Gambling Harm Experienced by Children Exposed to Parental Gambling: An Online Survey of Australians.

Although child wellbeing is known to be negatively affected by gambling, relatively little is known about the specific harms experienced by children exposed to parental gambling problems. The current study aimed to better understand gambling harm directly attributed to regular parental gambling in key areas of child wellbeing: financial, psychological, interpersonal wellbeing and intergenerational transmission of problem gambling. Using data from a national survey of Australian adults exposed to parental gambling under the age of 18 (n = 211), the results show that parental gambling was related significant levels of financial harm, abuse, neglect as well as relational and psychological problems as a direct result of parental gambling. The likelihood of experiencing gambling harms was positively associated with parental problem gambling severity. Harmful impacts of parental gambling as a child were also associated with a range of psychological problems in adulthood including depression, anxiety, Post-Traumatic Stress Disorder and intimate partner violence victimisation. Parental problem gambling severity was negatively associated with own lifetime gambling problems, suggesting a specific pattern of intergenerational transmission of problem gambling in children of regular, or heavy, gamblers. This research highlights the need for more supports for families with children in which at least one parent gambles regularly.

Health-care costs of underweight, overweight and obesity: Australian population-based study.

AIM: Child health varies with body mass index (BMI), but it is unknown by what age or how much this attracts additional population health-care costs. We aimed to determine the (1) cross-sectional relationships between BMI and costs across the first decade of life and (2) in longitudinal analyses, whether costs increase with duration of underweight or obesity. PARTICIPANTS: Baby (n = 4230) and Kindergarten (n = 4543) cohorts in the nationally representative Longitudinal Study of Australian Children. OUTCOME: Medicare Benefits Scheme (including all general practitioner plus a large proportion of paediatrician visits) plus prescription medication costs to federal government from birth to sixth (Baby cohort) and fourth to tenth (Kindergarten cohort) birthdays. PREDICTOR: biennial BMI measurements over the same period. RESULTS: Among Australian children under 10 years of age, 5-6% were underweight, 11-18% overweight and 5-6% obese. Excess costs with low and high BMI became evident from age 4-5 years, with normal weight accruing the least, obesity the most, and underweight and overweight intermediate costs. Relative to overall between-child variation, these excess costs per child were very modest, with a maximum of $94 per year at age 4-5 years. Nonetheless, this projects to a substantial cost to government of approximately $13 million per annum for all Australian children aged less than 10 years. CONCLUSIONS: Substantial excess population costs provide further economic justification for promoting healthy body weight. However, obese children's low individual excess health-care costs mean that effective treatments are likely to increase short-term costs to the public health purse during childhood.

Primary health-care costs associated with special health care needs up to age 7 years: Australian population-based study.

AIM: We studied infants and children with and without special health care needs (SHCN) during the first 8 years of life to compare the (i) types and costs to the government's Medicare system of non-hospital health-care services and prescription medication in each year and (ii) cumulative costs according to persistence of SHCN. METHODS: Data from the first two biennial waves of the nationally representative Longitudinal Study of Australian Children, comprising two independent cohorts recruited in 2004, at ages 0-1 (n = 5107) and 4-5 (n = 4983) years. Exposure condition: parent-reported Children with Special Health Care Needs Screener at both waves, spanning ages 0-7 years. OUTCOME MEASURE: Federal Government Medicare expenditure, via data linkage to the Medicare database, on non-hospital health-care attendances and prescriptions from birth to 8 years. RESULTS: At both waves and in both cohorts, >92% of children had complete SHCN and Medicare data. The proportion of children with SHCN increased from 6.1% at age 0-1 years to 15.0% at age 6-7 years. Their additional Medicare costs ranged from $491 per child at 6-7 years to $1202 at 0-1 year. This equates to an additional $161.8 million annual cost or 0.8% of federal funding for non-hospital-based health care. In both cohorts, costs were highest for children with persistent SHCNs. CONCLUSIONS: SHCNs incur substantial non-hospital costs to Medicare, and no doubt other sources of care, from early childhood. This suggests that economic evaluations of early prevention and intervention services for SHCNs should consider impacts on not only the child and family but also the health-care system.

Contact with mothers for children in out-of-home-care: Group-based trajectory modelling from the Pathways of Care Longitudinal Study (POCLS).

