Trends in Childhood Mental Health Flashcards
What does prevalence mean?
The number of people in the sample with a characteristic divided by the total number of people in the sample
Means how common a disorder is
What are the ways prevalence is reported as?
Point prevalence: problem at a specific moment in time (e.g. today)
Period prevalence: at any point during a given time period (e.g. past 12 months)
Lifetime prevalence: at some point in life
What did the mental health of young children survey do in 2017?
9,117 children aged 2-19 Child, parent and teacher reports Disorders identified according to ICD-10 standardised criteria using the development and wellbeing assessment Response rate 52% Disorders grouped into: Emotional disorders Behavioural/conduct disorders Hyperactivity disorders Other less common disorders
What did the mental health of young children survey show in 2017 for different disorders?
Rates of different disorder by age group:
- 1% reported emotional disorders - highest
- 6 - behavioural
- 6 - hyperactivity
- 1 - other less common disorders
What did the mental health of young children survey show in 2017 for gender?
Rates by age group and gender:
1 in 8, 5-19 year olds had at least one disorder
1 in 20 5-19 year olds met criteria for 2+ mental disorders
What are the gender patterns in mental disorders?
5-10 - boys more likely to get a disorder
11-16 (secondary school) - equally as likely
17-19 - girls over twice as likely to get a disorder
5-19 - the same
What are the age differences in mental disorders?
Older people are a lot more likely than younger people to get emotional disorders / any disorder
Behavioural disorders more common in younger age groups, most common in 11-16 year olds
Hyperactivity - low in all age groups, highest in 11-16
Less common disorders - goes down with age
When do mental health disorders emerge?
Anxiety - 11 years
Impulsive control - 11 years
Substance use - 20 years (interquartile range is smaller for this, less variability in age of onset)
Mood disorder - 30 years (range is bigger, more variability in the age of onset)
What is the prevalence like in the rest of the world? Polancyzk et al, 2015
Meta-analysis from 27 countries 87,742, 6-18 year olds Any MH disorder: 13.4% anxiety - 6.5% - most common depression - 2.6% disruptive - 5.7 Heterogeneity driven by methodological factors: sample representativeness sampling frame diagnostic instrument not explained by geographical location, or year of study 241m youths affected by MH disorders Comparable prevalence to chronic heath conditions
What are the consequences of childhood MH disorders?
Wide range of negative effects on well-being, health, social functioning and educational outcomes
Persistence into adulthood and reccurance
Heightened risk for suicide and early mortality
Increasing worldwide burden
How do you measure burden?
Disability adjusted life years
Years lived with a disability
Years of life lost due to premature mortality
What is the disability adjusted life years? DALYs
DALYs
Years lived with disability and years of life lost due to premature mortality
1 DALY = loss of 1 year of healthy life
How do you calculate years lived with disability? YLD
Prevalence of a disorder X disability weight (reflects severity of disease and magnitude of impact on health)
How do you calculate years of life lost due to premature mobility?
Estimate the length of time a person would have lived had they not died prematurely of the disorder
Is child mental health a global burden?
Child MH disorders are responsible for 55.5million DALYs in 0-24 year olds
6th leading cause of DALYs and accounts for 54.2 million YLDs
In high income countries, childhood MH was the leading cause of YLDs and DALYs
In low income countries, leading cause of YLDs but only 7th highest cause of disease burden - more of a burden in high income countries, but this is rising
Burden is on the rise, 1.3 of DALYs in 1990 vs 2.3% in 2010
Is childhood mental illness on the rise?
Child mental health has been increasing, as well as referral rates and treatment
What are the 3 ways we test trends in childhood MH?
Compare lifestyle rates of retrospectively reported MH disorders in different generations - weak approach, subject to memory bias
Use meta-analysis methods to compare prevalence rates from interviews in surveys conducted at different time points
Directly compare cohorts where data was collected using same methods but at different points in time e.g. comparing data of 8 year olds in 1990, 8 year olds in 2010. Strongest approach - need people with similar characteristics and sample
What are the trends in England 1999-2017?
