Prevalence of Children's Mental Health Problems and the Effectiveness of Population-Level Family Interventions

Six-year (2016-2022) longitudinal patterns of mental health service utilization rates among children developmentally vulnerable in kindergarten and the COVID-19 pandemic disruption

INTRODUCTION

In the context of the COVID-19 pandemic, it becomes important to comprehend service utilization patterns and evaluate disparities in mental health-related service access among children.

OBJECTIVE

This study uses administrative health records to investigate the association between early developmental vulnerability and healthcare utilization among children in Alberta, Canada from 2016 to 2022.

METHODS

Children who participated in the 2016 Early Development Instrument (EDI) assessment and were covered by public Alberta health insurance were included (N = 23 494). Linear regression models were employed to investigate the association between service utilization and vulnerability and biological sex. Separate models were used to assess vulnerability specific to each developmental domain and vulnerability across multiple domains. The service utilization was compared between pre- and post-pandemic onset periods.

RESULTS

The analysis reveals a significant decrease in all health services utilization from 2016 to 2019, followed by an increase until 2022. Vulnerable children had, on average, more events than non-vulnerable children. There was a consistent linear increase in mental health-related utilization from 2016 to 2022, with male children consistently experiencing higher utilization rates than females, particularly among vulnerable children. Specifically, there was a consistent linear increase in the utilization of anxiety-related services by children from 2016 to 2022, with females having, on average, 25 more events than males. The utilization of ADHD-related services showed different patterns for each group, with vulnerable male children having more utilization than their peers.

CONCLUSION

Utilizing population-wide data, our study reveals sex specific developmental vulnerabilities and its impact on children's mental health service utilization during the COVID-19 pandemic, contributing to the existing literature. With data from kindergarten, we emphasize the need for early and targeted intervention strategies, especially for at-risk children, offering a path to reduce the burden of childhood mental health disorders.

The validity and reliability of preschool age psychiatric assessment (PAPA) in Turkish population

INTRODUCTION

The Preschool Age Psychiatric Assessment (PAPA) was developed in response to the need for a standard and reliable tool for assessing preschool-age psychiatric disorders. The aim of this study was to translate PAPA into the Turkish language and evaluate the validity and reliability.

METHODS

The researchers translated the original PAPA to Turkish, and the Turkish version of PAPA was translated back into its original language by professional translators. After the psychiatric assessment of the 300 patients by child psychiatrist, the PAPA interview was implemented with the parents. The sociodemographic data form and the PAPA short forms were filled out by the clinician conducting the interview. The Child Behavior Checklist for Ages 1.5-5 (CBCL/1½-5) was completed by parents.

RESULTS

The rate of detecting true positives and true negatives in all subscales when comparing PAPA with CBCL in children under 60 months ranged from 65% to 88%. The AUC values were above 50%, ranging from 0.56 to 0.72, indicating that PAPA performed reasonably well in detecting true positives and true negatives compared to CBCL. According to DC: 0-5, it was found that the adjustment was good for total psychopathologies, separation anxiety disorder, social anxiety disorder, and depression (κ = 0.67-0.79), and excellent for GAD and PTSD (κ = 0.81-1.00) CONCLUSION: The validity and reliability obtained from this study are valuable in our country for the objective identification of preschool children showing problematic symptom levels and for distinguishing them from children showing typical characteristics.

Promoting optimal mental health outcomes for children and youth

While paediatric care providers are often the first point of contact for children or youth experiencing mental health challenges, they may lack the resources (e.g., access to a multidisciplinary team) or training to adequately identify or manage such problems. This joint statement describes the key roles and competencies required to assess and address child and youth mental health problems, and the factors that optimize outcomes in this age group. Evidence-informed guidance on screening for and discussing mental health concerns with young people and families is provided. Preventive and therapeutic interventions with demonstrated efficacy in community care settings are discussed. This foundational statement also focuses on the changes to medical education, health systems, and health policy that are needed to improve clinical practice and advocacy efforts in Canada, including appropriate remuneration models, stepped-care approaches, targeted government funding, and professional training and education.

