Changes in mental health service use among 8-year-old children: a 24-year time-trend study
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Abstract
The use of children’s mental health services has increased, but most children with psychiatric problems are still not in contact with these services. This time-trend study assessed changes in considered and reported service use over a 24-year period and studied the factors associated with it using four cross-sectional studies. Information was gathered on 8-year-old children living in the area covered by Turku University Hospital, Finland, at four time points: 986 children in 1989, 891 in 1999, 930 in 2005, and 942 in 2013. The same study design, methods and school districts were used each year and the participation rates varied between 86 and 95%. Parents and teachers completed questionnaires concerning the child’s psychiatric symptoms and service use. The considered and reported service use increased continuously during the study period. In 1989, 2.4% of children had used services and in 2013 this was 11.0% (OR 5.0, 95% CI 3.1–8.0). Reported service use also increased among children with comorbid problems, from 18.3 to 50.7% (OR 5.0, 95% CI 2.1–12.0). Psychiatric problems and some family factors were associated with service use, but the increase was not explained by these factors. The increase in child mental health service use may reflect better public awareness of mental health problems, fewer barriers to accessing care and decrease of stigma. Although more children are using mental health services, there are still a large number of children with mental health problems who have not been in contact with services.
Keywords
Mental health service use Psychiatric problem Time-trend study Change ChildNotes
Acknowledgements
The study was funded by grants from the Finnish Brain Foundation, the Foundation for Pediatric Research, Orion Research Foundation sr, and the University of Turku Graduate School (UTUGS) (Lotta Lempinen), and from the Academy of Finland (288960) and Turku University Hospital (EVO grant) (Andre Sourander). The authors wish to thank Kristiina Saanakorpi (RN) and Kalle Vaintola (MA) for assisting with the data collection.
Compliance with ethical standards
Conflict of interest
None of the authors has any biomedical, financial, or other potential conflicts of interest to report.
Ethical standards
The study was approved by the school principals, school authorities, and the ethics committee of Turku University Hospital.
Supplementary material
References
- 1.Sourander A, Niemelä S, Santalahti P, Helenius H, Piha J (2008) Changes in psychiatric problems and service use among 8-year-old children: a 16-year population-based time-trend study. J Am Acad Child Adolesc Psychiatry 47:317–327. https://doi.org/10.1097/CHI.0b013e318160b98f CrossRefPubMedGoogle Scholar
- 2.Zwaanswijk M, van Dijk CE, Verheij RA (2011) Child and adolescent mental health care in Dutch general practice: time trend analyses. BMC Fam Pract 12:133–143. https://doi.org/10.1186/1471-2296-12-133 CrossRefPubMedPubMedCentralGoogle Scholar
- 3.Tick NT, van der Ende J, Verhulst FC (2008) Ten-year increase in service use in the Dutch population. Eur Child Adolesc Psychiatry 17:373–380. https://doi.org/10.1007/s00787-008-0679-7 CrossRefPubMedGoogle Scholar
- 4.Jansen DEMC, Wiegersma P, Ormel J, Verhulst FC, Vollebergh WA, Reijneveld SA (2013) Need for mental health care in adolescents and its determinants: the TRAILS study. Eur J Public Health 23:236–241. https://doi.org/10.1093/eurpub/cks087 CrossRefPubMedGoogle Scholar
- 5.Ford T (2008) Practitioner review: how can epidemiology help us plan and deliver effective child and adolescent mental health services? J Child Psychol Psychiatry 49:900–914. https://doi.org/10.1111/j.1469-7610.2008.01927.x CrossRefPubMedGoogle Scholar