Upward trend over time in the prevalence of mental disorders, in both genders
Increase in emotional disorders, seen in both boys and girls
Slight drop in behavioural disorders, but not a significant change
Twenge et al, 2018 - trends in the US
506,820 US adolescents aged 13-18
Depressive symptoms assessed every year since 1991
Cross-cohort time-lag design:
Explore variables that might explain temporal trends in depressive symptoms
Mean depressive symptoms 1991-2015:
MH issues stable or declining from 1991-2009
Between 2009-2015, 33% more adolescence had high levels of depression - particularly in females
Increases similar in different races/ethnicities, different SES but larger increases in older adolscents
What is a cross-cohort time lag design?
Compare depressive symptoms in different cohorts of adolescence when they are the same age at different points in time (e.g. 15 years old) at different points in time (e.g. comparing depressive symptoms in 15 years olds in 1991 with 15 years old in 2015)
What is associated with higher depressive symptoms?
Social media and electronic device
TV viewing
What is associated with low depressive symptoms?
Print media use - non screen activities
Religious service attendance
Sports or exercise
In person social interaction
What isn’t associated with depressive symptoms?
Income inequality
Unemployment rates
Financial index
What leads to the most depressive symptoms?
Low social interaction and high social media
What has happened to ADHD diagnosis 1997-2016?
Significant increase in prevalence of ADHD from 1997-2016 - huge increase, regardless of sex, age, ethnicity, SES
What explains the increase of prevalence in ADHD?
Nonetiological factors - broader Dx criteria, better medical awareness, improved access to care
Etiological factors - maternal smoking/drug use, nutritional deficiencies, preterm birth, attachment
Does methodology impact ADHD rates? Polanczyk et al
Meta-regression of 135 ADHD prevalence studies conduct in last 30 years
Looked at if prevalence rates are explained by:
diagnostic criteria, informant (person who reported), requirement of impairment of diagnosis, geographical locations, year of study
Prediction of ADHD rates were highly due to methodological factors - prevalence rates were higher for teacher-informant, where impairment not required and when DSM-IV required
no effect of year of study or geographical location
What are the trends in Vietnam?
Lower/middle income families - Lee et al, 2012
2 cohorts, one from 2003.2004, and 2009,1010
Looked at adolescents experience of helplessness, hopelessness, self-harming, suicidal thoughts
Results:
more common in the cohort of adolescence they tested in 2009/2010
not sure why this has happened though
Is it just mental health?
No, there has been a significant decrease in happiness with life as a whole between 2009-10, and 2016-17
What are the changes in prevalence better explained by?
Greater openness in recent cohorts to report symptoms
Shift in thresholds for reporting symptoms as problematic - artificially inflate diagnosis
Tendency for parents to over-pathologies normal behaviours/symptoms - sensitivity in recent cohorts to behaviours, making behaviour seem problematic
How do the prevalence rates reflect real changes?
Different methods and different informants show the same pattern
Specificity in trends – i.e. more variation in rates of emotional problems than hyperactivity so not simply explained by greater parental sensitivity/openness - probably not just openness because there’s variation in different disorders
What is the ecological model to explain these changes? Collishaw, 2015
Explanatory factors to explain the increase can be grouped into:
sociocultural factors
extrafamilial factors
familiar factors
individual vulnerabiltiy
What are the sociocultural factors that can explain the increase in MH?
Technological change
Greater access to social media
Poverty
Professional and public recognition of MH problems
What are the extrafamiliar factors that can explain the increase in MH?
Increases in academic pressures
Bullying
What are the familial factors that can explain the increase in MH?
Change in family composition - not a driver
Parent mental health - child and adult mental health has increased
Changes in parent-child relationship
What are the individual vulnerability factors that can explain the increase in MH?
Increased survival of low birth rate infants - increased risk of MH issues
More women having children later
Changes in perinatal conditions
Changes in related difficulties - changes in sleep and eating patterns
Are there health inequalities?
No overall change in level of MH between 1999-2012
Poverty reliably associated with poorer child MH - lower income have higher MH
The MH gap between advantaged and disadvantaged children is getting worse - this is bad
Stellers et al - trends in MH outcomes
Hypothesis - Stronger associations between child MH and developmental outcomes in more recent cohorts, compared told cohorts
Results
Boys and girls with MH problems at age 7:
more social functioning problems
associations stronger in recent cohorts
less likely to achieve 5+ exam passes at age 16
had poorer MH at age 16
Negative outcomes have got worse, not better - assumed they would’ve got better because of improvements in services, improving treatment, more awareness
