Prevalence and risk factors of parental mental health problems: A cross-sectional study.

An understanding of the prevalence and risk factors of parental mental health problems is important for early intervention and prevention measures and shaping services for parents and their children. However, large representative surveys of parental mental health problems and associated risk factors are lacking. The aim of this study was to estimate prevalence rates of parental mental health problems using a standardised measure of psychiatric morbidity (General Health Questionnaire; GHQ-12), in a representative sample of parents and caregivers of children and young people (2-19 years) in Northern Ireland. Further, this study explored associated risk factors of parental mental health problems. A random household survey of parents and children was conducted between June 2019 and March 2020. Parental responses on demographic, economic, familial and psychological measures were collected (N = 2815) and 22% of parents and caregivers screened positive for mental health problems. The STROBE checklist for observational research was adhered to. Multivariate logistic regression indicated that being in receipt of benefits, having poor family support, a history of adverse childhood experiences, a history of exposure to politically motivated violence (the Troubles), and a child with conduct problems and poor health were all independent risk factors of increased parental mental health problems. Findings will help to inform future commissioning and development of services and broaden understanding of the correlates of parental mental health problems.

The structure of the Prodromal Questionnaire-16 (PQ-16) in a non-help-seeking youth population: Exploratory and confirmatory factor analyses study.

AIMS: The present study aimed to examine the structure of the Prodromal Questionnaire-16 (PQ-16) in a non-help-seeking youth population through exploratory and confirmatory factor analysis. Previous studies have not examined the structure of this self-report measure in this age group outside a clinical setting. METHODS: Participants (n = 1165) aged 11-19 years were recruited to an epidemiological study of young people in Northern Ireland, and completed the PQ-16 alongside other measures. The dataset was split randomly in two for separate factor analyses. A polychoric correlation matrix was created and exploratory factor analysis was used to identify the optimal number of factors. In addition, based on previous studies, six models were tested through confirmatory factor analysis to determine best fit. A one-factor, 3 two-factor, a three-factor and a four-factor model were all tested. RESULTS: The exploratory factor analysis indicated a two-factor structure of the PQ-16 in this population, which we have labelled 'general unusual experiences' and 'hallucinations'. Confirmatory analysis indicated that the two-factor model identified through the exploratory analysis was the best fit for the data. DISCUSSION: The present study suggests that the structure of the PQ-16 may vary across age groups in non-clinical settings, and adds further support to the validity of the PQ-16 is a cost-effective, easy to administer self-report measure that is suitable for use in non-help-seeking populations as a screening tool for prodromal symptoms.

The influence of adverse and positive childhood experiences on young people's mental health and experiences of self-harm and suicidal ideation.

BACKGROUND: Few studies have examined the interaction of adverse childhood experiences (ACEs) and positive childhood experiences (PCEs) with mental health outcomes in nationally representative European populations. OBJECTIVE: The primary objective was to test models of resilience through investigating associations between ACEs and PCEs and young people's risk of common mood and anxiety disorders, self-harm and suicidal ideation. PARTICIPANTS AND SETTING: Data were from the Northern Ireland Youth Wellbeing Survey (NIYWS), a stratified random probability household survey conducted between June 2019 and March 2020. Analysis is based on data from adolescents aged 11-19 years (n = 1299). METHOD: Logistic regression was used to test the direct effects of ACEs and PCEs on mental health outcomes and the moderating effect of PCEs at different levels of ACE exposure. RESULTS: Prevalence rates of mental health outcomes were: common mood and anxiety disorders (16 %); self-harm (10 %); suicidal ideation (12 %). ACEs and PCEs both independently predicted common mood and anxiety disorders, self-harm and suicidal ideation. Every additional ACE increased the likelihood of a common mood and anxiety disorder (81 %), self-harm (88 %) and suicidal ideation (88 %). Every additional PCE reduced common mood and anxiety disorders (14 %), self-harm (13 %) and suicidal ideation (7 %). There was no moderating effect of PCEs on ACEs and mental health outcomes. CONCLUSION: The findings suggest that PCEs act largely independently of ACEs and that initiatives to increase PCEs can assist in the prevention of mental health problems.

