Emulating a target trial of intensive nurse home visiting in the policy-relevant population using linked administrative data.

BACKGROUND: Populations willing to participate in randomized trials may not correspond well to policy-relevant target populations. Evidence of effectiveness that is complementary to randomized trials may be obtained by combining the 'target trial' causal inference framework with whole-of-population linked administrative data. METHODS: We demonstrate this approach in an evaluation of the South Australian Family Home Visiting Program, a nurse home visiting programme targeting socially disadvantaged families. Using de-identified data from 2004-10 in the ethics-approved Better Evidence Better Outcomes Linked Data (BEBOLD) platform, we characterized the policy-relevant population and emulated a trial evaluating effects on child developmental vulnerability at 5 years (n = 4160) and academic achievement at 9 years (n = 6370). Linkage to seven health, welfare and education data sources allowed adjustment for 29 confounders using Targeted Maximum Likelihood Estimation (TMLE) with SuperLearner. Sensitivity analyses assessed robustness to analytical choices. RESULTS: We demonstrated how the target trial framework may be used with linked administrative data to generate evidence for an intervention as it is delivered in practice in the community in the policy-relevant target population, and considering effects on outcomes years down the track. The target trial lens also aided in understanding and limiting the increased measurement, confounding and selection bias risks arising with such data. Substantively, we did not find robust evidence of a meaningful beneficial intervention effect. CONCLUSIONS: This approach could be a valuable avenue for generating high-quality, policy-relevant evidence that is complementary to trials, particularly when the target populations are multiply disadvantaged and less likely to participate in trials.

Effects of individual differences, society, and culture on youth-rated problems and strengths in 38 societies.

BACKGROUND: Clinicians increasingly serve youths from societal/cultural backgrounds different from their own. This raises questions about how to interpret what such youths report. Rescorla et al. (2019, European Child & Adolescent Psychiatry, 28, 1107) found that much more variance in 72,493 parents' ratings of their offspring's mental health problems was accounted for by individual differences than by societal or cultural differences. Although parents' reports are essential for clinical assessment of their offspring, they reflect parents' perceptions of the offspring. Consequently, clinical assessment also requires self-reports from the offspring themselves. To test effects of individual differences, society, and culture on youths' self-ratings of their problems and strengths, we analyzed Youth Self-Report (YSR) scores for 39,849 11-17 year olds in 38 societies. METHODS: Indigenous researchers obtained YSR self-ratings from population samples of youths in 38 societies representing 10 culture cluster identified in the Global Leadership and Organizational Behavioral Effectiveness study. Hierarchical linear modeling of scores on 17 problem scales and one strengths scale estimated the percent of variance accounted for by individual differences (including measurement error), society, and culture cluster. ANOVAs tested age and gender effects. RESULTS: Averaged across the 17 problem scales, individual differences accounted for 92.5% of variance, societal differences 6.0%, and cultural differences 1.5%. For strengths, individual differences accounted for 83.4% of variance, societal differences 10.1%, and cultural differences 6.5%. Age and gender had very small effects. CONCLUSIONS: Like parents' ratings, youths' self-ratings of problems were affected much more by individual differences than societal/cultural differences. Most variance in self-rated strengths also reflected individual differences, but societal/cultural effects were larger than for problems, suggesting greater influence of social desirability. The clinical significance of individual differences in youths' self-reports should thus not be minimized by societal/cultural differences, which-while important-can be taken into account with appropriate norms, as can gender and age differences.

The Conceptualization of the Positive Cognitive Triad and Associations with Depressive Symptoms in Adolescents.

The positive cognitive triad (positive cognitions about the self, world, and future) has been considered a protective factor against depressive symptoms. This study examines three conceptualizations of the positive cognitive triad and their relation to depressive symptoms. Analyses were replicated in two samples in order to provide evidence for the validity of findings. Two samples (n1 = 2982, Mage = 13.04, Rangeage = 11-15 years; n2 = 2540, Mage = 13.11, Rangeage = 11-16 years) of Australian adolescents completed the Positive Cognitive Triad Inventory and Center for Epidemiological Studies Depression Scale. Findings supported the notion that the overall positive cognitive triad is a protective factor for depressive symptoms, and specifically, the role of positive cognitions about the self in this protection. After future studies examine the directionality of the relation between positive cognitions and depressive symptoms, mental health providers using cognitive behavioral approaches may consider examining positive cognitions with patients.

