Global child and adolescent mental health: The orphan of development assistance for health.
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SUBMITTER: Lu C
PROVIDER: S-EPMC5844520 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ImportanceGrowth in financing has underpinned progress in most areas of health. Adolescent health has recently become a global priority, with inclusion in the Global Strategy for Women's, Children's and Adolescents' Health, but little is known about patterns of financing and development assistance for adolescent health (DAAH).ObjectiveTo provide estimates of DAAH at global, regional, and country levels.Design, setting, and participantsIn this quality improvement study, data from the Creditor Reporting System were used to estimate flows of total DAAH and per-adolescent DAAH and to assess its distribution by donors, regions, and countries and the leading causes of burden of disease (ie, disability-adjusted life-years) in 132 developing countries between January 1, 2003, and December 31, 2015. Through use of a key word search and various funding allocation methods, 2 sets of estimates were produced: adolescent-targeted DAAH that included disbursements to projects with a primary adolescent health target and adolescent-inclusive DAAH that included disbursements to projects with either a primary or partial adolescent health target, as well as projects that could benefit adolescent health but did not include age-related key words.Main outcomes and measuresEstimates of DAAH distinguishing between adolescent-targeted and adolescent-inclusive DAAH.ResultsThere were 19?921 projects in 132 countries in the adolescent-targeted estimation between 2003 and 2015, with a total funding amount of $3634.6 million, accounting for 1.6% of total development assistance for health. The top 5 donors (Global Fund to Fight AIDS, Tuberculosis and Malaria, $806.8 million; United Nations Population Fund, $401.3 million; United States, $389.9 million; United Kingdom, $251.8 million; and International Development Association, $218.6 million) together provided 56.9% of all adolescent-targeted DAAH. Sub-Saharan Africa received the largest cumulative DAAH per adolescent ($5.37) during the period. In 2015, among the 10 leading causes of disability-adjusted life-years, HIV and AIDS received the largest DAAH, followed by interpersonal violence, tuberculosis, and diarrheal diseases. Other leading causes, including road injuries and depressive disorders, received few disbursements, especially among the low-income countries.Conclusions and relevanceDespite an increasing rate, DAAH composed a small proportion of total development assistance for health, suggesting that adolescent health has gained little donor attention. Moreover, recent allocations of DAAH have not aligned well with either the burden of disease or the areas where the benefits of investment are likely to be high.
| S-EPMC6324521 | biostudies-literature
Project description:Background:Little is known about the patterns of development assistance (DA) for each component of reproductive, maternal, newborn, child and adolescent health (RMNCAH) in conflict-affected countries nor about the DA allocation in relation to the burden of disease. Methods:We tracked DA to RMNCAH in general and to each of its four components: reproductive health (RH), maternal and newborn health (MNH), child health (CH) and adolescent health (AH), in 25 conflict-affected countries between 2003 and 2017. We compared DA and disability-adjusted life years (DALYs) for each component. Using keyword searching and funding allocation methods, we produced two sets of estimates: DA primarily targeting RMNCAH (lower bound) and DA both primarily and partially for RMNCAH or DA not explicitly targeting RMNCAH but benefiting it (upper bound). Findings:Between 2003 and 2017, we identified 46?833 projects among the 25 countries that targeted RMNCAH. During the study period, DA to RMNCAH increased by seven-fold from $0.5?billion to $3.6?billion, with a slowdown since 2013. Cumulatively, RH received the largest proportion of DA to RMNCAH (50%) with 84% of its funding earmarked for HIV/AIDS, which contributed to less than 6% of the total RMNCAH-related DALYs. AH received 3% of the DA-RMNCAH but contributed 15% to the RMNCAH-related DALYs. Non-communicable diseases caused more than one-third of the DALYs among adolescents, but received only 3% of DA to AH. RMNCAH-inclusive estimates showed consistent results. Conclusion:While there was a substantial increase in funding to RMNCAH in conflict-affected countries over the period of study, some health issues with high disease burden (eg, AH and non-communicable diseases) received a disproportionately small portion of aid for RMNCAH. We recommend that donors increase investment to RMNCAH in conflict-affected countries, particularly in areas where the burden of disease or the potential benefit of investment is likely to be high.
