What is the Impact of COVID-19 & Lockdown on the Mental Health of Children & Adolescents?

Research Paper Title

Impact of COVID-19 and lockdown on mental health of children and adolescents: A narrative review with recommendations.

Background

COVID-19 pandemic and lockdown has brought about a sense of fear and anxiety around the globe. This phenomenon has led to short term as well as long term psychosocial and mental health implications for children and adolescents. The quality and magnitude of impact on minors is determined by many vulnerability factors like developmental age, educational status, pre-existing mental health condition, being economically underprivileged or being quarantined due to infection or fear of infection.

This paper is aimed at narratively reviewing various articles related to mental-health aspects of children and adolescents impacted by COVID-19 pandemic and enforcement of nationwide or regional lockdowns to prevent further spread of infection.

Methods

The researchers conducted a review and collected articles and advisories on mental health aspects of children and adolescents during the COVID-19 pandemic. They selected articles and thematically organized them.

Results

The researchers put up their major findings under the thematic areas of impact on young children, school and college going students, children and adolescents with mental health challenges, economically underprivileged children, impact due to quarantine and separation from parents and the advisories of international organisations. They have also provided recommendations to the above.

Conclusions

There is a pressing need for planning longitudinal and developmental studies, and implementing evidence based elaborative plan of action to cater to the psycho social and mental health needs of the vulnerable children and adolescents during pandemic as well as post pandemic. There is a need to ameliorate children and adolescents’ access to mental health support services geared towards providing measures for developing healthy coping mechanisms during the current crisis.

For this innovative child and adolescent mental health policies with direct and digital collaborative networks of psychiatrists, psychologists, paediatricians, and community volunteers are deemed necessary.

Reference

Singh, S., Roy, D. Sinha, K., Parveen, S., Sharma, G. & Joshi, G. (2020) Impact of COVID-19 and lockdown on mental health of children and adolescents: A narrative review with recommendations. Psychiatry Research. 293, pp.113429. doi: 10.1016/j.psychres.2020.113429. Online ahead of print.

What is the Impact of COVID-19 & Lockdown on the Mental Health of Children & Adolescents?

Research Paper Title

Impact of COVID-19 and lockdown on mental health of children and adolescents: A narrative review with recommendations.

Background

COVID-19 pandemic and lockdown has brought about a sense of fear and anxiety around the globe. This phenomenon has led to short term as well as long term psychosocial and mental health implications for children and adolescents.

The quality and magnitude of impact on minors is determined by many vulnerability factors like developmental age, educational status, pre-existing mental health condition, being economically underprivileged or being quarantined due to infection or fear of infection.

This paper is aimed at narratively reviewing various articles related to mental-health aspects of children and adolescents impacted by COVID-19 pandemic and enforcement of nationwide or regional lockdowns to prevent further spread of infection.

Methods

The researchers conducted a review and collected articles and advisories on mental health aspects of children and adolescents during the COVID-19 pandemic. They selected articles and thematically organised them. The researchers put up their major findings under the thematic areas of impact on young children, school and college going students, children and adolescents with mental health challenges, economically underprivileged children, impact due to quarantine and separation from parents and the advisories of international organisations. They have also provided recommendations to the above.

Conclusions

There is a pressing need for planning longitudinal and developmental studies, and implementing evidence based elaborative plan of action to cater to the psycho social and mental health needs of the vulnerable children and adolescents during pandemic as well as post pandemic.

There is a need to ameliorate children and adolescents’ access to mental health support services geared towards providing measures for developing healthy coping mechanisms during the current crisis.

For this innovative, child and adolescent mental health policies with direct and digital collaborative networks of psychiatrists, psychologists, paediatricians, and community volunteers are deemed necessary.

Reference

Singh, S., Roy, D., Sinha, K., Parveen, S. Sharma, G. & Joshi, G. (2020) Impact of COVID-19 and lockdown on mental health of children and adolescents: A narrative review with recommendations. Psychiatry Research. doi: 10.1016/j.psychres.2020.113429. Online ahead of print.

