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Ivanova MY, Achenbach TM, Turner L, Almqvist F, Begovac I, Bilenberg N, Bird H, Broberg AG, Córdova Calderón MA, Chahed M, Dang HM, Dobrean A, Döpfner M, Erol N, Forns M, Guðmundsson HS, Hannesdóttir H, Hewitt-Ramirez N, Kanbayashi Y, Karki S, Koot HM, Lambert MC, Leung P, Magai DN, Maggiolini A, Metzke CW, Minaei A, Monzani da Rocha M, Moreira PAS, Mulatu MS, Nøvik TS, Oh KJ, Petot D, Petot JM, Pisa C, Pomalima R, Roussos A, Rudan V, Sawyer MG, Shahini M, Simsek Z, Steinhausen HC, Verhulst FC, Weintraub S, Weiss B, Wolanczyk T, Zhang EY, Zilber N, Žukauskienė R. Effects of individual differences, society, and culture on youth-rated problems and strengths in 38 societies. J Child Psychol Psychiatry 2022; 63:1297-1307. [PMID: 35167140 DOI: 10.1111/jcpp.13569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Clinicians increasingly serve youths from societal/cultural backgrounds different from their own. This raises questions about how to interpret what such youths report. Rescorla et al. (2019, European Child & Adolescent Psychiatry, 28, 1107) found that much more variance in 72,493 parents' ratings of their offspring's mental health problems was accounted for by individual differences than by societal or cultural differences. Although parents' reports are essential for clinical assessment of their offspring, they reflect parents' perceptions of the offspring. Consequently, clinical assessment also requires self-reports from the offspring themselves. To test effects of individual differences, society, and culture on youths' self-ratings of their problems and strengths, we analyzed Youth Self-Report (YSR) scores for 39,849 11-17 year olds in 38 societies. METHODS Indigenous researchers obtained YSR self-ratings from population samples of youths in 38 societies representing 10 culture cluster identified in the Global Leadership and Organizational Behavioral Effectiveness study. Hierarchical linear modeling of scores on 17 problem scales and one strengths scale estimated the percent of variance accounted for by individual differences (including measurement error), society, and culture cluster. ANOVAs tested age and gender effects. RESULTS Averaged across the 17 problem scales, individual differences accounted for 92.5% of variance, societal differences 6.0%, and cultural differences 1.5%. For strengths, individual differences accounted for 83.4% of variance, societal differences 10.1%, and cultural differences 6.5%. Age and gender had very small effects. CONCLUSIONS Like parents' ratings, youths' self-ratings of problems were affected much more by individual differences than societal/cultural differences. Most variance in self-rated strengths also reflected individual differences, but societal/cultural effects were larger than for problems, suggesting greater influence of social desirability. The clinical significance of individual differences in youths' self-reports should thus not be minimized by societal/cultural differences, which-while important-can be taken into account with appropriate norms, as can gender and age differences.
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Affiliation(s)
- Masha Y Ivanova
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | | | - Lori Turner
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Fredrik Almqvist
- Department of Child Psychiatry, Helsinki University Hospital, Helsinki, Finland
| | - Ivan Begovac
- Department of Psychiatry and Psychological Medicine, School of Medicine, Clinical Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
| | - Niels Bilenberg
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Hector Bird
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Anders G Broberg
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Mery A Córdova Calderón
- Department of Psychology, Fiscalía Provincial of Orellana, Puerto Francisco de Orellana, Ecuador
| | - Myriam Chahed
- Department of Psychology, Université Paris-Nanterre, Paris, France
| | | | - Anca Dobrean
- Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Mandred Döpfner
- Department of Psychiatry and Psychotherapy of Childhood and Adolescence, University of Cologne, Cologne, Germany
| | - Nese Erol
- Department of Mental Health and Illness, Ankara University, Ankara, Turkey
| | - Maria Forns
- Department of Personality, Assessment and Psychological Treatment, University of Barcelona, Barcelona, Spain
| | | | | | | | | | - Suyen Karki
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Hans M Koot
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, The Netherlands
| | - Michael C Lambert
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Patrick Leung
- Department of Psychology, Chinese University of Hong Kong, Hong Kong, China
| | - Dorcas N Magai
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, The Netherlands
| | - Alfio Maggiolini
- Minotauro Istituto Di Analisi Dei Codici Affettivi, Milan, Italy
| | - Christa Winkler Metzke
- Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland
| | - Asghar Minaei
- Department of Educational and Psychological Measurement, Allameh Tabataba'i University, Tehran, Iran
| | - Marina Monzani da Rocha
- Centro de Ciências Biológicas e da Saúde (CCBS), Universidade Presbiteriana Mackenzie, Sao Paulo, Brazil
| | - Paulo A S Moreira
- Instituto de Psicologia e Ciências da Educação, Centro de Investigação em Psicologia para o Desenvolvimento (CIPD), Universidade Lusíada Norte (Porto), Porto, Portugal
| | - Mesfin S Mulatu
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Torunn Stene Nøvik
- Department of Child and Adolescent Psychiatry, St. Olav University Hospital, Trondheim, Norway.,Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kyung Ja Oh
- Department of Psychology, Yonsei University, Seoul, South Korea
| | - Djaouida Petot
- Department of Psychology, Université Paris-Nanterre, Paris, France
| | | | - Cecilia Pisa
- Minotauro Istituto Di Analisi Dei Codici Affettivi, Milan, Italy
| | - Rolando Pomalima
- Instituto Nacional de Salud Mental Honorio Delgado Hideyo Noguchi, Lima, Peru
| | | | - Vlasta Rudan
- Department of Psychiatry and Psychological Medicine, School of Medicine, Clinical Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
| | - Michael G Sawyer
- School of Psychology and Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | | | - Zeynep Simsek
- Faculty of Health Sciences, İstanbul Bilgi University, Istanbul, Turkey
| | | | - Frank C Verhulst
- Department of Child and Adolescent Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands.,Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Sheila Weintraub
- Department of Child Psychiatry, Helsinki University Hospital, Helsinki, Finland
| | - Bahr Weiss
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - Tomasz Wolanczyk
- Department of Child Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | | | - Nelly Zilber
- Kfar Shaul Mental Health Center, Falk Institute for Mental Health Studies, Jerusalem, Israel
| | - Rita Žukauskienė
- Institute of Psychology, Mykolas Romeris University, Vilnius, Lithuania
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Moreno-Betancur M, Lynch JW, Pilkington RM, Schuch HS, Gialamas A, Sawyer MG, Chittleborough CR, Schurer S, Gurrin LC. Emulating a target trial of intensive nurse home visiting in the policy-relevant population using linked administrative data. Int J Epidemiol 2022; 52:119-131. [PMID: 35588223 PMCID: PMC9908050 DOI: 10.1093/ije/dyac092] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 04/21/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Populations willing to participate in randomized trials may not correspond well to policy-relevant target populations. Evidence of effectiveness that is complementary to randomized trials may be obtained by combining the 'target trial' causal inference framework with whole-of-population linked administrative data. METHODS We demonstrate this approach in an evaluation of the South Australian Family Home Visiting Program, a nurse home visiting programme targeting socially disadvantaged families. Using de-identified data from 2004-10 in the ethics-approved Better Evidence Better Outcomes Linked Data (BEBOLD) platform, we characterized the policy-relevant population and emulated a trial evaluating effects on child developmental vulnerability at 5 years (n = 4160) and academic achievement at 9 years (n = 6370). Linkage to seven health, welfare and education data sources allowed adjustment for 29 confounders using Targeted Maximum Likelihood Estimation (TMLE) with SuperLearner. Sensitivity analyses assessed robustness to analytical choices. RESULTS We demonstrated how the target trial framework may be used with linked administrative data to generate evidence for an intervention as it is delivered in practice in the community in the policy-relevant target population, and considering effects on outcomes years down the track. The target trial lens also aided in understanding and limiting the increased measurement, confounding and selection bias risks arising with such data. Substantively, we did not find robust evidence of a meaningful beneficial intervention effect. CONCLUSIONS This approach could be a valuable avenue for generating high-quality, policy-relevant evidence that is complementary to trials, particularly when the target populations are multiply disadvantaged and less likely to participate in trials.
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Affiliation(s)
- Margarita Moreno-Betancur
- Corresponding author. Clinical Epidemiology and Biostatistics Unit, Department of Paediatrics, University of Melbourne, 50 Flemington Road, Parkville, Victoria 3052, Australia. E-mail:
| | - John W Lynch
- School of Public Health, University of Adelaide, Adelaide, SA, Australia,Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia,Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Rhiannon M Pilkington
- School of Public Health, University of Adelaide, Adelaide, SA, Australia,Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Helena S Schuch
- School of Public Health, University of Adelaide, Adelaide, SA, Australia,Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia,Postgraduate programme in Dentistry, Federal University of Pelotas, Pelotas, Brazil
| | - Angela Gialamas
- School of Public Health, University of Adelaide, Adelaide, SA, Australia,Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Michael G Sawyer
- Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia,School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Catherine R Chittleborough
- School of Public Health, University of Adelaide, Adelaide, SA, Australia,Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Stefanie Schurer
- School of Economics, University of Sydney, Sydney, NSW, Australia
| | - Lyle C Gurrin
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
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Keage HA, Muniz G, Kurylowicz L, Van hooff M, Clark L, Searle AK, Sawyer MG, Baghurst P, Mcfarlane A. Age 7 intelligence and paternal education appear best predictors of educational attainment: The Port Pirie Cohort Study. Australian Journal of Psychology 2020. [DOI: 10.1111/ajpy.12083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Hannah A.d. Keage
- Cognitive Neuroscience Laboratory, School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, South Australia, Australia,
| | - Graciela Muniz
- Centre for Traumatic Stress Studies, School of Population Health, University of Adelaide, Adelaide, South Australia, Australia,
| | - Lisa Kurylowicz
- Cognitive Neuroscience Laboratory, School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, South Australia, Australia,
| | - Miranda Van hooff
- Discipline of Paediatrics, University of Adelaide, Adelaide, South Australia, Australia,
| | - Levina Clark
- Discipline of Public Health, University of Adelaide, Adelaide, South Australia, Australia,
| | - Amelia K. Searle
- Discipline of Paediatrics, University of Adelaide, Adelaide, South Australia, Australia,
| | - Michael G. Sawyer
- School of Psychology, Flinders University, Adelaide, South Australia, Australia,
- Research and Evaluation Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia,
| | - Peter Baghurst
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK,
| | - Alexander Mcfarlane
- Discipline of Paediatrics, University of Adelaide, Adelaide, South Australia, Australia,
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Schnyder N, Sawyer MG, Lawrence D, Panczak R, Burgess P, Harris MG. Barriers to mental health care for Australian children and adolescents in 1998 and 2013-2014. Aust N Z J Psychiatry 2020; 54:1007-1019. [PMID: 32383402 DOI: 10.1177/0004867420919158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess changes in barriers to mental health care for children and adolescents over 16 years. METHODS We used data from two nationally representative surveys of Australian children and adolescents (4-17 years old), conducted in 1998 (N = 4509) and 2013-2014 (N = 6310). Barriers to care were assessed among parents who had reported a perceived partially met or unmet need for their child in the past 6 months in 1998, and the past 12 months in 2013-2014; barriers were similarly assessed among adolescents in relation to themselves. We addressed measurement inconsistencies between surveys by harmonising barriers to accommodate differences in wording and performing sensitivity analyses among those with a 1-month disorder to equalise the timeframes in which barriers were assessed. To assess change, we examined whether the rank order of the three most commonly endorsed barriers changed and whether the 95% confidence intervals (CI) around their estimates overlapped. RESULTS Similar proportions of parents reported a partially met or unmet need in 1998 (12.9%, 95% CI = [11.7, 14.0]) as in 2013-2014 (14.3%, 95% CI = [13.2, 15.3]), but the ratio of unmet to partially met need decreased from 3:1 in 1998 to 1:1 in 2013-2014. Top three parent-endorsed barriers ('self-reliance', 'unsure where to get help', and 'cost') were the same at both time points; 'self-reliance' decreased from 65.9% (95% CI = [61.1%, 70.7%]) to 34.9% (95% CI = [31.5%, 38.3%]). Top two adolescent-endorsed barriers ('self-reliance' and 'concerned what others might think') were the same at both time points, the third differed, but none of them decreased. CONCLUSION Perceived unmet need for mental health care for children and adolescents may have decreased between 1998 and 2013-2014, but the gap in receiving sufficient care may have increased. Despite investments in community awareness and treatment during this period, key barriers seemed largely unchanged. For parents, the decrease in self-reliance may reflect a positive shift in beliefs about the potential benefits of treatment.