Barriers to mental health care for Australian children and adolescents in 1998 and 2013-2014.

OBJECTIVE: To assess changes in barriers to mental health care for children and adolescents over 16 years. METHODS: We used data from two nationally representative surveys of Australian children and adolescents (4-17 years old), conducted in 1998 (N = 4509) and 2013-2014 (N = 6310). Barriers to care were assessed among parents who had reported a perceived partially met or unmet need for their child in the past 6 months in 1998, and the past 12 months in 2013-2014; barriers were similarly assessed among adolescents in relation to themselves. We addressed measurement inconsistencies between surveys by harmonising barriers to accommodate differences in wording and performing sensitivity analyses among those with a 1-month disorder to equalise the timeframes in which barriers were assessed. To assess change, we examined whether the rank order of the three most commonly endorsed barriers changed and whether the 95% confidence intervals (CI) around their estimates overlapped. RESULTS: Similar proportions of parents reported a partially met or unmet need in 1998 (12.9%, 95% CI = [11.7, 14.0]) as in 2013-2014 (14.3%, 95% CI = [13.2, 15.3]), but the ratio of unmet to partially met need decreased from 3:1 in 1998 to 1:1 in 2013-2014. Top three parent-endorsed barriers ('self-reliance', 'unsure where to get help', and 'cost') were the same at both time points; 'self-reliance' decreased from 65.9% (95% CI = [61.1%, 70.7%]) to 34.9% (95% CI = [31.5%, 38.3%]). Top two adolescent-endorsed barriers ('self-reliance' and 'concerned what others might think') were the same at both time points, the third differed, but none of them decreased. CONCLUSION: Perceived unmet need for mental health care for children and adolescents may have decreased between 1998 and 2013-2014, but the gap in receiving sufficient care may have increased. Despite investments in community awareness and treatment during this period, key barriers seemed largely unchanged. For parents, the decrease in self-reliance may reflect a positive shift in beliefs about the potential benefits of treatment.

A national child mental health literacy initiative is needed to reduce childhood mental health disorders.

Half of all lifetime mental health disorders emerge in childhood, so intervening in the childhood years is critical to prevent chronic trajectories of mental health disorders. The prevalence of child mental health disorders is not decreasing despite the increased availability of evidence-based interventions. One key reason for the high prevalence and low treatment uptake may be low levels of child mental health literacy in the general community. Mental health literacy refers to knowledge and beliefs about mental health disorders that aid in their recognition, prevention and management. There is emerging evidence of poor recognition of child mental health problems in the community and low levels of parental knowledge about how to seek help, along with high levels of stigmatising attitudes. Although Australia has been a world leader in research and practice in improving mental health literacy for adolescent and adult mental health disorders, particularly depression and anxiety, mental health literacy for childhood disorders has been largely overlooked. In order to improve knowledge of child mental health disorders, reduce stigma, improve appropriate help-seeking and impact on the prevalence of child mental health disorders, we argue that a national initiative focussing on increasing mental health literacy for childhood disorders is urgently needed.

Evaluating the Effectiveness of an App-Based Nurse-Moderated Program for New Mothers With Depression and Parenting Problems (eMums Plus): Protocol for a Pragmatic Randomized Controlled Trial.

