20; SD = 0.83). The five-factor model (with correlated errors added), and the five-factor model (with correlated errors added) with the reverse-worded items allowed to cross-load on the Prosocial subscale, displayed adequate goodness of-fit indices. Multi-group confirmatory factor analysis showed that the five-factor model (with correlated errors added) had partial strong measurement invariance by countries. A total of 11 of the 25 items were non-invariant across samples. The level of internal consistency of the Total difficulties score was 0.84, ranging between 0.69 and 0.78 for the SDQ subscales. The findings indicate that the SDQ's subscales need to be modified in various ways for screening emotional and behavioural problems in the five European countries that were analysed.
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Ryan SM, Jorm AF, Toumbourou JW, Lubman DI. Parent and family factors associated with service use by young people with mental health problems: a systematic review. Early Interv Psychiatry 2015; 9:433-46. [PMID: 25762206 DOI: 10.1111/eip.12211] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Accepted: 11/09/2014] [Indexed: 11/26/2022]
Abstract
AIM To conduct a systematic review of parent and family factors associated with service use for young people with mental health problems, to inform early intervention efforts aimed at increasing service use by young people. METHODS A systematic search of academic databases was performed. Articles were included in the review if they had: a sample of young people aged between 5 and 18 years; service use as the outcome measure; one or more parental or family variables as a predictor; and a comparison group of non-service using young people with mental health problems. In order to focus on factors additional to need, the mental health symptoms of the young person also had to be controlled for. Stouffer's method of combining P-values was used to draw conclusions as to whether or not associations between variables were reliable. RESULTS Twenty-eight articles were identified investigating 15 parental or family factors, 7 of which were found to be associated with service use for a young person with mental health needs: parental burden, parent problem perception, parent perception of need, parent psychopathology, single-parent household, change in family structure and being from the dominant ethnic group for the United States specifically. Factors not found to be related to service use were: family history of service use, parent-child relationship quality, family functioning, number of children, parent education level, parent employment status, household income and non-urban location of residence. CONCLUSIONS A number of family-related factors were identified that can inform effective interventions aimed at early intervention for mental health problems. Areas requiring further research were also identified.
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Affiliation(s)
- Siobhan M Ryan
- School of Psychology and Centre for Mental Health and Wellbeing Research, Deakin University, Melbourne, Victoria, Australia
| | - Anthony F Jorm
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - John W Toumbourou
- School of Psychology and Centre for Mental Health and Wellbeing Research, Deakin University, Melbourne, Victoria, Australia
| | - Dan I Lubman
- Turning Point Alcohol and Drug Centre, Eastern Health and Monash University, Melbourne, Victoria, Australia
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Stallard P, Skryabina E, Taylor G, Anderson R, Ukoumunne OC, Daniels H, Phillips R, Simpson N. A cluster randomised controlled trial comparing the effectiveness and cost-effectiveness of a school-based cognitive–behavioural therapy programme (FRIENDS) in the reduction of anxiety and improvement in mood in children aged 9/10 years. PUBLIC HEALTH RESEARCH 2015. [DOI: 10.3310/phr03140] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundAnxiety in children is common, impairs everyday functioning and increases the risk of severe mental health disorders in adulthood, yet few children with anxiety are identified and referred for treatment.ObjectiveTo investigate the clinical effectiveness and cost-effectiveness of a universal school-based preventative programme (FRIENDS) in reducing symptoms of anxiety and low mood.DesignCluster randomised controlled trial. Schools (n = 41) were randomly assigned after recruitment on a 1 : 1 : 1 basis to health-led FRIENDS, school-led FRIENDS and usual school provision.SettingPrimary schools in three local education authorities in the south-west of England.ParticipantsChildren (n = 1362) aged 9–10 years attending school and participating in personal, social and health education (PSHE).InterventionsThe FRIENDS programme is a cognitive–behavioural therapy programme that develops skills to counter the cognitive, emotional and behavioural aspects of anxiety. The FRIENDS programme was led by either a trained member of the school or a health leader external to the school and was delivered over 9 consecutive weeks. The comparison group received usual school PSHE lessons. Interventions were delivered in the academic year September 2011–July 2012.Main outcome measuresClinical effectiveness assessed by child report of symptoms of anxiety (Revised Child Anxiety and Depression Scale, RCADS); cost-effectiveness based on RCADS and quality-adjusted life-years (Child Health Utility 9 Dimensions, CHU-9D) between baseline and 6 months; process evaluation, evaluation of reach and attrition and qualitative feedback from children, school staff and parents.ResultsAt 12 months there was a difference in the adjusted mean RCADS scores for health-led FRIENDS compared with school-led FRIENDS [–3.91, 95% confidence interval (CI) –6.48 to –1.35] and for health-led FRIENDS compared with usual school provision (–2.66, 95% CI –5.22 to –0.09). At 24 months we were able to assess only 43.6% of our cohort. There were few differences in baseline characteristics between completers and non-completers. Child-reported anxiety in all three groups had reduced by 24 months and there were no longer any group effects. There were no between-group effects for any parent- or child-completed secondary outcomes at 12 or 24 months. The cost of the FRIENDS programme was £52–56 per child. We found no evidence that the FRIENDS programme was cost-effective over a 6-month period; however, our subgroup for the economic analysis differed significantly from our main trial cohort.ConclusionsAlthough greater reductions in anxiety were noted at 12 months when the FRIENDS programme was delivered by health leaders, these additional benefits were not maintained at 24 months. Children’s anxiety levels improved irrespective of the intervention that they received. Our economic evaluation and 24-month assessment had significant shortcomings. However, the universal delivery of specific anxiety prevention programmes will result in additional costs that may be beyond the finances available to most schools. Future work should identify the active ingredients and potential moderators of universal anxiety programmes to determine whether programme length can be reduced, short-term effectiveness maintained and cost-effectiveness improved. At present, our results find limited evidence to support the universal provision of specific anxiety prevention programmes in UK primary schools.Trial registrationCurrent Controlled Trials ISRCTN23563048.FundingThe National Institute for Health Research Public Health Research programme.
