Inferences about the effect of lockdowns on mental health require causal identification strategies: A reply to Thornley et al.

This letter responds to another letter in the journal (Thorney et al., 2021). Thornley et al. reported a time series analysis of "parasuicide" cases in New Zealand children and concluded that this time series demonstrates a "clear detrimental effect of COVID-19 lockdown policies on child mental health”. In this letter, we point out four reasons why this conclusion is not justified by the data presented by Thornley et al. [Note: Our letter did not have a formal abstract; this summary was added for the preprint.]

Predictors of Change in Children’s Internalising and Externalising Behaviour Before and During the Initial COVID-19 Lockdown in the UK and Turkey: A Cross-cultural Examination

Background: The COVID-19 pandemic has had a profound effect on the mental health and wellbeing of children and young people. Culture can influence emotional and behavioural responses to the pandemic and its consequences, but research is primarily focused on single culture experiences. The study examined the impact of caregiver emotional responses to the pandemic and the lockdown on child mental health and wellbeing in two culturally different countries that were severely affected by the pandemic: UK and Turkey Method: Participants were 1849 caregivers of children between 5- and 12-years old living in the UK (n= 995) and Turkey (n = 854), who completed a 20 -min electronic survey on child and family wellbeing distributed via social networks during the initial phase of the COVID-19 lockdown (July and August 2020). Findings: Worry of COVID-19 infection was higher amongst caregivers in the Turkish sample and it independently predicted change in children’s internalising behaviour in the Turkish sample only even after controlling for caregiver and child mental health, and caregiver perceived risk of COVID-19 infection. Caregivers in the UK sample reported more difficulty with family coexistence during the stay-at-home orders. However, difficulty with coexistence independently predicted change in children’s externalising and internalising symptoms before and during the lockdown in both samples. The study revealed cross-cultural differences in the predictors of change in children’s internalising and externalising behaviour before and during the initial national COVID-19 lockdown.

Parent and child mental health trajectories April 2020 to May 2021: Strict lockdown versus no lockdown in Australia

Objective: To control a second-wave COVID-19 outbreak, the state of Victoria in Australia experienced one of the world’s first long and strict lockdowns over July–October 2020, while the rest of Australia experienced ‘COVID-normal’ with minimal restrictions. We (1) investigate trajectories of parent/child mental health outcomes in Victoria vs non-Victoria and (2) identify baseline demographic, individual and COVID-19-related factors associated with mental health trajectories. Methods: Online community sample of 2004 Australian parents with rapid repeated assessment over 14 time-points over April 2020 to May 2021. Measures assessed parent mental health (Depression, Anxiety and Stress Scales-21), child depression symptoms (13-item Short Mood and Feelings Questionnaire) and child anxiety symptoms (four items from Brief Spence Children’s Anxiety Scale). Results: Mental health trajectories shadowed COVID-19 infection rates. Victorians reported a peak in mental health symptoms at the time of the second-wave lockdown compared to other states. Key baseline predictors, including parent and child loneliness (standardized regression coefficient [β] = 0.09–0.46), parent/child diagnoses (β = 0.07–0.21), couple conflict (β = 0.07–0.18) and COVID-19 stressors, such as worry/concern about COVID-19, illness and loss of job (β = 0.12–0.15), predicted elevated trajectories. Effects of predictors on parent and child mental health trajectories are illustrated in an online interactive app for readers ( https://lingtax.shinyapps.io/CPAS_trend/ ). Conclusion: Our findings provide evidence of worse trajectories of parent and child mental health symptoms at a time coinciding with a second COVID-19 outbreak involving strict lockdown in Victoria, compared to non-locked states in Australia. We identified several baseline factors that may be useful in detecting high-risk families who are likely to require additional support early on in future lockdowns.

The Potential Emergence of “Education as Mental Health Therapy” as a Feasible Form of Teacher-Delivered Child Mental Health Care in a Low and Middle Income Country: A Mixed Methods Pragmatic Pilot Study

Objective: We assessed task-shifting children's mental health care to teachers as a potential approach to improving access to child mental health care.Methods: In Darjeeling, India, we conducted a single-arm, mixed-methods feasibility study with 19 teachers and 36 children in five rural primary schools to determine whether teachers can deliver transdiagnostic mental health care to select children-in-need with fidelity to protocol, to assess which therapeutic options teachers chose to use within the protocol, and to evaluate for a potential signal of efficacy.Results: Participation rates for intervention activities were >80%. A majority of teachers met or exceeded quality benchmarks for all intervention activities. Teachers chose to deliver teacher-centric techniques, i.e., techniques that only teachers could deliver given their role in the child's life, 80% of the time. Children improved in mental health score percentiles on the Achenbach Teacher Report Form. Key facilitators included the flexibility to adapt intervention activities to their needs, while identified barriers included limited time for care delivery.Conclusion: Findings support the feasibility of task-shifting children's mental health care to classroom teachers in resource-limited schools. Fidelity to protocol appeared feasible, though the freedom to choose and adapt therapeutic techniques may also have enhanced feasibility. Surprisingly, teachers consistently chose to deliver teacher-centric therapeutic techniques that resulted in a potential signal of efficacy. This finding supports the potential emergence of “education as mental health therapy” (Ed-MH) as a new therapy modality. Continued investigation is required to test and refine strategies for involving teachers in the delivery of transdiagnostic mental health care.

Undergraduate Nurses’ Attitude Change to Health Technology Implementation

The poster will report upon a longitudinal study exploring the attitudes towards the implementation of health technology into clinical and community nursing practice from the perspective of third year undergraduate students studying adult, child, mental health and learning disability nursing.

How Engaged are Stakeholders in Evidence-Based Treatment Implementation Projects? Results From a Scoping Review of Children’s Mental Health Treatment Projects

Engaging stakeholders in child mental health evidence-based treatment (EBT) implementation projects may increase the likelihood of successful implementation; However, little is known about the extent of stakeholder engagement to inform the implementation of EBTs. We conducted a scoping review to characterize stakeholder engagement in child mental health EBT implementation projects. We performed data extraction and synthesis to describe key study and stakeholder characteristics, stakeholder engagement methods and rationales, reported impacts of stakeholder engagement, and quality of reporting on stakeholder engagement. We identified a total of 103 unique child mental health EBT implementation projects. The largest number of projects were in the United States and conducted in community mental health settings. Most projects engaged EBT providers during the active implementation phase and with limited depth, often gathering information from stakeholders about barriers and facilitators without sharing decision-making power. Across projects, impacts of stakeholder engagement spanned all implementation outcomes. Given that stakeholder engagement is often shallow and follows initial implementation efforts, additional effort should be made to increase engagement to preempt challenges to EBT implementation and ensure implementation success. Such efforts may ensure the just distribution of power in EBT implementation efforts and could be essential in addressing mental health disparities.