BACKGROUND: Postnatal depression adversely affects many mothers and infants with good evidence that caregiving difficulties associated with depressive symptoms play a key role in later adverse childhood outcomes. In many countries, there is only limited support available for women who experience symptoms of depression during the postnatal period, particularly those experiencing subthreshold symptom levels. Furthermore, mental health services and community family health services in many countries tend to focus primarily on providing help for depressive symptoms or maternal caregiving, respectively, despite these problems commonly being comorbid. Group-based nurse-led interventions delivered over the Web through mobile phone "apps" have the potential to be a cost-effective method of providing a large number of mothers with easy access to integrated support for both maternal depressive symptoms and caregiving difficulties. OBJECTIVE: This paper describes the protocol for a pragmatic randomized controlled trial of a 4-month group-based nurse-led intervention delivered over the Web when infants were 2-6 months. The primary aims of the trial are to determine whether the intervention (1) reduces levels of maternal depressive symptoms and (2) improves the quality of maternal caregiving when infants are 8-12 months of age. METHODS: The trial aimed to recruit and randomize 160 mothers of infants aged 2-8 weeks to either the intervention (eMums plus) or standard care. Assessments were completed when infants were aged 1-2 (preintervention), 8, and 12 months. The primary outcomes were the level of maternal depressive symptoms and the quality of maternal caregiving assessed when infants were aged 12 months. The intervention provided specific support for problems with mood and problems with caregiving. The intervention was delivered by community health nurses as a part of routine service delivery to mothers via a mobile phone app. RESULTS: Participant recruitment was carried out from March to July 2017. Follow-up data collection was completed in mid-2018. Data analysis has commenced. CONCLUSIONS: In the past, many mothers participated in nurse-led face-to-face groups postnatally. However, mothers' groups held in clinics can be difficult for busy mothers to attend. The eMums intervention was delivered over the Web by nurses, allowing easy access by mothers early in an infant's life. The intervention was evaluated while delivered as part of the routine service practice by community child health nurses. The advantage of evaluating the effectiveness of the intervention in the routine service practice is that if it is found to be effective, it can be more easily adopted by the service provider than if it had been assessed in an efficacy trial. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/11549.

Adequacy of treatment for child and adolescent mental disorders in Australia: A national study.

OBJECTIVE: Worldwide, little information is available about the extent to which children with mental disorders in the general population receive treatment from health professionals that meets minimal clinical practice guidelines. This study identifies the percentage of 6-17 year olds with mental disorders in the 2013-2014 Australian national survey of mental health who had sufficient contact with health professionals during the 18 months after the survey to have received treatment meeting criteria for minimally adequate treatment (MAT). It also identifies factors associated with children having this level of contact with health professionals. METHOD: Mental disorders were identified using the Diagnostic Interview Schedule for Children Version IV completed by parents. Health professional attendances and psychotropic medications dispensed were identified from linked national Medicare Benefits Schedule and Pharmaceutical Benefits Scheme records. RESULTS: Only 11.6% (95% confidence interval [CI] [9.1, 14.8]) of children with disorders ( n = 517) had sufficient contact to achieve study criteria for MAT. Furthermore, among children with mental disorders who had severe functional impairment and whose parents perceived that their child needed help ( n = 146), 20.2% (95% CI [14.3, 27.9]) had contact sufficient for MAT, 46.0% (95% CI [37.8, 54.4]) had contact that did not achieve MAT criteria and 33.8% (95% CI [26.1, 42.3]) had no contact with health professionals. In multivariable regression, children with moderate or severe functional impairment were more likely to have had sufficient contact to meet MAT criteria. CONCLUSION: During the 18 months after being identified with a mental disorder, only a small percentage of children have enough contact with health professionals to allow provision of MAT. This may be contributing to the unchanging high prevalence of childhood mental disorders.

Effectiveness of a 2-year post-natal nurse home-visiting programme when children are aged 5 years: Results from a natural experiment.

AIM: To evaluate the effect of a 2-year post-natal nurse home visiting (NHV) programme delivered in routine clinical practice to socially disadvantaged mothers on children's development at 5 years. METHODS: The study was a natural experiment resulting from progressive rollout of NHV (2008-2012). Children of three groups of mothers, all eligible for NHV, were compared: (i) mothers receiving NHV in a metropolitan region (n = 197); (ii) mothers in a rural region prior to NHV being available (n = 94); and (iii) mothers receiving NHV in the rural region after it became available (n = 84). Outcomes were evaluated using the Child Behaviour Checklist, Child-Parent Relationships Scale, Behaviour Inventory of Executive Functioning and Australian Early Development Index. RESULTS: Analyses were conducted using augmented inverse probability weighting accounting for differences in the groups' baseline characteristics. While some differences were observed in the range of 8-12% between the intervention and comparison groups (albeit with wide confidence intervals, e.g. 31% less likely to 4% more likely to be experiencing poor outcomes). For the majority of outcomes, however, there were no differences observed between the intervention and comparison groups. CONCLUSIONS: Post-natal NHV provided as a part of routine service delivery did not improve children's outcomes at 5 years. It may be that in the Australian context a NHV intervention, as offered in this study, does not provide additional benefits over standard care.

Has the Prevalence of Child and Adolescent Mental Disorders in Australia Changed Between 1998 and 2013 to 2014?