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Affiliation(s)
| | | | | | - Rob Anderson
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | | | - Harry Daniels
- Department of Education, University of Oxford, Oxford, UK
| | - Rhiannon Phillips
- Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK
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Ortuño-Sierra J, Chocarro E, Fonseca-Pedrero E, Riba SSI, Muñiz J. The assessment of emotional and Behavioural problems: Internal structure of The Strengths and Difficulties Questionnaire. Int J Clin Health Psychol 2015; 15:265-273. [PMID: 30487843 PMCID: PMC6225034 DOI: 10.1016/j.ijchp.2015.05.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 05/22/2015] [Indexed: 11/18/2022] Open
Abstract
The main purpose of this study was to analyze the internal structure and measurement invariance across gender and age of the Strengths and Difficulties Questionnaire (SDQ), self-reported version, in Spanish adolescents. The sample consisted of 1,547 participants, 606 were male (39.1%), with a mean age of 15.15 years (SD = 1.99). Results from the confirmatory factor analysis showed a five-factor model and a bifactor model with correlated errors added as the most appropriate. Nevertheless, the bifactor model displayed lower and non-significant factor loadings. The hypothesis of measurement invariance of the SDQ scores across gender and age was supported. The level of internal consistency of the Total difficulties score was .84, ranging between .71 and .75 for the SDQ subscales. The study of the psychometric properties showed that the Spanish version of the SDQ, self-reported form, seems to be an adequate tool for the screening of emotional and behavioural problems during adolescence. Future research should analyze the internal structure of the SDQ in other regions and testing the measurement invariance across cultures.
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Affiliation(s)
| | | | - Eduardo Fonseca-Pedrero
- Universidad de La Rioja, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | | | - José Muñiz
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
- Universidad de Oviedo, Spain
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Hintzpeter B, Klasen F, Schön G, Voss C, Hölling H, Ravens-Sieberer U. Mental health care use among children and adolescents in Germany: results of the longitudinal BELLA study. Eur Child Adolesc Psychiatry 2015; 24:705-13. [PMID: 25651821 DOI: 10.1007/s00787-015-0676-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Accepted: 01/03/2015] [Indexed: 10/24/2022]
Abstract
Data on mental health care use of children and adolescents in Germany is scarce. This study investigates the degree of mental health care use, its trajectories and influencing factors among children and adolescents in Germany, using longitudinal data of the BELLA study. The BELLA study is the mental health module of the representative German National Health Interview and Examination Survey for children and adolescents (KiGGS). Baseline data of N = 2,863 participants aged 7-17 years were collected between 2003 and 2006. The study sample was followed up in three additional measurement points, assessing general mental health problems and impairment, specific mental health problems, and mental health care use. In the current study, we analysed data from the first three measurement points. At baseline, 5.9 % of all participants used mental health care in the past 12 months. Among those with general mental health problems, 29.5 % sought professional help. Only a minority of participants reporting mental health care use at baseline also sought help at the following two measurement points. Analysing a random intercept only model, mental health care use was found to be more likely among participants living in larger communities as well as in the Eastern part of Germany, among those participants with impairment of mental health problems, and signs of externalizing problems. Our results indicate a temporary character of mental health care use. Participants' impairment was identified to be the strongest predictor of mental health care use.