La promotion de l'évolution optimale de la santé mentale chez les enfants et les adolescents

Les dispensateurs de soins pédiatriques sont souvent le premier point de contact des enfants et des adolescents aux prises avec des problèmes de santé mentale, mais ils ne possèdent pas nécessairement les ressources (p. ex., l'accès à une équipe multidisciplinaire) ni la formation nécessaires pour procéder à leur dépistage ou à leur prise en charge. Le présent document de principes conjoint décrit les principaux rôles et les principales compétences à maîtriser pour évaluer et traiter les problèmes de santé mentale chez les enfants et les adolescents, de même que les facteurs qui optimisent le plus possible l'évolution de la santé mentale dans ces groupes d'âge. Il contient des conseils fondés sur des données probantes à propos du dépistage des préoccupations en matière de santé mentale chez les jeunes et leur famille ainsi qu'à propos des échanges sur le sujet. Les interventions préventives et thérapeutiques dont l'efficacité est démontrée en milieu communautaire sont abordées. Le présent document de principes, qui est fondamental, traite également des changements à l'enseignement de la médecine ainsi qu'aux systèmes et aux politiques de santé qui s'imposent pour améliorer la pratique clinique et les efforts de revendications au Canada, y compris les modèles de rémunération appropriés, les approches des soins abordées étape par étape, le financement gouvernemental ciblé, l'enseignement et la formation professionnelle.

Risk factors associated with higher scores in internalizing and externalizing behaviors in Chilean preschoolers

Early detection of behavioral disorders in children is necessary for intervention. Available data show a high prevalence of child and adolescent psychiatric disorders in Chile (22.5%), but behavioral problems in younger children have not been evaluated. This work assesses behavioral disorders in preschoolers and their association with sociodemographic variables of the family and the child. The data was collected during the impact assessment of the Biopsychosocial Development Support Program "Chile Crece Contigo", using a multistage and representative random sample of 1377 preschoolers, aged between 30 and 48 months, who attended public health services. Homes were visited to apply a questionnaire and the Child Behavior Checklist (CBCL, 1.5-5 years). Results: Multivariable regression model for total raw scores shows that child's age, the number of chronic diseases in the child, and history of exposure to mother's alcohol consumption in pregnancy, remain significant when adjusted for all variables included (R2 of 17.8% and η2 of .19 (95% CI: .14-.22)). In externalizing and internalizing explanatory models, child's chronic diseases and a higher score of authoritarian beliefs about parenting show the two largest effect sizes. These results add to the evidence of urgent problems in preschool mental health.

Condemn or Treat? The Influence of Adults' Stigmatizing Attitudes on Mental Health Service Use for Children

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.

Relationship between parental mental health and developmental disorders in early childhood

Social intervention with children with disabilities and their families should be understood through the principles of family-centred practice. In Spain, early intervention is understood as interventions aimed at children from 0 to 6 years old and their families. Professionals carry out the reception, assessment and intervention. This study aims to analyse the relationship between mental and physical health, caregivers' levels of anxiety and depression and the child's development during the fostering and assessment phase. The sample is made up of 135 families using child development centres in the Balearic Islands. Four questionnaires were completed: Health-Related Quality of Life SF-12, Anxiety and Depression Scale, Child Behaviour Checklist (CBCL 1½-5) and socio-demographic questionnaire. The results show that parents of children with disabilities have higher levels of mental health impairment than physical health impairment. They also score higher on anxiety than on depression. It is worth noting that professional discipline is a variable to be taken into account in relation to parents' perception of their child's developmental improvement. In addition, the association between the developmental subscales, where the more the child is affected, the more the parents' mental health is affected. The same pattern occurs with caregivers' levels of anxiety and depression. In short, we propose a reflection on the application of family-centred practices during interventions, understanding the lack of professional training as a predictor of the quality of early intervention.

On the Parental Influence on Children's Physical Activities and Mental Health During the COVID-19 Pandemic

Background

While neighborhood safety and stranger danger have been mostly canonized to play a part in parents' physical activity (PA) avoidance, less is known about the impact of parental stress and perceived risk on children's PA avoidance and consequently on children's level of PA and wellbeing. Understanding the contributors to children's wellbeing during pandemic disease is the first critical step in contributing to children's health during epidemic diseases.

