Children\u27s Mental Health over the Early Life Course: The Impact of Economic Resources, Neighborhood Disorder, and Family Processes

Drawing upon a stress process and life course framework, and using data from the Child Supplement of the National Longitudinal Survey of Youth, the three papers presented in this dissertation examine the extent to which economic resources, neighborhood disorder, and family processes influence children’s trajectories of mental health. In the first paper, I empirically construct six categories that represent children with comparable profiles of family income over time: increasing, decreasing, fluctuating, and stability across low-, medium-, and high-income families. The income categories are incorporated in multiple group latent growth curve models to assess the extent to which they initiate and shape children’s mental health trajectories from age 4 to 14. Results reveal significant disparities in antisocial behavior and depression/anxiety at age 4 and over time across the income categories. In the second paper, I use these income categories to examine how stability and change in family income influences trajectories of maternal emotional support and the provision of cognitive stimulation in children’s home environments. In subsequent analyses, I examine the extent to which these different economic profiles moderate the relationship between family processes and children’s mental health trajectories. In the third and final paper, I examine the relationship between stability and change in perceived neighborhood disorder and children’s trajectories of mental health. I conceptualize perceived neighborhood disorder as a two-part process involving a binary component that distinguishes between children exposed to minimal vs. high levels of disorder, and a continuous component that represents the actual level of disorder for children in the latter category. These two processes capture stability and change in neighborhood disorder over time, and are included in parallel process latent growth models to examine their separate and distinct impact on children’s trajectories of mental health. The results from these papers underscore that the duration and sequencing of socioeconomic status, both at the family and neighborhood level, have important implications for children’s mental health and family processes. The results also underscore the complex and dynamic ways family processes influence children’s mental health in different economic contexts

Patterns of poverty exposure and children\u27s trajectories of externalizing and internalizing behaviors

Using data from the Child Supplement of the National Longitudinal Survey of Youth, we compare trajectories of externalizing and internalizing behaviors among children exposed to five patterns of poverty from birth to age 14: always or never poor – stable patterns; a single transition into or out of poverty, or repeated fluctuations in and out of poverty – changing patterns. We also examine how low maternal education and single parenthood interact with these poverty exposures to compound their adverse effects. Finally, we compare the magnitude of effects associated with the patterns of poverty exposure, as well as their interactions with low maternal education and single parenthood, on trajectories of externalizing and internalizing behaviors to determine if they are significantly different. Results reveal that initial levels and rates of change in children\u27s trajectories of externalizing and internalizing behaviors are similar across the three changing patterns of poverty exposure, leading us to combine them into a single group representing intermittent poverty. Initial disparities between children who are never poor and their counterparts who are always or intermittently poor are constant over time for internalizing behaviors and grow in magnitude for externalizing behaviors. The cumulative negative effect of poverty exposure over time is stronger for externalizing vs. internalizing behaviors. Low maternal education compounds the adverse effects of persistent poverty, an effect that is similar for externalizing and internalizing behaviors

Social assistance and trajectories of child mental health problems in Canada: evidence from the National Longitudinal Survey of Children and Youth

Objectives: To examine the link between stability and change in social assistance (SA) use and children’s mental health trajectories to better understand whether social policies targeted at low-income families might be an effective population-based mechanism for preventing mental health problems among children at risk. Methods: The National Longitudinal Survey of Children and Youth (N = 8981) is used to classify children into 5 categories based on their family’s pattern of SA use from age 4–5 to 10–11: always or never on SA, a single transition on or off SA, or fluctuations on and off SA. Latent growth modelling is used to compare trajectories of emotional and behavioural problems among children with different patterns of SA exposure to their counterparts never on SA over this same time period. Results: Child emotional and behavioural problems are exacerbated over time in accordance with patterns of SA use: chronic SA use (behavioural) and moving onto SA (emotional and behavioural). These differential rates of change result in mental health disparities at age 10–11 that were not present at age 4–5. Children exposed to SA when they were age 4–5 but subsequently moved off continue to demonstrate elevated levels of emotional and behavioural problems at age 10–11. Conclusions: Successful social policies and interventions will require understanding the specific mechanisms through which SA undermines child mental health and how programs can be modified to reduce its negative consequences

Six-Month Prevalence of Mental Disorders and Service Contacts among Children and Youth in Ontario: Evidence from the 2014 Ontario Child Health Study