OBJECTIVE: This study examined whether the 12-month prevalence of major depressive disorder (MDD), attention-deficit/hyperactivity disorder (ADHD), and conduct disorder (CD) among 6- to 17-year-olds in Australia changed between 1998 and 2013 to 2014. It also investigated whether changes in the prevalence of disorders over this time varied for children living in families containing 2 parents versus single parents, and families with high versus low income. METHOD: The study used data from national surveys conducted in Australia in 1998 (N = 3,597) and 2013 to 2014 (N = 5,359). In both surveys, the participating individuals were randomly selected from all 6- to 17-year-olds in Australia, and mental disorders were assessed using the Diagnostic Interview Schedule for Children Version IV (DISC-IV), completed by parents. RESULTS: There was little change in the overall prevalence of mental disorders between 1998 (12.5%, 95% CI = 11.4-13.7) and 2013 to 2014 (11.1%, 95% CI = 10.1-12.2). Although there were some differences in the changes for children with different disorders, most were small in magnitude. Specifically, MDD prevalence increased from 2.1% (95% CI = 1.7-2.7) to 3.2% (95% CI = 2.7-3.8), ADHD prevalence declined from 9.9% (95% CI = 8.9-10.9) to 7.8% (95% CI = 6.9-8.7), and CD prevalence declined from 2.7% (95% CI = 2.2-3.3) to 2.1% (95% CI = 1.7-2.7). There was a persisting pattern of higher prevalence among children living in single-parent and low-income households. CONCLUSION: Lack of change at a population level in the prevalence of child mental disorders suggests that new innovations in research, policy, and practice are needed to successfully address the major public health problem posed by child and adolescent mental disorders in the community.

Access to health professionals by children and adolescents with mental disorders: Are we meeting their needs?

OBJECTIVE: To identify the percentage of 4-17 year olds with mental disorders in Australia who attended health professionals for single or repeat visits to get help for emotional and behavioural problems during a 12-month period. To identify factors associated with single and repeat visits, and the average length of time between visits. To compare the number of parent-reported visits with visits recorded in the Medicare Benefits Schedule. METHOD: The study used data from the national survey of the mental health and wellbeing of 4-17 year olds conducted in 2013-2014 ( n = 6310). Participants were randomly selected from all 4 to 17 year olds in Australia. Information about visits was available from face-to-face interviews with parents, the Medicare Benefits Schedule and self-reports from 13 to 17 year olds. Mental disorders were assessed using the Diagnostic Interview Schedule for Children Version IV completed by parents. RESULTS: Parents reported that 51.1% of 4-17 year olds with mental disorders had attended a health professional during the previous 12 months. However, 13.6% of these children had attended on only a single occasion, most commonly with a general practitioner. With the exception of occupational therapists, 2-4 visits was the most common number of repeat visits. Children with comorbid disorders and severe functional impairment and those aged 12-17 years were more likely to have repeat visits. Among those with linked Medicare Benefits Schedule data, more children were reported by parents to have attended Medicare Benefits Schedule-funded health professionals (47.9%) than were recorded in Medicare Benefits Schedule data (38.0%). CONCLUSION: The typical number of visits to health professionals by children with mental disorders during a 12-month period is relatively small. Furthermore, parent-reports may overestimate the number of visits during this time. It seems unlikely that current patterns of attendance are of sufficient duration and frequency to allow full implementation of evidence-based treatment programmes for child and adolescent mental disorders.

Population cost-effectiveness of the Triple P parenting programme for the treatment of conduct disorder: an economic modelling study.

Parenting programmes are the recommended treatments of conduct disorders (CD) in children, but little is known about their longer term cost-effectiveness. This study aimed to evaluate the population cost-effectiveness of one of the most researched evidence-based parenting programmes, the Triple P-Positive Parenting Programme, delivered in a group and individual format, for the treatment of CD in children. A population-based multiple cohort decision analytic model was developed to estimate the cost per disability-adjusted life year (DALY) averted of Triple P compared with a 'no intervention' scenario, using a health sector perspective. The model targeted a cohort of 5-9-year-old children with CD in Australia currently seeking treatment, and followed them until they reached adulthood (i.e., 18 years). Multivariate probabilistic and univariate sensitivity analyses were conducted to incorporate uncertainty in the model parameters. Triple P was cost-effective compared to no intervention at a threshold of AU$50,000 per DALY averted when delivered in a group format [incremental cost-effectiveness ratio (ICER) = $1013 per DALY averted; 95% uncertainty interval (UI) 471-1956] and in an individual format (ICER = $20,498 per DALY averted; 95% UI 11,146-39,470). Evidence-based parenting programmes, such as the Triple P, for the treatment of CD among children appear to represent good value for money, when delivered in a group or an individual face-to-face format, with the group format being the most cost-effective option. The current model can be used for economic evaluations of other interventions targeting CD and in other settings.