Methods

This study employed 276 healthy children, aged 10-12 years, and their parents. Data were collected in October and November 2020, about 9 months after the local closing of schools due to the coronavirus disease 2019 (COVID-19) pandemic. Parents and children answered a separate set of questions. Besides the demographic information, the parents responded to questions on their stress level, perceived risk of COVID-19, and PA avoidance for children. Children responded to questions on their PA and wellbeing in the last week. Data were analyzed using SmartPLS and IBM SPSS 22.

Results

The result of the study supported the four directional research hypotheses of the sequential study model. As hypothesized, parents' stress and perceived risk levels of COVID-19 negatively affected children's PA. The PA level was shown to predict children's wellbeing and mental health. Housing type, parents' job security, number of siblings, number of members living together in-home, and history of death or hospitalization of relatives or family members due to COVID-19 were found to be associated with parents' stress and children's mental health.

Conclusion

This study sheds light on parents' role in children's wellbeing and mental health during the COVID-19 pandemic. Parents with higher stress and high restrictive behaviors might put their children at risk of mental disorders in the end.

Evaluating an Evidence-Based Parenting Intervention Among Filipino Parents: Protocol for a Pilot Randomized Controlled Trial

BACKGROUND

Filipino Americans underuse mental health and preventive care services even though studies have indicated that Filipino youth experience high rates of suicidal ideation, substance abuse, and teen pregnancies, whereas adults experience immigration stress, discrimination, and depression. Evidence-based parenting interventions provided in early childhood have proven to be effective in preventing the onset and escalation of child mental health disorders. In a pilot randomized controlled trial, we found that participation in the Incredible Years Basic Parent Training Program (IY) improved parenting stress and positive parenting practices and decreased child internalizing and externalizing symptoms among Filipino families. A fully powered trial is needed to determine the efficacy of IY as a prevention program among Filipino families.

OBJECTIVE

The aims of this study are to describe the design and rationale of a randomized controlled trial evaluating the effects of the web-based IY program among parents recruited from multiple community-based settings and its impact on parenting practices, parenting stress, and child problem behavior among Filipino Americans and describe the impact of COVID-19 on our study protocols.

METHODS

This study uses a randomized controlled 2-arm individually randomized group treatment pretest-posttest design for 180 parent-child dyads. Individuals are eligible if they are ≥18 years, live in California, and have at least one Filipino child aged 8-12 years. Consenting participants are randomly allocated to receive either the 12-week IY parenting intervention (intervention arm) or American Academy of Pediatrics' Bright Future handouts and placed on a waitlist to receive IY posttrial (waitlist control arm). Primary outcomes include the Parent Practices Interview and the Parenting Stress Index. Secondary outcomes will be measured using the Child Behavior Checklist (completed by parent) and will include child internalizing and externalizing behaviors and total problems. Data are collected at baseline and 3- and 6-month follow-ups.

RESULTS

Changes made to the protocol owing to COVID-19 include administration of surveys remotely and implementation of the intervention on the web. The pandemic has provided an opportunity to evaluate the effectiveness of a web-based version of IY that may improve access and increase use of the intervention. Recruitment and data collection procedures are still ongoing and are expected to be completed by December 2022.

CONCLUSIONS

Our research will determine whether IY promotes positive parenting practices and prevents child internalizing and externalizing behaviors in healthy but high-risk populations such as Filipino families. It will also uplift cultural narratives and add to the evidence base for web-based parenting programs and their implementation in real-world settings. If found efficacious, IY has the potential to prevent behavioral health disparities in this understudied and high-risk Filipino population and can be scaled, adapted, and implemented in other at-risk racial and ethnic minority communities.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04031170; https://clinicaltrials.gov/ct2/show/NCT04031170.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/21867.

An Evaluation of the Acceptability, Appropriateness, and Utility of a Bibliotherapy for Children of Parents With a Mental Illness

BACKGROUND

Children of parents with a mental illness are at higher risk for various psychiatric problems and adaptive difficulties compared to those of parents without mental health problems. Certain preventive psychoeducational interventions target these children to promote their well-being and resilience and prevent the emergence of adaptive difficulties. However, few such interventions have been developed and evaluated specifically for elementary school-aged children of parents with a mental illness.