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Affiliation(s)
- Birte Hintzpeter
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany,
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Predictors of and barriers to service use for children at risk of ADHD: longitudinal study. Eur Child Adolesc Psychiatry 2015; 24:545-52. [PMID: 25201055 DOI: 10.1007/s00787-014-0606-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 08/19/2014] [Indexed: 12/19/2022]
Abstract
Many children with, or at risk of, ADHD do not receive healthcare services for their difficulties. This longitudinal study investigates barriers to and predictors of specialist health service use. This is a 5-year follow-up study of children who participated in a cluster randomised controlled trial, which investigated school-level interventions (provision of books with evidence-based information and/or feedback of names of children) for children at risk of ADHD. 162 children who had high levels of ADHD symptoms at age 5 (baseline) were followed up at age 10 years. Using baseline data and follow-up information collected from parents and teachers, children who had and had not used specialist health services over the follow-up period were compared and predictors (symptom severity, comorbid problems, parental perception of burden, parental mental health, and socio-demographic factors) of specialist service use investigated. The most common parent-reported barrier reflected lack of information about who could help. Amongst children using specialist health services who met criteria for ADHD at follow-up, 36% had been prescribed stimulant medication. Specialist health service use was associated with each one-point increase in teacher-rated symptoms at baseline [inattention symptoms (adjusted OR = 1.40; 95% CI 1.12-1.76) and hyperactivity/impulsivity symptoms (adjusted OR = 1.23; 95% CI 1.05-1.44)]. Parental mental health problems were also independently associated with service use (for each one-point increase in symptoms, adjusted OR = 1.41; 95% CI 1.04-1.91). Severity of teacher-rated ADHD symptoms in early school years is a determinant of subsequent service use. Clinicians and teachers should be aware that parental mental health problems are independently associated with service use for children at risk of ADHD.
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Gronholm PC, Ford T, Roberts RE, Thornicroft G, Laurens KR, Evans-Lacko S. Mental health service use by young people: the role of caregiver characteristics. PLoS One 2015; 10:e0120004. [PMID: 25811867 PMCID: PMC4374853 DOI: 10.1371/journal.pone.0120004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 01/19/2015] [Indexed: 12/21/2022] Open
Abstract
AIMS Many children and adolescents experiencing mental health problems do not receive appropriate care. Strategies to encourage appropriate access to services might be improved by a more detailed understanding of service use determinants within this group. In view of caregivers' key role in young people's pathways to care, this study aimed to advance understanding of caregiver-related characteristics that influence service use among young people. METHODS We interviewed 407 primary caregivers of young people aged 9-18 years, recruited from a Greater London (United Kingdom) community sample. Caregivers reported on young people's service use in health care sector and/or education settings, and caregivers' intended stigmatising behaviours, help-seeking attitudes, and personal service use. Logistic regression analyses examined the relationship between these caregiver characteristics and young people's service use, controlling for young people's clinical and socio-demographic factors. RESULTS Caregivers' intended stigmatising behaviours in particular exerted a strong influence on young people's service use within each service setting. The impact of this characteristic interacted with caregivers' service use in influencing young people's service use across health care and education settings and health care settings specifically. For young people's service use within education settings, caregivers' intended stigmatising behaviours score had a main effect. CONCLUSIONS This study highlights the key role caregivers' attitudes and experiences hold in young people's service use. The findings indicate that strategies aiming to bridge the gap between young people's service needs and utilisation might be improved by targeting stigma amongst caregivers.
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Affiliation(s)
- Petra C. Gronholm
- Health Service and Population Research Department, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Tamsin Ford
- Institute of Health Research, University of Exeter Medical School, Exeter, United Kingdom
| | - Ruth E. Roberts
- Department of Forensic and Neurodevelopmental Science, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Graham Thornicroft
- Health Service and Population Research Department, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Kristin R. Laurens
- Department of Forensic and Neurodevelopmental Science, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
- School of Psychiatry, University of New South Wales, Sydney, Australia
- Schizophrenia Research Institute, Sydney, Australia
| | - Sara Evans-Lacko
- Health Service and Population Research Department, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
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Ortuño-Sierra J, Fonseca-Pedrero E, Paino M, Sastre i Riba S, Muñiz J. Screening mental health problems during adolescence: psychometric properties of the Spanish version of the Strengths and Difficulties Questionnaire. J Adolesc 2014; 38:49-56. [PMID: 25460680 DOI: 10.1016/j.adolescence.2014.11.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 11/05/2014] [Accepted: 11/06/2014] [Indexed: 11/29/2022]
Abstract
The main purpose of the present study was to test the psychometric properties of the Strength and Difficulties Questionnaire (SDQ), self-reported version, in Spanish adolescents, introducing a five-point Likert response scale. The sample consisted of 1474 adolescents with a mean age of 15.92 years (SD = 1.18). The level of internal consistency of the SDQ Total score was .75, ranging from .56 to .71 for the subscales. Results from exploratory factor analysis revealed a three-factor structure as the most satisfactory. Confirmatory factor analyses showed that the five-factor model (with modifications) displayed better goodness of-fit indices than the other hypothetical dimensional models tested. Furthermore, strong measurement invariance by age and partial measurement invariance by gender was supported. The study of the psychometric properties confirms that the Spanish version of the SDQ, self-reported form, is a useful tool for the screening of emotional and behavioural problems in adolescents.