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Affiliation(s)
- Nina Schnyder
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia.,Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Brisbane, QLD, Australia
| | - Michael G Sawyer
- School of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - David Lawrence
- Graduate School of Education, The University of Western Australia, Perth, WA, Australia
| | - Radoslaw Panczak
- Queensland Centre for Population Research, School of Earth and Environmental Science, The University of Queensland, Brisbane, QLD, Australia
| | - Philip Burgess
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia.,Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Brisbane, QLD, Australia
| | - Meredith G Harris
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia.,Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Brisbane, QLD, Australia
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5
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Tully LA, Hawes DJ, Doyle FL, Sawyer MG, Dadds MR. A call for mental health illiteracy: Response to Samuel. Aust N Z J Psychiatry 2020; 54:845-846. [PMID: 32529836 DOI: 10.1177/0004867420931158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lucy A Tully
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - David J Hawes
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Frances L Doyle
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Michael G Sawyer
- School of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - Mark R Dadds
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
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6
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Sawyer AC, Kaim ALE, Mittinity MN, Jeffs D, Lynch JW, Sawyer MG. Effectiveness of a 2-year post-natal nurse home-visiting programme when children are aged 5 years: Results from a natural experiment. J Paediatr Child Health 2019; 55:1091-1098. [PMID: 30575172 DOI: 10.1111/jpc.14348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 10/08/2018] [Accepted: 11/20/2018] [Indexed: 11/30/2022]
Abstract
AIM To evaluate the effect of a 2-year post-natal nurse home visiting (NHV) programme delivered in routine clinical practice to socially disadvantaged mothers on children's development at 5 years. METHODS The study was a natural experiment resulting from progressive rollout of NHV (2008-2012). Children of three groups of mothers, all eligible for NHV, were compared: (i) mothers receiving NHV in a metropolitan region (n = 197); (ii) mothers in a rural region prior to NHV being available (n = 94); and (iii) mothers receiving NHV in the rural region after it became available (n = 84). Outcomes were evaluated using the Child Behaviour Checklist, Child-Parent Relationships Scale, Behaviour Inventory of Executive Functioning and Australian Early Development Index. RESULTS Analyses were conducted using augmented inverse probability weighting accounting for differences in the groups' baseline characteristics. While some differences were observed in the range of 8-12% between the intervention and comparison groups (albeit with wide confidence intervals, e.g. 31% less likely to 4% more likely to be experiencing poor outcomes). For the majority of outcomes, however, there were no differences observed between the intervention and comparison groups. CONCLUSIONS Post-natal NHV provided as a part of routine service delivery did not improve children's outcomes at 5 years. It may be that in the Australian context a NHV intervention, as offered in this study, does not provide additional benefits over standard care.
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Affiliation(s)
- Alyssa Cp Sawyer
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.,Research and Evaluation Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia.,School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Amy LE Kaim
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.,Research and Evaluation Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia
| | - Murthy N Mittinity
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Debra Jeffs
- Child and Family Health Service, Women's and Children's Health Network, Adelaide, South Australia, Australia
| | - John W Lynch
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia.,Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Michael G Sawyer
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.,Research and Evaluation Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia
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7
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Sawyer MG, Reece CE, Sawyer AC, Hiscock H, Lawrence D. Adequacy of treatment for child and adolescent mental disorders in Australia: A national study. Aust N Z J Psychiatry 2019; 53:326-335. [PMID: 30387377 DOI: 10.1177/0004867418808895] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Worldwide, little information is available about the extent to which children with mental disorders in the general population receive treatment from health professionals that meets minimal clinical practice guidelines. This study identifies the percentage of 6-17 year olds with mental disorders in the 2013-2014 Australian national survey of mental health who had sufficient contact with health professionals during the 18 months after the survey to have received treatment meeting criteria for minimally adequate treatment (MAT). It also identifies factors associated with children having this level of contact with health professionals. METHOD Mental disorders were identified using the Diagnostic Interview Schedule for Children Version IV completed by parents. Health professional attendances and psychotropic medications dispensed were identified from linked national Medicare Benefits Schedule and Pharmaceutical Benefits Scheme records. RESULTS Only 11.6% (95% confidence interval [CI] [9.1, 14.8]) of children with disorders ( n = 517) had sufficient contact to achieve study criteria for MAT. Furthermore, among children with mental disorders who had severe functional impairment and whose parents perceived that their child needed help ( n = 146), 20.2% (95% CI [14.3, 27.9]) had contact sufficient for MAT, 46.0% (95% CI [37.8, 54.4]) had contact that did not achieve MAT criteria and 33.8% (95% CI [26.1, 42.3]) had no contact with health professionals. In multivariable regression, children with moderate or severe functional impairment were more likely to have had sufficient contact to meet MAT criteria. CONCLUSION During the 18 months after being identified with a mental disorder, only a small percentage of children have enough contact with health professionals to allow provision of MAT. This may be contributing to the unchanging high prevalence of childhood mental disorders.
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Affiliation(s)
- Michael G Sawyer
- 1 School of Medicine, The University of Adelaide, North Adelaide, SA, Australia.,2 Research and Evaluation Unit, Women's and Children's Hospital, Women's and Children's Health Network, North Adelaide, SA, Australia
| | - Christy E Reece
- 1 School of Medicine, The University of Adelaide, North Adelaide, SA, Australia.,2 Research and Evaluation Unit, Women's and Children's Hospital, Women's and Children's Health Network, North Adelaide, SA, Australia
| | - Alyssa Cp Sawyer
- 1 School of Medicine, The University of Adelaide, North Adelaide, SA, Australia.,2 Research and Evaluation Unit, Women's and Children's Hospital, Women's and Children's Health Network, North Adelaide, SA, Australia
| | - Harriet Hiscock
- 3 Centre for Community Child Health, The Royal Children's Hospital Melbourne, Melbourne, VIC, Australia.,4 Murdoch Children's Research Institute, Melbourne, VIC, Australia.,5 Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - David Lawrence
- 6 Graduate School of Education, The University of Western Australia, Perth, WA, Australia
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Abstract
Half of all lifetime mental health disorders emerge in childhood, so intervening in the childhood years is critical to prevent chronic trajectories of mental health disorders. The prevalence of child mental health disorders is not decreasing despite the increased availability of evidence-based interventions. One key reason for the high prevalence and low treatment uptake may be low levels of child mental health literacy in the general community. Mental health literacy refers to knowledge and beliefs about mental health disorders that aid in their recognition, prevention and management. There is emerging evidence of poor recognition of child mental health problems in the community and low levels of parental knowledge about how to seek help, along with high levels of stigmatising attitudes. Although Australia has been a world leader in research and practice in improving mental health literacy for adolescent and adult mental health disorders, particularly depression and anxiety, mental health literacy for childhood disorders has been largely overlooked. In order to improve knowledge of child mental health disorders, reduce stigma, improve appropriate help-seeking and impact on the prevalence of child mental health disorders, we argue that a national initiative focussing on increasing mental health literacy for childhood disorders is urgently needed.
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Affiliation(s)
- Lucy A Tully
- 1 School of Psychology, The University of Sydney, Camperdown, NSW, Australia
| | - David J Hawes
- 1 School of Psychology, The University of Sydney, Camperdown, NSW, Australia
| | - Frances L Doyle
- 1 School of Psychology, The University of Sydney, Camperdown, NSW, Australia
| | - Michael G Sawyer
- 2 School of Medicine, The University of Adelaide, North Adelaide, SA, Australia
- 3 Research and Evaluation Unit, Women's and Children's Hospital, Women's and Children's Health Network, North Adelaide, SA, Australia
| | - Mark R Dadds
- 1 School of Psychology, The University of Sydney, Camperdown, NSW, Australia
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Sawyer AC, Kaim AL, Reece CE, McDonald D, Le HN, Clark J, Lynch JW, Sawyer MG. Evaluating the Effectiveness of an App-Based Nurse-Moderated Program for New Mothers With Depression and Parenting Problems (eMums Plus): Protocol for a Pragmatic Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e11549. [PMID: 30664487 PMCID: PMC6351991 DOI: 10.2196/11549] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/09/2018] [Accepted: 10/10/2018] [Indexed: 01/16/2023] Open
Abstract
Background Postnatal depression adversely affects many mothers and infants with good evidence that caregiving difficulties associated with depressive symptoms play a key role in later adverse childhood outcomes. In many countries, there is only limited support available for women who experience symptoms of depression during the postnatal period, particularly those experiencing subthreshold symptom levels. Furthermore, mental health services and community family health services in many countries tend to focus primarily on providing help for depressive symptoms or maternal caregiving, respectively, despite these problems commonly being comorbid. Group-based nurse-led interventions delivered over the Web through mobile phone “apps” have the potential to be a cost-effective method of providing a large number of mothers with easy access to integrated support for both maternal depressive symptoms and caregiving difficulties. Objective This paper describes the protocol for a pragmatic randomized controlled trial of a 4-month group-based nurse-led intervention delivered over the Web when infants were 2-6 months. The primary aims of the trial are to determine whether the intervention (1) reduces levels of maternal depressive symptoms and (2) improves the quality of maternal caregiving when infants are 8-12 months of age. Methods The trial aimed to recruit and randomize 160 mothers of infants aged 2-8 weeks to either the intervention (eMums plus) or standard care. Assessments were completed when infants were aged 1-2 (preintervention), 8, and 12 months. The primary outcomes were the level of maternal depressive symptoms and the quality of maternal caregiving assessed when infants were aged 12 months. The intervention provided specific support for problems with mood and problems with caregiving. The intervention was delivered by community health nurses as a part of routine service delivery to mothers via a mobile phone app. Results Participant recruitment was carried out from March to July 2017. Follow-up data collection was completed in mid-2018. Data analysis has commenced. Conclusions In the past, many mothers participated in nurse-led face-to-face groups postnatally. However, mothers’ groups held in clinics can be difficult for busy mothers to attend. The eMums intervention was delivered over the Web by nurses, allowing easy access by mothers early in an infant’s life. The intervention was evaluated while delivered as part of the routine service practice by community child health nurses. The advantage of evaluating the effectiveness of the intervention in the routine service practice is that if it is found to be effective, it can be more easily adopted by the service provider than if it had been assessed in an efficacy trial. International Registered Report Identifier (IRRID) RR1-10.2196/11549
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Affiliation(s)
- Alyssa Cp Sawyer
- School of Public Health, University of Adelaide, Adelaide, Australia.,School of Medicine, University of Adelaide, Adelaide, Australia.,Research and Evaluation Unit, Women's and Children's Health Network, North Adelaide, Australia
| | - Amy L Kaim
- School of Medicine, University of Adelaide, Adelaide, Australia.,Research and Evaluation Unit, Women's and Children's Health Network, North Adelaide, Australia
| | - Christy E Reece
- School of Medicine, University of Adelaide, Adelaide, Australia.,Research and Evaluation Unit, Women's and Children's Health Network, North Adelaide, Australia
| | - Denise McDonald
- Child and Family Health Service, Women's and Children's Health Network, Adelaide, Australia
| | - Huynh-Nhu Le
- Department of Psychology, George Washington University, Washington, DC, United States
| | - Jennifer Clark
- School of Medicine, University of Adelaide, Adelaide, Australia.,Research and Evaluation Unit, Women's and Children's Health Network, North Adelaide, Australia
| | - John W Lynch
- School of Public Health, University of Adelaide, Adelaide, Australia.,Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Michael G Sawyer
- School of Medicine, University of Adelaide, Adelaide, Australia.,Research and Evaluation Unit, Women's and Children's Health Network, North Adelaide, Australia
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Sawyer MG, Reece CE, Sawyer AC, Johnson SE, Hiscock H, Lawrence D. Access to health professionals by children and adolescents with mental disorders: Are we meeting their needs? Aust N Z J Psychiatry 2018; 52:972-982. [PMID: 29498290 DOI: 10.1177/0004867418760713] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To identify the percentage of 4-17 year olds with mental disorders in Australia who attended health professionals for single or repeat visits to get help for emotional and behavioural problems during a 12-month period. To identify factors associated with single and repeat visits, and the average length of time between visits. To compare the number of parent-reported visits with visits recorded in the Medicare Benefits Schedule. METHOD The study used data from the national survey of the mental health and wellbeing of 4-17 year olds conducted in 2013-2014 ( n = 6310). Participants were randomly selected from all 4 to 17 year olds in Australia. Information about visits was available from face-to-face interviews with parents, the Medicare Benefits Schedule and self-reports from 13 to 17 year olds. Mental disorders were assessed using the Diagnostic Interview Schedule for Children Version IV completed by parents. RESULTS Parents reported that 51.1% of 4-17 year olds with mental disorders had attended a health professional during the previous 12 months. However, 13.6% of these children had attended on only a single occasion, most commonly with a general practitioner. With the exception of occupational therapists, 2-4 visits was the most common number of repeat visits. Children with comorbid disorders and severe functional impairment and those aged 12-17 years were more likely to have repeat visits. Among those with linked Medicare Benefits Schedule data, more children were reported by parents to have attended Medicare Benefits Schedule-funded health professionals (47.9%) than were recorded in Medicare Benefits Schedule data (38.0%). CONCLUSION The typical number of visits to health professionals by children with mental disorders during a 12-month period is relatively small. Furthermore, parent-reports may overestimate the number of visits during this time. It seems unlikely that current patterns of attendance are of sufficient duration and frequency to allow full implementation of evidence-based treatment programmes for child and adolescent mental disorders.