What is the Role of Informant Discrepancies in Mental Health in Relation to Sexuality?

Research Paper Title

Mental-health disparities between heterosexual and sexual-minority adolescents: Examining the role of informant discrepancies.

Background

An emerging literature documents substantial mental-health disparities by sexual orientation amongst adolescents, with sexual-minority youth exhibiting poorer mental health than heterosexual youth.

This brief report provides the first empirical account of how the association between sexual-minority status and adolescent mental health differs depending on who assesses adolescents’ mental health (child/mother/father/teacher), and how informant discrepancies in assessments of adolescent mental health differ by adolescents’ sexual orientation.

Methods

Data come from an Australian national sample of 14-/15-year-old adolescents (Longitudinal Study of Australian Children; n = 3,000).

Adolescent mental health is measured using multiple measures from the Strengths and Difficulties Questionnaire, and modelled using multivariable linear regression models.

Results

Mental-health disparities between sexual-minority and heterosexual adolescents emerged irrespective of who assessed the child’s mental health.

However, their magnitude varied substantially by informant, being largest when mental-health was reported by adolescents (~0.7 standard deviations) and smallest when reported by teachers (~0.2 standard deviations).

Discrepancies between mental-health scores collected from the child and other informants were largest for internalising than externalising behaviours, and in child-father than child-mother comparisons.

Conclusions

Understanding informant discrepancies and their meaning is pivotal to designing surveys that generate robust insights into the health of sexual-minority adolescents, as well as appropriate policy interventions.

Reference

Perales, F., Campbell, A. & Johnson, S. (2020) Mental-health disparities between heterosexual and sexual-minority adolescents: Examining the role of informant discrepancies. Journal of Adolescence. 79, pp.122-127. doi: 10.1016/j.adolescence.2020.01.006. Epub 2020 Jan 15.

The Importance of Positive Mental Health for both Mother & Child

Research Paper Title

Positive Maternal Mental Health, Parenting, and Child Development.

Background

While maternal mental health is an important influence on child development, the existing literature focuses primarily on negative aspects of maternal mental health, particularly symptoms of depression, anxiety, or states of distress.

The researchers provide a review of the evidence on the potential importance of positive mental health for both mother and child.

The evidence suggests that positive mental health is a distinct construct that is associated with improved birth outcomes and potentially with specific forms of parenting that promote both academic achievement and socioemotional function.

They review studies that provide a plausible biological basis for the link between positive mental health and parenting, focusing on oxytocin-dopamine interactions.

They caution that the evidence is largely preliminary and suggest directions for future research, noting the importance of identifying the operative dimensions of positive maternal mental health in relation to specific outcomes.

Finally, they suggest that the inclusion of positive maternal mental health provides the potential for a more comprehensive understanding of parental influences on child development.

Reference

Phua, D.Y., Lee, M.Z.L. & Meaney, M.J. (2020) Positive Maternal Mental Health, Parenting, and Child Development. Biological Psychiatry. 87(4), pp.328-337. doi: 10.1016/j.biopsych.2019.09.028. Epub 2019 Oct 16.

Preparation for Life…

“How has your field of study changed in the time you have been working in it?

We understand a lot more about how many mental health problems originate in early life. Experience in pregnancy sends a kind of weather report to the fetus to give it indicators of how life might be and to begin the process of preparation for that life. That is extraordinary and there is still a huge amount to learn.”

Reference

Ramchandani, P. (2020) The Back Pages: Q&A. New Scientist. 11 January 2020, pp.56.

Foster Care, Mental Health, & Primary Care Visits

Research Paper Title

A Comparison Study of Primary Care Utilization and Mental Health Disorder Diagnoses Among Children In and Out of Foster Care on Medicaid.

Background

The purpose of this study was to compare the utilisation of primary care services and presence of mental health disorder diagnoses among children in foster care to children on Medicaid not in foster care in a large health system.