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Affiliation(s)
| | | | | | | | - José Muñiz
- Department of Psychology, University of Oviedo, Spain; Center for Biomedical Research in the Mental Health Network (CIBERSAM), Spain
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35
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Savina E, Moskovtseva L, Naumenko O, Zilberberg A. How Russian teachers, mothers and school psychologists perceive internalising and externalising behaviours in children. EMOTIONAL AND BEHAVIOURAL DIFFICULTIES 2014. [DOI: 10.1080/13632752.2014.891358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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36
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Bevaart F, Mieloo CL, Wierdsma A, Donker MCH, Jansen W, Raat H, Verhulst FC, van Oort FVA. Ethnicity, socioeconomic position and severity of problems as predictors of mental health care use in 5- to 8-year-old children with problem behaviour. Soc Psychiatry Psychiatr Epidemiol 2014; 49:733-42. [PMID: 24077635 DOI: 10.1007/s00127-013-0761-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 08/30/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Empirical research on mental health care use and its determinants in young school-aged children is still scarce. In this study, we investigated the role of ethnicity, socioeconomic position (SEP) and perceived severity by both parents and teachers on mental health care use in 5- to 8-year old children with emotional and/or behavioural problems. METHODS Data from 1,269 children with a high score([P90) on the Strengths and Difficulties Questionnaire (SDQ) in the school year 2008–2009 were linked to psychiatric case register data over the years 2010–2011. Cox proportional hazards models were used to predict mental health care use from ethnicity, SEP and perceived severity of the child's problems. RESULTS During the follow-up period, 117 children with high SDQ scores (9.2 %) had used mental health care for the first time. Ethnic minority children were less likely to receive care than Dutch children (HR Moroccan/Turkish:0.26; 95 % CI 0.13-0.54, HR other ethnicity: 0.26; 95 %CI 0.12-0.58). No socioeconomic differences were found.After correction for previous care use, ethnicity and parental perceived severity, impact score as reported by teachers was significantly associated with mental healthcare use (HR 1.58; 95 % CI 1.01–2.46). CONCLUSIONS Ethnicity is an important predictor of mental health care use in young children. Already in the youngest school-aged children, ethnic differences in the use of mental health care are present.A distinct predictor of care use in this age group is severity of emotional and behavioural problems as perceived by teachers. Therefore, teachers may be especially helpful in the process of identifying young children who need specialist mental health care.
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Reijneveld SA, Wiegersma PA, Ormel J, Verhulst FC, Vollebergh WAM, Jansen DEMC. Adolescents' use of care for behavioral and emotional problems: types, trends, and determinants. PLoS One 2014; 9:e93526. [PMID: 24699408 PMCID: PMC3974777 DOI: 10.1371/journal.pone.0093526] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Accepted: 03/07/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE While adolescents use various types of care for behavioral and emotional problems, evidence on age trends and determinants per type is scarce. We aimed to assess use of care by adolescents because of behavioral and emotional problems, overall and by type, and its determinants, for ages 10-19 years. METHODS We obtained longitudinal data on 2,230 adolescents during ages 10-19 from four measurements regarding use of general care and specialized care (youth social care and mental healthcare) in the preceding 6 months, the Child Behavior Checklist (CBCL) and Youth Self-Report, and child and family characteristics. We analyzed data by multilevel logistic regression. RESULTS Overall rates of use increased from 20.1% at age 10/11 to 32.2% at age 19: general care was used most. At age 10/11 use was higher among boys, at age 19 among girls. Use of general care increased for both genders, whereas use of specialized care increased among girls but decreased among boys. This differential change was associated with CBCL externalizing and internalizing problems, school problems, family socioeconomic status, and parental divorce. Preceding CBCL problems predicted more use: most for mental health care and least for general care. Moreover, general care was used more frequently by low and medium socioeconomic status families, with odds ratios (95%-confidence intervals): 1.52 (1.23;1.88) and 1.40 (1.17;1.67); youth social care in case of parental divorce, 2.07 (1.36;3.17); and of special education, 2.66 (1.78;3.95); and mental healthcare in case of special education, 2.66 (1.60;4.51). DISCUSSION Adolescents with behavioral and emotional problems use general care most frequently. Overall use increases with age. Determinants of use vary per type.