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Affiliation(s)
- Michael G Sawyer
- 1 Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia.,2 Research and Evaluation Unit, Women's and Children's Hospital, Women's and Children's Health Network, North Adelaide, SA, Australia
| | - Christy E Reece
- 1 Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia.,2 Research and Evaluation Unit, Women's and Children's Hospital, Women's and Children's Health Network, North Adelaide, SA, Australia
| | - Alyssa Cp Sawyer
- 1 Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia.,2 Research and Evaluation Unit, Women's and Children's Hospital, Women's and Children's Health Network, North Adelaide, SA, Australia
| | - Sarah E Johnson
- 3 Telethon Kids Institute, The University of Western Australia, West Perth, WA, Australia
| | - Harriet Hiscock
- 4 Centre for Community Child Health, Royal Children's Hospital, Parkville, VIC, Australia.,5 Murdoch Children's Research Institute, Melbourne, VIC, Australia.,6 Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - David Lawrence
- 7 Graduate School of Education, The University of Western Australia, Perth, WA, Australia
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11
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Sampaio F, Barendregt JJ, Feldman I, Lee YY, Sawyer MG, Dadds MR, Scott JG, Mihalopoulos C. Population cost-effectiveness of the Triple P parenting programme for the treatment of conduct disorder: an economic modelling study. Eur Child Adolesc Psychiatry 2018; 27:933-944. [PMID: 29288334 PMCID: PMC6013530 DOI: 10.1007/s00787-017-1100-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 12/16/2017] [Indexed: 01/30/2023]
Abstract
Parenting programmes are the recommended treatments of conduct disorders (CD) in children, but little is known about their longer term cost-effectiveness. This study aimed to evaluate the population cost-effectiveness of one of the most researched evidence-based parenting programmes, the Triple P-Positive Parenting Programme, delivered in a group and individual format, for the treatment of CD in children. A population-based multiple cohort decision analytic model was developed to estimate the cost per disability-adjusted life year (DALY) averted of Triple P compared with a 'no intervention' scenario, using a health sector perspective. The model targeted a cohort of 5-9-year-old children with CD in Australia currently seeking treatment, and followed them until they reached adulthood (i.e., 18 years). Multivariate probabilistic and univariate sensitivity analyses were conducted to incorporate uncertainty in the model parameters. Triple P was cost-effective compared to no intervention at a threshold of AU$50,000 per DALY averted when delivered in a group format [incremental cost-effectiveness ratio (ICER) = $1013 per DALY averted; 95% uncertainty interval (UI) 471-1956] and in an individual format (ICER = $20,498 per DALY averted; 95% UI 11,146-39,470). Evidence-based parenting programmes, such as the Triple P, for the treatment of CD among children appear to represent good value for money, when delivered in a group or an individual face-to-face format, with the group format being the most cost-effective option. The current model can be used for economic evaluations of other interventions targeting CD and in other settings.
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Affiliation(s)
- Filipa Sampaio
- Department of Public Health and Caring Sciences (IFV), Uppsala University, BMC, Husargatan 3, 751 22 Uppsala, Sweden
| | - Jan J. Barendregt
- Epigear International, Sunrise Beach, QLD Australia
- School of Public Health, The University of Queensland, Herston, QLD Australia
| | - Inna Feldman
- Department of Public Health and Caring Sciences (IFV), Uppsala University, BMC, Husargatan 3, 751 22 Uppsala, Sweden
| | - Yong Yi Lee
- School of Public Health, The University of Queensland, Herston, QLD Australia
- Queensland Centre for Mental Health Research (QCMHR), The Park Centre for Mental Health, Wacol, QLD Australia
| | - Michael G. Sawyer
- School of Medicine, University of Adelaide, Adelaide, SA Australia
- Research and Evaluation Unit, Women’s and Children’s Health Network, Adelaide, SA Australia
| | - Mark R. Dadds
- Child Behaviour Research Clinic, University of Sydney, Sydney, Australia
| | - James G. Scott
- Queensland Centre for Mental Health Research (QCMHR), The Park Centre for Mental Health, Wacol, QLD Australia
- The University of Queensland Centre for Clinical Research, Herston, QLD Australia
- Metro North Mental Health, Royal Brisbane and Women’s Hospital, Herston, QLD Australia
| | - Cathrine Mihalopoulos
- School of Health and Social Development, Deakin Health Economics, Deakin University, Melbourne, Australia
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12
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Sawyer MG, Reece CE, Sawyer ACP, Johnson SE, Lawrence D. Has the Prevalence of Child and Adolescent Mental Disorders in Australia Changed Between 1998 and 2013 to 2014? J Am Acad Child Adolesc Psychiatry 2018; 57:343-350.e5. [PMID: 29706164 DOI: 10.1016/j.jaac.2018.02.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 01/16/2018] [Accepted: 03/12/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study examined whether the 12-month prevalence of major depressive disorder (MDD), attention-deficit/hyperactivity disorder (ADHD), and conduct disorder (CD) among 6- to 17-year-olds in Australia changed between 1998 and 2013 to 2014. It also investigated whether changes in the prevalence of disorders over this time varied for children living in families containing 2 parents versus single parents, and families with high versus low income. METHOD The study used data from national surveys conducted in Australia in 1998 (N = 3,597) and 2013 to 2014 (N = 5,359). In both surveys, the participating individuals were randomly selected from all 6- to 17-year-olds in Australia, and mental disorders were assessed using the Diagnostic Interview Schedule for Children Version IV (DISC-IV), completed by parents. RESULTS There was little change in the overall prevalence of mental disorders between 1998 (12.5%, 95% CI = 11.4-13.7) and 2013 to 2014 (11.1%, 95% CI = 10.1-12.2). Although there were some differences in the changes for children with different disorders, most were small in magnitude. Specifically, MDD prevalence increased from 2.1% (95% CI = 1.7-2.7) to 3.2% (95% CI = 2.7-3.8), ADHD prevalence declined from 9.9% (95% CI = 8.9-10.9) to 7.8% (95% CI = 6.9-8.7), and CD prevalence declined from 2.7% (95% CI = 2.2-3.3) to 2.1% (95% CI = 1.7-2.7). There was a persisting pattern of higher prevalence among children living in single-parent and low-income households. CONCLUSION Lack of change at a population level in the prevalence of child mental disorders suggests that new innovations in research, policy, and practice are needed to successfully address the major public health problem posed by child and adolescent mental disorders in the community.
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Affiliation(s)
- Michael G Sawyer
- School of Medicine, University of Adelaide, and the Women's and Children's Health Network, North Adelaide, Australia.
| | - Christy E Reece
- School of Medicine, University of Adelaide, and the Women's and Children's Health Network, North Adelaide, Australia
| | - Alyssa C P Sawyer
- School of Medicine, University of Adelaide, and the Women's and Children's Health Network, North Adelaide, Australia
| | - Sarah E Johnson
- Telethon Kids Institute, The University of Western Australia, West Perth
| | - David Lawrence
- Graduate School of Education, The University of Western Australia, Perth
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13
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Zubrick SR, Hafekost J, Johnson SE, Sawyer MG, Patton G, Lawrence D. The continuity and duration of depression and its relationship to non-suicidal self-harm and suicidal ideation and behavior in adolescents 12-17. J Affect Disord 2017; 220:49-56. [PMID: 28595098 DOI: 10.1016/j.jad.2017.05.050] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 05/29/2017] [Accepted: 05/30/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is a significant overlap between non-suicidal self-harm and suicidal ideation and behavior in young people with both symptom continuity and symptom duration implicated in this association. METHODS A population sample of Australian 12-17 year olds. Interviewers collected measures for DSM disorders, symptom duration and continuity, and background information from their parents, while young people self-reported symptoms of depression, non-suicidal self-harm and suicidal ideation and behaviors. This report focusses on the 265 young people who met the DSM criteria for Major Depressive Disorder based on their own self-reports. RESULTS Relative to young people who had at least one period 2 months or longer without symptoms since first onset, young people who had the continuous presence of depressive symptoms since their first onset had significantly higher odds for life-time self-harm, 12-month self-harm, multiple self-harm, suicidal ideation and suicide attempt within the past 12 months. The duration of depressive symptoms and the continuity of these symptoms each independently contribute to elevating the risks of non-suicidal self-harming and suicidal ideation and behaviors. LIMITATIONS Reliance on self-report from the young people and time constraints prohibiting administering diagnostic modules other than the Major Depressive Disorder and estimating self-reported co-morbidity. CONCLUSIONS Among young people with a Major Depressive Disorder, self-reports about duration of depressive symptoms as well as the continuity of symptoms, each independently contributes to elevated risks of non-suicidal self-harming and suicidal ideation and behaviors. As well, un-remitting as opposed to episodic symptoms in this group of young people are common and are a powerful indicator of suffering associated with both self-harm and suicidal behavior.
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Affiliation(s)
- Stephen R Zubrick
- University of Western Australia, Graduate School of Education, Nedlands 6009, Western Australia, Australia; Telethon Kids Institute, University of Western Australia, Subiaco 6008, Western Australia, Australia.
| | - Jennifer Hafekost
- Telethon Kids Institute, University of Western Australia, Subiaco 6008, Western Australia, Australia.
| | - Sarah E Johnson
- Telethon Kids Institute, University of Western Australia, Subiaco 6008, Western Australia, Australia.
| | - Michael G Sawyer
- School of Medicine, University of Adelaide, Adelaide, Australia; Research and Evaluation Unit, Women's and Children's Health Network, Adelaide, Australia.
| | - George Patton
- Department of Paediatrics, University of Melbourne, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.
| | - David Lawrence
- University of Western Australia, Graduate School of Education, Nedlands 6009, Western Australia, Australia; Telethon Kids Institute, University of Western Australia, Subiaco 6008, Western Australia, Australia.
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14
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Sawyer MG, Reece CE, Bowering K, Jeffs D, Sawyer ACP, Mittinty M, Lynch JW. Nurse-Moderated Internet-Based Support for New Mothers: Non-Inferiority, Randomized Controlled Trial. J Med Internet Res 2017; 19:e258. [PMID: 28739559 PMCID: PMC5547246 DOI: 10.2196/jmir.6839] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 02/23/2017] [Accepted: 06/02/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Internet-based interventions moderated by community nurses have the potential to improve support offered to new mothers, many of whom now make extensive use of the Internet to obtain information about infant care. However, evidence from population-based randomized controlled trials is lacking. OBJECTIVE The aim of this study was to test the non-inferiority of outcomes for mothers and infants who received a clinic-based postnatal health check plus nurse-moderated, Internet-based group support when infants were aged 1-7 months as compared with outcomes for those who received standard care consisting of postnatal home-based support provided by a community nurse. METHODS The design of the study was a pragmatic, preference, non-inferiority randomized control trial. Participants were recruited from mothers contacted for their postnatal health check, which is offered to all mothers in South Australia. Mothers were assigned either (1) on the basis of their preference to clinic+Internet or home-based support groups (n=328), or (2) randomly assigned to clinic+Internet or home-based groups if they declared no strong preference (n=491). The overall response rate was 44.8% (819/1827). The primary outcome was parenting self-competence, as measured by the Parenting Stress Index (PSI) Competence subscale, and the Karitane Parenting Confidence Scale scores. Secondary outcome measures included PSI Isolation, Interpersonal Support Evaluation List-Short Form, Maternal Support Scale, Ages and Stages Questionnaire-Social-Emotional and MacArthur Communicative Development Inventory (MCDI) scores. Assessments were completed offline via self-assessment questionnaires at enrolment (mean child age=4.1 weeks, SD 1.3) and again when infants were aged 9, 15, and 21 months. RESULTS Generalized estimating equations adjusting for post-randomization baseline imbalances showed that differences in outcomes between mothers in the clinic+Internet and home-based support groups did not exceed the pre-specified margin of inferiority (0.25 of a SD) on any outcome measure at any follow-up assessment, with the exception of MCDI scores assessing children's language development at 21 months for randomized mothers, and PSI Isolation scores at 9 months for preference mothers. CONCLUSION Maternal and child outcomes from a clinic-based postnatal health check plus nurse-moderated Internet-based support were not inferior to those achieved by a universal home-based postnatal support program. Postnatal maternal and infant support using the Internet is a promising alternative to home-based universal support programs. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry Number (ANZCTR): ACTRN12613000204741; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=363712&isReview=true (Archived by WebCite at http://www.webcitation.org/6rZeCJ3k1).
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Affiliation(s)
- Michael G Sawyer
- School of Medicine, University of Adelaide, Adelaide, Australia.,Research and Evaluation Unit, Women's and Children's Health Network, Adelaide, Australia
| | - Christy E Reece
- School of Medicine, University of Adelaide, Adelaide, Australia.,Research and Evaluation Unit, Women's and Children's Health Network, Adelaide, Australia
| | - Kerrie Bowering
- Child and Family Health Service, Women's and Children's Health Network, Adelaide, Australia.,SA State Office, Department of Social Services, Adelaide, Australia
| | - Debra Jeffs
- Child and Family Health Service, Women's and Children's Health Network, Adelaide, Australia
| | - Alyssa C P Sawyer
- School of Public Health, University of Adelaide, Adelaide, Australia
| | - Murthy Mittinty
- School of Public Health, University of Adelaide, Adelaide, Australia
| | - John W Lynch
- School of Public Health, University of Adelaide, Adelaide, Australia.,School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
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15
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Pössel P, Burton SM, Cauley B, Sawyer MG, Spence SH, Sheffield J. Associations between Social Support from Family, Friends, and Teachers and depressive Symptoms in Adolescents. J Youth Adolesc 2017; 47:398-412. [PMID: 28695369 DOI: 10.1007/s10964-017-0712-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 06/17/2017] [Indexed: 12/17/2022]
Abstract
Approximately 20% of adolescents develop depressive symptoms. Family, friends, and teachers are crucial sources of social support for adolescents, but it is unclear whether social support impacts adolescents directly (principle-effect model) or by moderating the effect of stress (stress-buffer model) and whether each source of social support remains meaningful when their influence is studied simultaneously. To help fill this gap, we followed 1452 Australian students (average age at enrollment = 13.1, SD = 0.5; range: 11-16 years; 51.9% female) for 5 years. Based on our findings, each source of support is negatively related to depressive symptoms one year later when studied independently but when combined, only family and teacher support predicted depressive symptoms. Family support in all grades and teacher support in grade 8 to 10 but not in grade 11 directly impacted adolescent depressive symptoms 1 year later. Family support in grades 8 and 11 also buffered against the negative impact of stress on depressive symptoms one year later. Based on the unexpected findings, the most important limitations seem to be that the used instruments do not allow for a separation of different groups of friends (e.g., classmates, same-gender peers, romantic partners), types of social support, and stress. In addition, the high, nonrandom attrition rate with adolescents reporting less social support, more stressful events, a higher frequency of depressive symptoms, and/or being of Torres Strait Islander or Aboriginal background limits the generalizability of our findings. Summarized, our findings demonstrate that adolescents facing stress might benefit more from family support compared to their peers without stressful life events and that friends may have a weaker presence in adolescent lives than expected.