Methods

The data for this study were analysed from a clinical database of a multi-practice paediatric health system in Houston, Texas.

The sample included more than 95 000 children covered by Medicaid who had at least one primary care visit during the 2-year study period.

Results and Conclusions

The results of the study demonstrated that children not in foster care had a greater number of primary care visits and the odds of having >3 visits were significantly lower for children in foster care with a mental health disorder diagnosis.

Additionally, more than a quarter of children in foster care had a diagnosis of a mental health disorder, compared with 15% of children not in foster care.

Reference

Keefe, R.J., Van Horne, B.S., Cain, C.M., Budolfson, K., Thompson, R. & Greeley, C.S. (2020) A Comparison Study of Primary Care Utilization and Mental Health Disorder Diagnoses Among Children In and Out of Foster Care on Medicaid. Clinical Pediatrics. 59(3), pp.252-258. doi: 10.1177/0009922819898182. Epub 2020 Jan 3.

Is There a link between Separation Anxiety Trajectory in Early Childhood & Risk for Sleep Bruxism?

Research Paper Title

High separation anxiety trajectory in early childhood is a risk factor for sleep bruxism at age 7.

Background

The evolution of sleep bruxism manifestations and their co-occurrence with separation anxiety in early childhood remain unclear.

The researchers threefold aim was to:

  1. Describe developmental sleep bruxism trajectories in early childhood;
  2. Investigate co-occurrences between trajectories of sleep bruxism and separation anxiety; and
  3. Determine whether distinct trajectories of separation anxiety increase the risk of presenting sleep bruxism during the first year of elementary school.

Methods

This study is part of the Québec Longitudinal Study of Child Development.

Sleep bruxism scores were assessed from age 1.5 to 7 years with the Self-Administered Questionnaire for Mother (n=1,946).

Separation anxiety scores were measured from age 1.5 to 6 years with the Interviewer-Completed Computerised Questionnaire (n=2,045).

Results

The researchers identified:

  • Four sleep bruxism trajectories from age 1.5 to 6 years:
    • High-Increasing sleep bruxism at age 1.5 (14.1%);
    • High-Increasing sleep bruxism at age 4 (18.3%);
    • Low-Persistent sleep bruxism (12.1%); and
    • Never-Persistent sleep bruxism (55.5%).
  • Four separation anxiety trajectories from age 1.5 to 6 years:
    • Low-Persistent separation anxiety (60.2%);
    • High-Increasing separation anxiety (6.9%);
    • High-Decreasing separation anxiety (10.8%); and
    • Low-Increasing separation anxiety (22.1%).

Sleep bruxism and separation anxiety trajectories were weakly associated (X2=37.84, P<0.001).

Compared with preschoolers belonging to the Low-Persistent separation anxiety trajectory, preschoolers in the High-Increasing separation anxiety trajectory had almost double the risk of presenting sleep bruxism at age 7 (95% CI=1.25-3.22, P=.04).

Conclusions

When separation anxiety issues are detected in early childhood, it would be useful to target sleep bruxism during the first year of elementary school.

Reference

Rostami, E.G., Touchette, É., Huynh, N., Montplaisir, J., Tremblay, R.E., Battaglia, M. & Boivin, M. (2020) High separation anxiety trajectory in early childhood is a risk factor for sleep bruxism at age 7.

Have Antidepressant Prescriptions, Including Tricyclics, Increased in Canadian Children?

Research Paper Title

Antidepressant Prescriptions, Including Tricyclics, Continue to Increase in Canadian Children.

Background

Few studies have longitudinally followed trends in antidepressant prescribing for Canadian children following the Black Box warning issued in 2004.

Using a national data source, we aim to describe trends in antidepressant recommendations for Canadian children ages 1-18 during 2012 to 2016.

