Measuring mental health and wellbeing outcomes for children and adolescents to inform practice and policy:a review of child self-report measures

There is a growing appetite for mental health and wellbeing outcome measures that can inform clinical practice at individual and service levels, including use for local and national benchmarking. Despite a varied literature on child mental health and wellbeing outcome measures that focus on psychometric properties alone, no reviews exist that appraise the availability of psychometric evidence and suitability for use in routine practice in child and adolescent mental health services (CAMHS) including key implementation issues. This paper aimed to present the findings of the first review that evaluates existing broadband measures of mental health and wellbeing outcomes in terms of these criteria. The following steps were implemented in order to select measures suitable for use in routine practice: literature database searches, consultation with stakeholders, application of inclusion and exclusion criteria, secondary searches and filtering. Subsequently, detailed reviews of the retained measures’ psychometric properties and implementation features were carried out. 11 measures were identified as having potential for use in routine practice and meeting most of the key criteria: 1) Achenbach System of Empirically Based Assessment, 2) Beck Youth Inventories, 3) Behavior Assessment System for Children, 4) Behavioral and Emotional Rating Scale, 5) Child Health Questionnaire, 6) Child Symptom Inventories, 7) Health of the National Outcome Scale for Children and Adolescents, 8) Kidscreen, 9) Pediatric Symptom Checklist, 10) Strengths and Difficulties Questionnaire, 11) Youth Outcome Questionnaire. However, all existing measures identified had limitations as well as strengths. Furthermore, none had sufficient psychometric evidence available to demonstrate that they could reliably measure both severity and change over time in key groups. The review suggests a way of rigorously evaluating the growing number of broadband self-report mental health outcome measures against standards of feasibility and psychometric credibility in relation to use for practice and policy

Predictors of mental health difficulties and subjective wellbeing in adolescents: A longitudinal study

BACKGROUND: Mental health and subjective well-being are of great interest in both health policy and research. There has been considerable debate regarding whether mental health difficulties and subjective wellbeing are two distinct domains or different ends of a single mental health spectrum. This study investigates if predictors of mental health difficulties and subjective wellbeing are the same or different in a large-scale community-based sample in the United Kingdom. METHODS: 13,500 adolescents in year 7 (aged 11-12) and again in year 8 (aged 12-13) completed surveys on emotional strengths and skills, support networks, mental health difficulties and wellbeing. Socio-demographic factors were gathered from the National Pupil Database. Mental health difficulties and wellbeing scores were standardized to allow comparisons. RESULTS: The correlation between mental health difficulties and subjective wellbeing was -0.48, indicating a moderate overlap between the two domains. Some of the predictors (e.g., gender, ethnicity, problem solving, emotion regulation) in year 7 predicted both mental health difficulties and subjective wellbeing in year 8. However, some of the predictors in year 7 only predicted mental health difficulties (e.g., special education needs, empathy) and some only subjective wellbeing (e.g., prosocial behaviour, peer support) in year 8. CONCLUSION: This study provides further evidence for differences in what predicts adolescents' mental health difficulties and subjective wellbeing. It highlights the importance of not only focusing on preventing or treating symptoms of mental illness but also focusing on improving children's wellbeing

Predictors of amounts of child and adolescent mental health service use

The aim of this study was to build evidence about how to tailor services to meet the individual needs of young people by identifying predictors of amounts of child and adolescent mental health service use. We conducted a secondary analysis of a large administrative dataset from services in England was conducted using the Mental Health Services Data Set (years 2016-17 and 2017-18). The final sample included N = 27,362 episodes of care (periods of service use consisting of at least two attended care contacts and less than 180 days between care contacts) from 39 services. There were 50-10,855 episodes per service. The descriptive statistics for episodes of care were: Mage = 13 years, SDage = 4.71, range = 0-25 years; 13,785 or 50% male. Overall, there were high levels of heterogeneity in number of care contacts within episodes of care: M = 11.12, SD = 28.28, range = 2-1529. Certain characteristics predicted differential patterns of service use. For example, young people with substance use (beta = 6.29, 95% CI = 5.06-7.53) or eating disorders (beta = 4.30, 95% CI = 3.29-5.30) were particularly more likely to have higher levels of service use. To build on this, evidence is needed about predictors of child and adolescent mental health treatment outcome and whether the same characteristics predict levels of improvement as well as levels of service use