BACKGROUND: Good quality contact with birth parents is considered important to successful out-of-home care (OOHC) placements. OBJECTIVE: There is, however, an absence of empirical evidence about contact needs of children in the OOHC system and how these needs change over time. PARTICIPANTS AND SETTING: The current analysis analyzed four waves of data from the Pathways of Care Longitudinal Study in Australia relating to 1507 children on yearly frequency of contact with mothers, relationship quality with mothers, and the extent that contact met the needs of the child. METHODS: Group-based trajectory modelling was used to examine in what ways frequency of contact, child-mother relationships and child's needs for maintaining family contact were associated over time. RESULTS: The analysis showed a positive association between these three outcomes that also held true as the children aged, with five distinct patterns: (1) low frequency and poor relationship (low poor) (14.5 % of the sample); (2) moderate frequency and poor relationship (moderate poor) (30.3 %); (3) increasing frequency and improving relationship (improving) (19.8 %); (4) declining frequency and declining relationship (declining) (19.5 %); and (5) high frequency, good relationship (high good) (15.9 %). Care type, child demographics, child socioemotional wellbeing and unsupervised contact arrangements were significantly associated with trajectory group membership. CONCLUSIONS: These results can be used to inform policy and practice around contact and to better match the heterogenous contact needs for children in OOHC.

The cost of healthcare for children with mental health difficulties.

OBJECTIVE: Childhood mental health difficulties affect one in every seven children in Australia, posing a potential financial burden to society. This paper reports on the early lifetime individual and population non-hospital healthcare costs to the Australian Federal Government for children experiencing mental health difficulties. It also reports on the use and cost of particular categories of service use, including the Medicare Benefits Schedule (MBS) mental health items introduced in 2006. METHOD: Data from the Longitudinal Study of Australian Children (LSAC) were used to calculate total Medicare costs (government subsidised healthcare attendances and prescription medications) from birth to the 8th birthday associated with childhood mental health difficulties measured to 8-9 years of age. RESULTS: Costs were higher among children with mental health difficulties than those without difficulties. While individual costs increased with the persistence of difficulties, population-level costs were highest for those with transient mental health difficulties. Although attenuated, these patterns persisted after child, parent and family characteristics were taken into account. Use of the MBS-reimbursed mental health services among children with a mental health difficulty was very low (around 2%). CONCLUSIONS: Australian healthcare costs for young children with mental health difficulties are substantial and provide further justification for early intervention and prevention. The current provision of Medicare-rebated mental health services does not appear to be reaching young children with mental health difficulties.

Psychosocial risk factors associated with fathers' mental health in the postnatal period: results from a population-based study.

PURPOSE: Fathers' psychological distress in the postnatal period can have adverse effects on their children's wellbeing and development, yet little is known about the factors associated with fathers' distress. This paper examines a broad range of socio-demographic, individual, infant and contextual factors to identify those associated with fathers' psychological distress in the first year postpartum. METHODS: Secondary analysis of data from 3,219 fathers participating in the infant cohort of the Longitudinal Study of Australian Children at wave 1 when children were 0-12 months of age. RESULTS: Approximately 10 % of fathers reported elevated symptoms of psychological distress. Logistic regression analyses revealed that the risk factors were poor job quality, poor relationship quality, maternal psychological distress, having a partner in a more prestigious occupation and low parental self-efficacy. CONCLUSION: These findings provide new information to guide the assessment of fathers' risk for psychological distress in postnatal period. There are also important social policy implications related to workplace entitlements and the provision of services for fathers.

Father mental health during the early parenting period: results of an Australian population based longitudinal study.

PURPOSE: The primary objective of this study was to report on the occurrence of mental health difficulties for a large national sample of Australian fathers of children aged 0-5 years (n = 3,471). Secondary objectives were to compare fathers' mental health against normative data for the general male adult population, and to examine the course of mental health problems for fathers across the early childhood period. METHODS: Secondary analysis of data from the infant cohort of the Longitudinal Study of Australian Children at three waves when children were 0-12 months, 2-3 and 4-5 years. Comparative data on the prevalence of psychological distress in the Australian adult male population sourced from the National Survey of Mental Health and Wellbeing. RESULTS: Approximately nine per cent of fathers reported symptomatic or clinical psychological distress at each wave, as measured by the Kessler-6. Approximately 30 % reporting distress at wave 1 continued to report distress at a similar or worse level across waves 2 and 3. Fathers not living with their children also had high rates of distress (14 % at wave 1 and 10 % at wave 2). Finally, fathers in the present study had 1.38 increased odds (95 % CI 1.12-1.69) for psychological distress compared with the Australian adult male population. CONCLUSIONS: Fathers are at risk of experiencing postnatal mental health difficulties, which may persist across the early childhood period for some fathers. The results suggest routine assessment of fathers' wellbeing should be undertaken in the postnatal period with mental health interventions and support provided across the early childhood period.

