Promoting equity in the mental wellbeing of children and young people: a scoping review

Abstract

There is increasing emphasis on wellbeing as a target for mental health promotion, especially during the formative period of childhood. Despite growing research on the importance of mental wellbeing, there is little information on how to effectively promote it or how to promote it equitably. This article presents a scoping review of interventions which seek to promote mental wellbeing and reduce inequities in children and young people living in high income countries. We used Fair Foundations: The VicHealth framework for health equity (VicHealth (2013) Melbourne, Australia: The Victorian Health Promotion Foundation) to identify points of entry at three layers of influence: (i) socioeconomic, cultural and political contexts, (ii) daily living conditions, and (iii) individual and family health-related factors. We identified more than 1000 interventions which aimed to prevent or treat childhood mental illness, but there were far fewer that aimed to promote children's or young people's mental wellbeing. The interventions we studied were either universal or specifically targeted children from disadvantaged families: none explicitly used an equity framework to guide their design or evaluation or addressed social gradients in wellbeing. Most interventions remained focused on proximate factors, although we also identified a handful of interventions that sought to address children's access to services and their educational and neighbourhood environments. However, we found encouraging evidence that interventions in family and educational settings were successful in building children's strengths and supporting positive parenting, universally and within disadvantaged groups. Such positive programme evaluations signal the potential for using a proportionate universalism approach that emphasizes equity in the promotion of mental wellbeing.

Supporting parenting to address social inequalities in health: a synthesis of systematic reviews

“…The programmes carried out in the home setting to promote socially disadvantaged families’ cognitive and socio-emotional development showed questionable results [44, 49]. Massage programmes aimed at boosting the mental and physical health of infants did not succeed in proving they were effective [43].…”

“…For the most part, the notions of equity related to their results and conclusions [28, 33, 34, 50, 51]. A fifth ( n  = 4) clearly integrated SIH into their analysis strategy, according to the PRISMA-equity criteria [29, 32, 42, 49]. …”

“…All of the reviews that tackled the SIH question presented their results and conclusions in relation to equity [21, 29, 32, 42, 44, 49]. Three of these clearly explained their results as supporting a reduction in inequalities [29, 32, 42], and one mentioned an increase in inequalities for some interventions [49].…”

“…Three of these clearly explained their results as supporting a reduction in inequalities [29, 32, 42], and one mentioned an increase in inequalities for some interventions [49]. A return to the original studies that were the subject of these reviews revealed that one programme, Sure Start, presented results that only seemed to benefit the most advantaged socioeconomic gradients [49]. …”

Psychopathology and socioeconomic position: what can be done to break the vicious circle?

“…And, by ricochet, limit the socioeconomic impact of psychiatric disorders. Moreover, contextual interventions, particularly ones that target family or school functioning have the potential to develop children's and adolescents' resources and have shown efficacy across diverse socioeconomic settings [17]. Finally, a unique study conducted by Costello et al [18] set in the 1990s among youths growing up on an American-Indian reserve, where some families benefited from additional revenue after a casino opened on their land, showed significantly improved mental health among youths whose families were lifted from poverty.…”