The Quebec Child Mental Health Survey (QCMHS) was conducted in 1992 on a representative sample of 2400 children and adolescents aged 6 to 14 years from throughout Quebec. Prevalences of nine Axis-I DSM-III-R (American Psychiatric Association, 1987) mental health disorders were calculated based on each informant (for 6-11-year-olds: child, parent, and teacher; for 12-14-year-olds: child and parent). Informant parallelism allows the classification of results of the demographic variables associated with disorders in the logistic regression models. This strategy applies to group variables (correlates of disorders) whereas informant agreement applies to individual diagnoses. Informant parallelism implies that results for two informants or more are in the same direction and significant. In the QCMHS, informant parallelism exists for disruptive disorders, i.e. in two ADHD regression models (child and parent) higher rates among boys and young children, and in three oppositional/conduct disorders regression models (child, parent, and teacher) higher rates among boys. No informant parallelism is observed in the logistic regression models for internalizing disorders, i.e. the patterns of association of demographic variables with anxiety and depressive disorders vary across informants. Urban-rural residence does not emerge as a significant variable in any of the logistic regression models. The overall 6-month prevalences reach 19.9% according to the parent and 15.8% according to the child. The implications of the results for policy makers and clinicians are discussed.
Caring for people in the community with persistent and disabling mental illnesses presents a major challenge to government, planners and mental health professionals. The success with which mentally disabled people are integrated into community life says much about the society in which we live. This article describes the experience of the Greater Vancouver Mental Health Service Society in offering community-based mental health services to persons with schizophrenia and other major mental disorders over the past 20 years. The key to its success lies in a decentralized, relatively non hierarchical organizational structure which allows committed and skilled multidisciplinary teams to work with patients and their families in their community. The resulting services are fully integrated within the fabric of the community and are responsive to local needs. Partnerships among professionals, patients, families and community agencies result in work that is creative, productive and effective.
The purpose of this study was to test the applicability of a standardized procedure for assessing Icelandic children's behavior/emotional problems and competencies, and to identify differences related to demographic variables. This study focuses upon the method of using the Child Behavior Checklist by Achenbach to estimate the self-reported prevalence by parents and adolescents of emotional and behavior problems in children from 2-16 years of age and self-reported prevalence of adolescents from 11-18 years, selected at random from the general population, both in urban and rural areas. The information was obtained by mailing lists with a letter to parents of children 2-10 years of age. The lists for adolescents 11-18 years of age were distributed by teachers in school. Those adolescents who were not in school received the lists by mail at their homes. The Child Behavior Checklists used for analyses were completed by 109 parents of 2-3 year old children; 943 parents of 4-16 year old children, and 546 non-referred adolescents from the general population. The rate of response was lowest for the youngest age group (47%), but increasing to 62% with increasing age of the child. The response rate among the adolescents answering the Youth Self Report was 64%. Comparisons are presented with the Child Behavior Checklist for this study with Dutch, American, French, Canadian, German and Chilean samples and show striking similarities in four of these countries in behavior/emotional problems reported. The present study prevalence data behavior/emotional problems in Icelandic children from the general population from 4-16 year olds for 943 children is 17.5 (boys 19.1; girls 15.).
This study investigated the mental health of Portuguese children in Canada. Preliminary work involved a survey of professionals serving the Portuguese community and the translation and assessment of a standardized child behaviour checklist. Forty-five Portuguese children and 45 non Portuguese children referred to a children's mental health centre were compared on demographic and family indicators and their referral source. There were similar proportions of boys and girls in the two groups, similar types of services were requested, and they had similar treatment histories. The Portuguese children were older at the time of referral and were more likely to be referred by educational agencies than the non Portuguese children. Portuguese families appeared to experience different stresses than non Portuguese families. Implications of these findings for the provision of culturally sensitive interventions for Portuguese children and their families are discussed.
The purpose of this study is to estimate the percentage of mental health problems in a pediatric outpatient Norwegian clinic. We used the Strengths and Difficulties Questionnaire to screen for mental health problems. Families of children aged 4-11 took part in the study, and 380 out of 982 possible families consented to take part, and 349 families contributed with questionnaire data. The main referral reasons for the patients were asthma, eneuresis and stomach pain. Mothers reported that 17.4% of boys and 17.8% of girls displayed mental clinical problems. The prevalence of problems did not differ significantly between somatic diagnostic groups. Although the study has low participation, it underlines the necessity of screening all pediatric patients for mental health problems. Future research in pediatric clinics should include factors of psychology because pediatric problems are not caused by somatics alone.
According to studies carried out in various countries, many parents (7-28%) contact some professionals due to a child's behavioral or emotional disorder, but a large part of children presenting psychic symptoms has remained outside of mental health services. Seeking for care has strongly increased in Finland over the last few years. Schools and day care centers are important not only in recognizing the problems but also in providing support and directing to specialized services.
We examined the relationship between service use and the number of problem areas as reported by parents and teachers on questionnaires among children aged 7-9 years old in the Bergen Child Study, a total population study including more than 9000 children. A problem area was counted as present if the child scored above the 95th percentile on parent and/or teacher questionnaire. A total number of 13 problem areas were included. Odd ratios (ORs) for contact with child and adolescent mental health services (CAMH), school psychology services (SPS), health visiting nurse/physician, and school support were calculated with gender as covariate. The number of symptom areas was highly predictive of service use, showing a dose-response relationship for all services. Children scoring on =4 problem areas had a more than hundredfold risk of being in contact with CAMH services compared to children without problems. The mean number of problem areas for children in CAMH and SPS was 6.1 and 4.4 respectively, strongly supporting the ESSENCE model predicting multisymptomatology in children in specialized services. Even after controlling for number of problem areas, boys were twice as likely as girls to be in contact with CAMH, replicating previous findings of female gender being a strong barrier to mental health services.
We compared parents' endorsement of having contacted a "mental health clinic or agency" when seeking help for their child, with parents' recognition of having contacted specific, named mental health agencies in their geographic region. Data were from two studies involving parents of children and adolescents seeking mental health services. Across the two studies, only 28 and 41% of parents reported having contacted a "mental health agency," but 100% reported contact when asked about specific agencies by name. Incorporating this simple modification in future studies could provide more accurate documentation of help-seeking for, and utilization of, children's mental health services.
MBBS, MPH, MA, MD, FRANZCP, FAFPHM, Diploma of the American Board of Psychiatry and Neurology, Regional Psychiatrist, Cairns and Hinterland Hospital and Health Service and Adjunct Professor, James Cook University, Cairns, QLD.
Mental health problems in Aboriginal and Torres Strait Islander peoples are common, changing and challenging. Particularly in remote settings, doctors will need to untangle the complex interplay of culture, context and clinical significance.
This paper emphasises the importance of local knowledge and cultural respect in complementing clinical competence in the management of Aboriginal and Torres Strait Islander peoples with mental health problems.
Anxiety, depression, psychosis, self-harm and problems of childhood and old age are used to exemplify differences by comparison with practice in non-Indigenous populations.
Mental Health problems and services in Magadan/Chukotka region were compared with those in Alaska. Both locations have similar geographic and climatic conditions, but have been separated from each other until recently with services developing along different tracks. Recommendations including opportunities for future research are briefly described.