Parental problem gambling and child wellbeing: Systematic review and synthesis of evidence.

BACKGROUND: Children living with a problem gambling parent are at risk of harm but no previous systematic reviews have specifically focused on the relationship of parental problem gambling and child wellbeing outcomes. The current review aimed to redress this gap by reviewing all available empirical evidence on parental problem gambling and child wellbeing. METHOD: Articles were identified by searching PsychINFO, CINAHL, Medline and Scopus. The search included terminology pertaining to parents, problem gambling and children and we included all peer-reviewed articles that reported parental problem gambling and child wellbeing outcome(s). RESULTS: Overall, 35 studies reporting a relationship between parental problem gambling and child wellbeing were included. Child wellbeing outcomes were reported across six domains: (1) psychological (k = 14); (2) family relationships (k = 17); (3) violence (k = 9); (4) behavioural (k = 7); (5) financial (k = 9); and (6) physical health (k = 3). The included studies were mostly unequivocal about negative impacts of parental problem gambling across the six domains. Sixteen studies provided evidence of negative child outcomes that were directly attributed to parental problem gambling (e.g., as a result of your parent's problematic gambling, you felt depressed). Nineteen studies reported evidence of the association of child negative outcomes and parental problem gambling but child outcomes were not directly attributed to parental problem gambling (e.g., parent is a problem gambler, child is depressed). Evidence was particularly robust on child distress and family dysfunction directly attributed to parental problem gambling. CONCLUSION: This is the first systematic review focusing exclusively on specific intra- and interpersonal problems experienced by children whose parents have a gambling problem.

Psychological distress in non-drinkers: associations with previous heavy drinking and current social relationships.

AIMS: The aim of this paper is to investigate two possible explanations for the higher levels of psychological distress observed among alcohol abstainers relative to light and moderate drinkers, and to investigate possible moderating effects of age on this association. The possible explanations were that: (i) the higher level of psychological distress among abstainers is due to the presence of a subset of former heavy drinkers in this group; and (ii) abstainers have poorer social relationships than light/moderate drinkers. METHODS: A national cross-sectional survey yielded data from 2856 Australians aged 20-22, 30-32 and 40-42 years (response rate 15.9%). RESULTS: The sample was representative for many socio-demographic factors but under-represented people not in the labour force and over-represented those with university qualifications. In the oldest but not the younger age groups, abstainers reported significantly higher psychological distress relative to light/moderate drinkers. While abstainers in the oldest age group who were former heavy drinkers showed the highest levels of distress, excluding them from the analysis did not account for differences in distress between current abstainers and light/moderate drinkers. Abstainers aged 40-42 years were less socially integrated, less extraverted and had lower social support than light/moderate drinkers, and controlling for these factors partially explained their increased distress. CONCLUSIONS: Significantly increased psychological distress of abstainers compared to light/moderate drinkers was demonstrated only in the oldest age group (40-42 years). The higher distress reported by abstainers in this age group was partially explained by abstainers having poorer social relationships than light/moderate drinkers.

Cluster randomized controlled trial (RCT) to support parental contact for children in out-of-home care.

BACKGROUND: There is an identified need to improve the evidence-base in relation to contact visits for children in the out-of-home-care (OOHC) system, to ensure optimal outcomes. OBJECTIVE: The aim of this cluster randomized controlled trial (RCT) was to test the effectiveness of a contact intervention for parents having supervised contact with children in long-term OOHC. PARTICIPANTS: 183 study children in 15 clusters (OOHC services) and their parent(s) were randomized to the intervention (8 clusters, 100 children) and control groups (7 clusters, 83 children) in three Australian jurisdictions. SETTING: The manualized intervention consisted of increasing the preparation and support provided by caseworkers to parents before and after their contact visits. METHOD: Interviews were conducted with carers, parents and caseworkers of the study children at baseline and nine months post-randomization. Interviews included standardized assessment tools measuring child and adult wellbeing and relationships, carer and caseworker ability to support contact, and contact visit cancellations by the parent. RESULTS: Compared with controls, the intention-to-treat (ITT) analyses showed that fewer visits were cancelled by parents in the intervention group at follow-up (-10.27; 95 % CI: -17.04 to -3.50, p = .006). In addition, per-protocol (PP) analyses showed higher caseworker receptivity to contact (6.03; 95 % CI: 0.04-12.03, p = .04), and higher parent satisfaction with contact (7.41; 95 % CI: 0.70-14.11, p = .03) in the intervention group at follow-up. CONCLUSIONS: While the intervention did not have an effect on child wellbeing, as measured by the SDQ, the trial reports significant positive findings and demonstrates the benefits of the kC kContact intervention in providing support to parents to attend contact visits. The findings of the current study provide an important contribution to knowledge in an area where few RCTs have been completed, notwithstanding the null findings.