Associations between Social Support from Family, Friends, and Teachers and depressive Symptoms in Adolescents.

Approximately 20% of adolescents develop depressive symptoms. Family, friends, and teachers are crucial sources of social support for adolescents, but it is unclear whether social support impacts adolescents directly (principle-effect model) or by moderating the effect of stress (stress-buffer model) and whether each source of social support remains meaningful when their influence is studied simultaneously. To help fill this gap, we followed 1452 Australian students (average age at enrollment = 13.1, SD = 0.5; range: 11-16 years; 51.9% female) for 5 years. Based on our findings, each source of support is negatively related to depressive symptoms one year later when studied independently but when combined, only family and teacher support predicted depressive symptoms. Family support in all grades and teacher support in grade 8 to 10 but not in grade 11 directly impacted adolescent depressive symptoms 1 year later. Family support in grades 8 and 11 also buffered against the negative impact of stress on depressive symptoms one year later. Based on the unexpected findings, the most important limitations seem to be that the used instruments do not allow for a separation of different groups of friends (e.g., classmates, same-gender peers, romantic partners), types of social support, and stress. In addition, the high, nonrandom attrition rate with adolescents reporting less social support, more stressful events, a higher frequency of depressive symptoms, and/or being of Torres Strait Islander or Aboriginal background limits the generalizability of our findings. Summarized, our findings demonstrate that adolescents facing stress might benefit more from family support compared to their peers without stressful life events and that friends may have a weaker presence in adolescent lives than expected.

Nurse-Moderated Internet-Based Support for New Mothers: Non-Inferiority, Randomized Controlled Trial.

BACKGROUND: Internet-based interventions moderated by community nurses have the potential to improve support offered to new mothers, many of whom now make extensive use of the Internet to obtain information about infant care. However, evidence from population-based randomized controlled trials is lacking. OBJECTIVE: The aim of this study was to test the non-inferiority of outcomes for mothers and infants who received a clinic-based postnatal health check plus nurse-moderated, Internet-based group support when infants were aged 1-7 months as compared with outcomes for those who received standard care consisting of postnatal home-based support provided by a community nurse. METHODS: The design of the study was a pragmatic, preference, non-inferiority randomized control trial. Participants were recruited from mothers contacted for their postnatal health check, which is offered to all mothers in South Australia. Mothers were assigned either (1) on the basis of their preference to clinic+Internet or home-based support groups (n=328), or (2) randomly assigned to clinic+Internet or home-based groups if they declared no strong preference (n=491). The overall response rate was 44.8% (819/1827). The primary outcome was parenting self-competence, as measured by the Parenting Stress Index (PSI) Competence subscale, and the Karitane Parenting Confidence Scale scores. Secondary outcome measures included PSI Isolation, Interpersonal Support Evaluation List-Short Form, Maternal Support Scale, Ages and Stages Questionnaire-Social-Emotional and MacArthur Communicative Development Inventory (MCDI) scores. Assessments were completed offline via self-assessment questionnaires at enrolment (mean child age=4.1 weeks, SD 1.3) and again when infants were aged 9, 15, and 21 months. RESULTS: Generalized estimating equations adjusting for post-randomization baseline imbalances showed that differences in outcomes between mothers in the clinic+Internet and home-based support groups did not exceed the pre-specified margin of inferiority (0.25 of a SD) on any outcome measure at any follow-up assessment, with the exception of MCDI scores assessing children's language development at 21 months for randomized mothers, and PSI Isolation scores at 9 months for preference mothers. CONCLUSION: Maternal and child outcomes from a clinic-based postnatal health check plus nurse-moderated Internet-based support were not inferior to those achieved by a universal home-based postnatal support program. Postnatal maternal and infant support using the Internet is a promising alternative to home-based universal support programs. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry Number (ANZCTR): ACTRN12613000204741; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=363712&isReview=true (Archived by WebCite at http://www.webcitation.org/6rZeCJ3k1).

