Amelia K. Searle

Identifying and implementing prevention programmes for childhood mental health problems

Abstract:  A substantial number of children and adolescents in Australia have mental health problems. This review provides guidance to service providers for selecting prevention programmes designed to reduce mental health problems experienced by children. It addresses three issues. First, it highlights the importance of utilising programmes that focus on risk and protective factors which have a causal relationship with mental health problems. Second, it describes approaches that can be used to assess the quality of programme evaluations, and identifies common characteristics of more effective programmes. Finally, it identifies general factors which influence the uptake of innovations, such as new prevention programmes, in health services. These features include, for example, compatibility with potential providers’ values, norms and perceived needs, and some flexibility which allows potential providers to adapt programmes to suit their specific needs and context. Addressing these general issues is important to maximise the uptake of effective new prevention programmes.

Resource factors for mental health resilience in early childhood: An analysis with multiple methodologies

BackgroundGiven 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.MethodsA 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).ResultsGreater 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.ConclusionsFindings 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.

Prospective associations between childhood low-level lead exposure and adult mental health problems: the Port Pirie cohort study.

Low-level environmental lead exposure during childhood is associated with poorer emotional/behavioural functioning in later childhood and adolescence. Scarce research has examined whether these apparent effects persist into adulthood. This study is the first to examine prospective associations between lead exposure across early childhood and several common adult mental health problems. Childhood data (including blood lead concentrations) and adult data (from mental health questionnaires and psychiatric interviews) were available for 210 participants (44% males, mean age=26.3 years) from the Port Pirie cohort study (1979-1982 birth cohort). Participants had a mean childhood (to 7 years) average blood lead concentration of 17.2μg/dL. Among females, childhood blood lead showed small significant positive associations with lifetime diagnoses of drug and alcohol abuse and social phobia, and with anxiety, somatic and antisocial personality problems. For example: for a 10μg/dL blood lead increase, females were 2.84 times (95% CI 1.10, 7.30) more likely to have an alcohol abuse diagnosis. However, adjustment for childhood covariates - particularly stimulation within the home environment - rendered these associations non-significant. No significant or sizeable unadjusted or adjusted associations were seen for males. The associations between early lead exposure and emotional/behavioural functioning in children might persist into adulthood, at least for females. However, it is unclear whether such results arise from residual confounding, or other mechanisms. Interventions that focus on improving the childhood home environment may have a long-term positive impact on adult mental health outcomes. However, more prospective research using large and representative samples is needed to substantiate these results.

The validity of military screening for mental health problems: diagnostic accuracy of the PCL, K10 and AUDIT scales in an entire military population

Depression, alcohol use disorders and post‐traumatic stress disorder (PTSD) are serious issues among military personnel due to their impact on operational capability and individual well‐being. Several military forces screen for these disorders using scales including the Kessler Psychological Distress Scale (K10), Alcohol Use Disorders Identification Test (AUDIT), and Post‐traumatic Stress Disorder Checklist (PCL). However, it is unknown whether established cutoffs apply to military populations. This study is the first to test the diagnostic accuracy of these three scales in a population‐based military cohort.

Tracing the long-term legacy of childhood lead exposure: A review of three decades of the Port Pirie Cohort study

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.

Predictors of Children's Kindergarten Classroom Engagement: Preschool Adult–Child Relationships, Self-Concept, and Hyperactivity/Inattention

The aim of this prospective study was to identify preschool factors that are associated with childrens classroom engagement during their 1st school year. The study was guided by a social-motivational process model that highlights the importance of parent–child and teacher–child relationships in promoting engagement. In preschool, parents and teachers completed questionnaires assessing childrens (n = 562) parent–child and teacher–child relationships, global self-concept, and mental health problems. Teachers rated childrens engagement levels 1 year later in kindergarten. Research Findings: Results from structural equation modeling suggested that experiencing good-quality relationships with parents and teachers and positive self-concept during preschool were only indirectly associated with childrens kindergarten classroom engagement through their negative associations with hyperactivity/inattention; only hyperactivity/inattention had a significant direct (small-moderate and negative) association with childrens engagement. Practice or Policy: Interventions that improve adult–child relationships may reduce childhood hyperactivity/inattention during preschool and potentially improve childrens engagement, helping them start school ready and eager to learn.

Prospective Associations between Children’s Preschool Emotional and Behavioral Problems and Kindergarten Classroom Engagement, and the Role of Gender

This 1-year prospective study aimed to examine associations between children’s preschool emotional and behavioral problems and their kindergarten classroom engagement, and to identify any gender differences in this association. In preschool, parents and teachers completed questionnaires assessing aspects of children’s (n = 575) emotional and behavioral problems. Teachers rated children’s engagement levels 1 year later in kindergarten. Compared with girls, boys showed higher levels of preschool hyperactivity/inattention and conduct problems, and lower kindergarten engagement. Regression analyses revealed that boys’ higher hyperactivity/inattention levels almost completely accounted for their engagement disadvantage. However, the lack of interactions suggested that emotional/behavioral problems were related to engagement similarly for boys and girls. Preschool emotional and behavioral problems appear to be important correlates of kindergarten engagement and may be worthwhile targets for early intervention. Though girls and boys may benefit similarly from interventions, boys are disadvantaged from preschool onward and may benefit from greater support.

The Australian Defence Force Mental Health Prevalence and Wellbeing Study: design and methods

Background The Australian Defence Force (ADF) Mental Health Prevalence and Wellbeing Study (MHPWS) is the first study of mental disorder prevalence in an entire military population. Objective The MHPWS aims to establish mental disorder prevalence, refine current ADF mental health screening methods, and identify specific occupational factors that influence mental health. This paper describes the design, sampling strategies, and methodology used in this study. Method At Phase 1, approximately half of all regular Navy, Army, and Air Force personnel (n=24,481) completed self-report questionnaires. At Phase 2, a stratified sub-sample (n=1,798) completed a structured diagnostic interview to detect mental disorder. Based on data from non-responders, data were weighted to represent the entire ADF population (n=50,049). Results One in five ADF members met criteria for a 12-month mental disorder (22%). The most common disorder category was anxiety disorders (14.8%), followed by affective (9.5%) and alcohol disorders (5.2%). At risk ADF sub-groups were Army personnel, and those in the lower ranks. Deployment status did not have an impact on mental disorder rates. Conclusion This study has important implications for mental health service delivery for Australian and international military personnel as well as contemporary veterans.

Is greater improvement in early self-regulation associated with fewer behavioral problems later in childhood?

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. Childrens level of self-regulation was assessed using the parent-completed Devereux Early Childhood Assessment when children were aged 4, 5, and 6. Childrens 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 childrens 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.

Student-teacher relationship trajectories and mental health problems in young children

BackgroundThis 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.MethodsA 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 childrens mental health problems using the Strengths and Difficulties Questionnaire.ResultsLatent-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.ConclusionsFindings suggest that early intervention and prevention strategies that focus on building stable high quality student-teacher relationships during preschool and childrens transition into formal schooling, may help reduce rates of childhood mental health problems during the early school years.