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16
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Sawyer MG, Reece CE, Sawyer ACP, Johnson S, Lawrence D, Zubrick SR. The Prevalence of Stimulant and Antidepressant Use by Australian Children and Adolescents with Attention-Deficit/Hyperactivity Disorder and Major Depressive Disorder: A National Survey. J Child Adolesc Psychopharmacol 2017; 27:177-184. [PMID: 27154239 DOI: 10.1089/cap.2016.0017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To identify the prevalence of stimulant and antidepressant medication use by children and adolescents with symptoms meeting the criteria for attention-deficit/hyperactivity disorder (ADHD) and major depressive disorder (MDD) in Australia. To identify factors associated with stimulant and antidepressant use by children and adolescents in Australia. METHODS Data are from a nationally representative sample of 4- to 17-year-olds (n = 6310). Parents completed the Diagnostic Interview Schedule for Children-Version IV (DISC-IV) and the Strengths and Difficulties Questionnaire. Eleven- to 17-year-olds completed a self-report version of the DISC-IV MDD module. Interviewers recorded prescribed medications used by participants in the previous 2 weeks. RESULTS During a 2-week period, 1.3% of all 4- to 17-year-olds and 13.7% of those with symptoms meeting the criteria for ADHD had used stimulant medication, while 0.9% of all 4- to 17-year-olds and 13.4% with MDD had used antidepressants. In total, 22.6% of those using stimulant medications and 57.7% using antidepressant medications did not have symptoms meeting criteria for ADHD or MDD, respectively. Among 11- to 17-year-olds, 5.6% of those with adolescent-only-reported MDD, 10.9% of those with parent/carer-only-reported MDD, and 25.7% of those with MDD reported by both parents/carers and adolescents were using antidepressant medications. CONCLUSIONS Only a minority of 4- to 17-year-olds with ADHD and MDD were being treated with stimulant or antidepressant medication. The percentage of adolescents with MDD using antidepressant medications varied depending on whether adolescents, parents/carers, or both identified the presence of MDD. This highlights the importance of using information from both these informants when assessing and treating adolescent depressive disorder.
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Affiliation(s)
- Michael G Sawyer
- 1 School of Medicine, University of Adelaide , Adelaide, South Australia, Australia .,2 Research and Evaluation Unit, Women's and Children's Health Network , Adelaide, South Australia, Australia
| | - Christy E Reece
- 1 School of Medicine, University of Adelaide , Adelaide, South Australia, Australia .,2 Research and Evaluation Unit, Women's and Children's Health Network , Adelaide, South Australia, Australia
| | - Alyssa C P Sawyer
- 1 School of Medicine, University of Adelaide , Adelaide, South Australia, Australia .,3 School of Public Health, University of Adelaide , Adelaide, South Australia, Australia
| | - Sarah Johnson
- 4 Telethon Kids Institute, The University of Western Australia , Perth, Western Australia, Australia
| | - David Lawrence
- 4 Telethon Kids Institute, The University of Western Australia , Perth, Western Australia, Australia
| | - Stephen R Zubrick
- 4 Telethon Kids Institute, The University of Western Australia , Perth, Western Australia, Australia
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17
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Jeyaseelan DC, Sawyer MG. Developmental literacy: A universal intervention to help children with developmental disorders. J Paediatr Child Health 2017; 53:101-104. [PMID: 28052434 DOI: 10.1111/jpc.13456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 10/03/2016] [Accepted: 10/31/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Deepa C Jeyaseelan
- Child and Family Health Service, Women's and Children's Health Network, Adelaide, South Australia, Australia.,Child Development Unit, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Michael G Sawyer
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.,Research and Evaluation Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia
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18
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Lawrence D, Hafekost J, Johnson SE, Saw S, Buckingham WJ, Sawyer MG, Ainley J, Zubrick SR. Key findings from the second Australian Child and Adolescent Survey of Mental Health and Wellbeing. Aust N Z J Psychiatry 2016; 50:876-86. [PMID: 26644606 DOI: 10.1177/0004867415617836] [Citation(s) in RCA: 144] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To estimate the prevalence of mental disorders in children and adolescents in Australia, and the severity and impact of those mental disorders. METHOD Seven mental disorders were assessed using the parent- or carer-completed version of the Diagnostic Interview Schedule for Children Version IV, and major depressive disorder was also assessed using the youth self-report version of the Diagnostic Interview Schedule for Children Version IV. Severity and impact were assessed using an extended version of the Diagnostic Interview Schedule for Children Version IV impact on functioning questions, and days absent from school due to symptoms of mental disorders. Data were collected in a national face-to-face survey of 6310 parents or carers of children and adolescents aged 4-17 years, with 2969 young people aged 11-17 years also completing a self-report questionnaire. RESULTS Twelve-month prevalence of mental disorders was 13.9%, with 2.1% of children and adolescents having severe disorders, 3.5% having moderate disorders and 8.3% having mild disorders. The most common class of disorders was attention-deficit/hyperactivity disorder followed by anxiety disorders. Mental disorders were more common in step-, blended- or one-parent families, in families living in rented accommodation and families where one or both carers were not in employment. Mental disorders were associated with a substantial number of days absent from school particularly in adolescents. CONCLUSION Mental disorders are common in children and adolescents, often have significant impact and are associated with substantial absences from school. Child and adolescent mental disorders remain an important public health problem in Australia. Accurate information about prevalence and severity of child and adolescent mental disorders is an essential prerequisite for effective mental health policy and service planning.
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Affiliation(s)
- David Lawrence
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Jennifer Hafekost
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Sarah E Johnson
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Suzy Saw
- Health Data Analysis Pty Ltd, Canberra, ACT, Australia
| | | | - Michael G Sawyer
- Discipline of Paediatrics, The University of Adelaide, Adelaide, SA, Australia
| | - John Ainley
- Australian Council for Educational Research, Melbourne, VIC, Australia
| | - Stephen R Zubrick
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
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19
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Hafekost J, Lawrence D, Boterhoven de Haan K, Johnson SE, Saw S, Buckingham WJ, Sawyer MG, Ainley J, Zubrick SR. Methodology of Young Minds Matter: The second Australian Child and Adolescent Survey of Mental Health and Wellbeing. Aust N Z J Psychiatry 2016; 50:866-75. [PMID: 26698821 DOI: 10.1177/0004867415622270] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe the study design of Young Minds Matter: The second Australian Child and Adolescent Survey of Mental Health and Wellbeing. The aims of the study, sample design, development of survey content, field procedures and final questionnaires are detailed. METHOD During 2013-2014, a national household survey of the mental health and wellbeing of young people was conducted involving a sample of 6310 families selected at random from across Australia. The survey included a face-to-face diagnostic interview with parents/carers of 4- to 17-year-olds and a self-report questionnaire completed by young people aged 11-17 years. RESULTS The overall response rate to the survey was 55% with 6310 parents/carers of eligible households participating in the survey. In addition, 2967 or 89% of young people aged 11-17 years in these participating households completed a questionnaire. The survey sample was found to be broadly representative of the Australian population on major demographic characteristics when compared with data from the Census of Population and Housing. However, adjustments were made for an over-representation of younger children aged 4 to 7 years and also families with more than one eligible child in the household. CONCLUSION Young Minds Matter provides updated national prevalence estimates of common child and adolescent mental disorders, describes patterns of service use and will help to guide future decisions in the development of policy and provision of mental health services for children and adolescents. Advancements in interviewing methodology, addition of a data linkage component and informed content development contributed to improved breadth and quality of the data collected.
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Affiliation(s)
- Jennifer Hafekost
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - David Lawrence
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | | | - Sarah E Johnson
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Suzy Saw
- Health Data Analysis Pty Ltd, Canberra, ACT, Australia
| | | | - Michael G Sawyer
- Discipline of Paediatrics, The University of Adelaide, Adelaide, SA, Australia
| | - John Ainley
- Australian Council for Educational Research, Melbourne, VIC, Australia
| | - Stephen R Zubrick
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
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Sawyer MG, Reece CE, Bowering K, Jeffs D, Sawyer ACP, Peters JD, Mpundu-Kaambwa C, Clark JJ, McDonald D, Mittinty MN, Lynch JW. Usage, adherence and attrition: how new mothers engage with a nurse-moderated web-based intervention to support maternal and infant health. A 9-month observational study. BMJ Open 2016; 6:e009967. [PMID: 27496227 PMCID: PMC4985835 DOI: 10.1136/bmjopen-2015-009967] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To identify factors predicting use, adherence and attrition with a nurse-moderated web-based group intervention designed to support mothers of infants aged 0-6 months. DESIGN 9-Month observational study. SETTING Community maternal and child health service. PARTICIPANTS 240 mothers attending initial postnatal health checks at community clinics who were randomly assigned to the intervention arm of a pragmatic preference randomised trial (total randomised controlled trial, n=819; response rate=45%). INTERVENTION In the first week (phase I), mothers were assisted with their first website login by a research assistant. In weeks 2-7 (phase II), mothers participated in the web-based intervention with an expectation of weekly logins. The web-based intervention was comparable to traditional face-to-face new mothers' groups. During weeks 8-26 (phase III), mothers participated in an extended programme at a frequency of their choosing. PRIMARY OUTCOME MEASURES Number of logins and posted messages. Standard self-report measures assessed maternal demographic and psychosocial characteristics. RESULTS In phase II, the median number of logins was 9 logins (IQR=1-25), and in phase III, it was 10 logins (IQR=0-39). Incident risk ratios from multivariable analyses indicated that compared to mothers with the lowest third of logins in phase I, those with the highest third had 6.43 times as many logins in phase II and 7.14 times in phase III. Fifty per cent of mothers logged-in at least once every 30 days for 147 days after phase I and 44% logged-in at least once in the last 30 days of the intervention. Frequency of logins during phase I was a stronger predictor of mothers' level of engagement with the intervention than their demographic and psychosocial characteristics. CONCLUSIONS Mothers' early use of web-based interventions could be employed to customise engagement protocols to the circumstances of individual mothers with the aim of improving adherence and reducing attrition with web-based interventions. TRIAL REGISTRATION NUMBER ACTRN12613000204741; Results.
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Affiliation(s)
- Michael G Sawyer
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Research and Evaluation Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia
| | - Christy E Reece
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Research and Evaluation Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia
| | - Kerrie Bowering
- Child and Family Health Service, Women's and Children's Health Network, Adelaide, South Australia, Australia
| | - Debra Jeffs
- Child and Family Health Service, Women's and Children's Health Network, Adelaide, South Australia, Australia
| | - Alyssa C P Sawyer
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Jacqueline D Peters
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Research and Evaluation Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia
| | - Christine Mpundu-Kaambwa
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Research and Evaluation Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia
| | - Jennifer J Clark
- Research and Evaluation Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia
| | - Denise McDonald
- Child and Family Health Service, Women's and Children's Health Network, Adelaide, South Australia, Australia
| | - Murthy N Mittinty
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - John W Lynch
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Pössel P, Rakes C, Rudasill KM, Sawyer MG, Spence SH, Sheffield J. Associations Between Teacher-Reported School Climate and Depressive Symptoms in Australian Adolescents: A 5-Year Longitudinal Study. School Mental Health 2016. [DOI: 10.1007/s12310-016-9191-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sawyer ACP, Miller-Lewis LR, Searle AK, Sawyer MG, Lynch JW. Is greater improvement in early self-regulation associated with fewer behavioral problems later in childhood? Dev Psychol 2015; 51:1740-55. [PMID: 26501724 DOI: 10.1037/a0039829] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The aim of this study was to determine whether the extent of improvement in self-regulation achieved between ages 4 and 6 years is associated with the level of behavioral problems later in childhood. Participants were 4-year-old children (n = 510) attending preschools in South Australia. Children's level of self-regulation was assessed using the parent-completed Devereux Early Childhood Assessment when children were aged 4, 5, and 6. Children's level of behavioral problems was assessed using total, internalizing, and externalizing scores on parent- and teacher-rated Strengths and Difficulties Questionnaires (SDQs) when children were 6 years old. Random effects regression was used to describe the changes to children's self-regulation between 4 and 6 years. Linear regression models were then used to determine the strength of the association between the extent of self-regulation improvement and level of behavioral problems. Greater improvement in self-regulation, adjusted for family characteristics and baseline self-regulation scores, was associated with lower levels of parent- (B = -3.57, 95% confidence interval [CI] [-4.49, -2.65]) and teacher-rated SDQ total difficulties scores at 6 years (B = -2.42, 95% CI [-3.50, -1.34]). These effects remained after adjustment for level of parent-rated behavioral problems at 4 years. Similar effects were found for internalizing and externalizing scores at age 6 years. The results highlight the importance of improvements in self-regulation from 4-6 years for childhood behavioral problems during the early school years. Children with lower levels of improvement in self-regulation early in life are at risk for higher levels of behavioral problems both at home and at school.