OBJECTIVES

This study aims to evaluate an interpersonal psychotherapy-based book targeting children living with a parent with a mental illness.

METHODS

The study examines children, parents and psychosocial workers' perception of the acceptability, appropriateness and utility of the book. In total, 22 participants answered online open-ended questions after reading the book.

RESULTS

The book was highly appreciated and positively perceived by the families and psychosocial workers. Results suggest that children, parents and psychosocial workers viewed it as an appropriate and useful tool for supporting children with a parent with a mental illness. The present study reveals that the bibliotherapy appears well adapted to the developmental level of school-age children.

DISCUSSION

This study presents a book that shows promise for supporting the resilience of elementary school-aged children having a parent with a mental illness. Results highlight the importance of tailoring the content and modalities of interventions to the developmental level, needs and preferences of elementary school-aged children. The relevance of a collaborative method is also discussed, thus providing knowledge regarding this type of approach for the development of interventions targeting children.

National or population level interventions addressing the social determinants of mental health - an umbrella review

Background

Social circumstances in which people live and work impact the population’s mental health. We aimed to synthesise evidence identifying effective interventions and policies that influence the social determinants of mental health at national or scaled population level. We searched five databases (Cochrane Library, Global Health, MEDLINE, EMBASE and PsycINFO) between Jan 1st 2000 and July 23rd 2019 to identify systematic reviews of population-level interventions or policies addressing a recognised social determinant of mental health and collected mental health outcomes. There were no restrictions on country, sub-population or age. A narrative overview of results is provided. Quality assessment was conducted using Assessment of Multiple Systematic Reviews (AMSTAR 2). This study was registered on PROSPERO (CRD42019140198).

Results

We identified 20 reviews for inclusion. Most reviews were of low or critically low quality. Primary studies were mostly observational and from higher income settings. Higher quality evidence indicates more generous welfare benefits may reduce socioeconomic inequalities in mental health outcomes. Lower quality evidence suggests unemployment insurance, warm housing interventions, neighbourhood renewal, paid parental leave, gender equality policies, community-based parenting programmes, and less restrictive migration policies are associated with improved mental health outcomes. Low quality evidence suggests restriction of access to lethal means and multi-component suicide prevention programmes are associated with reduced suicide risk.

Conclusion

This umbrella review has identified a small and overall low-quality evidence base for population level interventions addressing the social determinants of mental health. There are significant gaps in the evidence base for key policy areas, which limit ability of national policymakers to understand how to effectively improve population mental health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12145-1.

Prevalence of mental illness among parents of children receiving treatment within child and adolescent mental health services (CAMHS): a scoping review

People affected by mental illness often come from families with patterns of mental illness that span across generations. Hence, child and adolescent mental health services (CAMHS) likely provide treatment to many children with parents who also experience mental illness. The aim of this scoping review was to: (1) identify the prevalence of mental illness among parents of children in CAMHS; (2) identify and appraise the methodologies that have been implemented to assess the prevalence of parental mental illness in CAMHS; (3) identify additional circumstances associated with families where both parent and child experience mental illness; and (4) present recommendations that have been made for CAMHS practice based on these findings. English language, peer-reviewed studies (2010-2018) that had investigated the mental health of parents in CAMHS were included in the review. Literature searching yielded 18 studies which were found to have utilised diverse methodologies to assess parental mental health. Overall, reported prevalence of parental mental illness ranged from 16 to 79%; however, a single study that was deemed to be comprehensive reported prevalence rates of 36% for mothers and 33% for fathers. Across studies, parent and child mental illness was found to be associated with additional adversities impacting family functioning and wellbeing. For children who receive treatment for mental illness, having a parent who also experiences mental illness is a frequent family circumstance that has implications for their prospects for recovery. Accordingly, the mental health of parents should be an important consideration within the mental health care CAMHS provide to children.

