Cultural Stigma and Mental Health
June 29, 2023Mindfulness and How the Chair of Joy Can Promote the Mental Well-being of Children
June 29, 2023
Mental Health Research in Children
Introduction:
Mental health in children has worsened over the last decade, especially with the recent COVID-19 pandemic. In 2020, a survey of over 1,000 parents by the Ann & Robert H. Lurie Children’s Hospital of Chicago taken around the United States had 71% of parents say that the pandemic had taken a toll on their children’s mental health, and 69% said that it was the worst thing to happen to the mental health of their child. In 2020, there was an increase in mental health hospital-related visits from 24% of children ages 5-11 and 31% ages 12-17.
The American Rescue Plan Act passed in March of 2021, addressed this issue by providing 170 billion dollars for schools to train and implement more psychiatrists in the school setting. This is especially helpful in states like Nevada, which was ranked last in providing services for mental health in the US. The allocation of this money is to be utilized to increase the workforce dedicated to the mental well-being of the youth in the US. This is an action that needs to be taken before the issue can be appropriately addressed [1].
The American Rescue Plan Act passed in March of 2021, addressed this issue by providing 170 billion dollars for schools to train and implement more psychiatrists in the school setting. This is especially helpful in states like Nevada, which was ranked last in providing services for mental health in the US. The allocation of this money is to be utilized to increase the workforce dedicated to the mental well-being of the youth in the US. This is an action that needs to be taken before the issue can be appropriately addressed [1].
The next step is more permanent funding. Although this addresses the crises exacerbated by the pandemic, this needs to be sustained long-term. Psychologists are also helping train teachers to deal with emotional and behavioral issues. Teachers are incorporating mental health lessons in the classroom to reduce the burden on school psychologists and increase mental health knowledge and awareness in students [1].
The current article looks at the mental well-being of children and adolescents over the past decade. It will explore the mental health issues related to children that have become a growing problem before and during the pandemic, interventions based at school, in the community, and at home, and using mental health promotion strategies to improve mental health in children.
This is by no means an exhaustive review of the literature but a sampling of research to give perspective on the current state of mental health of children and what can be done about the growing mental illness crisis. Hopefully, this provides needed information to many parents with children and the public on mental health research in the US and worldwide.
Prevalence of Mental Health Issues of Children Before and During the Pandemic:
A study evaluating the National Survey of Children’s Health from 2016 analyzed responses concerning mental health, particularly depression, anxiety disorders, and behavioral problems. During this period, pre-COVID, it was observed that approximately 7.1% (4.4 million) had anxiety issues, 7.4% (4.5 million) had behavioral problems, and 3.2% (1.9 million) suffered from depression. These results are for children in the US ages 3-17 years of age. Therapy was given to almost 80% of children that suffered from depression but only 60% and 50% for anxiety and behavioral problems, respectively [2]. During and after the pandemic, depression and anxiety increased to 9.4% and 4.4%, respectively, in children 3-17 years of age, and 20% of high-school students experienced persistent depression, with 7 in 100,000 committing suicide and only 1 in 4 children in this age group had received mental health services [3, 4]. The pandemic exacerbated the comorbidity of anxiety and depression but not individually [4].
Also, it has been reported that the severity of depression in children increased in a study of an inpatient care unit in an urban community compared to three years prior. In the same study, the intake of black adolescents in the psychiatric hospital doubled, and there was an increase of 17% in attempted suicide through all demographics [5]. A similar study at another urban children’s psychiatric hospital saw an increase over four-fold increase in the use of restraints in the middle of the pandemic compared to pre-pandemic conditions and a notable increase in the use of psychotropic drugs [6].
Children with more severe mental health issues like obsessive-compulsive disorder (OCD) increasingly suffered during the COVID pandemic. A survey study of children ages 6-18 previously diagnosed with OCD reported that over 50% reported an increase in the severity of their symptoms, such as increased cleaning or washing, obsessive checking of previous activities, and fear of contamination during the pandemic as compared to before [7] There is still lack of evidence for the impact of COVID on the mental health of children with more severe psychotic disorders such as post-traumatic stress disorder (PTSD) and schizophrenia.
Mental Health Interventions at School, within the Community, and at Home:
There have been many approaches to remedy or prevent children’s mental illness and protect their well-being. Which studies prove to be most effective, however? Which setting is most appropriate for providing mental healthcare to children of different age groups? The answer to these and many more questions are complex in nature. Rarely are studies in this field conducted similarly and comparably or analyzed the same. One review by Das et al. [8] attempts to provide some answers on the effectiveness of school, community, and home/family-based interventions that were aimed at providing help for mentally ill children. It rated 38 systemic reviews covering these approaches and that cover several mental illnesses like depression, anxiety, and eating disorders.
In one review covering 15 studies, mental health promotion programs, which will be discussed further in the next section, significantly positively impacted younger children and adolescents [9]. Another review analysis found that school-based preventative mental health measures were also influential. Nurture groups in school that focus on the student’s social, behavioral, and emotional well-being had a direct and substantial impact on the well-being of the student participants [10]. This approach was practical because it dealt with the child’s well-being and should be considered further for future intervention studies. Short-term therapy that is solution based had mixed results in another review but overall showed promise in reducing negative emotions and correcting behavioral issues [11]. In low-income urban schools, mental health interventions were helpful but were age and gender-specific in their impact [12].