The continuity and duration of depression and its relationship to non-suicidal self-harm and suicidal ideation and behavior in adolescents 12-17.

BACKGROUND: There is a significant overlap between non-suicidal self-harm and suicidal ideation and behavior in young people with both symptom continuity and symptom duration implicated in this association. METHODS: A population sample of Australian 12-17 year olds. Interviewers collected measures for DSM disorders, symptom duration and continuity, and background information from their parents, while young people self-reported symptoms of depression, non-suicidal self-harm and suicidal ideation and behaviors. This report focusses on the 265 young people who met the DSM criteria for Major Depressive Disorder based on their own self-reports. RESULTS: Relative to young people who had at least one period 2 months or longer without symptoms since first onset, young people who had the continuous presence of depressive symptoms since their first onset had significantly higher odds for life-time self-harm, 12-month self-harm, multiple self-harm, suicidal ideation and suicide attempt within the past 12 months. The duration of depressive symptoms and the continuity of these symptoms each independently contribute to elevating the risks of non-suicidal self-harming and suicidal ideation and behaviors. LIMITATIONS: Reliance on self-report from the young people and time constraints prohibiting administering diagnostic modules other than the Major Depressive Disorder and estimating self-reported co-morbidity. CONCLUSIONS: Among young people with a Major Depressive Disorder, self-reports about duration of depressive symptoms as well as the continuity of symptoms, each independently contributes to elevated risks of non-suicidal self-harming and suicidal ideation and behaviors. As well, un-remitting as opposed to episodic symptoms in this group of young people are common and are a powerful indicator of suffering associated with both self-harm and suicidal behavior.

The Prevalence of Stimulant and Antidepressant Use by Australian Children and Adolescents with Attention-Deficit/Hyperactivity Disorder and Major Depressive Disorder: A National Survey.

OBJECTIVES: To identify the prevalence of stimulant and antidepressant medication use by children and adolescents with symptoms meeting the criteria for attention-deficit/hyperactivity disorder (ADHD) and major depressive disorder (MDD) in Australia. To identify factors associated with stimulant and antidepressant use by children and adolescents in Australia. METHODS: Data are from a nationally representative sample of 4- to 17-year-olds (n = 6310). Parents completed the Diagnostic Interview Schedule for Children-Version IV (DISC-IV) and the Strengths and Difficulties Questionnaire. Eleven- to 17-year-olds completed a self-report version of the DISC-IV MDD module. Interviewers recorded prescribed medications used by participants in the previous 2 weeks. RESULTS: During a 2-week period, 1.3% of all 4- to 17-year-olds and 13.7% of those with symptoms meeting the criteria for ADHD had used stimulant medication, while 0.9% of all 4- to 17-year-olds and 13.4% with MDD had used antidepressants. In total, 22.6% of those using stimulant medications and 57.7% using antidepressant medications did not have symptoms meeting criteria for ADHD or MDD, respectively. Among 11- to 17-year-olds, 5.6% of those with adolescent-only-reported MDD, 10.9% of those with parent/carer-only-reported MDD, and 25.7% of those with MDD reported by both parents/carers and adolescents were using antidepressant medications. CONCLUSIONS: Only a minority of 4- to 17-year-olds with ADHD and MDD were being treated with stimulant or antidepressant medication. The percentage of adolescents with MDD using antidepressant medications varied depending on whether adolescents, parents/carers, or both identified the presence of MDD. This highlights the importance of using information from both these informants when assessing and treating adolescent depressive disorder.

Usage, adherence and attrition: how new mothers engage with a nurse-moderated web-based intervention to support maternal and infant health. A 9-month observational study.

