Changes in mental health service use among 8-year-old children: a 24-year time-trend study
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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.
KeywordsMental health service use Psychiatric problem Time-trend study Change Child
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.
The study was approved by the school principals, school authorities, and the ethics committee of Turku University Hospital.
- 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
- 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 CrossRefGoogle 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
- 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
- 23.Rutter M, Tizard J, Whitmore K (1970) Education, health and behaviour. Longman Publishing Group, LondonGoogle 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 CrossRefGoogle 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 CrossRefGoogle 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 CrossRefGoogle 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