Study Identifies Barriers, Facilitators to African American Parents Seeking MH Care for Children

Many factors influence parents’ abilities to seek help for their children experiencing mental health problems. A report in Psychiatric Services found that African American parents were more likely to postpone seeking professional help for a child experiencing emotional or behavioral problems if they feared the child might be involuntary hospitalized and/or if their health insurance would not cover treatment.

“Barriers to mental health care are greater for African American parents, who are more likely than White parents to experience structural obstacles that hinder timely diagnosis,” wrote Jennifer Richmond, Ph.D., M.S.P.H., of Vanderbilt University Medical Center and colleagues. “African American children are also exposed to systemic racism and other harmful structures in the health care system … As a result, African American children with emotional and behavioral challenges are more often misdiagnosed and less likely to receive early intervention than are White children.”

Richmond and colleagues used data from the Teaching Advocacy Skills for Kids study, which included 289 African American parents living in North Carolina who were raising children with several mental health or developmental challenges. Parents completed a computer-assisted telephone interview upon recruitment to the study. During the interviews, the authors determined whether the parents rapidly sought care (defined as seeking care within 30 days of identifying their child’s need) or deferred care (defined as waiting one year or longer to seek care) for their children after recognizing the children had mental health or developmental challenges.

Parent activation (meaning the parent had the knowledge, skills, and confidence to access and engage in the appropriate services) was assessed using the 13-item parent-focused Patient Activation Measure. The authors also assessed if there were other adults with mental health challenges living in the home; if parents mistrusted doctors; and if they were deterred from getting help for their children for other reasons, including a fear of involuntary hospitalization, lack of health insurance coverage, or not initially finding the children’s behaviors to be bothersome.

About 22% of parents rapidly sought care, while 49% deferred care. Parents were more likely to rapidly seek care if they had higher parent activation scores or if they lived with other adults with mental health challenges. They were less likely to rapidly seek care if their children’s challenges did not initially bother them or if their health insurance would not cover the service. Similarly, they were more likely to defer care if they feared involuntary hospitalization for their children.

Contrary to the authors’ hypothesis, parents were more likely to rapidly seek care for their children if they reported mistrusting doctors. “It is possible that parents who mistrust doctors make different choices for their children than for themselves,” the authors theorized. “For example, parents who mistrust doctors, perhaps because of previous negative health care experiences, may be more motivated to advocate for their child to receive rapid, high-quality care so that their family can avoid further negative experiences.”

For related information, see the Psychiatric Services article “Barriers to Increasing Access to Brief Pediatric Mental Health Treatment From Primary Care.”

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People With Disabilities at Elevated Risk of Suicidal Behavior, Study Suggests

People with disabilities appear to be significantly more likely to think about, plan, and/or attempt suicide than people without disabilities, according to a report in the American Journal of Preventive Medicine. Individuals with multiple disabilities were found to be at a particularly heightened risk of suicidal behavior.

The findings highlight the need to consider functional disability when implementing suicide prevention strategies, “particularly the presence of complex activity limitations or multiple disabilities,” wrote Nicole M. Marlow, Ph.D., M.S.P.H., of the University of Florida and colleagues.

Marlow and colleagues analyzed data collected as part of the National Survey on Drug Use and Health between 2015 and 2019. The final sample included 198,640 U.S. adults who had answered survey questions regarding the presence or absence of any suicidal thoughts, plans, and attempts during the 12 months prior to the survey. These respondents also answered six questions about the presence or absence of functional disabilities.

The researchers categorized the respondents into seven groups based on their reported functional disability type; these groups included those with no functional disability, hearing limitation only, vision limitation only, cognitive limitation only, mobility limitation only, complex activity limitation only, and ≥2 limitations. The researchers also categorized respondents into six groups based on the number of disabilities they reported (0, 1, 2, 3, 4, or ≥5 limitations)

Overall, 19.8% of respondents reported any disability. People with any disability were found to be more than twice as likely to report suicidal ideation, suicide planning without attempt, and suicide attempt compared with people without disabilities. Among disability categories, individuals with a cognitive limitation or complex activity limitation had the highest rates of suicidal behaviors. Additional analysis revealed that those with ≥5 limitations were nearly four times as likely to report suicidal ideation, more than six times as likely to report suicide planning without attempt, and more than eight times as likely to report a suicide attempt compared with people without a disability.

“Because many disability types tend to be associated with an increase in prevalence as well as severity with aging, the results of this study may underestimate the extent to which suicide-related outcomes reduce quality of life over time,” Marlow and colleagues wrote. “Future research should examine how functional disability is associated with suicide-related outcomes over time.”

