Study On The Assessment Of Mental Health Problems Among Children And Adolescents And Their Health Effects

Objective: The World Health Organization defines mental health as a state of well-being in which an individual is aware of his or her potential,is able to cope with the normal stresses of life,and is able to work productively and contribute to the community in which he or she lives.Mentally healthy individuals are not only vital and socially well-adjusted,but also have a positive mental state that allows them to reach their physical and mental potential and to perform positive social functions.Mental health problems,such as behavioral problems,emotional problems,and hyperactivity disorders,can affect an individual’s daily behavioral activities,which in turn can lead to a decrease in quality of life.Childhood and adolescence are critical stages of physical and mental development,and the competitive educational system,high parental expectations,and rapidly changing socioeconomic status all place stress on children and adolescents,making this group more vulnerable to mental health problems.Domestic and international studies reveal that the current situation of children and adolescents’ mental health is not optimistic,with about 10-20% of children and adolescents worldwide having mental health problems,and domestic studies also show that the detection rate of mental health problems among children and adolescents in China is increasing year by year.Early detection and treatment of mental health problems is crucial,as if these problems are not addressed in a timely manner,their severity will increase with age and can lead to various chronic and complex complications in adulthood,and these complications are often disabling,as well as entailing high treatment and rehabilitation costs.However,the measurement methods used in current national and international studies are not uniform,making the assessment of mental health problems difficult.Parents of children and adolescents with psychiatric disorder(PD)are at increased risk of developing psychiatric symptoms.The type and severity of mental illness in children and adolescents is closely related to parental stress and caregiving burden,which can lead to psychological problems or mental illness in both parents(especially parents of children with psychiatric co-morbidities).Moreover,both the child’s and the parent’s mental status have an impact on the entire family,and this impact is mutual and cyclical.Currently,few studies have assessed the mental health status of parents of children with mental illness in China,while studies in other countries have shown that most parents of children with mental illness have significantly higher psychological problem scores than parents of normals or children without mental illness.Mental health problems can affect the learning effectiveness of children and adolescents,leading to low interest in learning and lower academic performance,and can even affect the development of children and adolescents later in life,making them lack self-confidence and suffer from mental disorders such as depression,anxiety,and autism;most seriously,children with mental health problems are more likely to develop suicidal thoughts,take suicidal actions,and eventually die.Suicide is a complex social phenomenon,and WHO data show that children and adolescents have the highest risk of suicide in nearly 1/3 of the world’s countries.In China,suicide is the leading cause of death in the 15-34 age group,and psychological problems are the main factor of suicide among children and adolescents,and the trend of suicide is at a younger age.Therefore,we believe that the suicide mortality rate of children and adolescents can reflect the mental health status of this population to a certain extent,and can also indicate the actual health effects of mental health problems of children and adolescents on themselves to a certain extent.Therefore,this study intends to find out the appropriate method to assess the actual detection rate of mental health problems in children and adolescents by combining information from multiple information assessors and impact scores,and to explore the association of mental health between parents and children and between spouses to reveal the effect of children with mental illness on their parents’ health,and finally to indirectly reveal the effect of mental health problems in children and adolescents on their own health through the suicide death of children and adolescents.Finally,the impact of mental health problems of children and adolescents on their own health is indirectly revealed through the suicide deaths of children and adolescents.Methods: A cross-sectional survey was conducted among elementary,middle,and high school students(6-17 years old)in three urban(Shenyang,Panjin,and Benxi)and three rural(Donggang,Changwu,and Qingyuan)areas of Liaoning Province based on regional(urban versus rural)and economic development status.The SDQ,DAWBA,and GHQ-12 questionnaires were used as instruments to measure the mental health status of children and adolescents as well as parents of children with mental illness.Suicide deaths among children and adolescents aged 10-19 years(ICD-10 codes X60-X84)from 2004-2017 were collected from urban monitoring sites(Shenyang,Dalian,Anshan,Fushun,Benxi,Dandong,Fuxin,etc.)and rural monitoring sites(Fuxin,Changwu,Dawu,Donggang,Jianping,Qingyuan,Liaoyang counties,etc.)of Liaoning Province Vital Statistics Monitoring System The web-based information was reported.Case information of the deceased was exported,including basic information,such as date of birth,gender,education level,and place of residence,as well as suicide information,such as suicide time,suicide location,and suicide method,etc.This process requires strict confidentiality of the respondents’ personal privacy.Local demographic information was obtained from local public security departments,including demographic data of different genders and different age groups.Results: 1.Detection rate of mental health problems in children and adolescents.When we considered 1 informant,the detection rate of mental health problems was higher for students’ own evaluations(5.9%-14.2%)than for teachers’(3.3%-14.0%)and parents’(2.5%-8.2%)evaluations.When we considered 2 informants,the detection rate was greater for the student-teacher combination(8.7% to 24.7%)than for the student-parent combination(7.5% to 18.8%)and the parent-teacher combination(5.5% to19.8%).The detection rate was highest when we considered 3 informants at the same time(10.1% to 28.3%).The detection rates of overall mental health problems when considering both impact scores and 3 informants were 10.1%(impact scores ≥2)and14.5%(impact scores ≥1),much lower than when we considered only symptom scores(28.3%).2.Effects of child-adolescent mental health status on their parents’ health.Spouse’s GHQ score,personal history of PD,and presence of psychiatric co-morbidity in children were significant independent predictors of father’s and mother’s GHQ scores,with a particularly strong effect of spouse’s GHQ score.Low family income(β = 0.091,P= 0.001)and chronic illness(β = 0.068,P = 0.014)were significant independent predictors of fathers’ GHQ scores,whereas children’s LCD status(β = 0.064,P = 0.024)and literacy(β =-0.080,P = 0.003)were significant predictors of mothers’ GHQ scores.3.Child adolescents’ suicide mortality rate.The suicide mortality rate among children and adolescents in Liaoning province was 2.79/100,000 in 2004 and 0.90/100,000 in 2017,with a decreasing trend during this 14-year period(APC =-4.71%,P < 0.05).The suicide mortality rate during 2004-2014 roughly showed: drug use > suicide fall jump >hanging > drowning,while 2014-2014 The period of 2017 showed the characteristics of:suicide fall and jump > taking medication > hanging > drowning;from 2004-2017,the overall suicide mortality rate of both male and female children and adolescents showed a decreasing trend,and the decreasing trend of female suicide mortality rate was statistically significant;from 2004 to 2017,the suicide mortality rate of rural children and adolescents in Liaoning Province was higher than that of urban children and adolescents.Conclusion: The detection rate of mental health problems among our students varied significantly when assessed by different informants,different combinations of informants,and when impact scores were considered,with a significant increase in the detection rate of mental health problems as the number of informants increased,and a decrease when impact scores were considered.Therefore,when using the SDQ to assess mental health problems,the type,number,and combination of informants,the SDQ boundaries,and the use of impact scores should be fully considered depending on the purpose of the survey or screening.It is best to use multiple informants and consider impact scores to better assess the actual burden of mental health problems in children and adolescents.Parents of children with mental illness(especially those with psychiatric co-morbidity)are more likely to have symptoms of mental disorders than parents of children without mental illness.The severity of these psychiatric symptoms is correlated between spouses and tends to occur in clusters within families.Screening and treatment of parents of children with PD may improve outcomes and the well-being of offspring,and may help break the cycle of psychiatric symptoms between parents and children.Based on relevant analyses,this study concludes that it is still necessary to focus on the mental health of children and adolescents,and to provide appropriate interventions for this population to maintain and promote their mental health,prevent suicidal events,and enable their healthy growth.