Methods

A database called the Canadian Disease and Therapeutic Index (CDTI), provided by IQVIA, was used to conduct analyses. The CDTI dataset collects a quarterly sample of paediatric antidepressant recommendations, projected using a weight procedure from a dynamic sample of 652 Canadian office-based physicians.

The term “recommendations” is used because nonprescription drugs may be recommended and there is no confirmation in the database that the prescriptions were filled or medications taken.

The data were collected from 2012 to 2016 and the sample population was projected by IQVIA to be representative of the entire Canadian paediatric population.

Results

The total number of projected antidepressant recommendations for children increased from 2012 to 2016. Selective serotonin reuptake inhibitors were the most recommended class of antidepressants.

Analysis indicated that fluoxetine was the most frequently recommended drug.

Findings also suggest that recommendations for tricyclic antidepressants (TCAs) are increasing, but predominantly for reasons other than treatment of depression.

Conclusions

Overall, antidepressant use in Canadian children increased over the study period.

Unsurprisingly, fluoxetine was the most recommended antidepressant for Canadian children.

However, the observed increase in TCA use for a paediatric population is unexpected.

The data source is descriptive and lacks detailed measures supporting comprehensive explanation of the findings, therefore, further research is required.

Reference

Lukmanji, A., Pringsheim, T., Bulloch, A.G., Stewart, D.G., Chan, P., Tehrani, A. & Patten, S.B. (2020) Antidepressant Prescriptions, Including Tricyclics, Continue to Increase in Canadian Children. Journal of Child and Adolescent Psychopharmacology. doi: 10.1089/cap.2019.0121. [Epub ahead of print].

Childhood Trauma: Time, Trust, and Opportunities

Research Paper Title

Repairing the effects of childhood trauma: The long and winding road.

Background

  • What is known on this subject:
    • Domestic and family violence contributes to mental distress and the development of mental illness and can reverberate throughout a person’s life.
  • What this paper adds to existing knowledge.
    • Therapeutic work with people who experience domestic and family violence needs to take considerable time to allow the process to unfold.
    • Understanding the triggers that cause past traumas to be re-experienced helps people to recognise and change their conditioned emotional responses.
  • What are the implications for practice?
    • Time needs to be invested to develop a secure and trusting relationship to enable a person to work through childhood experiences that have the potential to overwhelm.
    • It is important for adults who have experienced childhood trauma to have an opportunity to process the abuse to help minimise its intrusion in their lives.

Reference

Palmer, C., Williams, Y. & Harrington, A. (2019) Repairing the effects of childhood trauma: The long and winding road. Journal of Psychiatric and Mental Health Nursing. doi: 10.1111/jpm.12581. [Epub ahead of print].

Measuring Functional Independence using the interRAI Child and Youth Mental Health Assessment System.

Research Paper Title

Examining the Structure of a New Pediatric Measure of Functional Independence Using the interRAI Child and Youth Mental Health Assessment System.

Background

Activities of daily living (ADL) are key to daily living and adjustment. A number of ADL scales have been developed and validated to examine functional performance in the paediatric population; however, most of these scales are limited to specific groups.

The purpose of this research was to test the plausibility of developing and validating a hierarchical versus additive ADL summary scale for children and youth using the interRAI Child Youth Mental Health (ChYMH) assessment system.

Methods

Data from 8980 typically developing children (mean age 12.02 years) and 655 children with developmental disabilities (mean age 11.9 years) was used to develop ADL summary scales. Patterns among the data were analysed and, unlike with adult populations, a hierarchical scale did not capture ADL performance and mastery.

Results

Two new ADL additive summary scales for children and youth were developed to measure ADL skills within this group.

Reference

Stewart, S.L., Morris, J.N., Asare-Bediako, Y.A. & Toohey, A. (2019) Examining the Structure of a New Pediatric Measure of Functional Independence Using the interRAI Child and Youth Mental Health Assessment System. Developmental Neurorehabilitation. 1-8. doi: 10.1080/17518423.2019.1698070. [Epub ahead of print].