Predictors of child and adolescent mental health treatment outcome

BACKGROUND: To examine the predictors of treatment outcome or improvement in mental health difficulties for young people accessing child and adolescent mental health services. METHODS: We conducted a secondary analysis of routinely collected data from services in England using the Mental Health Services Data Set. We conducted multilevel regressions on N = 5907 episodes from 14 services (Mage = 13.76 years, SDage = 2.45, range = 8-25 years; 3540 or 59.93% female) with complete information on mental health difficulties at baseline. We conduct similar analyses on N = 1805 episodes from 10 services (Mage = 13.59 years, SDage = 2.33, range = 8-24 years; 1120 or 62.05% female) also with complete information on mental health difficulties at follow up. RESULTS: Girls had higher levels of mental health difficulties at baseline than boys (β = 0.28, 95% CI = 0.24-0.32). Young people with higher levels of mental health difficulties at baseline also had higher levels of deterioration in mental health difficulties at follow up (β = 0.72, 95% CI = 0.67-0.76), and girls had higher levels of deterioration in mental health difficulties at follow up than boys (β = 0.09, 95% CI = 0.03-0.16). Young people with social anxiety, panic disorder, low mood, or self-harm had higher levels of mental health difficulties at baseline and of deterioration in mental health difficulties at follow up compared to young people without these presenting problems. CONCLUSIONS: Services seeing higher proportions of young people with higher levels of mental health difficulties at baseline, social anxiety, panic disorder, low mood, or self-harm may be expected to show lower levels of improvement in mental health difficulties at follow up

Temporal effects of maternal psychological distress on child mental health problems at ages 3, 5, 7 and 11: analysis from the UK Millennium Cohort Study

Background: Psychological distress is common among women of childbearing age, and limited longitudinal research suggests prolonged exposure to maternal distress is linked to child mental health problems. Estimating effects of maternal distress over time is difficult due to potential influences of child mental health problems on maternal distress and time-varying confounding by family circumstances. Methods: We analysed the UK Millennium Cohort Study, a nationally representative sample with data collected throughout childhood. Adopting a marginal structural modelling framework, we investigated effects of exposure to medium/high levels of maternal psychological distress (Kessler-6 score 8+) on child mental health problems (Strengths and Difficulties Questionnaire borderline/abnormal behaviour cut-off) using maternal and child mental health data at 3, 5, 7 and 11 years, accounting for the influence of child mental health on subsequent maternal distress, and baseline and time-varying confounding. Results: Prior and concurrent exposures to maternal distress were associated with higher levels of child mental health problems at ages 3, 5, 7 and 11 years. For example, elevated risks of child mental health problems at 11 years were associated with exposure to maternal distress from 3 years [risk ratio (RR) 1.27 (95% confidence interval (CI) 1.08–1.49)] to 11 years [RR 2.15 (95% CI 1.89–2.45)]. Prolonged exposure to maternal distress at ages 3, 5, 7 and 11 resulted in an almost fivefold increased risk of child mental health problems. Conclusions: Prior, concurrent and, particularly, prolonged exposure to maternal distress raises risks for child mental health problems. Greater support for mothers experiencing distress is likely to benefit the mental health of their children

Associations between mental health competence and indicators of physical health and cognitive development in eleven year olds: findings from the UK Millennium Cohort Study

