Thursday, April 6, 2023

Promoting Parental Mental Health, Access to Preschool May Reduce MH Inequities in Children

Promoting parental mental health and preschool attendance among socioeconomically disadvantaged children can reduce mental health problems, according to a study published this week in Pediatrics.

“Evidence suggests only 9% to 27% of children aged 4 to 13 years with mental health problems access mental health services, with barriers to access disproportionately impacting families experiencing socioeconomic disadvantage,” wrote Sharon Goldfeld, Ph.D., of the Centre for Community Child Health at the Murdoch Children’s Research Institute in Melbourne, Australia, and colleagues. “Reducing children’s mental health inequities will likely require a coordinated approach by stacking multiple complementary interventions across the various environments in which children grow and live over time.”

Goldfeld and colleagues drew on data from the Longitudinal Study of Australian Children, a nationally representative sample of 5,107 infants that began in May 2004. Information from parent interviews and/or self-report questionnaires was collected when the children were aged 0 to 1, 2 to 3, 4 to 5, 6 to 7, and 10 to 11 years. Family socioeconomic status was measured during the first year with self-reported annual income, highest education, and occupation level. Families were considered disadvantaged if they were among “the 25% least socioeconomically advantaged families” in the study.

When children were aged 4 to 5 years, each child’s primary caregiver reported on his or her own mental health using the Kessler Screening Scale, with higher scores indicating greater psychological distress. Parents who scored between 6 and 13 were classified as having low psychological distress, while those who scored 14 or above were classified as having high psychological distress. Parents were also asked whether their children attended preschool. Finally, children’s mental health problems were measured when they were aged 10 to 11 years using the parent-reported Strengths and Difficulties Questionnaire; children were considered to have “elevated mental health symptoms” if their total score was in the 80th to 100th percentile.

Over 21% of children aged 10 to 11 were found to have elevated mental health symptoms, the authors noted. Children who were disadvantaged had a higher prevalence of elevated mental health symptoms (about 33%) compared with their nondisadvantaged peers (about 19%). Nearly 15% of children aged 4 to 5 who were disadvantaged had a parent experiencing high psychological distress compared with nearly 9% of their peers who were not disadvantaged, and fewer disadvantaged children attended preschool (about 61% vs. 69%).

Goldfeld and colleagues next simulated hypothetical interventions related to parental mental health and preschool attendance to estimate the potential impact on the children’s mental health. The authors estimated that improving parental mental health and preschool attendance among children who are disadvantaged to the level of their peers who are not disadvantaged could reduce 6.5% and 0.3% of socioeconomic differences in their mental heath problems, respectively. However, even when the authors modeled improvement in parental mental health and preschool attendance, the children who were disadvantaged had a 10% higher prevalence of mental health symptoms compared with their nondisadvantaged peers.

“This highlights a critical point: these interventions alone are not sufficient, especially for those who are marginalized and socioeconomically disadvantaged,” wrote Jessica Young, M.D., Ph.D., and Rebecca Baum, M.D., of the University of North Carolina-Chapel Hill School of Medicine, in an accompanying commentary. “Maximum impact on child mental health inequities will likely require a multisectoral and sustained strategy, stacking diverse types of complementary interventions over childhood, including those addressing disadvantage itself (e.g., family income support), together with strategies such as improved parental support and preschool provision.”

For related information, see the Psychiatric News article “Treating Family Members Can Break Depression Cycle, Says Expert.”

(Image: iStock/FatCamera)

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