For related information, see the Psychiatric Services article “Predictors of Mental Health Crises Among Individuals With Intellectual and Developmental Disabilities Enrolled in the START Program.”

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Children of Dads With Psychological Distress May Be More Likely to Show Behavioral Problems

Children whose fathers are experiencing greater feelings of hopelessness, worthlessness, and depression may be more likely to display behavioral problems compared with children whose fathers are experiencing fewer of these symptoms, according to a study in the Journal of the American Academy of Child & Adolescent Psychiatry.

“Our study … clearly suggests that interventions to prevent and treat psychological distress in fathers may have much benefit for their children,” wrote Eirini Flouri, Ph.D., of the University College London. “The first step in doing that is increasing awareness of the role that paternal psychological distress can have in child development.”

For the study, Flouri and colleagues analyzed data from the Millennium Cohort Study (MCS), an ongoing population study of children born in 2000-2002 in the United Kingdom. As part of the MCS, parent-reported data were collected through interviews and questionnaires when children were 9 months, 3 years, 5 years, 7 years, 11 years, and 14 years. Beginning at the age 3 assessment, parents were asked to fill out the Strengths and Difficulties Questionnaire—which asks questions about a child’s emotions, interactions with peers, attention, and more over the past six months. Parents also completed the Kessler six-item psychological distress scale, which asks participants to reflect on distress over the past month, with such questions as “How often did you feel so depressed that nothing could cheer you up?” and “How often did you feel hopeless?”

A total of 13,442 children, whose mothers and fathers had valid data on psychological distress in at least one of these time points were included in the study sample.

After adjusting for maternal psychological distress, paternal psychological distress predicted all four domains of child problem behaviors examined (hyperactivity and conduct, emotional, and peer problems). High levels of paternal psychological distress predicted some problems (emotional symptoms and hyperactivity) more strongly in boys than girls, they added.

“[O]ur study showed that paternal psychological distress was related to several aspects of child problem behavior. … A priority for future studies should be to examine the mechanisms of this effect, which are likely both genetic and environmental,” they concluded.

For related information, see the American Journal of Psychiatry article “Offspring of Depressed Parents: 30 Years Later.”

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Punitive Discipline May Work in Short Term but Could Cause Long-Term Emotional Damage

Young children whose parents employed punitive discipline styles, such as smacking or shouting at them, tended to have fewer conduct problems and less hyperactivity, but it came at a high cost: they tended to develop more emotional problems and less prosocial behaviors at age 11, according to a study published in the January issue of the Journal of the American Academy of Child & Adolescent Psychiatry.

The findings offer yet another example of why parents should avoid physical punishment and verbal abuse of children, as was recently emphasized in an updated policy statement against corporal punishment by the American Academy of Pediatrics.

Pryia Rajyaguru, M.R.C.Psych, of Bristol Medical School and colleagues analyzed data from nearly 5,000 mothers who were participating in the UK Millennium Cohort Study, a national longitudinal study monitoring the lives of children born in 2000 and 2001 in the United Kingdom. The mothers completed a questionnaire on their parenting styles when their children were 3 years old, which quantified their use of “active” punishment (such as smacking, shouting, and telling off) and “withdrawal of reward” styles of discipline (such as ignoring, removal of privileges, and sending children to their bedroom). Additionally, the mothers completed a brief questionnaire called the Strengths and Difficulties Questionnaire (SDQ), which asked them to evaluate emotional and behavioral problems in the 3-year-olds; the mothers repeated this assessment when the children were aged 11.

Older mothers used relatively less discipline overall, whereas those who were educated and of higher socioeconomic status used relatively more withdrawal of rewards and less active punishment approaches, the study found. Children subjected to both active punishment and withdrawal-of-reward approaches had fewer conduct problems from age 3 to 11, the researchers wrote. However, those subjected to active punishment developed increased emotional problems not seen with the withdrawal-of-rewards discipline style.

Both approaches, however, increased child-reported emotional symptoms, as measured by a six-item questionnaire completed by the children at age 11. This suggests that both active punishment and withdrawal of rewards might negatively influence the child’s mood.

“This study demonstrates that for those mother-child dyads in which discipline is frequent, the type of approach used appears important with distinct later childhood mental health outcome,” Rajyaguru and colleagues wrote. “[I]f mothers adopted more withdrawal and less active approaches, then later emotional and behavioral problems might be decreased.”

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