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Affiliation(s)
- Sijmen A. Reijneveld
- University Medical Center Groningen, University of Groningen, Department of Health Sciences, Groningen, the Netherlands
| | - P. Auke Wiegersma
- University Medical Center Groningen, University of Groningen, Department of Health Sciences, Groningen, the Netherlands
| | - Johan Ormel
- University Medical Center Groningen, University of Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation, Groningen, the Netherlands
| | - Frank C. Verhulst
- Erasmus Medical Center, Department of Child and Adolescent Psychiatry, Rotterdam, the Netherlands
| | | | - Danielle E. M. C. Jansen
- University Medical Center Groningen, University of Groningen, Department of Health Sciences, Groningen, the Netherlands
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Stallard P, Taylor G, Anderson R, Daniels H, Simpson N, Phillips R, Skryabina E. The prevention of anxiety in children through school-based interventions: study protocol for a 24-month follow-up of the PACES project. Trials 2014; 15:77. [PMID: 24624990 PMCID: PMC3995629 DOI: 10.1186/1745-6215-15-77] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 02/11/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anxiety in children is common and incapacitating and increases the risk of mental health disorders in adulthood. Although effective interventions are available, few children are identified and referred for specialist treatment. Alternative approaches in which prevention programmes are delivered in school appear promising. However, comparatively little is known about the best intervention leader (health care-led vs. school-led), long-term effects or the primary preventive value of such programmes. METHODS/DESIGN Preventing Anxiety in Children through Education in Schools, or PACES, is a pragmatic cluster randomised controlled trial evaluating the effectiveness of a cognitive-behavioural therapy prevention programme (FRIENDS) on symptoms of anxiety and low mood in 9- to 10-year-old children. Forty-one schools were randomly assigned to one of three conditions: school-led FRIENDS, health care-led FRIENDS or treatment as usual. Assessments were undertaken at baseline, 6 months and 12 months, with the primary outcome measure being the Revised Child Anxiety and Depression Scale score at 12 months. Secondary outcome measures are changes in self-esteem, worries, bullying and life satisfaction. DISCUSSION This protocol summarises the procedure for the 24-month follow-up of this cohort. The study will determine the medium-term effectiveness of an anxiety prevention programme delivered in schools. TRIAL REGISTRATION ISRCTN23563048.
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Affiliation(s)
- Paul Stallard
- Department for Health, University of Bath, 22-23 Eastwood, Bath BA2 7AY, UK
| | - Gordon Taylor
- Department for Health, University of Bath, 22-23 Eastwood, Bath BA2 7AY, UK
| | - Rob Anderson
- University of Exeter Medical School, The Veysey Building, Salmon Pool Lane, Exeter EX2 4SG, UK
| | - Harry Daniels
- Department of Education, University of Oxford, 15 Norham Gardens, Oxford OX2 6PY, UK
| | - Neil Simpson
- Sirona Care and Health, Headquarters building, Bath BA2 5RP, UK
| | - Rhiannon Phillips
- Wales School for Primary Care Research, Cardiff University School of Medicine, Heath Park, Cardiff CF14 4XN, UK
| | - Elena Skryabina
- Department for Health, University of Bath, 22-23 Eastwood, Bath BA2 7AY, UK
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Mueller J, M. Callanan M, Greenwood K. Parents' communication to primary school-aged children about mental health and ill-health: a grounded theory study. JOURNAL OF PUBLIC MENTAL HEALTH 2014. [DOI: 10.1108/jpmh-09-2013-0063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– Stigma around mental health problems is known to emerge in middle childhood and persist into adulthood, yet almost nothing is known about the role of parents in this process. This paper aims to develop a model of parental communication to primary school-aged children around mental health and ill-health, to increase understanding about how stigma develops.
Design/methodology/approach
– Semi-structured interviews were performed with ten UK-based parents of children aged 7-11 years. Analysis followed an exploratory grounded theory approach, incorporating quality assurance checks.
Findings
– Parents’ communications are governed by the extent to which they view a particular issue as related to “Them” (mental ill-health) or to “Us” (mental health). In contrast to communication about “Us”, parental communication about mental “illness” is characterized by avoidance and contradiction, and driven by largely unconscious processes of taboo and stigma.
Originality/value
– This study was the first to explore parents’ communications to their 7-11 year old children about mental health and mental illness, and proposes a preliminary theoretical model that may offer insight into the development of stigma in childhood and the intergenerational transmission of stigmatized attitudes.