- 6.Zwaanswijk M, Van Der Ende J, Verhaak PFM, Bensing JM, Verhulst FC (2003) Factors associated with adolescent mental health service need and utilization. J Am Acad Child Adolesc Psychiatry 42:692–700CrossRefGoogle Scholar
- 7.Sawyer MG, Arney PA, Baghurst BA, Clark JJ, Graetz BW, Kosky RJ, Nurcombe B, Patton GC, Prior MR, Raphael B, Rey JM, Whaites LC, Zubrick SR (2001) The mental health of young people in Australia: key findings from the child and adolescent component of the national survey of mental health and well-being. Aust N Z J Psychiatry 35:806–814CrossRefGoogle Scholar
- 8.Sourander A, Lempinen L, Brunstein Klomek A (2016) Changes in mental health, bullying behavior and service use among eight-year-old children over 24 years. J Am Acad Child Adolesc Psychiatry 55:717–725. https://doi.org/10.1016/j.jaac.2016.05.018 CrossRefPubMedGoogle Scholar
- 9.Olfson M, Blanco C, Wang S, Laje G, Correll CU (2014) National trends in the mental health care of children, adolescents, and adults by office-based physicians. JAMA Psychiatry 71:81–90. https://doi.org/10.1001/jamapsychiatry.2013.3074 CrossRefPubMedGoogle Scholar
- 10.Olfson M, Druss BG, Marcus SC (2015) Trends in mental health care among children and adolescents. N Engl J Med 372:2029–2038. https://doi.org/10.1056/NEJMsa1413512 CrossRefPubMedGoogle Scholar
- 11.Sourander A, Santalahti P, Haavisto A, Piha J, Ikäheimo K, Helenius H (2004) Have there been changes in children’s psychiatric symptoms and mental health service use? A 10-year comparison from Finland. J Am Acad Child Adolesc Psychiatry 43:1134–1145CrossRefGoogle Scholar
- 12.Gyllenberg D, Marttila M, Sund R, Jokiranta-Olkoniemi E, Sourander A, Gissler M, Ristikari T (2018) Temporal changes in the incidence of treated psychiatric and neurodevelopmental disorders during adolescence in two birth cohorts. Lancet Psychiatry 5:227–236. https://doi.org/10.1016/S2215-0366(18)30038-5 CrossRefPubMedGoogle Scholar
- 13.Kumpulainen K, Räsänen E, Henttonen I, Moilanen I, Piha J, Puura K, Tamminen T, Almqvist F (1999) Children’s behavioural/emotional problems: a comparison of parents’ and teachers’ reports for elementary school-aged children. Eur Child Adolesc Psychiatry 8:41–47CrossRefGoogle Scholar
- 14.Achenbach TM, McConaughy SH, Howell CT (1987) Child/adolescent behavioural and emotional problems: implications of cross-informant correlations for situational specificity. Psychol Bull 101:213–232CrossRefGoogle Scholar
- 15.van der Ende J, Verhulst FC, Tiemeier H (2012) Agreement of informants on emotional and behavioral problems from childhood to adulthood. Psychol Assess 24:293–300CrossRefGoogle Scholar
- 16.Statistics of Finland 2017. Avioliittojen ja avioerojen määrä vuosina 1965–2016. The number of marriages and divorces in 1965–2016. http://www.stat.fi/til/ssaaty/2016/ssaaty_2016_2017-04-20_tau_001_fi.html. Accessed 2 Feb 2018
- 17.Rinne R, Kivirauma J, Simola H (2002) Shoots of revisionist 1 education policy or just slow readjustment? The Finnish case of educational reconstruction. J Educ Policy 17:643–658CrossRefGoogle Scholar
- 18.Heino T (2008) Lastensuojelun avohuolto ja perhetyö: kehitys, nykytila, haasteet ja kehittämisehdotukset. The non-institutional social care and family work of child welfare: development, present state, challenges and developing proposals. In: Stakes Working papers 9. www.stakes.fi/verkkojulkaisut/tyopaperit/T9-2008-VERKKO.pdf. Accessed 7 June 2018
- 19.Angold A, Messer SC, Stangl D, Farmer EM, Costello EJ, Burns BJ (1998) Perceived parental burden and service use for child and adolescent psychiatric disorders. Am J Public Health 88:75–80CrossRefGoogle Scholar
- 20.Zwaanswijk M, Verhaak PFM, Bensing JM, van der Ende J, Verhulst FC (2003) Help seeking for emotional and behavioural problems in children and adolescents: a review of recent literature. Eur Child Adolesc Psychiatry 12:153–161CrossRefGoogle Scholar
