Major study finds one in five children have mental health problems

Hamilton, ON (April 17, 2019) – One in five Ontario children and youth suffer from a mental disorder, but less than one-third have had contact with a mental health care provider, says the Ontario Child Health Study (OCHS).

Although those overall results echo a similar study from 1983, the new study found a much larger proportion of children and youth with a disorder had contact with other health providers and in other settings, most often through schools.

The new study, called the 2014 OCHS for when data collection started, found that the patterns of prevalence among different sexes and age groups have changed.

Hyperactivity disorder in boys four to 11 years old jumped dramatically from nine to 16 percent, but there has been a substantial drop in disruptive behaviour among males 12 to 16 years old from 10 to 3 per cent. There has been a steep increase in anxiety and depression among both male and female youth from 9 to 13 per cent.

At the same time, there was a significant rise in perceptions of need for professional help with mental health disorders, rising from seven per cent in the original OCHS in 1983 to 19 per cent in the 2014 OCHS. However, the study authors say it is difficult to estimate whether it is tied to the growing prominence of anti-stigma and mental health awareness campaigns over the past three decades.

In 30 years, the prevalence of any disorder increased in communities with a population of 1,000 to 100,000, rather than large urban areas, and there is strong evidence that poor children are more likely to have a disorder if their neighbourhood is one where violence is more common.

The study also found that in the past year more than eight per cent of youth thought about suicide, and 4 per cent reported a suicide attempt.

The 2014 OCHS study included 10,802 children and youth aged four to 17 in 6,537 families. It replicated and expanded on the landmark 1983 Ontario Child Health Study of 3,290 children in 1,869 families.

The Canadian Journal of Psychiatry has simultaneously published eight papers on different aspects of the 2014 OCHS results.

“This is a very robust study we feel represents the situation in Canada,” said Michael Boyle, co-principal investigator of the study. “That means there are more than a million Canadian children and youth with a mental health problem. This needs to be addressed.”

Co-principal investigator Kathy Georgiades added: “This study underscores the continued need for effective prevention and intervention programs.”

###

Boyle and Georgiades led the 2014 OCHS research team of the Offord Centre for Child Studies of McMaster University and Hamilton Health Sciences (HHS). Boyle is a professor emeritus and Georgiades is an associate professor of the Department of Psychiatry and Behavioural Neurosciences of McMaster and holds the David R. (Dan) Offord Chair in Child Studies.

The study was funded by the Canadian Institutes of Health Research (CIHR) and by the Ontario Ministry of Health and Long-Term Care, Ontario Ministry of Children and Youth Services and the Ontario Ministry of Education.

Editors:

A more detailed backgrounder on the eight papers is below.

The papers and a related editorial may be found at https://journals.sagepub.com/toc/cpab/current

Backgrounder

Top-note findings of 2014 Ontario Child Health Study

Hamilton, ON (April 17, 2019) – Listed below are a few of the key findings of the eight papers from the 2014 Ontario Child Health Study (OCHS) published today in the Canadian Journal of Psychiatry, along with information regarding the corresponding authors.

The principal investigators are members of the Offord Centre for Child Studies of McMaster University and Hamilton Health Sciences.

The papers may be found at: https://journals.sagepub.com/toc/cpab/current

Six-Month Prevalence of Mental Disorders and Service Contacts among Children and Youth in Ontario: Evidence from the 2014 Ontario Child Health Study

• Eighteen to 22 per cent of children and youth met criteria for at least one mental disorder in the preceding six months of the Ontario Child Health Study. Behaviour disorders are the most common among children (four-11 years) and anxiety disorders most common among youth (12-17 years).
• Among children and youth with a parent-identified mental disorder, 26 per cent of children and 34 per cent of youth had contact with a mental health provider.
• However, 60 per cent had contact with one or more providers or service settings, most often through schools.