© The Author(s) 2019. Objectives: To present the 6-month prevalence and sociodemographic correlates of mental disorders and mental health–related service contacts in a sample of children (4 to 11 years) and youth (12 to 17 years) in Ontario. Methods: The 2014 Ontario Child Health Study is a provincially representative survey of 6537 families with children aged 4 to 17 years in Ontario. DSM-IV-TR mental disorders were assessed using the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) and included mood (major depressive episode), anxiety (generalized anxiety, separation anxiety, social phobia, specific phobia), and behaviour disorders (attention-deficit/hyperactivity disorder, oppositional-defiant disorder, conduct disorder).The MINI-KID was administered independently to the primary caregiver and youth aged 12 to 17 years in the family’s home. Results: Past 6-month prevalence of any mental disorder ranged from 18.2% to 21.8% depending on age and informant. Behaviour disorders were the most common among children, and anxiety disorders were the most common among youth. Among children and youth with a parent-identified mental disorder, 25.6% of children and 33.7% of youth had contact with a mental health provider. However, 60% had contact with one or more of the providers or service settings assessed, most often through schools. Conclusions: Between 18% and 22% of children and youth in Ontario met criteria for a mental disorder but less than one-third had contact with a mental health provider. These findings provide support for strengthening prevention and early intervention efforts and enhancing service capacity to meet the mental health needs of children and youth in Ontario

Poverty, Neighbourhood Antisocial Behaviour, and Children’s Mental Health Problems: Findings from the 2014 Ontario Child Health Study

© The Author(s) 2019. Objectives: To determine if levels of neighbourhood poverty and neighbourhood antisocial behaviour modify associations between household poverty and child and youth mental health problems. Methods: Data come from the 2014 Ontario Child Health Study—a provincially representative survey of 6537 families with 10,802 four- to 17-year-olds. Multivariate multilevel modelling was used to test if neighbourhood poverty and antisocial behaviour interact with household poverty to modify associations with children’s externalizing and internalizing problems based on parent assessments of children (4- to 17-year-olds) and self-assessments of youth (12- to 17-year-olds). Results: Based on parent assessments, neighbourhood poverty, and antisocial behaviour modified associations between household poverty and children’s mental health problems. Among children living in households below the poverty line, levels of mental health problems were 1) lower when living in neighbourhoods with higher concentrations of poverty and 2) higher when living in neighbourhoods with more antisocial behaviour. These associations were stronger for externalizing versus internalizing problems when conditional on antisocial behaviour and generalized only to youth-assessed externalizing problems. Conclusion: The lower levels of externalizing problems reported among children living in poor households in low-income neighbourhoods identify potential challenges with integrating poorer households into more affluent neighbourhoods. More important, children living in poor households located in neighbourhoods exhibiting more antisocial behaviour are at dramatically higher risk for mental health problems. Reducing levels of neighbourhood antisocial behaviour could have large mental health benefits, particularly among poor children

The 2014 Ontario Child Health Study—Methodology

© The Author(s) 2019. Objective: To describe the methodology of the 2014 Ontario Child Health Study (OCHS): a province-wide, cross-sectional, epidemiologic study of child health and mental disorder among 4- to 17-year-olds living in household dwellings. Method: Implemented by Statistics Canada, the 2014 OCHS was led by academic researchers at the Offord Centre for Child Studies (McMaster University). Eligible households included families with children aged 4 to 17 years, who were listed on the 2014 Canadian Child Tax Benefit File. The survey design included area and household stratification by income and 3-stage cluster sampling of areas and households to yield a probability sample of families. Results: The 2014 OCHS included 6,537 responding households (50.8%) with 10,802 children aged 4 to 17 years. Lower income families living in low-income neighbourhoods were less likely to participate. In addition to measures of childhood mental disorder assessed by the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) and OCHS Emotional Behavioural Scales (OCHS-EBS), the survey contains measures of neighbourhoods, schools, families and children, and includes administrative data held by the Ministries of Education and Health and Long-Term Care. Conclusions: The complex survey design and differential non-response of the 2014 OCHS required the use of sampling weights and adjustment for design effects. The study is available throughout Canada in the Statistics Canada Research Data Centres (RDCs). We urge external investigators to access the study through the RDCs or to contact us directly to collaborate on future secondary analysis studies based on the OCHS

Area-Level Variation in Children’s Unmet Need for Community-Based Mental Health Services: Findings from the 2014 Ontario Child Health Study