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Ortuño-Sierra J, Fonseca-Pedrero E, Paíno M, Aritio-Solana R. [Prevalence of emotional and behavioral symptomatology in Spanish adolescents]. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2014; 7:121-30. [PMID: 24530346 DOI: 10.1016/j.rpsm.2013.12.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 10/09/2013] [Accepted: 12/23/2013] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The main purpose of this study was to examine the prevalence of symptoms of an emotional and behavioral nature, as well as prosocial type capabilities, measured using the Strengths and Difficulties Questionnaire, in non-clinical adolescents. METHOD The final sample was composed of a total of 508 students, 208 male (40.9%). The age of participants ranged from 11 to 18 years (M=13.91 years; SD=1.71). RESULTS The results show that a significant number of adolescents self-reported emotional and behavioral problems. The mean scores of the Strengths and Difficulties Questionnaire subscales varied according the gender and age of the adolescents. CONCLUSIONS In the present study, the prevalence of psychological difficulties among adolescents was similar to that reported in other national and international studies. In view of these results, there is a need to develop programs for the early detection of these types of problems in schools in children and adolescents ages.
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Affiliation(s)
- Javier Ortuño-Sierra
- Departamento de Ciencias de la Educación, Universidad de La Rioja, Logroño, España.
| | - Eduardo Fonseca-Pedrero
- Departamento de Ciencias de la Educación, Universidad de La Rioja, Logroño, España; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), España
| | - Mercedes Paíno
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), España; Departamento de Psicología, Universidad de Oviedo, Oviedo, España
| | - Rebeca Aritio-Solana
- Departamento de Ciencias de la Educación, Universidad de La Rioja, Logroño, España
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Lillevoll KR, Vangberg HCB, Griffiths KM, Waterloo K, Eisemann MR. Uptake and adherence of a self-directed internet-based mental health intervention with tailored e-mail reminders in senior high schools in Norway. BMC Psychiatry 2014; 14:14. [PMID: 24443820 PMCID: PMC3901754 DOI: 10.1186/1471-244x-14-14] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 01/16/2014] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Internet-based cognitive behavioural therapy (ICBT) is a promising approach to the prevention and reduction of depressive symptoms among adolescents. This study aimed to evaluate the feasibility and efficacy of disseminating a self-directed internet-based mental health intervention (MoodGYM) in senior high schools. It also sought to investigate possible effects of tailored and weekly e-mail reminders on initial uptake and adherence to the intervention. METHOD A baseline survey was conducted in four senior high schools in two Norwegian municipalities (n = 1337). 52.8% (707/1337) of the students consented to further participation in the trial and were randomly allocated to one of three MoodGYM intervention groups (tailored weekly e-mail reminder (n = 175), standardized weekly e-mail reminder (n = 176 ) or no e-mail reminder (n = 175)) or a waitlist control group (n = 180). We tested for effects of the intervention on depression and self-esteem using multivariate analysis of variance, effects of tailored e-mail and self-reported current need of help on initial uptake of the intervention using logistic regression and the effect of weekly e-mails on adherence using ordinal regression. RESULTS There was substantial non-participation from the intervention, with only 8.5% (45/527) participants logging on to MoodGYM, and few proceeding beyond the first part of the programme. No significant effect on depression or self-esteem was found among the sample as a whole or among participants with elevated depression scores at baseline. Having a higher average grade in senior high school predicted initial uptake of the intervention, but tailored e-mail and self-reported current need of help did not. Weekly e-mail prompts did not predict adherence. The main reasons for non-use reported were lack of time/forgetting about it and doubt about the usefulness of the program. CONCLUSION Overall, disseminating a self-directed internet-based intervention to a school population proved difficult despite steps taken to reduce barriers in terms of tailoring feedback and dispatching weekly e-mail reminders. Providing mental health interventions within the school environment is likely to ensure better uptake among senior high school students, but there is a need to effectively communicate that such programmes can be helpful. TRIAL REGISTRATION The trial was registered retrospectively as ACTRN12612001106820.
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Affiliation(s)
| | | | - Kathleen M Griffiths
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Knut Waterloo
- Department of Psychology, University of Tromsø, Tromsø, Norway
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Stallard P, Buck R. Preventing depression and promoting resilience: feasibility study of a school-based cognitive-behavioural intervention. Br J Psychiatry 2013; 54:s18-23. [PMID: 23288496 DOI: 10.1192/bjp.bp.112.119172] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The limited reach and effectiveness of psychological treatments for adolescent depression have fuelled interest in alternative approaches designed to promote resilience. Schools offer a convenient location for the widespread delivery of depression prevention programmes, although little research has evaluated the feasibility of delivering interventions in this setting. AIMS To investigate the feasibility of delivering and evaluating a universal school-based depression prevention programme for children aged 12-16 years. METHOD A three-arm pilot study was conducted in one UK secondary school (n = 834). RESULTS Interventions had good reach (96%), with high rates of consent (89%) and reasonable retention (78%). The majority of intervention sessions were delivered as intended, with 85% of students attending seven or more sessions. The programme was acceptable to students and teachers, with the specific content of the active intervention being rated differently from the control programmes. CONCLUSIONS Delivering and undertaking methodologically robust evaluations of universal school-based depression programmes is feasible.