Corresponding author:

Katholiki (Kathy) Georgiades, PhD, associate professor, Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON

Prevalence and Correlates of Youth Suicidal Ideation and Attempts: Evidence from the 2014 Ontario Child Health Study

• Eight per cent of youth aged 14 to 17 had suicidal thoughts, and 4 per cent endorsed attempting suicide in the past year.
• Suicidal thoughts and attempts often co-occur with mental disorders and high risk behaviours, particularly depression, non-suicidal-self-injury and heavy episodic drinking

Corresponding author:

Katholiki (Kathy) Georgiades, PhD, associate professor, Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON

Children’s Mental Health Need and Expenditures in Ontario: Findings from the 2014 Ontario Child Health Study

• This study found making needs-adjustments to population counts by using population estimates of child mental health need provides additional value for informing and evaluating funding allocation decisions for children’s mental health services.

Corresponding author:

Laura Duncan, MA, research co-ordinator, Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON

Poverty, Neighbourhood Antisocial Behaviour and Child Mental Health Problems: Findings from the 2014 Ontario Child Health Study

• When exposed to high levels of neighbourhood antisocial behaviour, children living in households below the poverty line are at much higher risk for behavioural problems. However, children living in households below the poverty line are at lower risk for emotional and behavioural problems when they live in neighbourhoods with higher concentrations of poverty.

Corresponding author:

Michael Boyle, PhD, professor emeritus, Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON

Changes in the Prevalence of Child and Youth Mental Disorders and Perceived Need for Professional Help between 1983 and 2014: Evidence from the Ontario Child Health Study

• This paper examines whether there have been changes in the prevalence of mental disorders and perceived need for professional help among children (age 4-11) and youth (age 12-16) between the 1983 and 2014 Ontario Child Health Studies, and whether these changes differ by age, sex, and demographic background.
• The overall prevalence of perceived need for professional help increased from seven to 19 per cent among four to 16 year olds.
• An increase in any disorder among children (15 to 20 per cent) was attributable to an increase in hyperactivity among males (nine to 16 per cent).
• Although the prevalence of any disorder did not change among youth, conduct disorder decreased (seven to 2.5 per cent) while emotional disorder increased (nine to 13 per cent). The prevalence of any disorder increased more in rural and small-medium urban areas versus large urban areas. The prevalence of any disorder decreased for children and youth in immigrant but not non-immigrant families.

Corresponding author:

Jinette Comeau, PhD, assistant professor, Department of Sociology, King’s University College at Western University, London, ON

Tracking Children’s Mental Health in the 21st Century: Lessons from the 2014 OCHS

• This study highlighted changes in children’s mental health over the past 30 years and ongoing concerns about limited service access for children with mental health needs.
• The lack of information on children’s mental health in Ontario makes it impossible to tell if the health care system is responding to children’s needs.
• This challenge could be resolved by collecting information at regular intervals on children’s mental health in the general population, as well as from children using community-based child mental health agencies.
• Collecting information from both sources (general population and agencies) would make it possible to evaluate service access, effectiveness, and resource allocation.

Corresponding author:

Michael Boyle, PhD, professor emeritus, Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON

2014 Ontario Child Health Study Findings: Policy Implications for Canada

• 2014 OCHS is a 30-year report card on children’s mental health, showing that in Canada we need to do better.
• The main findings are: 1) prevalence of childhood mental disorders remains high; 2) service reach remains low; 3) needs have increased over the past 30 years; and 4) exposure to avoidable adversities (such as income disparities and violence) influcences children’s mental health.
• Governance of children’s mental health services in Canada resides within provinces/territories and often spans multiple sectors including health care, schools, early childhood education and children’s mental health and related services – making central expert leadership and planning crucial for improving children’s mental health in the next 30 years.
• Next steps include: 1) ensuring coherent policy leadership in each province/territory; 2) making and sustaining comprehensive children’s mental health plans that address both prevention and treatment; 3) ensuring the use of effective interventions; 4) reaching all children with mental disorders with innovative service approaches; 5) addressing avoidable childhood adversities; and 6) ensuring adequate and dedicated children’s mental health budgets.

Corresponding author:

Charlotte Waddell, MD, professor, Faculty of Health Sciences, Simon Fraser University, Vancouver, BC

The 2014 Ontario Child Health Study – Methodology

• The study is a province-wide, cross-sectional study of child health and mental disorder among 10,802 four to 17 year olds living in 6,537 households.

Corresponding author:

Michael Boyle, PhD, professor emeritus, Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON