Predicting mental health improvement and deterioration in a large community sample of 11- to 13-year-olds

Abstract

Of children with mental health problems who access specialist help, 50% show reliable improvement on self-report measures at case closure and 10% reliable deterioration. To contextualise these figures it is necessary to consider rates of improvement for those in the general population. This study examined rates of reliable improvement/deterioration for children in a school sample over time. N = 9074 children (mean age 12; 52% female; 79% white) from 118 secondary schools across England provided self-report mental health (SDQ), quality of life and demographic data (age, ethnicity and free school meals (FSM) at baseline and 1 year and self-report data on access to mental health support at 1 year). Multinomial logistic regressions and classification trees were used to analyse the data. Of 2270 (25%) scoring above threshold for mental health problems at outset, 27% reliably improved and 9% reliably deteriorated at 1-year follow up. Of 6804 (75%) scoring below threshold, 4% reliably improved and 12% reliably deteriorated. Greater emotional difficulties at outset were associated with greater rates of reliable improvement for both groups (above threshold group: OR = 1.89, p < 0.001, 95% CI [1.64, 2.17], below threshold group: OR = 2.23, p < 0.001, 95% CI [1.93, 2.57]). For those above threshold, higher baseline quality of life was associated with greater likelihood of reliable improvement (OR = 1.28, p < 0.001, 95% CI [1.13, 1.46]), whilst being in receipt of FSM was associated with reduced likelihood of reliable improvement (OR = 0.68, p < 0.01, 95% CI [0.53, 0.88]). For the group below threshold, being female was associated with increased likelihood of reliable deterioration (OR = 1.20, p < 0.025, 95% CI [1.00, 1.42]), whereas being from a non-white ethnic background was associated with decreased likelihood of reliable deterioration (OR = 0.66, p < 0.001, 95% CI [0.54, 0.80]). For those above threshold, almost one in three children showed reliable improvement at 1 year. The extent of emotional difficulties at outset showed the highest associations with rates of reliable improvement.

Barriers and Facilitators to Sustaining School-Based Mental Health and Wellbeing Interventions: A Systematic Review

“…In the United Kingdom (U.K.), research has found that emotional problems such as anxiety and depression are the most common issues experienced by young people, followed by behavioural problems [ 2 ]. It is widely acknowledged that these difficulties may have a costly negative impact on educational attainment, drug use, criminality, physical health, poorer employment outcomes, not in education, employment or training (NEET) status, and financial difficulties [ 3 , 4 , 5 , 6 ]. The World Health Organisation (WHO) has called for a coordinated response from different sectors of society, noting that “among all the sectors that play critical roles in adolescent health, education is key” [ 7 ] (p. 8).…”

Authors’ reply

“…This is an approach that has been used before and now forms the basis of analysis being considered in relation to child mental health outcomes for children seen across the National Health Service. 10,11 We hope this helps clarify the points raised. We would want to thank Professor Ford and Ms McManus again for engaging with us on this important topic in our shared aim to understand levels of mental health need in children and young people in order to determine how best to meet this need.…”

“…This is an approach that has been used before and now forms the basis of analysis being considered in relation to child mental health outcomes for children seen across the National Health Service. 10,11…”

A School-Based Approach to Building Resilience and Mental Health Among Adolescents on the Autism Spectrum: A Longitudinal Mixed Methods Study

“…This finding is important and promising in the context of prevention as it demonstrates that students did not appear to experience the same level of deterioration in mental health at final follow-up that is often reported in other real-world studies of clinical and non-clinical samples of neurotypical young adolescents. The aforementioned synthesis of individual-level change in youth depression treatment outcomes found that 6% of young adolescents reliably deteriorated (Bear et al, 2020), and large trials in the United Kingdom found that 9-12% of adolescents reliably deteriorated (Warren et al, 2010;Wolpert et al, 2016Wolpert et al, , 2020. It is possible that the multilevel, strength-focused, resilience building features of RAP-ASD are responsible for this promising finding.…”