OBJECTIVES: To identify factors predicting use, adherence and attrition with a nurse-moderated web-based group intervention designed to support mothers of infants aged 0-6 months. DESIGN: 9-Month observational study. SETTING: Community maternal and child health service. PARTICIPANTS: 240 mothers attending initial postnatal health checks at community clinics who were randomly assigned to the intervention arm of a pragmatic preference randomised trial (total randomised controlled trial, n=819; response rate=45%). INTERVENTION: In the first week (phase I), mothers were assisted with their first website login by a research assistant. In weeks 2-7 (phase II), mothers participated in the web-based intervention with an expectation of weekly logins. The web-based intervention was comparable to traditional face-to-face new mothers' groups. During weeks 8-26 (phase III), mothers participated in an extended programme at a frequency of their choosing. PRIMARY OUTCOME MEASURES: Number of logins and posted messages. Standard self-report measures assessed maternal demographic and psychosocial characteristics. RESULTS: In phase II, the median number of logins was 9 logins (IQR=1-25), and in phase III, it was 10 logins (IQR=0-39). Incident risk ratios from multivariable analyses indicated that compared to mothers with the lowest third of logins in phase I, those with the highest third had 6.43 times as many logins in phase II and 7.14 times in phase III. Fifty per cent of mothers logged-in at least once every 30 days for 147 days after phase I and 44% logged-in at least once in the last 30 days of the intervention. Frequency of logins during phase I was a stronger predictor of mothers' level of engagement with the intervention than their demographic and psychosocial characteristics. CONCLUSIONS: Mothers' early use of web-based interventions could be employed to customise engagement protocols to the circumstances of individual mothers with the aim of improving adherence and reducing attrition with web-based interventions. TRIAL REGISTRATION NUMBER: ACTRN12613000204741; Results.

Methodology of Young Minds Matter: The second Australian Child and Adolescent Survey of Mental Health and Wellbeing.

OBJECTIVE: To describe the study design of Young Minds Matter: The second Australian Child and Adolescent Survey of Mental Health and Wellbeing. The aims of the study, sample design, development of survey content, field procedures and final questionnaires are detailed. METHOD: During 2013-2014, a national household survey of the mental health and wellbeing of young people was conducted involving a sample of 6310 families selected at random from across Australia. The survey included a face-to-face diagnostic interview with parents/carers of 4- to 17-year-olds and a self-report questionnaire completed by young people aged 11-17 years. RESULTS: The overall response rate to the survey was 55% with 6310 parents/carers of eligible households participating in the survey. In addition, 2967 or 89% of young people aged 11-17 years in these participating households completed a questionnaire. The survey sample was found to be broadly representative of the Australian population on major demographic characteristics when compared with data from the Census of Population and Housing. However, adjustments were made for an over-representation of younger children aged 4 to 7 years and also families with more than one eligible child in the household. CONCLUSION: Young Minds Matter provides updated national prevalence estimates of common child and adolescent mental disorders, describes patterns of service use and will help to guide future decisions in the development of policy and provision of mental health services for children and adolescents. Advancements in interviewing methodology, addition of a data linkage component and informed content development contributed to improved breadth and quality of the data collected.

Key findings from the second Australian Child and Adolescent Survey of Mental Health and Wellbeing.

OBJECTIVE: To estimate the prevalence of mental disorders in children and adolescents in Australia, and the severity and impact of those mental disorders. METHOD: Seven mental disorders were assessed using the parent- or carer-completed version of the Diagnostic Interview Schedule for Children Version IV, and major depressive disorder was also assessed using the youth self-report version of the Diagnostic Interview Schedule for Children Version IV. Severity and impact were assessed using an extended version of the Diagnostic Interview Schedule for Children Version IV impact on functioning questions, and days absent from school due to symptoms of mental disorders. Data were collected in a national face-to-face survey of 6310 parents or carers of children and adolescents aged 4-17 years, with 2969 young people aged 11-17 years also completing a self-report questionnaire. RESULTS: Twelve-month prevalence of mental disorders was 13.9%, with 2.1% of children and adolescents having severe disorders, 3.5% having moderate disorders and 8.3% having mild disorders. The most common class of disorders was attention-deficit/hyperactivity disorder followed by anxiety disorders. Mental disorders were more common in step-, blended- or one-parent families, in families living in rented accommodation and families where one or both carers were not in employment. Mental disorders were associated with a substantial number of days absent from school particularly in adolescents. CONCLUSION: Mental disorders are common in children and adolescents, often have significant impact and are associated with substantial absences from school. Child and adolescent mental disorders remain an important public health problem in Australia. Accurate information about prevalence and severity of child and adolescent mental disorders is an essential prerequisite for effective mental health policy and service planning.