| S-EPMC6730579 | biostudies-literature
Project description:The treatment or prevention of child and adolescent mental health (CAMH) disorders often requires an individualized, sequential approach to intervention, whereby treatments (or prevention efforts) are adapted over time based on the youth's evolving status (e.g., early response, adherence). Adaptive interventions are intended to provide a replicable guide for the provision of individualized sequences of interventions in actual clinical practice. Recently, there has been great interest in the development of adaptive intervenions by investigators working in CAMH. The development of such replicable, real-world, individualized sequences of decision rules to guide the treatment or prevention of CAMH disorders represents an important "next step" in interventions research. The primary purpose of this special issue is to showcase some recent work on the science of adaptive interventions in CAMH. In this overview article, we review why individualized sequences of interventions are needed in CAMH, provide an introduction to adaptive interventions, briefly describe each of the articles included in this special issue, and describe some exciting areas of ongoing and future research. A hopeful outcome of this special issue is that it encourages other researchers in CAMH to pursue creative and significant research on adaptive interventions.
| S-EPMC4930370 | biostudies-other
Project description:The author, a child and adolescent psychoanalytic psychotherapist working in the UK NHS, ponders the varied impacts of 'lockdown' on adolescents, their parents and the psychotherapists who work with them, during the COVID-19 pandemic. She asks, particularly, how psychological therapies are positioned during such a crisis, and whether the pressures of triage and emergency can leave time and space for sustained emotional and psychological care. She wonders how psychoanalytic time with its sustaining rhythm can be held onto in the face of the need for triage on the one hand and the flight to online and telephone delivery on the other. Above all, the author questions how the apparent suspension of time during lockdown is belied by the onward pressure of adolescent time, and how this can be understood by, and alongside, troubled adolescents.
| S-EPMC7424913 | biostudies-literature
Project description:Introduction:Globally, 10-20% of children and adolescents suffer from mental disorders, with half of all them starting by the age of 14 and three-quarters before the age of 25. In Nepal, 40% of the population is younger than 18 years of age, and as such there is a large proportion of the population that is at risk of developing a mental disorder. There has been a recent recognition of child and adolescent mental health problems in Nepal, although prior to this it had remained almost invisible on the health agenda. In response to growing concern, there is a need to conduct a review on children and adolescent mental health problems in Nepal. Objective:To review the existing studies on child and adolescent mental health problems in Nepal. Methodology:A scoping review approach was used to identify studies on child and adolescent mental problems in Nepal. A search of Medline and PubMed databases for articles published from the database inception to August 2018 was conducted. Results:Ten papers were identified, and they all together included 7876 participants. Two studies reported on Post traumatic Stress Symptoms (PTSS) and described a prevalence of 10.7% to 51% of earthquake-affected children and adolescents in the Kathmandu district of Nepal. Another study reported that 53.2% of former child soldiers met the cut-off score for PTSS. Two school surveys found that the prevalence of emotional and behavioural problems in school children ranged between 12.9 and 17.03%, whereas a study on emotional and behavioural disorders in homeless children reported a prevalence of 28.6%. The prevalence of Autism Spectrum Disorder (ASD) was estimated to be as high as three in every 1000 persons in Nepal by one study. The clinical prevalence of anxiety disorders was reported ranging from 18.8% to 24.4% while that of Attention Deficit Hyperactivity Disorder (ADHD) was 10-11.7% in various clinical samples of children and adolescents. Conclusion:Only a few studies on the prevalence of child and adolescent mental health in Nepal have been conducted. Clearly, there is a need for better study design and larger studies to understand more fully the prevalence of child and adolescent mental health disorders in Nepal, in order to adequately plan public health services accordingly.
| S-EPMC6689861 | biostudies-other
Project description:ObjectiveParanoia may be particularly prevalent during adolescence, building on the heightened social vulnerabilities at this age. Excessive mistrust may be corrosive for adolescent social relationships, especially in the context of mental health disorders. We set out to examine the prevalence, symptom associations, and persistence of paranoia in a cohort of young people attending child and adolescent mental health services.MethodA total of 301 patients (11-17 years old) completed measures of paranoia, affect, peer difficulties and behavioural problems. Clinicians also rated each participant's psychiatric symptoms. Patterns of association were examined using linear regressions and network analyses. In total, 105 patients repeated the measures several months later.ResultsMost of the adolescents had affective disorders (n = 195), self-harm/suicidality (n = 82), or neurodevelopmental conditions (n = 125). Few had suspected psychosis (n = 7). Rates of paranoia were approximately double compared with previous reports from the general population. In this patient sample, 35% had at least elevated paranoia, 15% had at least moderate paranoia, and 6% had high paranoia. Paranoia had moderate associations with clinician-rated peer difficulties, self-harm, and trauma, and small associations with clinician-rated social anxiety, depression, generalised anxiety, and educational problems. Network analyses showed paranoia had the strongest unique relationship with peer difficulties. Paths from peer difficulties to anxiety, self-harm, post-traumatic stress disorder symptoms, and behavioural problems were all via paranoia. Both self-harm and post-traumatic stress disorder were solely associated with paranoia in the network. Paranoia remained persistent for three-quarters and was associated with greater psychological problems over time.ConclusionParanoia is relatively common and persistent across a range of clinical presentations in youth. When paranoia occurs alongside emotional problems, important peer interactions may be adversely affected. Wider consideration of paranoia in adolescent patients is needed.