Health Care Costs Associated With Parent-Reported ADHD: A Longitudinal Australian Population-Based Study.

OBJECTIVE: To examine the health care costs associated with ADHD within a nationally representative sample of children. METHOD: Data were from Waves 1 to 3 (4-9 years) of the Longitudinal Study of Australian Children ( N = 4,983). ADHD was defined by previous diagnosis and a measure of ADHD symptoms (Strengths and Difficulties Questionnaire [SDQ]). Participant data were linked to administrative data on health care costs. Analyses controlled for demographic factors and internalizing and externalizing comorbidities. RESULTS: Costs associated with health care attendances and medications were higher for children with parent-reported ADHD at each age. Cost differences were highest at 8 to 9 years for both health care attendances and medications. Persistent symptoms were associated with higher costs ( p < .001). Excess population health care costs amounted to Aus$25 to Aus$30 million over 6 years, from 4 to 9 years of age. CONCLUSION: ADHD is associated with significant health care costs from early in life. Understanding the costs associated with ADHD is an important first step in helping to plan for service-system changes.

Healthcare costs associated with language difficulties up to 9 years of age: Australian population-based study.

PURPOSE: This study aimed to quantify the non-hospital healthcare costs associated with language difficulties within two nationally representative samples of children. METHOD: Data were from three biennial waves (2004-2008) of the Longitudinal Study of Australian Children (B cohort: 0-5 years; K cohort: 4-9 years). Language difficulties were defined as scores ≤ 1.25 SD below the mean on measures of parent-reported communication (0-3 years) and directly assessed vocabulary (4-9 years). Participant data were linked to administrative data on non-hospital healthcare attendances and prescription medications from the universal Australian Medicare subsidized healthcare scheme. RESULT: It was found that healthcare costs over each 2-year age band were higher for children with than without language difficulties at 0-1, 2-3, and 4-5 years, notably 36% higher (mean difference = $AU206, 95% CI = $90, $321) at 4-5 years (B cohort). The slightly higher 2-year healthcare costs for children with language difficulties at 6-7 and 8-9 years were not statistically different from those without language difficulties. Modelled to the corresponding Australian child population, 2-year government costs ranged from $AU1.2-$AU12.1 million (depending on age examined). Six-year healthcare costs increased with the persistence of language difficulties in the K cohort, with total Medicare costs increasing by $192 (95% CI = $74, $311; p = .002) for each additional wave of language difficulties. CONCLUSION: Language difficulties (whether transient or persistent) were associated with substantial excess population healthcare costs in childhood, which are in addition to the known broader costs incurred through the education system. It is unclear whether healthcare costs were specifically due to the assessment and/or treatment of language difficulties, as opposed to conditions that may be co-morbid with or may cause language difficulties.

Thirty years of the United Nations and global ageing: an Australian perspective.

Over the past three decades, the United Nations (UN) has slowly devoted increasing attention to global ageing. Concern for individually based welfare or health-care programs for older people in developed countries has progressed to also consider the contributions of older people and implications of ageing for socioeconomic advancement in developing countries, including those in Asia Oceania. These shifts are evident in the International Plans of Action on Ageing from Vienna in 1982 to Madrid in 2002; recent 10-year reviews of the Madrid Plan; and current advocacy for inclusion of ageing in the influential UN Millennium Plan post-2015. Australia has demonstrated progressive policies and contributed to ageing developments by the UN, International Federation on Ageing the World Health Organization and the International Association of Gerontology. Key ideas driving further action are the importance of valuing people at all ages, addressing inequalities over the life-course and implementing human rights approaches to ageing.