Brain structure is linked to the association between family environment and behavioral problems in children in the ABCD study

Children’s behavioral problems have been associated with their family environments. Here, we investigate whether specific features of brain structures could relate to this link. Using structural magnetic resonance imaging of 8756 children aged 9-11 from the Adolescent Brain Cognitive Developmental study, we show that high family conflict and low parental monitoring scores are associated with children’s behavioral problems, as well as with smaller cortical areas of the orbitofrontal cortex, anterior cingulate cortex, and middle temporal gyrus. A longitudinal analysis indicates that psychiatric problems scores are associated with increased family conflict and decreased parental monitoring 1 year later, and mediate associations between the reduced cortical areas and family conflict, and parental monitoring scores. These results emphasize the relationships between the brain structure of children, their family environments, and their behavioral problems.

Child behavior has been associated with parenting behavior. Here, the authors investigate associations between child behavior, parental behavior, and structural MRI using the Adolescent Brain Cognitive Developmental (ABCD) study dataset.

Combined Effects of Mother's, Father's and Teacher's Psychological Distress on Schoolchildren's Mental Health Symptoms

PURPOSE

Few studies have assessed the individual and joint effects of the mother's, father's and teacher's mental health symptoms on schoolchildren's behavior and emotional well-being simultaneously in the same study.

PATIENTS AND METHODS

A cross-sectional survey was conducted among 8488 Chinese schoolchildren aged 6-17 years in northeast China. The Strengths and Difficulties Questionnaire (SDQ) and General Health Questionnaire (GHQ) were used to measure the mental health of the students, their parents and the teacher in charge of the class, respectively. A total of 6173 students (72.73%) with full mental health information from all three caretakers were included in the final analysis.

RESULTS

We found a significantly elevated risk of mental health symptoms in children when their mothers (odds ratios (OR)=2.30, 95% CI=1.93-2.73), fathers (OR=2.08, 95% CI=1.73-2.50) and teachers (OR=1.18, 95% CI=1.01-1.39) reported poorer mental health, and the risk increased significantly with the number of the caretakers with mental symptoms. A father with poor mental health has both direct and indirect effects on a child's emotional health, by worsening the influence of a mother's poor mental health.

CONCLUSION

All three caretakers have a significant negative influence on schoolchildren's emotional well-being, in the order of mother > father > teacher. It is desirable to assess and manage students' mental health in the both the family and school contexts.

Policy Recommendations for Preventing Problematic Internet Use in Schools: A Qualitative Study of Parental Perspectives

Parenting in the digital age has been characterized as one of the most challenging tasks of the modern era. Parents are ambivalent about their mediating role. However, problematic aspects of adolescent online use have not been adequately addressed in education. The present study investigated parental perceptions of intervention needs within schools to prevent excessive/problematic use, enhance parent-child communication, and reduce family conflicts. Nine interviews with parents of adolescents residing in the UK were carried out and analyzed utilizing thematic analysis. Three main themes emerged as parental proposals: (i) schools as digital education providers and prevention hubs, (ii) provision of mental health literacy to raise awareness, resolve ambiguity regarding impacts and mitigate excessive use and impacts, and (iii) psychoeducation and upskilling. The third theme related to impacts from time spent on screens (time displacement), content-related impacts, and context-related impacts. The present study offers recommendations for media literacy during adolescence beyond e-safety (i.e., addressing interpersonal communication problems, privacy vs. disclosure issues), based on parents' views, and provides new insights for media and emotional health literacy collaboration efforts. Future work should investigate the feasibility and effectiveness of such interventions to support the emotional health of young people and prevent problematic internet use escalation.

Parental training in groups: a brief health promotion program

OBJECTIVE

To propose a brief parenting program offered in the context of health promotion and evaluate the immediate results relating to use of appropriate parenting practices and quality of parent-child interaction.

METHODS

Forty-five parents of school-age children from two non-governmental institutions located in a medium-sized city in the state of Sao Paulo participated in the study. The following assessment tools were used in the pre and post-tests: the Child Behavior Checklist (CBCL), Quality of Family Interaction Scales (EQIFs), and the Brazilian Economic Classification Criteria (CCEB). Only scores of parents who attended 75% of the program were included in the analysis (25 participants).