Background: Positive mental health may support healthy development in childhood, although few studies have investigated this at a population level. We aimed to construct a measure of mental health competence (MHC), a skills-based assessment of positive mental health, using existing survey items in a representative sample of UK children, and to investigate its overlap with mental health difficulties (MHD), socio-demographic patterning, and relationships with physical health and cognitive development. Methods: We analysed the UK Millennium Cohort Study (MCS) when children were aged 11 years. Maternal (n = 12,082) and teacher (n = 6739) reports of prosocial behaviours (PS) and learning skills (LS) were entered into latent class models to create MHC measures. Using descriptive statistics, we examined relationships between MHC and MHD, and the socio-demographic patterning of MHC. Associations between MHC and physical health and cognitive development were examined with relative risk ratios [RRR] (from multinomial models): BMI status (healthy weight, overweight, obesity); unintentional injuries since age 7 (none, 1, 2+); asthma symptoms (none, 1, 2+); and tertiles of test scores for verbal ability, spatial working memory and risk-taking. Models were adjusted for potential confounding. Results: Four MHC classes were identified [percentages for maternal and teacher reports, respectively]: high MHC (high PS, high LS) [37%; 39%], high-moderate MHC (high PS, moderate LS) [36%; 26%]; moderate MHC (moderate PS, moderate LS) [19%; 19%]; low MHC (moderate PS, low LS) [8%; 16%]. Higher MHC was less common in socially disadvantaged children. While MHC and MHD were associated, there was sufficient separation to indicate that MHC captures more than the absence of MHD. Compared to children with high MHC, those in other MHC classes tended to have poorer physical health and cognitive development, particularly those with low MHC or high-moderate MHC. For example, children with maternal-report Low MHC were more likely to have experienced 2+ unintentional injuries (RRR: 1.5 [1.1–2.1]) and to have lower verbal ability scores (RRR: 2.5 [1.9–3.2]). Patterns of results were similar for maternal- and teacher-report MHC. Conclusion: MHC is not simply the inverse of MHD, and high MHC is associated with better physical health and cognitive development. Findings suggest that interventions to improve MHC may support healthy development, although they require replication

The impact of area level mental health interventions on outcomes for secondary school pupils: Evidence from the HeadStart programme in England

In light of the dramatic rise in mental health disorders amongst adolescents seen in the past decade across the world, there is an urgent need for robust evidence on what works to combat this trend. This paper provides the first robust evaluation of the impacts on school outcomes of 6-year funding programme (HeadStart) for area-level mental health interventions for adolescents. Exploiting educational administrative data on ten cohorts of state-educated secondary school students, we use the synthetic control method to construct counterfactual outcomes for areas that received the funding. We show that the funding did not affect students’ absenteeism or academic attainment, but it prevented around 800 students (c. 10% of students typically excluded yearly) from being excluded in its first year. The transient nature of this effect suggests that sustained funding for intervention may be a necessary but not sufficient condition to maintain programme effectiveness over time

How does the association between special education need and absence vary overtime and across special education need types?

School absenteeism is a significant social and public health problem, and it has considerable negative consequences on the development of children and adolescents not only in the short term but also in the long term. We investigated special education needs (SEN) as a risk factor for absenteeism. For 418,455 mainstream secondary school students from 151 local authorities in England, multilevel linear regression models were run to investigate the association between SEN, SEN types and absenteeism during their secondary school period from year 7 to year 11. Local authority level variation was also investigated. Adolescents with SEN were more likely to be absent than their peers without SEN. Of adolescents with SEN, those with physical disability, followed by those with behavioural, emotional and social difficulties had the highest rates of absenteeism. Absenteeism rates increased as adolescents grew older. The association between absenteeism and having any SEN varied substantially across Local authorities. The results suggest that early interventions/preventative measures could mitigate loss of schooling due to absence. Moreover, the substantial variation in attendance for children across different local authorities suggest that there may be scope for local authorities to influence absence rates among adolescents

Feedback from Outcome Measures and Treatment Effectiveness, Treatment Efficiency, and Collaborative Practice: A Systematic Review.

Due to recent increases in the use of feedback from outcome measures in mental health settings, we systematically reviewed evidence regarding the impact of feedback from outcome measures on treatment effectiveness, treatment efficiency, and collaborative practice. In over half of 32 studies reviewed, the feedback condition had significantly higher levels of treatment effectiveness on at least one treatment outcome variable. Feedback was particularly effective for not-on-track patients or when it was provided to both clinicians and patients. The findings for treatment efficiency and collaborative practice were less consistent. Given the heterogeneity of studies, more research is needed to determine when and for whom feedback is most effective