Combining work and family: rewards or risks for children's mental health?

Prevailing child psychopathology paradigms focus on caregiving in isolation from market work. Yet most children's caregivers - mothers and fathers - are also employed. Although policy and academic debate has voiced concerns that employment could hamper mothers' capacity to care, less emphasis is given to the benefits generated by mothers' jobs. By contrast, theories of child mental health often view fathers' employment as beneficial, indeed necessary, for children's wellbeing, and few problematise fathers' capacity to combine work and care. This paper aims to integrate these seemingly contradictory concerns. We consider whether mothers' and fathers' rewards from combining employment with childcare may be protective for children's mental health, and whether their conflicts and dilemmas generate risks. Analyses use cross-sectional data from a representative survey of families with 4-5 year old children (Growing Up in Australia Study). We restricted our sample to employed parents (N = 2809 mothers; 3982 fathers), using data gathered in 2004. While a majority of parents reported benefits and rewards from working (work-family facilitation), more than one third also reported difficulties and conflicts (work-family conflict). When mothers or fathers experienced conflict we found elevations in young children's emotional and behavioural symptoms, with the risks compounding if both parents experienced conflict between work and family. Associations persisted after adjusting for family socioeconomic circumstances and composition, and they were not offset by work-family facilitation. We did not find evidence for heightened vulnerability to work-family conflict in families with few socioeconomic resources. However, among these disadvantaged families we observed stronger protective associations with children's mental health when parents had rewarding and supportive jobs. Our study extends current paradigms of child mental health by considering the interplay between care environments and market work. Jobs which help mothers and fathers to combine employment with caregiving could yield health benefits across generations.

Socioeconomic inequality profiles in physical and developmental health from 0-7 years: Australian National Study.

BACKGROUND: Early and persistent exposure to socioeconomic disadvantage impairs children's health and wellbeing. However, it is unclear at what age health inequalities emerge or whether these relationships vary across ages and outcomes. We address these issues using cross-sectional Australian population data on the physical and developmental health of children at ages 0-1, 2-3, 4-5 and 6-7 years. METHODS: 10 physical and developmental health outcomes were assessed in 2004 and 2006 for two cohorts each comprising around 5000 children. Socioeconomic position was measured as a composite of parental education, occupation and household income. RESULTS: Lower socioeconomic position was associated with increased odds for poor outcomes. For physical health outcomes and socio-emotional competence, associations were similar across age groups and were consistent with either threshold effects (for poor general health, special healthcare needs and socio-emotional competence) or gradient effects (for illness with wheeze, sleep problems and injury). For socio-emotional difficulties, communication, vocabulary and emergent literacy, stronger socioeconomic associations were observed. The patterns were linear or accelerated and varied across ages. CONCLUSIONS: From very early childhood, social disadvantage was associated with poorer outcomes across most measures of physical and developmental health and showed no evidence of either strengthening or attenuating at older compared to younger ages. Findings confirm the importance of early childhood as a key focus for health promotion and prevention efforts.

Risk factors for childhood mental health symptoms: national longitudinal study of Australian children.

OBJECTIVE: To determine predictors of child externalizing (behavioral) and internalizing (emotional) symptoms in a national population sample. METHODS: Data were collected in 3 biennial waves (2004, 2006, and 2008) from 2 cohorts in the Longitudinal Study of Australian Children, initially including 5107 children 0 to 1 year of age and 4983 children 4 to 5 years of age. The primary outcomes were child externalizing and internalizing symptoms. Relationships between potential risk factors and child mental health outcomes were described by using linear regression. RESULTS: In unadjusted analyses, children's mental health symptoms were predicted by a large number of risk factors. In multivariate models, early childhood factors (birth through 5 years) explained 30% and 18% of variations in externalizing and internalizing symptoms, respectively, at 4 to 5 years of age. Middle childhood (5-9 years of age) factors explained 20% and 23% of variations in externalizing and internalizing symptoms, respectively, at 8 to 9 years of age. Harsh discipline was a strong consistent predictor of externalizing symptoms in both age groups, whereas poorer child physical health, maternal emotional distress, harsh discipline, and overinvolved/protective parenting (younger cohort only) predicted internalizing symptoms consistently. CONCLUSIONS: National data on predictors of child mental health symptoms highlighted a small number of significant risk factors, situated in the family context and present from a very young age. This knowledge is informing population-level, randomized, prevention trials of family support programs.