RESULTS

Most of the participants who completed the program were grouped in socioeconomic levels B and C (72%) and the complaints reported in the pre-test centered on disobedience and stubbornness (29.6%, each). Regarding parents' perceptions of their educational practices and interaction with the children, improvements were detected in several of the aspects measured: affective relationship, involvement, model, communication, rules and monitoring, and children's feelings, besides reduction in use of physical punishment and negative marital atmosphere (p < 0.03). Reductions were detected in aggressive behavior (p = 0.02) and externalizing problems (p = 0.04).

CONCLUSION

Despite the small sample and application in a specific community, this quick and affordable intervention seems to have yielded improvements in parent's monitoring and their affective relationships with their children, in addition to reductions in punishments and children's aggressive behavior, contributing to better parent-child interaction in the community.

Prevalence of mental health problems in Chinese schoolchildren: The influence of measuring impact score and combining information from multiple informants

BACKGROUND

To measure the effects of using different combinations of multiple informants and the impact score on the estimated prevalence of mental health problems in Chinese schoolchildren.

METHODS

Complete information on the Strengths and Difficulties Questionnaire (SDQ) were obtained from students (S), parents (P), and teachers (T) for 4986 schoolchildren (11-17 years-old). We used 3 criteria to determine the prevalence of mental health problems: SDQ cut-off value (previously established in the United Kingdom), SDQ cut-off value plus an impact score of 1 or more, or plus an impact score of 2 or more. A student was defined as having a mental health problem if any informant (S, P, or T) classified the child as 'abnormal'. We compared the prevalence of mental health problems determined from 1 informant, 2 informants, and 3 informants.

RESULTS

The prevalence of overall mental health problems increased with rising number of informants, but decreased with increasing impact score. When the impact score was not considered, the prevalence was 8.2% to 14.2% when rated by 1 informant, 18.8% to 24.7% when rated by 2 informants, and 28.3% when rated by all 3 informants. Failure to measure the impact score led to a two to threefold greater estimate of the prevalence of mental health problems.

CONCLUSIONS

The types, number, and combinations of multiple informants and use of the impact score must be considered when comparing the results of different studies. It is preferable to use multiple informants and have the impact score taken the impact into account to reflect the real burden of mental health burden in children and adolescent.

Identification of Preschool Children with Mental Health Problems in Primary Care: Systematic Review and Meta-analysis

OBJECTIVE

Primary care practitioners determine access to care for many preschool children with mental health (MH) problems. This study examined rates of mental health (MH) problem identification in preschoolers within primary healthcare settings, related service use, and MH status at follow-up. The findings may inform evidence-based policy and practice development for preschool MH.

METHOD

For this systematic review, MEDLINE®, EMBASE®, PsycInfo®, and ERIC ® were searched from inception to March 7, 2018 for reports in which a screening measure was used to identify MH problems in children aged 24-72 months, seen in primary and community health care settings. Meta-analyses, using random effects models to provide pooled estimates, were used when three or more studies examined identification rates. Findings on service use and persistence of disorders are summarized.

RESULTS

Thirty-five publications representing 21 studies met the inclusion criteria. MH problems were identified in 17.6% of preschoolers (95% Confidence Interval (CI): 11.1-24.1), Q = 4.9, p > 0.1 by primary/community healthcare practitioners. Psychiatric diagnoses were identified in 18.4% of preschoolers (95% CI: 12.3 - 24.4), Q= 1.6, p > 0.1. Based on three studies, parents of 67-72% of identified children received advice and 26-42% received specialist referrals. In the subset of studies examining persistence of MH disorders, 25-67% of identified children had MH disorders after one to three years.

CONCLUSION

While the identification rate by primary/community practitioners is similar to the diagnostic rate, these may not consistently be the same children. Substantial variability in management and outcomes indicate need for more rigorous evaluation of primary care services for this population.

