The association between depression and later educational attainment in children and adolescents: a systematic review protocol

The association of breastfeeding with cognitive development and educational achievement in sub-Saharan Africa: A systematic review

Background

Systematic reviews and meta-analyses of studies mainly from high-income countries suggest that breastfeeding improves cognitive function and educational achievement. However, these associations may be a manifestation of who breastfeeds in these settings rather than an actual effect of breastfeeding. We investigated the association of breastfeeding with cognitive development and educational achievements in sub-Saharan Africa, where breastfeeding is the norm, and socioeconomic status is not strongly correlated with ever breastfeeding.

Methods

We searched Medline, Embase, PsycINFO, Cochrane Central Register of Controlled Trials (CENTRAL), and Africa-Wide Information in January 2021 for studies that assessed the cognitive and educational benefits of breastfeeding in children and adolescents in sub-Saharan Africa. Two reviewers independently screened, extracted, and critically appraised the included studies.

Results

After reviewing 5552 abstracts and 151 full-text articles, seventeen studies on cognitive development and two on educational achievements met our predefined inclusion criteria. The included studies were from ten sub-Saharan African countries and published between 2013 and 2021, with sample sizes ranging from 54 to 6573. Most of the studies (n = 14) were prospective cohort studies, but only nine collected data on breastfeeding prospectively. The studies differed in analytic approaches and cognitive and educational achievements measurements. Of the 17 studies on cognitive development, only four adjusted sufficiently for key confounders. None of these four studies found an overall association between breastfeeding and cognitive development in children or adolescents in sub-Saharan Africa. The two studies on education measured achievements based on the highest grade of school attained, 12 or more years of education, or grade repetition at age 7-11 years. Both studies adjusted for a range of sociodemographic factors and found no evidence that children exclusively breastfed or breastfed for a longer duration have a better educational outcome than sub-optimally breastfed children.

Conclusions

The current evidence from sub-Saharan Africa is limited but does not corroborate previous findings that breastfeeding is associated with improved cognitive development and educational achievement.

Registration

This study is registered with PROSPERO, CRD42021236009.

Can information infrastructure development improve the health care environment? Evidence from China

Existing studies ignore the importance of information infrastructure development in improving regional health care environment. This paper adopts a spatial difference-in-difference (DID) model to assess the impact of information infrastructure development on urban health care environment based on a quasi-natural experiment of the "Broadband China" city pilots (BCCP). A balanced panel of 259 cities from 2010 to 2019 is selected for empirical analysis in this paper. Our findings show that the implementation of BCCP resulted in a 4.1 and 2.9% improvement in local medical workforce and medical infrastructure. In addition, there is significant spatial spillover effects of the implementation of BCCP, with 7.2 and 12.5% improvement in medical workforce and medical infrastructure in the surrounding areas. Our findings also suggest that information infrastructure development enhances the health care environment by driving industrial upgrading and education levels. Further analysis shows that BCCP has the strongest improvement on medical workforce in the eastern region and non-ordinary prefecture-level cities. For medical infrastructure, BCCP has stronger improvement in central region, western region, and non-ordinary prefecture-level cities. Finally, the paper conducts a series of robustness tests to ensure the reliability of the analysis results, including parallel trend tests, placebo tests, and re-estimation with different methods. Policies to improve the health care environment through information infrastructure development are proposed.

Exploring Behavioural Activation as a treatment for low mood within CAMHS: An IPA study of adolescent experiences

Low mood is the most commonly diagnosed mental health condition affecting adolescents; however, it remains complex to treat due to multi-systemic risk and maintaining factors. Behavioural Activation (BA) is a brief therapy which demonstrates promising treatment outcomes, although limited qualitative accounts exist of how adolescents experience this. This is one of the first studies undertaken in Child and Adolescent Mental Health Services (CAMHS) to explore the perspectives of adolescent's with low mood who have received BA therapy. Interpretative phenomenological analysis was conducted from one-to-one interviews with nine adolescents who received BA, generating an idiographic account of their experiences. Three superordinate themes emerged: how the format of BA can promote the integration of coping skills into one's life; how interpersonal connections and therapeutic relationships may improve intervention outcomes; and how BA principles could be internalised as part of a young person's day-to-day life. Participants valued the structure and flexibility of the manualised approach, forming an alliance with the therapist, and enhancing interpersonal relationships. This study details how BA can enhance resiliency skills for adolescents experiencing low mood and illustrates some of the change process at inter and intrapersonal levels, which should guide further youth-led research.

