Childhood social and early developmental factors associated with mental health service use

Abstract.

Background: The aim of this study was to determine the influence of family and child variables on the pathway to mental health care in children. Methods: A blinded, matched case control study was conducted, involving a retrospective analysis of prospectively collected data from routine examinations at the Youth Health Care Division from the Municipal Health Centre Maastricht (YHCD), where all children in a geographically defined area from foetal life through to age 19 years are periodically screened. The sample included 400 children, 80 referred to the Community Mental Health Centre in Maastricht and 320 matched controls, aged 6–13 years. Results: The most potent risk factors associated with mental health service use were: being small at birth, having a younger mother at delivery, living in a one-parent family, having a divorced mother and/or unemployed father, observations of externalising behaviour and/or motor developmental problems, speech problems and experiencing several adverse family circumstances. The group of variables pertaining to the family (e. g. one-parent family, parental mental health problems, etc.) influenced mental health service independently of the group of variables pertaining to the child (e. g. birth length, speech problems, etc.) and vice versa. Several combinations of risk factors, under realistic prevalence estimates, had positive predictive values of up to 26 %. Conclusion: Pathways to child psychiatric care are heavily influenced by the child's family environment as well as by deviance in social, motor and speech development. Independence of child developmental effects suggests these are not merely on the causal pathway between adverse family environment and psychiatric service use outcome. Combinations of risk factors may be useful to develop a screening approach with the possibility of early prevention.