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Affiliation(s)
| | | | - Amelia K Searle
- School of Public Health and Centre for Traumatic Stress Studies
| | - Michael G Sawyer
- Research and Evaluation Unit, Women's and Children's Health Network
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Whitham JN, Spurrier NJ, Baghurst PA, Weston P, Sawyer MG. Visual evoked potential latencies of three-year-old children prenatally exposed to buprenorphine or methadone compared with non-opioid exposed children: The results of a longitudinal study. Neurotoxicol Teratol 2015; 52:17-24. [PMID: 26432025 DOI: 10.1016/j.ntt.2015.09.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 09/27/2015] [Accepted: 09/28/2015] [Indexed: 10/23/2022]
Abstract
This study compared the latency of pattern reversal visual evoked potentials (VEP) of 36-month old children exposed to opioid pharmacotherapy in utero to that of a group of non-exposed children. Pregnant women were enrolled as part of an open-label non-randomised flexible dosing longitudinal study. Participants were 21 children whose mothers were treated with buprenorphine- (n=11) or methadone-pharmacotherapy (n=10) during pregnancy, and 15 children not exposed to opioids in pregnancy. One-way between groups analyses of variance (ANOVA) were conducted to test the statistical significance of differences between the mean latencies of the peak response to two different sized checkerboard patterns (48' and 69' of retinal arc). Standard multiple regression analyses were conducted to determine whether there was a significant relationship between group status and VEP latencies after adjusting for the effect of covariates. VEP latencies ranged from 98 to 112 milliseconds (ms) for checks of 48' arc, and from 95 to 113ms for checks of 69' arc. Latencies were comparable across groups. After adjusting for covariates children prenatally exposed to methadone or buprenorphine did not differ significantly from non-opioid exposed children in their responses to either check size. Nor were there any significant differences in VEP latencies between children prenatally exposed to methadone and children prenatally exposed to buprenorphine. Head circumference (HC) was significantly associated with P100 latencies for both check sizes. Data from this controlled, non-randomised study suggest that neither buprenorphine nor methadone appear to have any long-term effects on visual maturity assessed at 36months of age.
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Affiliation(s)
- Justine N Whitham
- Discipline of Paediatrics, School of Paediatrics and Reproductive Health, The University of Adelaide, South Australia 5005, Australia; Research and Evaluation Unit, Women's and Children's Health Network, 72 King William Rd, North Adelaide, South Australia 5006, Australia.
| | - Nicola J Spurrier
- Department of Paediatrics and Child Health, Flinders University, Bedford Park, South Australia 5042, Australia; Public Health Partnership Branch, Department for Health and Ageing, SA Health, Citicentre 11 Hindmarsh Square, Adelaide 5000, South Australia, Australia.
| | - Peter A Baghurst
- Public Health Research Unit, Women's and Children's Health Network, 72 King William Rd, North Adelaide, South Australia 5006, Australia.
| | - Paul Weston
- Department of Neurology, Women's and Children's Hospital, 72 King William Rd, North Adelaide, South Australia 5006, Australia.
| | - Michael G Sawyer
- Research and Evaluation Unit, Women's and Children's Health Network, 72 King William Rd, North Adelaide, South Australia 5006, Australia.
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Tearne JE, Allen KL, Herbison CE, Lawrence D, Whitehouse AJO, Sawyer MG, Robinson M. The association between prenatal environment and children's mental health trajectories from 2 to 14 years. Eur Child Adolesc Psychiatry 2015; 24:1015-24. [PMID: 25431038 DOI: 10.1007/s00787-014-0651-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 11/12/2014] [Indexed: 11/26/2022]
Abstract
The prenatal period is recognised as a critical period for later behavioural development. This study aimed to elucidate how an adverse prenatal environment, as defined by the presence of a number of known prenatal risk factors, would influence mental health trajectories in children to 14 years of age. The Raine Study provided comprehensive data from 2,900 pregnancies. Offspring were followed up at ages 2, 5, 8, 10, and 14 years using the Child Behaviour Checklist (CBCL). We used linear mixed regression models with random intercept and slope (random effects models) to examine the extent to which the predictor variables considered influenced changes in continuous CBCL total, internalising, and externalising T scores from ages 2 to 14. In the final multivariate models, increased offspring CBCL T scores were significantly predicted by the mother not finishing high school, smoking during pregnancy, having a total family income below the poverty line, being diagnosed with gestational hypertension and experiencing stressful life events during pregnancy. Conversely, as maternal age increased, CBCL T scores were significantly decreased. Child age also significantly interacted with maternal education, total family income, and maternal stressful life events, such that these variables predicted increases in CBCL scores from age 2 to age 10, and from age 2 to age 14 years. In the Raine Study sample, children who experienced adverse prenatal environments experienced increased levels of problem behaviours in childhood, and more problematic mental health trajectories. Maternal health risk behaviours and other psychosocial variables more commonly affected child behaviour than obstetric complications.
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Affiliation(s)
- Jessica E Tearne
- Telethon Kids Institute, The University of Western Australia, Perth, Australia,
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Sawyer MG, Erskine HE, Sawyer ACP, Morrissey M, Lynch JW. Childhood mental disorders: A forgotten problem? Aust N Z J Psychiatry 2015; 49:774-5. [PMID: 26126898 DOI: 10.1177/0004867415592958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Michael G Sawyer
- School of Paediatrics & Reproductive Health, The University of Adelaide, Adelaide, SA, Australia Research and Evaluation Unit, Women's and Children's Health Network (WCHN), North Adelaide, SA, Australia
| | - Holly E Erskine
- School of Public Health, The University of Queensland, St Lucia, QLD, Australia Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia
| | - Alyssa C P Sawyer
- School of Population Health, The University of Adelaide, Adelaide, SA, Australia
| | | | - John W Lynch
- School of Population Health, The University of Adelaide, Adelaide, SA, Australia School of Social and Community Medicine, University of Bristol, Bristol, UK
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Sawyer ACP, Chittleborough CR, Mittinty MN, Miller-Lewis LR, Sawyer MG, Sullivan T, Lynch JW. Are trajectories of self-regulation abilities from ages 2-3 to 6-7 associated with academic achievement in the early school years? Child Care Health Dev 2015; 41:744-54. [PMID: 25332070 DOI: 10.1111/cch.12208] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND The aim of this study was to estimate the association between two key aspects of self-regulation, 'task attentiveness' and 'emotional regulation' assessed from ages 2-3 to 6-7 years, and academic achievement when children were aged 6-7 years. METHODS Participants (n = 3410) were children in the Longitudinal Study of Australian Children. Parents rated children's task attentiveness and emotional regulation abilities when children were aged 2-3, 4-5 and 6-7. Academic achievement was assessed using the Academic Rating Scale completed by teachers. Linear regression models were used to estimate the association between developmental trajectories (i.e. rate of change per year) of task attentiveness and emotional regulation, and academic achievement at 6-7 years. RESULTS Improvements in task attentiveness between 2-3 and 6-7 years, adjusted for baseline levels of task attentiveness, child and family confounders, and children's receptive vocabulary and non-verbal reasoning skills at age 6-7 were associated with greater teacher-rated literacy [B = 0.05, 95% confidence interval (CI) = 0.04-0.06] and maths achievement (B = 0.04, 95% CI = 0.03-0.06) at 6-7 years. Improvements in emotional regulation, adjusting for baseline levels and covariates, were also associated with better teacher-rated literacy (B = 0.02, 95% CI = 0.01-0.04) but not with maths achievement (B = 0.01, 95% CI = -0.01-0.02) at 6-7 years. For literacy, improvements in task attentiveness had a stronger association with achievement at 6-7 years than improvements in emotional regulation. CONCLUSIONS Our study shows that improved trajectories of task attentiveness from ages 2-3 to 6-7 years are associated with improved literacy and maths achievement during the early school years. Trajectories of improving emotional regulation showed smaller effects on academic outcomes. Results suggest that interventions that improve task attentiveness when children are aged 2-3 to 6-7 years have the potential to improve literacy and maths achievement during the early school years.
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Affiliation(s)
- A C P Sawyer
- Discipline of Public Health, School of Population Health, University of Adelaide, Adelaide, SA, Australia
| | - C R Chittleborough
- Discipline of Public Health, School of Population Health, University of Adelaide, Adelaide, SA, Australia
| | - M N Mittinty
- Discipline of Public Health, School of Population Health, University of Adelaide, Adelaide, SA, Australia
| | - L R Miller-Lewis
- Research and Evaluation Unit, Women's and Children's Health Network, Adelaide, SA, Australia.,Discipline of Paediatrics, University of Adelaide, Adelaide, SA, Australia
| | - M G Sawyer
- Research and Evaluation Unit, Women's and Children's Health Network, Adelaide, SA, Australia.,Discipline of Paediatrics, University of Adelaide, Adelaide, SA, Australia
| | - T Sullivan
- Discipline of Public Health, School of Population Health, University of Adelaide, Adelaide, SA, Australia
| | - J W Lynch
- Discipline of Public Health, School of Population Health, University of Adelaide, Adelaide, SA, Australia.,School of Social and Community Medicine, University of Bristol, Bristol, UK
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Smithers LG, Chittleborough CR, Stocks N, Sawyer MG, Lynch JW. Can items used in 4-year-old well-child visits predict children's health and school outcomes? Matern Child Health J 2015; 18:1345-53. [PMID: 24068298 DOI: 10.1007/s10995-013-1369-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
To examine whether items comprising a preschool well-child check for use by family doctors in Australia with 4-5-year old children predicts health and academic outcomes at 6-7 years. The well-child check includes mandatory (anthropometry, eye/vision, ear/hearing, dental, toileting, allergy problems) and non-mandatory (processed food consumption, low physical activity, motor, behaviour/mood problems) items. The predictive validity of mandatory and non-mandatory items measured at 4-5 years was examined using data from the Longitudinal Study of Australian Children. Outcomes at 6-7 years included overweight/obesity, asthma, health care/medication needs, general health, mental health problems, quality of life, teacher-reported mathematics and literacy ability (n = 2,280-2,787). Weight or height >90th centile at 4-5 years predicted overweight/obesity at 6-7 years with 60% sensitivity, 79% specificity and 40% positive predictive value (PPV). Mood/behaviour problems at 4-5 predicted mental health problems at 6-7 years with 86% sensitivity, 40% specificity and 8% PPV. Non-mandatory items improved the discrimination between children with and without mental health problems at 6-7 years (area under the receiver operating characteristic curve 0.75 compared with 0.69 for mandatory items only), but was weak for most outcomes. Items used in a well-child health check were moderate predictors of overweight/obesity and mental health problems at 6-7 years, but poor predictors of other health and academic outcomes.
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Affiliation(s)
- Lisa G Smithers
- Discipline of Public Health, School of Population Health, The University of Adelaide, Mail drop DX 650 550, Adelaide, 5005, Australia,
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Gialamas A, Mittinty MN, Sawyer MG, Zubrick SR, Lynch J. Social inequalities in childcare quality and their effects on children's development at school entry: findings from the Longitudinal Study of Australian Children. J Epidemiol Community Health 2015; 69:841-8. [PMID: 25827468 DOI: 10.1136/jech-2014-205031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 03/09/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Higher quality childcare in the years before school may help narrow developmental gaps between the richest and poorest children in our societies, but specific evidence is limited and inconsistent. We address this issue by examining whether higher quality childcare is associated with better developmental outcomes at school entry for children from lower than higher income families. METHODS The sample from the Longitudinal Study of Australian Children included children attending childcare from 2 to 3 years (n=980-1187, depending on outcome). Childcare quality was measured using carers assessment of their relationship with the child. Children's receptive vocabulary was directly assessed in the child's home, and behavioural difficulties were measured by teachers and parents at 4-5 years. We assessed additive and multiplicative income-related effect measure modification of the quality of carer-child relationship on developmental outcomes. RESULTS After adjusting for confounding, there was some evidence of effect measure modification on the additive and multiplicative scales of childcare quality by income. Children experiencing higher quality relationships and lower income had almost the same risk of poorer receptive vocabulary as children in higher quality relationships and higher incomes (relative excess risk due to interaction=0.18; 95% CI -0.20 to 0.52), ratio of relative risks=1.11 (1.04 to 1.17)). These patterns were similar for teacher-reported and parent-reported behavioural difficulties. CONCLUSIONS The effects of higher quality childcare, in terms of quality relationships with carers, on children's cognitive and behavioural development at school entry were stronger among children from lower income families. This provides some evidence that higher quality relationships in childcare may be especially important in helping reduce developmental gaps for children from lower income families.