There is limited empirical evidence documenting the magnitude and correlates of area-level variability in unmet need for children’s mental health services. Research is needed that identifies area-level characteristics that can inform strategies for reducing unmet need in the population. The study purpose is to: (1) estimate area-level variation in children’s unmet need for mental health services (using Service Areas as defined by the Ontario Ministry of Children and Youth Services), and (2) identify area-level service arrangements, and geographic and population characteristics associated with unmet need. Using individual-level general population data, area-level government administrative data and Census data from Ontario, Canada, we use multilevel regression models to analyze unmet need for mental health services among children (level 1) nested within Service Areas (level 2). The study finds that 1.64% of the reliable variance in unmet need for mental health services is attributable to between-area differences. Across areas, we find that Service Areas with more agencies had a lower likelihood of unmet need for mental health services. Compared to other Service Areas, Toronto had much lower likelihood of unmet need compared to the rest of Ontario. Rural areas, areas with unsatisfactory public transport, and areas with higher levels of socio-economic disadvantage had a higher likelihood of unmet need for mental health services. These findings identify challenges in service provision that researchers, policymakers and administrators in children’s mental health services need to better understand. Policy implications and potential Service Area strategies that could address equitable access to mental health services are discussed

Children’s Mental Health Need and Expenditures in Ontario: Findings from the 2014 Ontario Child Health Study

Objective: To estimate the alignment between the Ontario Ministry of Children and Youth Services (MCYS) expenditures for children’s mental health services and population need, and to quantify the value of adjusting for need in addition to population size in formula-based expenditure allocations. Two need definitions are used: “assessed need,” as the presence of a mental disorder, and “perceived need,” as the subjective perception of a mental health problem. Methods: Children’s mental health need and service contact estimates (from the 2014 Ontario Child Health Study), expenditure data (from government administrative data), and population counts (from the 2011 Canadian Census) were combined to generate formula-based expenditure allocations based on 1) population size and 2) need (population size adjusted for levels of need). Allocations were compared at the service area and region level and for the 2 need definitions (assessed and perceived). Results: Comparisons were made for 13 of 33 MCYS service areas and all 5 regions. The percentage of MCYS expenditure reallocation needed to achieve an allocation based on assessed need was 25.5% at the service area level and 25.6% at the region level. Based on perceived need, these amounts were 19.4% and 27.2%, respectively. The value of needs-adjustment ranged from 8.0% to 22.7% of total expenditures, depending on the definition of need. Conclusion: Making needs adjustments to population counts using population estimates of children’s mental health need (assessed or perceived) provides additional value for informing and evaluating allocation decisions. This study provides much-needed and current information about the match between expenditures and children’s mental health need

Prevalence and Correlates of Youth Suicidal Ideation and Attempts: Evidence from the 2014 Ontario Child Health Study

© The Author(s) 2019. Objectives: To present the 12-month prevalence and correlates of suicidal ideation and attempts in a sample of youth in Ontario. Methods: Data come from the 2014 Ontario Child Health Study, a provincially representative survey of families with children in Ontario. Youth aged 14 to 17 y (n = 2,396) completed a computer-assisted, self-administered questionnaire in their home to assess the occurrence of suicidal ideation, suicidal attempts, and associated correlates, including non-suicidal self-injury, mental disorders, substance use, peer victimization and exposure to child maltreatment. Socio-demographic information was collected from the parent. Logistic regression models were used to identify correlates that distinguished between youth reporting: 1) no suicidal ideation or attempts, 2) suicidal ideation but no attempts, and 3) suicidal ideation and attempts. Results: The 12-month prevalence of suicidal ideation and attempts was 8.1% and 4.3%, respectively. All clinical and behavioural correlates were significantly higher among youth reporting suicidal ideation or attempts, as compared with non-suicidal youth. In adjusted models, depression and non-suicidal self-injury were each independently associated with elevated odds of suicidal ideation (OR = 4.84 and 4.19, respectively) and suicidal attempt (OR = 7.84 and 22.72, respectively). Among youth who reported suicidal ideation, the only variable that differentiated youth who attempted suicide v. those who did not, in adjusted models, was non-suicidal self-injury (OR = 3.89). Conclusions: Suicidal ideation and attempts are common among youth in Ontario, often co-occurring with mental disorders and high-risk behaviours. These findings underscore the need for effective prevention and intervention strategies, particularly for youth depression and non-suicidal self-injury