What should a Universal School-Based Psychoeducational Programme to Support Psychological Well-Being amongst Children and Young People in South Africa Focus on and how should it be Delivered? A Multi-Stakeholder Perspective

Children and young people are vulnerable to developing mental health problems. In South Africa, this vulnerability is compounded by contextual risk factors such as community violence and poverty. However, mental health services are scarce and costly, which precludes access for many. Universal school-based mental health programmes can prevent the onset of mental health problems in children and young people and have been implemented to good effect in high-income settings. We sought to understand stakeholder perspectives on what such a programme should focus on and how it could be implemented in practice within the South African context. We interviewed children and young people (n = 22), parents (n = 21), teachers (n = 17), and school mental health counsellors (n = 6) recruited from two schools in the Western Cape, South Africa. Interviews were audio-recorded, transcribed verbatim and analysed thematically. We generated three overarching themes: ‘the value of a mental health and well-being programme’, ‘content and delivery’, and ‘practicalities and logistics’. Participants were optimistic about the potential value of such a programme. Developing content that was appropriate for group delivery, flexible and timed to fit within the school schedule was important. Finding ways to make activities meaningful for large classes was important logistically, as was determining to what extent leaners would feel comfortable participating alongside their peers. Participants felt that outsiders, as opposed to school staff, should deliver the programme and that parents should be involved where possible. Developing a mental health programme for children and young people in the South African context requires careful understanding of who the key role players in such an intervention will be and how exactly they want to be involved and, how the challenges associated with practicalities and logistics can be overcome.

Family Group Conferences as a Shared Decision-Making Strategy in Adults Mental Health Work

Family Group conferences (FGC) provide a system by which a client and their family reach jointly key intervention decisions, from a number of options proposed by professionals. The system originated in child protection social work. Conceptually FGC is based on the assumption that the family is potentially a supportive social system for an individual with a variety of difficulties, including mental ill health. Reaching a family network agreement can lead to long term positive outcomes in self-confidence and social relationships. This strategy of shared decision making (SDM) can re-unite the family around the client's needs and wishes. It fits well the strengths based and the recovery-oriented approaches to mental ill health. Methodologically, this article provides a narrative review of existing empirical research about FGC in the context of adult mental health. In addition, two community case studies consisting of videos of a mother experiencing mental ill health and a daughter are analysed in terms of their subjective experience of the FGCs they were involved in, and looks at both the process and the outcomes of FGCs. The key findings demonstrate a high level of satisfaction from participating in the FGC meeting, while the evidence pertaining to the outcomes is inconclusive. Only very few systematic review studies, or comparative studies of different approaches to family decision making, exist, and there are no studies which offer cost effectiveness analysis. Discussion: The observed gap between the satisfaction from the process of FGC by the participants vs. the inconclusive outcomes relates to the implementation phase, in which the decisions made by the family are tested. Evaluating FGC processes and outcomes is complex. A systematic and comprehensive research of the implementation process is missing at this stage. In conclusion, FGC is a promising strategy of SDM in adult mental health. The research evidence indicates the need for further exploration of its implementation process, evaluative methodology and methods.

Systematic Review and Meta-analysis: The Association Between Child and Adolescent Depression and Later Educational Attainment

OBJECTIVE

The association between depression and educational attainment in young people is unclear. This systematic review and meta-analysis examines the longitudinal association between depression and subsequent attainment, and its potential effect modifiers and mediators.