Prevalence of probable eating disorders and associated risk factors: An analysis of the Northern Ireland Youth Wellbeing Survey using the SCOFF.

OBJECTIVES: Eating disorders (ED) are associated with significant morbidity and mortality rates and are most common in young people aged between 15 and 19 years. Large representative surveys on disordered eating in youth are lacking. The main aims were to estimate the prevalence of disordered eating in a representative sample of 11-19 year olds in Northern Ireland and investigate the associations between probable eating disorder and a range of risk factors. DESIGNS AND METHODS: A large nationally representative household survey was conducted, and the bivariate and multivariate associations between demographic, familial, economic and psychological risk factors and probable eating disorder were assessed. RESULTS: A total of 16.2% (n = 211) of the sample met the SCOFF screening criteria for disordered eating. Probable eating disorder was associated with being female (OR = 2.44), having a parent with mental health problems (OR = 1.68), suffering from certain psychological problems, such as mood or anxiety disorder (OR = 2.55), social media disorder (OR = 2.95), being the victim of physical bullying (OR = 1.71) and having smoked (OR = 2.46). CONCLUSIONS: This study provides the first prevalence estimates of probable eating disorder among youth in Northern Ireland. Furthermore, the study identifies unique risk factors for probable eating disorder among this representative sample.

Prevalence and predictors of benevolent childhood experiences among a representative sample of young people.

Emerging research evidence suggests that benevolent childhood experiences (BCEs) may partly explain more favourable mental health outcomes among individuals affected by adverse childhood experiences (ACEs). However, much of this research has focused on adult populations. Consequently, this study sought to provide the first rigorous assessment of the prevalence and predictors of BCEs using a nationally representative sample of young people from Northern Ireland (NI). Participants were 11-19-years-olds (N = 1293) who participated in the NI Youth Wellbeing Prevalence Survey (NI-YWS, 2020). Prevalence rates, gender differences and predictors of BCEs were investigated. Results revealed how most of the sample experienced multiple BCEs (95%, n = 1084), with females reporting higher levels of BCEs. Significant positive predictors of BCEs were female gender, parental education, living with both biological parents, and living in areas with lower deprivation, while significant negative predictors of BCEs included family being in receipt of social welfare and older age. Overall, this study highlights how BCEs are common, while the identification of factors associated with likelihood of having positive experiences during early development provides novel insights into those young people who may be at greater risk for maladaptive psychological outcomes.

The Prevalence, Patterns and Correlates of Childhood Trauma Exposure in a Nationally Representative Sample of Young People in Northern Ireland.

Purpose: Childhood trauma (CT) exposure is common, with many young people affected by multiple co-occurring traumas. Methods: Participants were a representative sample of 11-19-year-olds (n = 1293), who participated in the largest ever representative survey of youth mental health in Northern Ireland (NI) - the NI Youth Wellbeing Prevalence Survey 2020. This study used latent class analysis (LCA) to identify typologies that were most representative of trauma experience and co-occurrence among young people living in NI. Demographic, parental and deprivation variables were then used within a multinomial logistic regression analysis to describe trauma class membership. Results: Over 35% (n = 478) of participants reported exposure to at least one CT, with over 50% (n = 259) of trauma-exposed young people reporting multiple trauma exposure. LCA results provided support for a three-class model; 'low-exposure', 'moderate-exposure: community-victimization' and 'high-exposure: sexual-trauma'. While none of the child, parental or familial covariates differentiated members of the 'moderate-exposure: community-victimization' from 'low-exposure', those in 'high-exposure: sexual-trauma' were over four and a half times more likely to belong to a family in receipt of income benefits and over ten times more likely to have experienced some form of out-of-home care. Conclusions: This study highlights the presence of three distinct trauma classes in the NI adolescent population. In particular, this study identifies a small minority of young people who have experienced multiple CT's, including sexually based traumas, with these traumas most likely to have occurred in the context of out-of-home care and familial poverty.