It is worth noting that no one method is perfect or can be used for all children in all demographics. Culture, socioeconomic status, gender, and age all play an essential role in the effectiveness of these interventions. It would be helpful if there were more nationwide or global studies to parse out or confirm what approaches fit a particular environment.
The same review by Das et al. [8] evaluated several community-based studies that turned out to have a positive impact on children’s mental health, depending on the approach. Activities provided by the community for children positively impacted behavioral outcomes and self-esteem [13]. Another review analyzed the effectiveness of community-provided parent training for depressive symptoms showed promise in reducing the severity in children [14]. For studies focusing on low-income urban settings, both interventions incorporating a personal approach and an environmental system had a significant impact on children’s mental health, while targeting the environmental issues was most effective [15]. This makes sense, considering that the mental health issues associated with children in low-income backgrounds would likely have the root of their mental health concerns based on the lack of essential resources.
Studies on home-based and individual mental health interventions reveal mixed results [8]. Exercise in several studies was shown to be very effective on depressive symptoms compared to no intervention. Although, compared to receiving medication or psychotherapy, there was no comparable difference and had no significant effect on anxiety or dropout rates [16]. Cognitive behavioral therapy (CBT) was evaluated as very effective for anxiety disorders. Both medication and therapy were similar in treating depression with regard to reducing subsequent depressive episodes and dropping out of school, but therapy was more effective in reducing suicidal thoughts [17]. Also, the combination of both therapy and medication had a positive impact on depressive symptoms when compared to placebo [18]. Home-based therapies were also seen as an effective strategy for curbing behavioral issues but not significantly compared to inpatient care [19].
These reviews of particular intervention strategies in different settings are only a few of many that have been conducted around the world. Still, more research must be done to determine what works and what does not. What may work for children in one demographic may only work for some. Finding an effective strategy to reduce mental illness in culturally diverse countries like the US is incredibly challenging.
Mental Health Promotion Strategies for Children:
Another approach that needs more consideration and research is using mental health promotion strategies for children. Much more research has been done on reducing symptoms of the mentally ill, but it is also essential to build positive mental health and create a state of well-being. The World Health Organization (WHO) defines mental health as “a state of well-being in which the individual realizes his or her abilities, can cope with the normal stresses of life, can work productively and fruitfully, and can make a contribution to his or her community” and mental health promotion as “the process of enabling people to increase control over, and to improve their health [20] .”
Three main overarching strategies can be employed for mental health promotion: universal (a method used to target a population without regard to current mental health status), indicated (targeting a sub-population that has risk factors for developing mental illness but doesn’t meet the diagnostic threshold), and selective (targeting the population that has a mental illness). Universal and selective strategies tend to be more efficacious [21].
This is highlighted in a German study that implemented a program in a secondary school called Stress SOS. This mental health promotion exercise is an 8-week, 90 minutes session program focusing on coping mechanisms, self-esteem and emotional training, and mental health knowledge. The study split participants into three groups: those without mental health issues, at risk for mental health issues, and those with mental health issues. The results from this universal, indicated, and selective study show that the program helped reduce stress levels in the mentally ill population but not in the at-risk or mentally healthy groups. Although, mental health knowledge did increase in all three groups [22]. As mentioned, the at-risk students may have benefited more from an environmental approach or a combination of environmental intervention and mental health promotion.
Another study targeting younger students, ages 9-11, utilized a program called Passport: Skills for Life. This program equips children with coping mechanisms to enhance their mental well-being. This was a universal study that did not separate the mental health condition of the students. This study followed up for one year to assess the retention of the effects of the intervention. They concluded that the students significantly retained emotional coping mechanisms provided by the program compared to the control group. Again, this and the previous study highlighted how similar analyses can be executed differently. A similar program to Passport: Skills for Life has also been implemented for younger children [23]. This study, utilizing the universal strategy, shows that mental health promotion can benefit many students, not just those with a mental illness. However, it would be interesting to see the breakdown of how effective it is in the targeted mental health groups at risk and mentally ill.
Discussion:
One size doesn’t fit all when it comes to mental health strategies. More research must be done to fine-tune what methods work for different demographics. A lot has been done since the turn of the century, especially recently, with the COVID pandemic taking a toll on many children’s mental health. In the US, several states have recently taken action to improve students’ mental health. Nevada is allowing students to take mental health days, and so is Illinois, which also plans to invest 24 million dollars towards mental health. Maryland is providing 25 million dollars from the CARES Act to bring more counselors and psychologists into school and expand the Boys and Girls Club to all counties. Massachusetts plans to pass the Thrives Act to expand mental health promotional and preventative mental health services in schools. In Atlanta, 30,000 children from pre-K to 12th grade will be screened for mental health, and in Miami, they plan to train staff to provide mental health services for students better and hire 45 more mental health coordinators [1]. However, the pandemic was tough for everyone, especially children. The US and other countries have now begun to put children’s mental health to the forefront.
Mental health promotion for children is a burgeoning approach recently gaining traction. Teaching children coping skills and increasing mental health knowledge is as essential as treating those with mental illnesses. A positive psychological process such as mindfulness could be a beneficial tool to improve children’s mental well-being.
The Chair of Joy (COJ) mindfulness technique could be employed at home or at school to help increase the mental well-being of children, staff, and parents. There needs to be future research to see how effective this method could be helpful for children of different demographics. Still, the simplicity and cost-effectiveness make it a viable option. Currently, the COJ process is used more for corporate, hospital, and individual settings. It would be interesting to perform a larger-scale study to see how beneficial it could be for children on a larger scale in school or at home.
Discussion:
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