Physical activity mediates the relationship between outdoor time and mental health

Both spending time outdoors and participating in physical activity improve mental health. Given that the outdoor environment provides an ideal location for physical activity, better understanding of the relationships among time spent outdoors, physical activity and positive mental health is needed to help guide interventions. The aim was to examine if physical activity moderates or mediates the relationship between outdoor time and positive mental health. Two-hundred-forty-two participants (15 ± 1 years old, 59% girls) from New Brunswick, Canada were included in the current analysis. Youth self-reported time spent outdoors and moderate-to-vigorous physical activity (MVPA) three times between October 2016 and June 2017. Data on their mental health were collected in October 2017. Values of outdoor time and MVPA were averaged across the three time points to represent the exposure and mediator variables, respectively. Mental health, dichotomized as flourishing/not flourishing, was the outcome in the mediation analysis. An interaction term tested if the mediation effect depended on outdoor time. Analyses were undertaken in 2019 using the mediation package in R. In univariate analyses, both MVPA (p < 0.001) and outdoor time (p = 0.05) were positive predictors of flourishing mental health. In mediation analyses, a small indirect mediation (OR: 1.02, 95% CI: 1.01-1.04) and no direct (1.00, 0.98-1.05) effect were noted, suggesting that MVPA mediates the effect of outdoor time on positive mental health. This effect did not vary as a function of outdoor time (interaction: 1.00, 0.99-1.01). Physical activity mediates the relationship between outdoor time and positive mental health. Outdoor time could promote positive mental health among youth through increases in physical activity.

Adaptation and implementation of the German social-emotional learning programme Papilio in Finland: A pilot study

This study investigated the cross-national adaptation and implementation of Papilio, a German social-emotional learning programme, in Finnish early childhood education and care (ECEC) centres. Papilio is a developmentally focused, scientifically based intervention programme focused on preventing behavioural problems and fostering social-emotional competence in children aged 3-7. The aim of this study was to investigate and evaluate the cross-national adaptation and cross-cultural adaptation and implementation of Papilio in the Finnish ECEC context. Results from qualitative interviews with one Finnish Papilio trainer, 11 early childhood education (ECE) teachers, two ECE special education teachers and two nursery nurses are supplemented with teachers' and nursery nurses' (N = 75) questionnaire data. Qualitative thematic analysis revealed that cultural adaptations were necessary on four levels: accommodation of materials, adaptation of the contents of the materials, structure and delivery. The materials and training contents were culturally adapted, whereas the delivery of the intervention was adapted according to Finnish ECEC practices. The structural adaptation included discarding timeout, due to opposition by some educators. The educators were committed to implementing the programme as instructed and resolving the practical difficulties they encountered. Their motivation to implement Papilio increased as they observed improvements in the children's social-emotional competence during intervention.

Population-Based System of Parenting Support to Reduce the Prevalence of Child Social, Emotional, and Behavioural Problems: Difference-In-Differences Study

The quality of parenting is recognised as an important determinant of children's mental health. Parenting interventions typically target high-risk families rather than adopting a universal approach. This study examined the population impact of the Triple P Positive Parenting Programme on the prevalence of children's social, emotional, and behavioural problems. A propensity score matching difference-in-differences method was used to compare intervention and comparison regions matched on socio-demographic characteristics in midlands Ireland. The pre-intervention sample included 1501 and 1495 parents of children aged 4-8 years in the intervention and comparison regions respectively. The post-intervention sample included 1521 and 1544 parents respectively. The primary outcome measure was parental reports on the Strengths and Difficulties Questionnaire. There were some significant reductions in the prevalence rates of social, emotional, and behavioural problems in the intervention regions compared to the comparison regions. Children in the intervention sample experienced lower total difficulties, emotional symptoms, and conduct problems than children in the comparison sample, and they were less at risk of scoring within the borderline/abnormal range for total difficulties, conduct problems, and hyperactivity. The programme reduced the proportion of children scoring within the borderline/abnormal range by 4.7% for total difficulties, 4.4% for conduct problems, and 4.5% for hyperactivity in the total population. This study demonstrated that a universal parenting programme implemented at multiple levels using a partnership approach may be an effective population health approach to targeting child mental health.

Social-emotional problems among three-year-olds differ based on the child's gender and custody arrangement

AIM

The aim of this study was to investigate mental health with respect to social-emotional problems among three-year-olds in relation to their gender, custody arrangements and place of residence.