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Affiliation(s)
- Paul Stallard
- Child and Adolescent Mental Health Research Group, 22-23 Eastwood, Department for Health, University of Bath, Bath BA2 7AY, UK.
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Stallard P. School-based interventions for depression and anxiety in children and adolescents. EVIDENCE-BASED MENTAL HEALTH 2013; 16:60-1. [PMID: 23580540 DOI: 10.1136/eb-2013-101242] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Paul Stallard
- Department of Health, University of Bath and Head of Psychological Therapies Oxford Health NHS Foundation Trust, Bath BA2 7AY, UK.
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Rawal A, Collishaw S, Thapar A, Rice F. 'The risks of playing it safe': a prospective longitudinal study of response to reward in the adolescent offspring of depressed parents. Psychol Med 2013; 43:27-38. [PMID: 22617461 DOI: 10.1017/s0033291712001158] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Alterations in reward processing may represent an early vulnerability factor for the development of depressive disorder. Depression in adults is associated with reward hyposensitivity and diminished reward seeking may also be a feature of depression in children and adolescents. We examined the role of reward responding in predicting depressive symptoms, functional impairment and new-onset depressive disorder over time in the adolescent offspring of depressed parents. In addition, we examined group differences in reward responding between currently depressed adolescents, psychiatric and healthy controls, and also cross-sectional associations between reward responding and measures of positive social/environmental functioning. Method We conducted a 1-year longitudinal study of adolescents at familial risk for depression (n = 197; age range 10-18 years). Reward responding and self-reported social/environmental functioning were assessed at baseline. Clinical interviews determined diagnostic status at baseline and at follow-up. Reports of depressive symptoms and functional impairment were also obtained. RESULTS Low reward seeking predicted depressive symptoms and new-onset depressive disorder at the 1-year follow-up in individuals free from depressive disorder at baseline, independently of baseline depressive symptoms. Reduced reward seeking also predicted functional impairment. Adolescents with current depressive disorder were less reward seeking (i.e. bet less at favourable odds) than adolescents free from psychopathology and those with externalizing disorders. Reward seeking showed positive associations with social and environmental functioning (extra-curricular activities, humour, friendships) and was negatively associated with anhedonia. There were no group differences in impulsivity, decision making or psychomotor slowing. CONCLUSIONS Reward seeking predicts depression severity and onset in adolescents at elevated risk of depression. Adaptive reward responses may be amenable to change through modification of existing preventive psychological interventions.
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Affiliation(s)
- A Rawal
- Department of Clinical, Educational and Health Psychology, University College London, UK.
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Estudio de epidemiología psiquiátrica en niños y adolescentes en Chile. Estado actual. REVISTA MÉDICA CLÍNICA LAS CONDES 2012. [DOI: 10.1016/s0716-8640(12)70346-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Goodman A, Heiervang E, Fleitlich-Bilyk B, Alyahri A, Patel V, Mullick MSI, Slobodskaya H, Dos Santos DN, Goodman R. Cross-national differences in questionnaires do not necessarily reflect comparable differences in disorder prevalence. Soc Psychiatry Psychiatr Epidemiol 2012; 47:1321-31. [PMID: 22033632 PMCID: PMC3405234 DOI: 10.1007/s00127-011-0440-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Accepted: 10/07/2011] [Indexed: 11/09/2022]
Abstract
PURPOSE To examine whether the widely used Strengths and Difficulties Questionnaire (SDQ) can validly be used to compare the prevalence of child mental health problems cross nationally. METHODS We used data on 29,225 5- to 16-year olds in eight population-based studies from seven countries: Bangladesh, Brazil, Britain, India, Norway, Russia and Yemen. Parents completed the SDQ in all eight studies, teachers in seven studies and youth in five studies. We used these SDQ data to calculate three different sorts of "caseness indicators" based on (1) SDQ symptoms, (2) SDQ symptoms plus impact and (3) an overall respondent judgement of 'definite' or 'severe' difficulties. Respondents also completed structured diagnostic interviews including extensive open-ended questions (the Development and Well-Being Assessment, DAWBA). Diagnostic ratings were all carried out or supervised by the DAWBA's creator, working in conjunction with experienced local professionals. RESULTS As judged by the DAWBA, the prevalence of any mental disorder ranged from 2.2% in India to 17.1% in Russia. The nine SDQ caseness indicators (three indicators times three informants) explained 8-56% of the cross-national variation in disorder prevalence. This was insufficient to make meaningful prevalence estimates since populations with a similar measured prevalence of disorder on the DAWBA showed large variations across the various SDQ caseness indicators. CONCLUSIONS The relationship between SDQ caseness indicators and disorder rates varies substantially between populations: cross-national differences in SDQ indicators do not necessarily reflect comparable differences in disorder rates. More generally, considerable caution is required when interpreting cross-cultural comparisons of mental health, particularly when these rely on brief questionnaires.