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Affiliation(s)
- Angela Gialamas
- School of Population Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Murthy N Mittinty
- School of Population Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Michael G Sawyer
- Research and Evaluation Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia Discipline of Paediatrics, University of Adelaide, Adelaide, South Australia, Australia
| | - Stephen R Zubrick
- The University of Western Australia, Telethon Institute for Child Health Research, Perth, Western Australia, Australia
| | - John Lynch
- School of Population Health, University of Adelaide, Adelaide, South Australia, Australia School of Social and Community Medicine, University of Bristol, Bristol, UK
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Gialamas A, Mittinty MN, Sawyer MG, Zubrick SR, Lynch J. Time spent in different types of childcare and children's development at school entry: an Australian longitudinal study. Arch Dis Child 2015; 100:226-32. [PMID: 25204736 DOI: 10.1136/archdischild-2014-306626] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate whether the total amount of time in childcare through the first 3 years of life was associated with children's receptive vocabulary, externalising and internalising problem behaviours at age 4-5 years, and whether this association varied for different types of childcare. METHODS We used data from the prospective, population-based Longitudinal Study of Australian Children (n=3208-4066, depending on outcome). Parental reports of the time spent in different types of childcare were collected at face-to-face interviews at age 0-1years and at age 2-3 years. Children's receptive vocabulary was directly assessed in the child's home, and externalising and internalising behaviours were measured by questionnaire, completed by parents and teachers at age 4-5 years. RESULTS At 3 years of age, 75% of the sample spent regular time in the care of someone other than the parent. After adjustment, more time in childcare was not associated with children's receptive vocabulary ability but was associated with higher levels of parent-reported (β=0.10 (95% CI 0.00 to 0.21)) and teacher-reported (β=0.31 (0.19 to 0.44)) externalising problem behaviours and lower levels of parent-reported internalising problem behaviours (β=-0.08 (-0.15 to -0.00)). Compared with children who did not attend any type of childcare, children in centre-based care had higher parent-reported and teacher-reported externalising and lower internalising problem behaviours. CONCLUSIONS More time in centre-based childcare (but not other types of care) through the first 3 years of life was associated with higher parent-reported and teacher-reported externalising problem behaviours, and lower parent-reported internalising problem behaviours but not with children's receptive vocabulary ability at school entry.
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Affiliation(s)
- Angela Gialamas
- School of Population Health, University of Adelaide, Adelaide, Australia
| | - Murthy N Mittinty
- School of Population Health, University of Adelaide, Adelaide, Australia
| | - Michael G Sawyer
- Research and Evaluation Unit, Women's and Children's Health Network, Adelaide, Australia Discipline of Paediatrics, University of Adelaide, Adelaide, Australia
| | - Stephen R Zubrick
- The University of Western Australia, Telethon Institute for Child Health Research, Perth, Australia
| | - John Lynch
- School of Population Health, University of Adelaide, Adelaide, Australia School of Social and Community Medicine, University of Bristol, Bristol, UK
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Boterhoven de Haan KL, Hafekost J, Lawrence D, Sawyer MG, Zubrick SR. Reliability and validity of a short version of the general functioning subscale of the McMaster Family Assessment Device. Fam Process 2015; 54:116-123. [PMID: 25385473 DOI: 10.1111/famp.12113] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The General Functioning 12-item subscale (GF12) of The McMaster Family Assessment Device (FAD) has been validated as a single index measure to assess family functioning. This study reports on the reliability and validity of using only the six positive items from the General Functioning subscale (GF6+). Existing data from two Western Australian studies, the Raine Study (RS) and the Western Australian Child Health Survey (WACHS), was used to analyze the psychometric properties of the GF6+ subscale. The results demonstrated that the GF6+ subscale had virtually equivalent psychometric properties and was able to identify almost all of the same families who had healthy or unhealthy levels of functioning as the full GF12 subscale. In consideration of the constraints faced by large-scale population-based surveys, the findings of this study support the use of a GF6+ subscale from the FAD, as a quick and effective tool to assess the overall functioning of families.
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Sawyer MG, Pfeiffer S, Sawyer A, Bowering K, Jeffs D, Lynch J. Effectiveness of nurse home visiting for families in rural South Australia. J Paediatr Child Health 2014; 50:1013-22. [PMID: 24957571 DOI: 10.1111/jpc.12679] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2014] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the effectiveness of a 2-year post-natal home-visiting programme delivered by nurses to socially disadvantaged mothers in rural regions of South Australia. METHODS The intervention group consisted of 225 mothers who lived in rural regions and enrolled in the programme between 2010 and 2012. The comparison group consisted of 239 mothers who lived in rural areas between 2008 and 2009 when the programme was not yet available. All participants were eligible for enrolment in the home-visiting programme. Participants in both groups were assessed at baseline (mean child age = 15.2 weeks, SD = 2.4), prior to programme enrolment, and again when children were aged 9, 18 and 24 months. Outcomes were evaluated using the Parent Stress Index, Kessler Psychological Distress Scale, Ages and Stages Questionnaire, Child Behaviour Checklist, and MacArthur Communicative Developmental Inventory. RESULTS During the follow-up period, there was little difference in the pattern of scores across the two groups. Mixed models adjusting for baseline differences between the groups did not identify any significant Group × Time interactions. This suggests that the linear trajectories of scores on outcomes did not differ significantly between the two groups. CONCLUSIONS Findings suggest that the home-visiting programme did not have a measurable effect on maternal or child outcomes. However, the programme was relatively early in its rollout, and the greater challenges of recruitment, training and support, along with rural nurses' broader responsibilities for delivering other maternal and child health services, may explain why effects seen in the metropolitan area were not evident in rural regions.
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Affiliation(s)
- Michael G Sawyer
- Discipline of Paediatrics, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, South Australia, Australia; Research and Evaluation Unit, Women's and Children's Health Network, North Adelaide, South Australia, Australia
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Gialamas A, Sawyer ACP, Mittinty MN, Zubrick SR, Sawyer MG, Lynch J. Quality of childcare influences children's attentiveness and emotional regulation at school entry. J Pediatr 2014; 165:813-9.e3. [PMID: 25039045 DOI: 10.1016/j.jpeds.2014.06.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 04/28/2014] [Accepted: 06/04/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To examine the association between domain-specific qualities of formal childcare at age 2-3 years and children's task attentiveness and emotional regulation at age 4-5 and 6-7 years. STUDY DESIGN We used data from the Longitudinal Study of Australian Children (n = 1038). Three domain-specific aspects of childcare quality were assessed: provider and program characteristics of care, activities in childcare, and carer-child relationship. Two self-regulatory abilities were considered: task attentiveness and emotional regulation. Associations between domain-specific qualities of childcare and self-regulation were investigated in linear regression analyses adjusted for confounding, with imputation for missing data. RESULTS There was no association between any provider or program characteristics of care and children's task attentiveness and emotional regulation. The quality of activities in childcare were associated only with higher levels of emotional regulation at age 4-5 years (β = 0.24; 95% CI, 0.03-0.44) and 6-7 years (β = 0.26; 95% CI, 0.04-0.48). Higher-quality carer-child relationships were associated with higher levels of task attentiveness (β = 0.20; 95% CI, 0.05-0.36) and emotional regulation at age 4-5 years (β = 0.19; 95% CI, 0.04-0.34) that persisted to age 6-7 years (β = 0.26; 95% CI, 0.10-0.42; β = 0.31; 95% CI, 0.16-0.47). CONCLUSION Among children using formal childcare, those who experienced higher-quality relationships were better able to regulate their attention and emotions as they started school. Higher emotional regulation was also observed for children engaged in more activities in childcare. Beneficial effects were stable over time.
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Affiliation(s)
- Angela Gialamas
- School of Population Health, University of Adelaide, Adelaide, Australia.
| | - Alyssa C P Sawyer
- School of Population Health, University of Adelaide, Adelaide, Australia
| | - Murthy N Mittinty
- School of Population Health, University of Adelaide, Adelaide, Australia
| | - Stephen R Zubrick
- Telethon Institute for Child Health Research, University of Western Australia, Perth, Australia
| | - Michael G Sawyer
- Research and Evaluation Unit, Women's and Children's Health Network, Adelaide, Australia; Discipline of Pediatrics, University of Adelaide, Adelaide, Australia
| | - John Lynch
- School of Population Health, University of Adelaide, Adelaide, Australia; School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
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Miller-Lewis LR, Sawyer ACP, Searle AK, Mittinty MN, Sawyer MG, Lynch JW. Student-teacher relationship trajectories and mental health problems in young children. BMC Psychol 2014; 2:27. [PMID: 25685350 PMCID: PMC4317136 DOI: 10.1186/s40359-014-0027-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 08/06/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This longitudinal study classified groups of children experiencing different trajectories of student-teacher relationship quality over the transition from preschool into school, and determined the strength of the association between different student-teacher relationship trajectories and childhood mental health problems in the second year of primary school. METHODS A community sample of 460 Australian children were assessed in preschool (age 4), the first school year (age 5), and second school year (age 6). Teachers at all three assessments reported on student-teacher relationship quality with the Student Teacher Relationship Scale. When the children were at preschool and in their second school year, parents and teachers rated children's mental health problems using the Strengths and Difficulties Questionnaire. RESULTS Latent-class growth modelling identified two trajectories of student-teacher relationship quality: (1) a stable-high student-teacher relationship quality and (2) a moderate/declining student-teacher relationship quality trajectory. Generalised linear models found that after adjusting for family demographic characteristics, having a stable high quality student-teacher relationship trajectory was associated with fewer parent-rated and teacher-rated total mental health problems, and fewer conduct, hyperactivity, and peer problems, and greater prosocial behaviour at age 6. A stable high quality trajectory was also associated with fewer teacher-rated, but not parent-rated emotional symptoms. These effects remained after adjustment for levels of mental health problems at age 4. CONCLUSIONS Findings suggest that early intervention and prevention strategies that focus on building stable high quality student-teacher relationships during preschool and children's transition into formal schooling, may help reduce rates of childhood mental health problems during the early school years.
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Affiliation(s)
- Lauren R Miller-Lewis
- />Discipline of Paediatrics, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, South Australia 5005 Australia
- />Research and Evaluation Unit, Women’s and Children’s Hospital, Women’s and Children’s Health Network, 72 King William Road, North Adelaide, South Australia 5006 Australia
| | - Alyssa CP Sawyer
- />Discipline of Public Health, School of Population Health, University of Adelaide, Adelaide, South Australia 5005 Australia
| | - Amelia K Searle
- />Discipline of Public Health, School of Population Health, University of Adelaide, Adelaide, South Australia 5005 Australia
- />Centre for Traumatic Stress Studies, School of Population Health, University of Adelaide, Adelaide, South Australia 5005 Australia
| | - Murthy N Mittinty
- />Discipline of Public Health, School of Population Health, University of Adelaide, Adelaide, South Australia 5005 Australia
| | - Michael G Sawyer
- />Discipline of Paediatrics, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, South Australia 5005 Australia
- />Research and Evaluation Unit, Women’s and Children’s Hospital, Women’s and Children’s Health Network, 72 King William Road, North Adelaide, South Australia 5006 Australia
| | - John W Lynch
- />Discipline of Public Health, School of Population Health, University of Adelaide, Adelaide, South Australia 5005 Australia
- />School of Social and Community Medicine, University of Bristol, Bristol, UK
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Sawyer ACP, Chittleborough CR, Lynch JW, Baghurst P, Mittinty MN, Kaim ALE, Sawyer MG. Can screening 4-5 year olds accurately identify children who will have teacher-reported mental health problems when children are aged 6-7 years? Aust N Z J Psychiatry 2014; 48:554-63. [PMID: 24301519 DOI: 10.1177/0004867413514491] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the screening accuracy of information obtained from parents of 4-5-year-old children for the purpose of identifying the children who have teacher-reported mental health problems when they are aged 6-7 years. METHOD The study used data from the Longitudinal Study of Australian Children (LSAC) obtained when children were aged 4-5 years and 6-7 years. The level of children's mental health problems was assessed using the Strengths and Difficulties Questionnaire (SDQ) completed by parents when children were aged 4-5 years and by teachers when children were aged 6-7 years (n=2163). When children were aged 4-5 years, parenting skills were assessed using three questionnaires developed for the parent-completed LSAC questionnaire and maternal mental health was assessed using the Kessler Psychological Distress Scale (K6). RESULTS When the level of parent-reported childhood mental health problems at 4-5 years old was used to identify children with teacher-reported mental health problems (i.e. a score in the "abnormal" range of the teacher-reported SDQ Total Difficulties Scale) when the children were aged 6-7 years, sensitivity was 26.8%, positive predictive value was 22.8%, and specificity was 92.9%. The addition of further information about the characteristics of children and their parents made only a small improvement to screening accuracy. CONCLUSIONS Targeted interventions for preschool children may have the potential to play an important role in reducing the prevalence of mental health problems during the early school years. However, current capacity to accurately identify preschoolers who will experience teacher-reported mental health problems during the early school years is limited.