Prevalence and risk factors of mood and anxiety disorders in children and young people: Findings from the Northern Ireland Youth Wellbeing Survey.

OBJECTIVE: This paper presents the key findings from the Northern Ireland Youth Wellbeing Prevalence Survey (NIYWS), specifically the prevalence of common mental health disorders and their association with personal, familial and socio-economic risk factors. METHODS: The Northern Ireland Youth Wellbeing Survey (NIYWS) is a large nationally representative household survey of young people aged 2-19 years (N = 3074) and their parents (N = 2816). Data collection was by means of a stratified random probability household survey. Children and young people were eligible to take part if they were aged 2 to 19 and lived in Northern Ireland. Mood and anxiety disorders were measured using the Revised Children's Anxiety and Depression Scale (RCADS: Chorpita et al., 2000). RESULTS: Based on the cut-off scores for the RCADS 11.5% of the sample met the criteria for any mental health disorder. The most prevalent disorder was panic disorder (6.76%) and the least common was generalised anxiety disorder (2.69%). Poor child health, special educational needs, parental separation, living in a household in receipt of benefits, living in an area of deprivation and living in an urban area were all significant predictors of any mood or anxiety disorder. CONCLUSIONS: The results indicate somewhat elevated prevalence rates of mood and anxiety disorders in children and young people in Northern Ireland compared to England and other international countries. These findings can be used to help inform mental health policy and practice.

Prevalence and predictors of ICD-11 posttraumatic stress disorder and complex PTSD in young people.

OBJECTIVE: The prevalence, construct validity, risk factors and psychopathological correlates associated with ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) as measured by the International Trauma Questionnaire for Children and Adolescents (ITQ-CA) were assessed in a sample of young people from Northern Ireland. METHOD: Participants were trauma-exposed 11-19-year-olds (N = 507) who participated in the Northern Ireland Youth Wellbeing Prevalence Survey (YWS-NI, 2020). Factor mixture modelling (FMM) was used to test the latent structure of the ITQ-CA. Risk-factors and psychopathological correlates associated with latent class membership, and ICD-11diagnostic status, were also investigated. RESULTS: More participants met the ITQ-CA criteria for CPTSD (3.4%, n = 44) than PTSD (1.5%, n = 19). A second-order FMM comprising a 'partial-PTSD class', a 'CPTSD class', a 'DSO class' and a 'low symptom endorsement class' was the best-fitting model. Younger age and cumulative trauma were risk factors for all trauma classes. Female gender and two or more violent traumas were significant predictors of the 'PTSD' and 'CPTSD' classes, while single sexual trauma was a significant predictor of the 'DSO' and 'CPTSD' classes. Two or more sexual traumas was a unique predictor of 'CPTSD class', while two or more vicarious traumas was a unique predictor of 'DSO class'. The 'CPTSD' class displayed the most notable comorbidity. CONCLUSIONS: Findings indicate that CPTSD may be more prevalent than PTSD in children and young people. Support for the ICD-11 conceptualisation of CPTSD as representing a unique diagnostic construct was supported using FMM, with findings indicating trauma symptom class-specific risk profiles.

Experiences of childhood adversity across generations - Continuity or change? A study from the Northern Ireland youth wellbeing survey.