METHOD

We searched Embase, PsycINFO, PubMed, ERIC, and the British Education Index from inception to October 23, 2019, conducted citation searching, and contacted authors for articles. Eligible studies reported on the longitudinal association between depression in children and adolescents 4 to 18 years of age and later educational attainment. Two reviewers independently conducted screening, data extraction, and risk of bias assessment. Correlation coefficients were pooled in meta-analysis, and effect modifiers were explored using meta-regression and stratification. Other evidence on confounders, modifiers, and mediators was narratively synthesized. The PROSPERO record for the study is CRD42019123068.

RESULTS

A total of 31 studies were included, of which 22 were pooled in meta-analysis. There was a small but statistically significant association between depression and lower subsequent attainment (pooled Fisher z = -0.19, 95% CI = -0.22 to -0.16, I2 = 62.9%). A total of 15 studies also reported an enduring effect after adjusting for various confounders. No statistically significant effect modifiers were identified. Social and school problems may mediate between depression and low attainment.

CONCLUSION

Depression was associated with lower educational attainment, but further research is needed to establish mechanisms. Nonetheless, there is a clear need for mental health and educational support among children and adolescents with depression.

Educational attainment inequalities in depressive symptoms in more than 100,000 individuals in Europe

Background

Increasing educational attainment (EA) could decrease the occurrence of depression. We investigated the relationship between EA and depressive symptoms in older individuals across four European regions.

Methods

We studied 108,315 Europeans (54% women, median age 63 years old) from the Survey on Health, Ageing and Retirement in Europe assessing EA (seven educational levels based on International Standard Classification of Education [ISCED] classification) and depressive symptoms (≥4 points on EURO-D scale). Logistic regression estimated the association between EA and depressive symptoms, adjusting for sociodemographic and health-related factors, testing for sex/age/region and education interactions.

Results

Higher EA was associated with lower odds of depressive symptoms, independent of sociodemographic and health-related factors. A threshold of the lowest odds of depressive symptoms was detected at the first stage of tertiary education (OR 0.60; 95% confidence interval [CI] 0.55–0.65; p < 0.001; relative to no education). Central and Eastern Europe showed the strongest association (OR for high vs. low education 0.37; 95% CI 0.33–0.40; p < 0.001) and Scandinavia the weakest (OR for high vs. low education 0.69; 95% CI 0.60–0.80; p < 0.001). The association was strongest among younger individuals. There was a sex and education interaction only within Central and Eastern Europe.

Conclusions

Level of EA is reflected in later-life depressive symptoms, suggesting that supporting individuals in achieving EA, and considering those with lower EA at increased risk for depression, could lead to decreased burden of depression across the life course. Further educational support in Central and Eastern Europe may decrease the higher burden of depressive symptoms in women.

Fear N. Identifying Veterans Using Electronic Health Records in the United Kingdom: A Feasibility Study

There is a lack of quantitative evidence concerning UK (United Kingdom) Armed Forces (AF) veterans who access secondary mental health care services-specialist care often delivered in high intensity therapeutic clinics or hospitals-for their mental health difficulties. The current study aimed to investigate the utility and feasibility of identifying veterans accessing secondary mental health care services using National Health Service (NHS) electronic health records (EHRs) in the UK. Veterans were manually identified using the Clinical Record Interactive Search (CRIS) system-a database holding secondary mental health care EHRs for an NHS Trust in the UK. We systematically and manually searched CRIS for veterans, by applying a military-related key word search strategy to the free-text clinical notes completed by clinicians. Relevant data on veterans' socio-demographic characteristics, mental disorder diagnoses and treatment pathways through care were extracted for analysis. This study showed that it is feasible, although time consuming, to identify veterans through CRIS. Using the military-related key word search strategy identified 1600 potential veteran records. Following manual review, 693 (43.3%) of these records were verified as "probable" veterans and used for analysis. They had a median age of 74 years (interquartile range (IQR): 53-86); the majority were male (90.8%) and lived alone (38.0%). The most common mental diagnoses overall were depressive disorders (22.9%), followed by alcohol use disorders (10.5%). Differences in care pathways were observed between pre and post national service (NS) era veterans. This feasibility study represents a first step in showing that it is possible to identify veterans through free-text clinical notes. It is also the first to compare veterans from pre and post NS era.