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Affiliation(s)
- Alyssa C P Sawyer
- Discipline of Public Health, School of Population Health, University of Adelaide, Adelaide, SA, Australia
| | - Catherine R Chittleborough
- Discipline of Public Health, School of Population Health, University of Adelaide, Adelaide, SA, Australia
| | - John W Lynch
- Discipline of Public Health, School of Population Health, University of Adelaide, Adelaide, SA, Australia School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Peter Baghurst
- Discipline of Paediatrics, University of Adelaide, Adelaide, SA, Australia
| | - Murthy N Mittinty
- Discipline of Public Health, School of Population Health, University of Adelaide, Adelaide, SA, Australia
| | - Amy L E Kaim
- Discipline of Paediatrics, University of Adelaide, Adelaide, SA, Australia Research and Evaluation Unit, Women's and Children's Health Network, Adelaide, SA, Australia
| | - Michael G Sawyer
- Discipline of Paediatrics, University of Adelaide, Adelaide, SA, Australia Research and Evaluation Unit, Women's and Children's Health Network, Adelaide, SA, Australia
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Sawyer ACP, Lynch J, Bowering K, Jeffs D, Clark J, Mpundu-Kaambwa C, Sawyer MG. An equivalence evaluation of a nurse-moderated group-based internet support program for new mothers versus standard care: a pragmatic preference randomised controlled trial. BMC Pediatr 2014; 14:119. [PMID: 24886238 PMCID: PMC4108010 DOI: 10.1186/1471-2431-14-119] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 04/25/2014] [Indexed: 11/21/2022] Open
Abstract
Background All mothers in South Australia are offered a clinic or home-visit by a Child and Family Health community nurse in the initial postnatal weeks. Subsequent support is available on request from staff in community clinics and from a telephone helpline. The aim of the present study is to compare equivalence of a single clinic-based appointment plus a nurse-moderated group-based internet intervention when infants were aged 0–6 months versus a single home-visit together with subsequent standard services (the latter support was available to mothers in both study groups). Methods/Design The evaluation utilised a pragmatic preference randomised trial comparing the equivalence of outcomes for mothers and infants across the two study groups. Eligible mothers were those whose services were provided by nurses working in one of six community clinics in the metropolitan region of Adelaide. Mothers were excluded if they did not have internet access, required an interpreter, or their nurse clinician recommended that they not participate due to issues such as domestic violence or substance abuse. Randomisation was based on the service identification number sequentially assigned to infants when referred to the Child and Family Health Services from birthing units (this was done by administrative staff who had no involvement in recruiting mothers, delivering the intervention, or analyzing results for the study). Consistent with design and power calculations, 819 mothers were recruited to the trial. The primary outcomes for the trial are parents’ sense of competence and self-efficacy measured using standard self-report questionnaires. Secondary outcomes include the quality of mother-infant relationships, maternal social support, role satisfaction and maternal mental health, infant social-emotional and language development, and patterns of service utilisation. Maternal and infant outcomes will be evaluated using age-appropriate questionnaires when infants are aged <2 months (pre-intervention), 9, 15, and 21 months. Discussion We know of no previous study that has evaluated an intervention that combines the capacity of nurse and internet-based services to improve outcomes for mothers and infants. The knowledge gained from this study will inform the design and conduct of community-based postnatal mother and child support programs. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12613000204741
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Affiliation(s)
- Alyssa C P Sawyer
- School of Population Health, University of Adelaide, Adelaide, Australia.
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Searle AK, Baghurst PA, van Hooff M, Sawyer MG, Sim MR, Galletly C, Clark LS, McFarlane AC. Tracing the long-term legacy of childhood lead exposure: a review of three decades of the port Pirie cohort study. Neurotoxicology 2014; 43:46-56. [PMID: 24785378 DOI: 10.1016/j.neuro.2014.04.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 03/28/2014] [Accepted: 04/21/2014] [Indexed: 11/17/2022]
Abstract
Several prospective cohort studies have demonstrated that childhood lead levels show small but statistically significant adjusted associations with subsequent development in later childhood and adolescence. The Port Pirie Cohort study is one of the few prospective cohort studies to follow participants into adulthood. This paper reviews all childhood and adulthood findings of the Port Pirie Cohort study to date. Cohort members (initially, 723 infants born in/around the lead-smelting town of Port Pirie) showed a wide range of childhood blood lead levels, which peaked around 2 years old (M=21.3μg/dL, SD=1.2). At all childhood assessments, postnatal lead levels - particularly those reflecting cumulative exposure - showed small significant associations with outcomes including cognitive development, IQ, and mental health problems. While associations were substantially attenuated after adjusting for several childhood covariates, many remained statistically significant. Furthermore, average childhood blood lead showed small significant associations with some adult mental health problems for females, including anxiety problems and phobia, though associations only approached significance following covariate adjustment. Overall, there did not appear to be any age of greatest vulnerability or threshold of effect, and at all ages, females appeared more susceptible to lead-associated deficits. Together, these findings suggest that the associations between early childhood lead exposure and subsequent developmental outcomes may persist. However, as the magnitude of these effects was small, they are not discernible at the individual level, posing more of a population health concern. It appears that the combination of multiple early childhood factors best predicts later development. As such, minimising lead exposure in combination with improving other important early childhood factors such as parent-child interactions may be the best way to improve developmental outcomes.
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Affiliation(s)
- Amelia K Searle
- Centre for Traumatic Stress Studies, School of Population Health, University of Adelaide, South Australia 5000, Australia.
| | - Peter A Baghurst
- Discipline of Public Health, University of Adelaide, South Australia 5000, Australia; Discipline of Paediatrics, University of Adelaide, South Australia 5000, Australia
| | - Miranda van Hooff
- Centre for Traumatic Stress Studies, School of Population Health, University of Adelaide, South Australia 5000, Australia
| | - Michael G Sawyer
- Discipline of Paediatrics, University of Adelaide, South Australia 5000, Australia; Research and Evaluation Unit, Women's and Children's Health Network, South Australia 5000, Australia
| | - Malcolm R Sim
- Department of Epidemiology & Preventive Medicine, Monash University, Victoria 3004, Australia
| | - Cherrie Galletly
- Discipline of Psychiatry, University of Adelaide, South Australia 5000, Australia
| | - Levina S Clark
- Psychology Clinic, Flinders University, South Australia 5000, Australia
| | - Alexander C McFarlane
- Centre for Traumatic Stress Studies, School of Population Health, University of Adelaide, South Australia 5000, Australia
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McFarlane AC, Searle AK, Van Hooff M, Baghurst PA, Sawyer MG, Galletly C, Sim MR, Clark LS. Prospective associations between childhood low-level lead exposure and adult mental health problems: The Port Pirie cohort study. Neurotoxicology 2013; 39:11-7. [DOI: 10.1016/j.neuro.2013.08.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 08/06/2013] [Accepted: 08/06/2013] [Indexed: 10/26/2022]
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Robinson M, Whitehouse AJO, Jacoby P, Mattes E, Sawyer MG, Keelan JA, Hickey M. Umbilical cord blood testosterone and childhood internalizing and externalizing behavior: a prospective study. PLoS One 2013; 8:e59991. [PMID: 23573225 PMCID: PMC3613417 DOI: 10.1371/journal.pone.0059991] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 02/22/2013] [Indexed: 11/30/2022] Open
Abstract
Antenatal testosterone exposure influences fetal neurodevelopment and gender-role behavior in postnatal life and may contribute to differences in developmental psychopathology during childhood. We prospectively measured the associations between umbilical cord blood testosterone levels at birth and childhood behavioral development in both males and females from a large population based sample. The study comprised 430 females and 429 males from the Western Australian Pregnancy Cohort (Raine) Study where umbilical cord blood had been collected. Total testosterone concentrations were determined by mass spectrometry and bioavailable testosterone (BioT) levels were calculated. At two, five, eight and ten years of age, the participants completed the Child Behavior Checklist (CBCL). Linear regression models were used to analyse the relationship between BioT concentrations (in quartiles) and CBCL scores (total, internalizing, externalizing and selected syndrome). Boys had higher mean CBCL T-scores than girls across all ages of follow-up. There was no significant relationship between cord blood BioT quartiles and CBCL total, internalizing and externalizing T-scores at age two or five to ten combined. In the syndrome score analyses, higher BioT quartiles were associated with significantly lower scores for attention problems for boys at age five, eight and ten, and greater withdrawal symptoms in pre-school girls (age five). We did not identify a consistent relationship between antenatal testosterone exposure and total, internalizing or externalizing behavioral difficulties in childhood. Higher umbilical cord BioT levels were associated with lower scores for attention problems in boys up to 10 years and more withdrawn behavior in 5-year-old girls; however, these findings were not consistent across ages and require further investigation in a larger sample.
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Affiliation(s)
- Monique Robinson
- Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Perth, Australia.
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Miller-Lewis LR, Searle AK, Sawyer MG, Baghurst PA, Hedley D. Resource factors for mental health resilience in early childhood: An analysis with multiple methodologies. Child Adolesc Psychiatry Ment Health 2013; 7:6. [PMID: 23432929 PMCID: PMC3598384 DOI: 10.1186/1753-2000-7-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 02/14/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Given that relatively little is known about the development of resilience in early childhood, this longitudinal study aimed to identify preschool resource factors associated with young children's mental health resilience to family adversity. METHODS A community sample of 474 young Australian children was assessed in preschool (mean age 4.59 years, 49% male), and again two years later after their transition into formal schooling. At each assessment, standard questionnaires were used to obtain ratings from both parents and teachers about the quality of children's relationships with parents and teachers, children's self-concept and self-control, mental health (Strengths and Difficulties Questionnaire), and family adversities (including stressful life events and socioeconomic disadvantage). RESULTS Greater exposure to cumulative family adversities was associated with both greater teacher- and parent-reported child mental health difficulties two years later. Multiple methodologies for operationalizing resilience were used to identify resources associated with resilient mental health outcomes. Higher quality child-parent and child-teacher relationships, and greater child self-concept and self-control were associated with resilient mental health outcomes. With the exception of child-teacher relationships, these resources were also prospective antecedents of subsequent resilient mental health outcomes in children with no pre-existing mental health difficulties. Child-parent relationships and child self-concept generally had promotive effects, being equally beneficial for children facing both low- and high-adversity. Child self-control demonstrated a small protective effect on teacher-reported outcomes, with greater self-control conferring greater protection to children under conditions of high-adversity. CONCLUSIONS Findings suggest that early intervention and prevention strategies that focus on fostering child-adult relationship quality, self-concept, and self-control in young children may help build children's mental health and their resilience to family adversities.
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Affiliation(s)
- Lauren R Miller-Lewis
- Discipline of Paediatrics, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, South Australia 5005, Australia
- Research and Evaluation Unit, Women’s and Children’s Health Network, 72 King William Road, North Adelaide, South Australia 5006, Australia
| | - Amelia K Searle
- Discipline of Paediatrics, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, South Australia 5005, Australia
- Research and Evaluation Unit, Women’s and Children’s Health Network, 72 King William Road, North Adelaide, South Australia 5006, Australia
- Centre for Traumatic Stress Studies, School of Population Health, University of Adelaide, Adelaide, South Australia, 5005, Australia
| | - Michael G Sawyer
- Discipline of Paediatrics, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, South Australia 5005, Australia
- Research and Evaluation Unit, Women’s and Children’s Health Network, 72 King William Road, North Adelaide, South Australia 5006, Australia
| | - Peter A Baghurst
- Public Health Research Unit, Women’s and Children’s Health Network, 72 King William Road, North Adelaide, South Australia, 5006, Australia
- School of Population Health, University of Adelaide, Adelaide, South Australia, 5005, Australia
| | - Darren Hedley
- Research and Evaluation Unit, Women’s and Children’s Health Network, 72 King William Road, North Adelaide, South Australia 5006, Australia
- Child Development Center, Nationwide Children’s Hospital and Ohio State University, Columbus, Ohio, USA
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Pössel P, Rudasill KM, Sawyer MG, Spence SH, Bjerg AC. Associations between teacher emotional support and depressive symptoms in Australian adolescents: a 5-year longitudinal study. Dev Psychol 2013; 49:2135-46. [PMID: 23379297 DOI: 10.1037/a0031767] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Approximately 1/5 of adolescents develop depressive symptoms. Given that youths spend a good deal of their lives at school, it seems plausible that supportive relationships with teachers could benefit their emotional well-being. Thus, the purpose of this study is to examine the association between emotionally supportive teacher relationships and depression in adolescence. The so-called principle-effect and stress-buffer models could explain relationships between teacher emotional support and depressive symptoms, yet no study has used both models to test bidirectional relationships between teacher support and depressive symptoms in students separately by sex. Four-thousand three-hundred forty-one students (boys: n = 2,063; girls: n = 2,278) from Grades 8 to 12 completed the Center for Epidemiological Studies Depression Scale (CES-D), List of Threatening Experiences Questionnaire (LTEQ), and an instrument developed for the study to measure teacher support annually for 5 years. Results support neither of the 2 proposed models. Instead, they indicate that in the 1st years of high school, students of both sexes with average and high numbers of stressful events benefit from teacher support, while teacher support might have iatrogenic effects on students experiencing low numbers of stressful events. Possible explanations for the findings and future research are discussed.
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Affiliation(s)
- Patrick Pössel
- Department of Educational and Counseling Psychology, University of Louisville
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Ratcliffe J, Stevens K, Flynn T, Brazier J, Sawyer MG. Whose values in health? An empirical comparison of the application of adolescent and adult values for the CHU-9D and AQOL-6D in the Australian adolescent general population. Value Health 2012; 15:730-6. [PMID: 22867783 DOI: 10.1016/j.jval.2012.04.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 03/29/2012] [Accepted: 04/04/2012] [Indexed: 05/20/2023]
Abstract
OBJECTIVES The Child Health Utility-9D (CHU-9D) and the Assessment of Quality of Life-6D (AQOL-6D) presently represent the only two generic preference-based instruments developed for application with young people with both adult- and adolescent-specific scoring algorithms. The main objective of this study was to compare and contrast the application of adult and adolescent scoring algorithms for the CHU-9D and AQOL-6D in valuing the health of a community-based sample of adolescents. METHODS A Web-based survey including the CHU-9D and the AQOL-6D was developed for administration to adolescents, aged 11 to 17 years, residing in Australia (n = 500). Individual responses to both instruments were converted to values by using first the adult and second the adolescent scoring algorithms pertaining to each instrument. RESULTS Both the AQOL-6D and the CHU-9D discriminated well according to health status and the presence of long-standing illness regardless of the scoring algorithm. Within each instrument, however, important discrepancies were found in that employment of the adolescent algorithm was found to result in consistently lower mean health state values for the CHU-9D but consistently higher mean health state values for the AQOL-6D relative to the employment of their respective adult algorithms and these differences were statistically significant (P < 0.05). CONCLUSION The differences in adolescent and adult values for identical health states are more profound for the CHU-9D and ultimately may be significant enough to have an impact on health care policy. It is important to note that there are important differences between the CHU-9D instrument and the AQOL-6D instrument that may also have a significant impact on the valuations obtained.