BACKGROUND: Although a wealth of international literature consistently links cumulative experiences of adverse childhood experiences (ACEs) with physical, mental and emotional problems in later life, only a few studies have focused on intergenerational ACE exposure and research using nationally representative populations is lacking. OBJECTIVE: This paper examines intergenerational associations between parent and child ACE scores in a large nationally representative sample of parent-child dyads. PARTICIPANTS AND SETTING: Participant comprise 1042 pairs of parents and young people (11-19 year olds) who both completed questions relating to their exposure to ACEs (N = 1042) as part the Northern Ireland Youth Wellbeing Survey (NIYWS) - a stratified random probability household survey of the prevalence of mental health disorders among 2 to 19 year olds in Northern Ireland (N = 3074). METHODS: Hierarchical regression was used to identify the relationship between parent and young people ACE scores and investigate the extent to which this is influenced by child, parent, family and socio-economic variables. RESULTS: In the final model, young person ACE scores were associated with older child age (ß = 0.082, p = .016), younger parental age (ß = -0.083, p = .022), fewer children in the household (ß = -0.120, p < .001), poor child health (ß = 0.160, p < .001), low family support (ß = 0.118, p = .001) and the household being in receipt of benefits (ß = 0.223, p < .001). CONCLUSIONS: This study found a small association between parent and young person ACE exposure which was attenuated through other variables.

Rationale and methods of the 'Northern Ireland Youth Wellbeing Survey' and initial findings from the Strengths and Difficulties Questionnaire.

Backgrounds and Aims: The Northern Ireland Youth Wellbeing Survey (NIYWS) was commissioned by the Health and Social Care Board (NI) with the aim of providing reliable prevalence estimates of the mental health problems of children and young people aged 2-19 years. Method: The NIYWS used a random probability design, stratified by deprivation decile and county, to ensure even geographical distribution and representation. The survey used a broad range of validated measures to identify children and young people who met established clinical criteria for common mood, anxiety and behaviour disorders, trauma related disorders, as well as those at risk of autism spectrum disorder, eating disorders, future psychotic illness, self-injury or suicide. Results: Data were collected on 3074 children and young people aged 2-19 years, as well as over 2800 parents. The survey achieved a high response rate (67%) and initial findings indicated that 11% of the sample were at risk of emotional or behavioural problems. Conclusions: The NIYWS was the first large scale nationally representative survey of the mental health of children and young people in NI. Despite the legacy of political violence the initial findings show comparable levels of emotional and behavioural problems to England.

Trauma Informed Child Welfare Systems-A Rapid Evidence Review.

Trauma informed care (TIC) is a whole system organisational change process which emerged from the seminal Adverse Childhood Experiences (ACE) study, establishing a strong graded relationship between the number of childhood adversities experienced and a range of negative outcomes across multiple domains over the life course. To date, there has been no systematic review of organisation-wide implementation initiatives in the child welfare system. As part of a wider cross-system rapid evidence review of the trauma-informed implementation literature using systematic search, screening and review procedures, twenty-one papers reporting on trauma-informed implementation in the child welfare system at state/regional and organisational/agency levels were identified. This paper presents a narrative synthesis of the various implementation strategies and components used across child welfare initiatives, with associated evidence of effectiveness. Training was the TIC implementation component most frequently evaluated with all studies reporting positive impact on staff knowledge, skills and/or confidence. The development of trauma-informed screening processes, and evidence-based treatments/trauma focused services, where evaluated, all produced positive results. Whilst weaknesses in study design often limited generalisability, there was preliminary evidence for the efficacy of trauma-informed approaches in improving the mental and emotional well-being of children served by community-based child welfare services, as well as their potential for reducing caregiver stress and improving placement stability.

The association between child maltreatment and adult poverty - A systematic review of longitudinal research.

Child maltreatment is a global problem affecting millions of children and is associated with an array of cumulative negative outcomes later in life, including unemployment and financial difficulties. Although establishing child maltreatment as a causal mechanism for adult economic outcomes is fraught with difficulty, understanding the relationship between the two is essential to reducing such inequality. This paper presents findings from a systematic review of longitudinal research examining experiences of child maltreatment and economic outcomes in adulthood. A systematic search of seven databases found twelve eligible retrospective and prospective cohort studies. From the available evidence, there was a relatively clear relationship between 'child maltreatment' and poorer economic outcomes such as reduced income, unemployment, lower level of job skill and fewer assets, over and above the influence of family of origin socio-economic status. Despite an extremely limited evidence base, neglect had a consistent relationship with a number of long-term economic outcomes, while physical abuse has a more consistent relationship with income and employment. Studies examining sexual abuse found less of an association with income and employment, although they did find a relationship other outcomes such as sickness absence, assets, welfare receipt and financial insecurity. Nonetheless, all twelve studies showed some association between at least one maltreatment type and at least one economic measure. The task for future research is to clarify the relationship between specific maltreatment types and specific economic outcomes, taking account of how this may be influenced by gender and life course stage.