- 21.Nanninga M, Jansen DE, Knorth EJ, Reijneveld SA (2014) Enrolment of children and adolescents in psychosocial care: more likely with low family social support and poor parenting skills. Eur Child Adolesc Psychiatry 24:407–416. https://doi.org/10.1007/s00787-014-0590-3 CrossRefPubMedGoogle Scholar
- 22.Wichstrom L, Belsky J, Jozefiak T, Sourander A, Berg-Nielsen TS (2014) Predicting service use for mental health problems among young children. Pediatrics 133:1054–1060. https://doi.org/10.1542/peds.2013-3184 CrossRefPubMedGoogle Scholar
- 23.Rutter M, Tizard J, Whitmore K (1970) Education, health and behaviour. Longman Publishing Group, LondonGoogle Scholar
- 24.Rutter M (1967) A children’s behaviour questionnaire for completion by teachers: preliminary findings. J Child Psychol Psychiatry 8:1–11CrossRefGoogle Scholar
- 25.Kresanov K, Tuominen J, Piha J, Almqvist F (1998) Validity of child psychiatric screening methods. Eur Child Adolesc Psychiatry 7:85–95CrossRefGoogle Scholar
- 26.Sourander A, Klomek AB, Niemelä S, Haavisto A, Gyllenberg D, Helenius H, Sillanmäki L, Ristkari T, Kumpulainen K, Tamminen T, Moilanen I, Piha J, Almqvist F, Gould MS (2009) Childhood predictors of completed and severe suicide attempts: findings from the Finnish 1981 birth cohort study. Arch Gen Psychiatry 66:398–406. https://doi.org/10.1001/archgenpsychiatry.2009.21 CrossRefPubMedGoogle Scholar
- 27.Sourander A, Jensen PS, Davies M, Niemelä S, Elonheimo H, Ristkari T, Helenius H, Sillanmäki L, Piha J, Kumpulainen K, Tamminen T, Moilanen I, Almqvist F (2007) Who is at greatest risk for adverse long-term outcomes? The Finnish from a boy to a man study. J Am Acad Child Adolesc Psychiatry 46:1148–1161CrossRefGoogle Scholar
- 28.Gyllenberg D, Sourander A, Niemelä S, Helenius H, Sillanmäki L, Ristkari T, Piha J, Kumpulainen K, Tamminen T, Moilanen I, Almqvist F (2011) Childhood predictors of use and costs of antidepressant medication by age 24 years: findings from the Finnish nationwide 1981 birth cohort study. J Am Acad Child Adolesc Psychiatry 50:406–415. https://doi.org/10.1016/j.jaac.2010.12.016 CrossRefPubMedGoogle Scholar
- 29.Murthy RS, Bertolote JM, Epping-Jordan J, Funk M, Prentice T, Saraceno B, Saxena S (2001) The world health report 2001—Mental Health: New understanding, new hope. http://www.who.int/entity/whr/2001/en/whr01_en.pdf?ua=1. Accessed 2 Feb 2018
- 30.Joelsson P, Chudal R, Gyllenberg D, Kesti AK, Hinkka-Yli-Salomäki S, Virtanen JP, Huttunen J, Ristkari T, Parkkola K, Gissler M, Sourander A (2016) Demographic characteristics and psychiatric comorbidity of children and adolescent diagnosed with ADHD in specialized healthcare. Child Psychiatry Hum Dev 47:574–582. https://doi.org/10.1007/s10578-015-0591-6 CrossRefPubMedGoogle Scholar
- 31.Kronström K, Ellilä H, Kuosmanen L, Kaljonen A, Sourander A (2016) Changes in the clinical features of child and adolescent psychiatric inpatients: a nationwide time-trend study from Finland. Nord J Psychiatry 70:436–441. https://doi.org/10.3109/08039488.2016.1149617 CrossRefPubMedGoogle Scholar
- 32.Hakulinen-Viitanen T, Hietanen-Peltola M, Hastrup A, Wallin M, Pelkonen M (2012) Laaja terveystarkastus: Ohjeistus äitiys- ja lastenneuvolatoimintaan sekä kouluterveydenhuoltoon. Extensive health examination: Instructions for work in maternity and child welfare clinics and in school health care. National institute for health and welfare. manual 22. Juvenes Print, Tampereen yliopistopaino Oy. http://www.julkari.fi/bitstream/handle/10024/90831/URN_ISBN_978-952-245-708-0.pdf. Accessed 7 June 2018
- 33.Kuoppala T, Säkkinen S (2014) Child welfare 2013. Statistical report. National institute for Health and Welfare.http://www.julkari.fi/bitstream/handle/10024/116946/Tr26_14.pdf. Accessed 2 Feb 2018
- 34.Sellers R, Maughan B, Pickles A, Thapar A, Collishaw S (2015) Trends in parent- and teacher-rated emotional, conduct and ADHD problems and their impact in prepubertal children in Great Britain: 1999–2008. J Child Psychol Psychiatry 56:49–57. https://doi.org/10.1111/jcpp.12273 CrossRefPubMedGoogle Scholar