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Affiliation(s)
- Julie Ratcliffe
- Flinders Clinical Effectiveness, Repatriation General Hospital, Flinders University, Adelaide, South Australia, Australia.
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Whitehouse AJO, Mattes E, Maybery MT, Sawyer MG, Jacoby P, Keelan JA, Hickey M. Sex-specific associations between umbilical cord blood testosterone levels and language delay in early childhood. J Child Psychol Psychiatry 2012; 53:726-34. [PMID: 22276678 DOI: 10.1111/j.1469-7610.2011.02523.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Preliminary evidence suggests that prenatal testosterone exposure may be associated with language delay. However, no study has examined a large sample of children at multiple time-points. METHODS Umbilical cord blood samples were obtained at 861 births and analysed for bioavailable testosterone (BioT) concentrations. When participating offspring were 1, 2 and 3 years of age, parents of 767 children (males = 395; females = 372) completed the Infant Monitoring Questionnaire (IMQ), which measures Communication, Gross Motor, Fine Motor, Adaptive and Personal-Social development. Cut-off scores are available for each scale at each age to identify children with 'clinically significant' developmental delays. Chi-square analyses and generalized estimating equations examined longitudinal associations between sex-specific quartiles of BioT concentrations and the rate of developmental delay. RESULTS Significantly more males than females had language delay (Communication scale) at age 1, 2 and 3 years (p-values ≤. 01). Males were also more likely to be classified as delayed on the Fine-Motor (p = .04) and Personal-Social (p < .01) scales at age 3 years. Chi-square analyses found a significant difference between BioT quartiles in the rate of language delay (but not Fine-Motor and Personal-Social delay) for males (age 3) and females (age 1 and 3). Generalized estimating equations, incorporating a range of sociodemographic and obstetric variables, found that males in the highest BioT quartile were at increased risk for a clinically significant language delay during the first 3 years of life, with an odds ratio (OR) of 2.47 (95% CI: 1.12, 5.47). By contrast, increasing levels of BioT reduced the risk of language delay among females (Quartile 2: OR = 0.23, 95% CI: 0.09, 0.59; Quartile 4: 0.46, 95% CI: 0.21, 0.99). CONCLUSION These data suggest that high prenatal testosterone levels are a risk factor for language delay in males, but may be a protective factor for females.
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Affiliation(s)
- Andrew J O Whitehouse
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, 100 Roberts Road, Subiaco, WA 6008, Australia.
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Sawyer MG, Borojevic N, Ettridge KA, Spence SH, Sheffield J, Lynch J. Do help-seeking intentions during early adolescence vary for adolescents experiencing different levels of depressive symptoms? J Adolesc Health 2012; 50:236-42. [PMID: 22325128 DOI: 10.1016/j.jadohealth.2011.06.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Revised: 05/16/2011] [Accepted: 06/16/2011] [Indexed: 10/17/2022]
Abstract
PURPOSE To investigate whether help-seeking intentions for depressive symptoms vary for adolescents experiencing low, mild-to-moderate, and high levels of depressive symptoms. METHODS A total of 5,362 participants aged 12-14 years had completed the baseline assessment for a randomized controlled trial evaluating the effectiveness of a universal intervention designed to reduce depressive symptoms among high school students. The participants reported their help-seeking intentions in response to a vignette describing an individual experiencing depressive symptoms consistent with a diagnosis of a minor depressive disorder. Standard measures were used to assess participants' level of depressive symptoms and perceived level of social support. RESULTS Logistic regression models examined relationships between help-seeking intentions and levels of depression, after adjustment for demographic characteristics and perceived support. As compared with those with low levels of depressive symptoms, adolescents with high levels of symptoms reported less intention to seek help from friends (odds ratio [OR] = .42) or family members (OR = .29). They were also four times more likely to report that they would not seek help from anybody (OR = 4.55). A similar pattern was evident during comparisons of help-seeking intentions reported by adolescents with mild-to-moderate levels of depressive symptoms versus those with low levels of symptoms. CONCLUSIONS Targeted and universal interventions need to encourage peers and family members to actively engage with young adolescents experiencing depressive symptoms rather than waiting for them to initiate help-seeking. This is particularly important for adolescents experiencing higher levels of depressive symptoms who may not initiate help-seeking themselves.
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Affiliation(s)
- Michael G Sawyer
- Discipline of Paediatrics, University of Adelaide, North Adelaide, South Australia, Australia.
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Sawyer MG, Bittman M, LA Greca AM, Crettenden AD, Borojevic N, Raghavendra P, Russo R. Time demands of caring for children with cerebral palsy: what are the implications for maternal mental health? Dev Med Child Neurol 2011; 53:338-43. [PMID: 21232052 DOI: 10.1111/j.1469-8749.2010.03848.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To examine the relationship between maternal mental health problems and the time required by mothers to care for children with cerebral palsy (CP). METHOD Cross-sectional study of 158 mothers of children with cerebral palsy (98 males, 60 females; mean age 11y 3mo, range 6-17y). Gross Motor Function Classification System levels of the children were 37% level I, 20% level II, 9% level III, 12% level IV, and 22% level V. Manual Ability Classification System levels were 19% level I, 27% level II, 22% level III, 13% level IV, and 19% level V. Maternal mental health problems were assessed using the General Health Questionnaire. Depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale. A time-diary was used to measure caregiving time. Experience of time pressure was assessed using the Time Crunch Scale. RESULTS On average, mothers spent 6.0 hours per 24 hours on weekdays and 8.3 hours per 24 hours on weekends caring for children with CP. There was a significant positive relationship between maternal psychological problems and both caregiving time required per 24 hours (p = 0.03) and mothers' experience of time pressure (p < 0.001). There was also a significant positive association between maternal depressive symptoms and experience of time pressure (p = 0.003). INTERPRETATION It is important to support mothers to find ways of reducing the real and perceived impact of caregiving. This might include identifying sources of 'respite' support for caregivers, training in stress and time management, and appropriate treatment of mental health problems.
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Affiliation(s)
- Michael G Sawyer
- Children, Youth and Women's Health Service, Adelaide, Australia.
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45
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Abstract
How one man's vision to fund health research grew to become the country's largest non-government funder of research into mental illness.
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Abstract
CONTEXT The promotion of optimism has been widely advocated for children and adolescents, but epidemiologic data to support this approach are scant. METHODS This was a 3-wave longitudinal study of health and social development in younger adolescents from 3 Australian states. The 5634 student participants, initially aged 12 to 14 years, were assessed for optimistic thinking style, emotional problems, substance use, and antisocial behaviors. RESULTS Cross-sectional associations between optimism and each of the study outcomes were strongly protective but tended to differ according to gender in extent. In prospective analyses of the onset of new cases of each study outcome, protective associations were weaker. Those in the highest optimism quartile had risks for depressive symptoms that were reduced by almost half (odds ratio: 0.54 [95% confidence interval: 0.42-0.70]) compared with those in the lowest category. No effect was seen in prevention of anxiety symptoms after adjustment for other aspects of psychological style. In predicting the onset of heavy substance use and antisocial behavior, high optimism had modest protective effects. CONCLUSIONS Optimistic thinking style is somewhat protective against adolescent health risks; the clearest effects are seen against depressive symptoms. Promoting optimism along with other aspects of psychological and emotional style has a role in mental health promotion that is likely to be enhanced if an intervention also addresses risk and protective factors in an adolescent's social context.
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Affiliation(s)
- George C Patton
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Victoria, Australia.
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Sawyer MG, Guidolin M, Schulz K, McGinnes B, Baghurst P, Zubrick SR. Mental health problems among young people on remand: has anything changed since 1989? Aust N Z J Public Health 2010; 34:594-7. [DOI: 10.1111/j.1753-6405.2010.00628.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Lawrence D, Mitrou F, Sawyer MG, Zubrick SR. Smoking status, mental disorders and emotional and behavioural problems in young people: child and adolescent component of the National Survey of Mental Health and Wellbeing. Aust N Z J Psychiatry 2010; 44:805-14. [PMID: 20815667 DOI: 10.3109/00048674.2010.482921] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To examine the relationship between smoking behaviour, mental disorders and emotional and behavioural problems in a nationally representative sample of young people. METHOD Data were taken from the child and adolescent component of the National Survey of Mental Health and Wellbeing which assessed mental health problems in two main ways: using a fully structured interview (the Diagnostic Interview Schedule for Children) and using the Child Behaviour Checklist and the Youth Self Report, which assess emotional and behavioural problems on a dimensional scale. The relationship between smoking and mental health problems was assessed using logistic regression. RESULTS Among young people with conduct disorder 72% had smoked in the last 30 days, 46% of young people with depressive disorder, and 38% among young people with attention deficit hyperactivity disorder. This compared with 21% of young people with none of these disorders. Odds ratios (OR) for current smoking were consistently elevated for young people with mental health problems after adjusting for demographic and socio-economic factors across all measures of mental health used. The OR for current smoking in young people with parent-reported externalizing behaviours in the clinical range was 4.5 (95%CI: 3.1-6.8), and for young people with parent-reported internalizing problems in the clinical range the OR was 2.7 (95%CI: 1.8-4.0). Young people with mental health problems started smoking on average at a younger age, were more likely to progress to current smoking, and smoked on average a higher number of cigarettes per day. CONCLUSIONS After adjusting for demographic and socio-economic factors, young people with mental health problems were more likely to start smoking, progress to daily smoking, and smoke more heavily. Mental illness is an important issue to consider in tobacco control in young people.
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Affiliation(s)
- David Lawrence
- Centre for Developmental Health, Curtin Health Innovation Research Institute, Curtin University of Technology, Australia.
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Jorm AF, Kitchener BA, Sawyer MG, Scales H, Cvetkovski S. Mental health first aid training for high school teachers: a cluster randomized trial. BMC Psychiatry 2010; 10:51. [PMID: 20576158 PMCID: PMC2908569 DOI: 10.1186/1471-244x-10-51] [Citation(s) in RCA: 157] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Accepted: 06/24/2010] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Mental disorders often have their first onset during adolescence. For this reason, high school teachers are in a good position to provide initial assistance to students who are developing mental health problems. To improve the skills of teachers in this area, a Mental Health First Aid training course was modified to be suitable for high school teachers and evaluated in a cluster randomized trial. METHODS The trial was carried out with teachers in South Australian high schools. Teachers at 7 schools received training and those at another 7 were wait-listed for future training. The effects of the training on teachers were evaluated using questionnaires pre- and post-training and at 6 months follow-up. The questionnaires assessed mental health knowledge, stigmatizing attitudes, confidence in providing help to others, help actually provided, school policy and procedures, and teacher mental health. The indirect effects on students were evaluated using questionnaires at pre-training and at follow-up which assessed any mental health help and information received from school staff, and also the mental health of the student. RESULTS The training increased teachers' knowledge, changed beliefs about treatment to be more like those of mental health professionals, reduced some aspects of stigma, and increased confidence in providing help to students and colleagues. There was an indirect effect on students, who reported receiving more mental health information from school staff. Most of the changes found were sustained 6 months after training. However, no effects were found on teachers' individual support towards students with mental health problems or on student mental health. CONCLUSIONS Mental Health First Aid training has positive effects on teachers' mental health knowledge, attitudes, confidence and some aspects of their behaviour. TRIAL REGISTRATION ACTRN12608000561381.
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Affiliation(s)
- Anthony F Jorm
- Orygen Youth Health Research Centre, University of Melbourne, Locked Bag 10, Parkville, Victoria, Australia.
| | - Betty A Kitchener
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Locked Bag 10, Parkville, Victoria, Australia
| | - Michael G Sawyer
- Research and Evaluation Unit, Youth and Women's Health Service, Discipline of Paediatrics, University of Adelaide, South Australia, Australia
| | - Helen Scales
- South Australian Department of Education and Children's Services, Adelaide, South Australia, Australia
| | - Stefan Cvetkovski
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Locked Bag 10, Parkville, Victoria, Australia
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Sawyer MG, Bittman M, La Greca AM, Crettenden AD, Harchak TF, Martin J. Time demands of caring for children with autism: what are the implications for maternal mental health? J Autism Dev Disord 2010. [PMID: 19949845 DOI: 10.1077/s10803-009-0912-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
This study examined the relationship between maternal mental health problems and both caregiving time and experience of time pressure for 216 mothers of children with autism. Data describing caregiving time was obtained using 24-h time-diaries. Standard questionnaires were used to assess time pressure, social support, children's emotional and behavioural problems, and maternal mental health problems. After adjusting for the effect of children's age, maternal social support, and children's behaviour problems, time pressure but not hours of caregiving, had a significant positive relationship with maternal mental health problems. Findings suggest that the quality of home-based care for children with autism may be adversely affected if time pressure experienced by caregivers compromises their mental health and well being.
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Affiliation(s)
- Michael G Sawyer
- Research and Evaluation Unit, Children, Youth and Women's Health Service, North Adelaide, SA, Australia.
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