Exploring the influence of reporting delay on criminal justice outcomes: comparing child and adult reporters of childhood sexual abuse.

Delay between disclosure and reporting child sexual abuse is common and has significant implications for the prosecution of such offenses. While we might expect the relationship to be a linear one with longer delay reducing the likelihood of prosecution, the present study confirms a more complex interaction. Utilizing data from 2,079 police records in Northern Ireland, the study investigated the impact of reporting delay on pretrial criminal justice outcomes for child and adult reporters of child sexual abuse. While teenagers were found to be the group most disadvantaged by reporting delay, increased delay actually appeared advantageous for some groups, notably adult females reporting offenses that occurred when they were 0 to 6 years old. Conversely, adult males reporting child sexual abuse did not appear to benefit from increased delay, suggesting both an adult and gender bias within decision-making processes. The implications for future research are discussed.

School-based counseling using systematic feedback: a cohort study evaluating outcomes and predictors of change.

The outcomes of school-based counseling incorporating the Partners for Change Outcome Monitoring System (PCOMS) were evaluated using a cohort design, with multilevel modeling to identify predictors of change. Participants were 288 7-11 year olds experiencing social, emotional or behavioral difficulties. The intervention was associated with significant reductions in psychological distress, with a pre-post effect size (d) of 1.49 on the primary outcome measure and 88.7% clinical improvement. Greater improvements were found for disabled children, older children, and where CBT methods were used. The findings provide support for the use of systematic feedback in therapy with children.

Sexual offences against children: an exploration of attrition in the Northern Ireland criminal justice system.

OBJECTIVE: This paper uses data provided by the Police Service for Northern Ireland (PSNI) to compare the characteristics and outcomes of reported sexual offences involving child and adult victims and explore the factors associated with case outcomes. METHOD: PSNI provided data on 8,789 sexual offences recorded between April 2001 and March 2006. Case outcomes were based on whether a case was recorded by police as having sufficient evidence to summons, charge, or caution an offender (detected). Where an offender was summonsed, charged, or cautioned, this is classified as detection with a formal sanction. A case can also be classified as "detected" without a formal sanction. The analysis focused on two key categories of detection without formal sanction: cases in which the police deem there to be sufficient evidence to charge an offender but took no further action because the victim did not wish to prosecute, or because the police or the Public Prosecution Service (PPS) decided that no useful purpose would be served by proceeding. RESULTS: The analysis confirmed that the characteristics of recorded sexual offences involving adult and child victims vary significantly according to gender, offence type, the timing of report and victim-offender relationship. Almost half of child sex abuse cases are not detected by police and a quarter do not proceed through the criminal justice system because either the victim declines to prosecute or the Police/PPS decide not to proceed. Only one in five child cases involved detection with a formal sanction. Child groups with lower detection with formal sanction rates included children under 5, teenagers, those who do not report when the abuse occurs but disclose at a later date; and those who experience abuse at the hands of peers and adults known to them but not related. The analysis also highlighted variation in formal sanction rates depending on where the offence was reported. CONCLUSIONS: Consideration needs to be given to improving the criminal justice response to specific child groups as well as monitoring detection rates in different police areas in order to address potential practice variation. PRACTICE IMPLICATIONS: Consideration needs to be given to improving the professional response in relation to with particularly lower detection with formal sanction rates. There is also a need to monitor case outcomes to ensure that child victims in different areas receive a similar service.