METHODS

A cross-sectional population-based design was used, encompassing 7179 three-year-olds in northern Sweden during the period 2014-2017 from the regional Salut Register. Descriptive and comparative analyses were performed based on parents' responses on the Ages and Stages Questionnaires: Social-Emotional, supplemented with items on gender, custody arrangement and place of residence.

RESULTS

Parental-reported social-emotional problems were found in almost 10% of the children. Boys were reported to have more problems (12.3%) than girls (5.6%; p < 0.001). Parents were most concerned about children's eating habits and interactions at mealtimes. Parents not living together reported more problems among their children than those living together (p < 0.001). When stratifying by custody arrangement, girls in rural areas living alternately with each parent had more problems compared to those in urban areas (p < 0.008).

CONCLUSION

Gender and custody arrangements appear to be important factors for social-emotional problems among three-year-olds. Thus, such conditions should receive attention during preschool age, preferably by a systematic preventive strategy within Child Health Care.

Effectiveness of a Positive Parental Practices Training Program for Chilean Preschoolers' Families: A Randomized Controlled Trial

Background: Evidence for the effectiveness of parental training as a strategy for promotion of positive parental practices and prevention of child behavior problems in low and middle income countries is not conclusive. This study aims to assess the effectiveness of a universal positive parental training program designed for this context, “Día a Día” UdeC © (“Day by Day” University of Concepción), in Chilean preschoolers’ families (3–6 years old children).

Methods: A cluster randomized controlled trial (cRCT) was carried out in 19 preschool education centers. There were two treatment arms: 10 centers (including 178 families) were randomly assigned to the intervention group and nine centers (including 154 families) were assigned to the waiting list control condition. Intervention groups received Day by Day UdeC, a six group sessions program for parents, including two group sessions for preschool educators, focused in affective communication; daily and child-directed play; directed attention; routines and transitions; reinforcement and incentive programs; planned inattention-ignore and time out; and logical consequences. Parental practices, parental satisfaction, and presence of children behavioral problems were examined at two-time points: T1 (4 weeks before intervention) and T2 (5–6 weeks after intervention).

Results: Intention-to-treat analysis shows a reduction in physical punishment and an increase in parental involvement, as well as a reduction in children behavioral problems. A per-protocol analysis revealed an additional effect: increase in observed parental practices.

Conclusion: This cRCT provided evidence for the effectiveness of a parental training program for the promotion of positive parental practices in low and middle income countries. The observed effects of the program in decreasing physical punishment and children’s behavioral problems make it a promising strategy for prevention purposes.

Trial Registration: This study was registered under ISRCTN.com (ISRCTN90762146; https://doi.org/10.1186/ISRCTN90762146).

Does having a difficult child lead to poor maternal mental health?

OBJECTIVES

Considerable evidence suggests maternal psychopathology influences that of their offspring. The probability of a reverse causal pathway has been only rarely considered but is a concern, given around 10% of children manifest mental impairment during their early years. This study determines the extent to which child behavior problems at ages 5 and 14 years are associated with mothers' mental health at 21 years post birth.

STUDY DESIGN

Longitudinal study.

METHODS

Data were taken from a sample of 3650 women from Mater and University of Queensland Study of Pregnancy birth cohort. Women's mental health was measured using the Mental Disorder Screening Tool at 21 years post birth. The Child Behavior Check List was used to measure internalizing, combined social/attention/thought disorder, and aggression at the age of 5 and 14 years. Logistic regression was used to derive odds ratios and 95% confidence intervals. A number of confounders were used to test for independence.

RESULTS

Following all adjustments, child internalizing behaviors and combined social/attention/thought disorder at 5 years, and all measures of child behavior problem at 14 years were associated with mothers meeting criteria for mental health impairment at 21 years post birth. Moreover mothers of children with behavior problems at 14 years were approximately 2-3 times more likely to these meet these criteria.

CONCLUSIONS

Mothers of children with behavior problems at 5 and 14 years of age were more likely to have mental health impairment at 21 years post birth. Child health professionals should be cognizant of the mother-child relationship having mutual mental health vulnerability.