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Affiliation(s)
- Anna Goodman
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
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Vostanis P, O'Reilly M, Taylor H, Day C, Street C, Wolpert M, Edwards R. What can education teach child mental health services? Practitioners' perceptions of training and joint working. EMOTIONAL AND BEHAVIOURAL DIFFICULTIES 2012. [DOI: 10.1080/13632752.2012.672869] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Russell G, Norwich B. Dilemmas, diagnosis and de-stigmatization: parental perspectives on the diagnosis of autism spectrum disorders. Clin Child Psychol Psychiatry 2012; 17:229-45. [PMID: 22219019 DOI: 10.1177/1359104510365203] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Many children who display autistic behaviours at clinical levels do not receive a formal diagnosis. This study used qualitative methods to examine parental influence in pursuing or avoiding a diagnosis of autism spectrum disorder (ASD). The aim was to explore the function of ASD diagnosis for parents, and examine whether a diagnosis affected how parents perceived ASD. Seventeen parents participated in in-depth semi-structured interviews, which were analyzed using thematic and grounded theory approaches. Data analysis revealed dilemmas faced by parents: whether to act to retain the 'normal' status of the child or to 'normalize' the child through diagnosis and subsequent remediation. Parents who had received an ASD diagnosis for their children became proactive in trying to reduce stigmatization of ASD more widely, and in some cases actively advocating ASD diagnosis to other parents. Thus their actions may make it more likely that others will opt for diagnosis in the future.
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Affiliation(s)
- Ginny Russell
- ESRC Centre for Genomics in Society (Egenis), University of Exeter, UK.
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Vostanis P, Taylor H, Day C, Edwards R, Street C, Weare K, Wolpert M. Child mental health practitioners' knowledge and experiences of children's educational needs and services. Clin Child Psychol Psychiatry 2011; 16:385-405. [PMID: 21212083 DOI: 10.1177/1359104510366283] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The improved joint working between child and adolescent mental health services (CAMHS) and schools is a policy priority. Although there have been a range of school-based initiatives and studies on teachers' awareness of mental health issues, there has been limited evidence on the training needs of CAMHS practitioners. The aim of this study was to explore how much CAMHS staff know about educational issues and how confident they feel working collaboratively with education colleagues. Ninety-six staff from four specialist CAMHS completed a questionnaire with 40 items on perceptions of knowledge, practice and attitudes towards educational issues and services, and three case vignettes. Despite the fact that participants reported frequent contact with children with education-related needs and with education services, they also highlighted concerns about their level of training and skills in this regard. Perceptions of knowledge and attitudes significantly predicted response to case vignettes. Previous training and experience were associated with knowledge, but did not predict case vignettes scores. The results suggest that training of CAMHS staff should be integral to all services in helping improve their understanding of school and education systems, improve clinical skills in detecting education-related mental health problems, and develop strategies in increasing joint working.
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Affiliation(s)
- Panos Vostanis
- University of Leicester, Greenwood Institute of Child Health, UK.
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The 'DAWBA bands' as an ordered-categorical measure of child mental health: description and validation in British and Norwegian samples. Soc Psychiatry Psychiatr Epidemiol 2011; 46:521-32. [PMID: 20376427 DOI: 10.1007/s00127-010-0219-x] [Citation(s) in RCA: 140] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2009] [Accepted: 03/23/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE To describe and validate the 'DAWBA bands'. These are novel ordered-categorical measures of child mental health, based on the structured sections of the Development and Well-Being Assessment (DAWBA). METHODS We developed computer algorithms to generate parent, teacher, child and multi-informant DAWBA bands for individual disorders and for groups of disorder (e.g. 'any emotional disorder'). The top two (out of 6) levels of the DAWBA bands were used as computer-generated DAWBA diagnoses. We validated these DAWBA bands in 7,912 British children (7-19 years) and 1,364 Norwegian children (11-13 years), using clinician-rated DAWBA diagnoses as a gold standard. RESULTS In general, the prevalence of clinician-rated diagnosis increased monotonically across all levels of the DAWBA bands, and also showed a dose-response association with service use and risk factors. The prevalence estimates of the computer-generated DAWBA diagnoses were of roughly comparable magnitude to the prevalence estimates from the clinician-generated diagnoses, but the estimates were not always very close. In contrast, the estimated effect sizes, significance levels and substantive conclusions regarding risk factor associations were very similar or identical. The multi-informant and parent DAWBA bands performed especially well in these regards. CONCLUSION Computer-generated DAWBA bands avoid the cost and delay occasioned by clinical rating. They may, therefore, sometimes provide a useful alternative to clinician-rated diagnoses, when studying associations with risk factors, generating rough prevalence estimates or implementing routine mental health screening.
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