| S-EPMC8649424 | biostudies-literature
Project description:ObjectiveTo examine, through photo-elicitation, the personal and professional impact of the COVID-19 pandemic on mental health professionals working with children and adolescents around the globe.MethodsWe invited the submission of images collected about the pandemic between May and August 2020. We encouraged participants to yoke personal reflections or voice memos to their images. Using snowball sampling, we began with two invitations, including one to the graduates of a mentorship program continuously hosted since 2004 by the International Association of Child and Adolescent Psychiatry and Allied Professions (IACAPAP). We analyzed de-identified images and anonymized transcripts through iterative coding using thematic analysis informed by rich picture analysis and aided by NVivo software.ResultsWe collected submissions from child and adolescent mental health professionals (n = 134) working in 54 countries spread across the five continents. We identified four overarching domains with component themes that revealed both the commonality and the uniqueness of the pandemic experience around the globe: (1) Place (adjusting to emptiness and stillness; shifting timeframes; blending of spaces); (2) Person (disruption to life rhythms; emotional toll; positives of the pandemic); (3) Profession (changing practices; outreach efforts; guild pride-and guilt); and (4) Purpose (from pandemic to syndemic; from lamenting to embracing; planning toward a better tomorrow).ConclusionsPhoto-elicitation provided a disarming and efficient means to learn about individual, regional, and global similarities and differences regarding the professionals charged with addressing the mental health needs of children and adolescents around the globe. These findings may help inform practice changes in post-pandemic times.
| S-EPMC7852478 | biostudies-literature
Project description:BackgroundBecause most children and adolescents visit their general practitioner (GP) regularly, general practice is a useful setting in which child and adolescent mental health problems can be identified, treated or referred to specialised care. Measures to strengthen Dutch primary mental health care have stimulated cooperation between primary and secondary mental health care and have led to an increase in the provision of social workers and primary care psychologists. These measures may have affected GPs' roles in child and adolescent mental health care. This study aims to investigate the identification and treatment of child and adolescent mental health problems in general practice over a five-year period (2004-2008).MethodsData of patients aged 0-18 years (N ranging from 37716 to 73432) were derived from electronic medical records of 42-82 Dutch general practices. Time trends in the prevalence of recorded mental health problems, prescriptions for psychotropic medication, and referrals to primary and secondary mental health care were analysed.ResultsIn 2008, 6.6% of children and 7.5% of adolescents were recorded as having mental health problems; 15.2% of these children and 29.4% of these adolescents were prescribed psychotropic medication; 18.9% of these children and 22.9% of these adolescents were referred, mainly to secondary mental health care. Between 2004 and 2008, the percentages of children (chi-square: 22.06; p < 0.001) and adolescents (chi-square: 9.15; p = 0.003) who were diagnosed with mental health problems increased. An increase was also found in the percentage of children who were prescribed psychostimulants (chi-square: 8.29; p = 0.004). Prescriptions for antidepressants decreased over time in both age groups (children: chi-square: 6.80; p = 0.009; adolescents: chi-square: 13.52; p < 0.001). The percentages of children who were referred to primary (chi-square: 6.98; p = 0.008) and secondary mental health care (chi-square: 5.76; p = 0.02) increased over the years, whereas no significant increase was found for adolescents.ConclusionsAlthough GPs' identification of mental health problems and referrals to primary mental health care have increased, most referrals are still made to secondary care. To further strengthen primary mental health care, effective short-term interventions for child and adolescent mental health problems that can be applied in general practice need to be developed.
| S-EPMC3267656 | biostudies-literature
Project description:Governments in high income countries allocate funding for Official Development Assistance (ODA), and population-based surveys tend to show support for the concept of affluent nations assisting the development of poorer regions. A public opinion survey was conducted in Hong Kong to: (1) assess public support for foreign aid for social development and Hong Kong's current Disaster Relief Fund (DRF); and (2) assess how much respondents thought should be contributed to foreign aid for social development and/or DRF. Interviewers conducted a random telephone survey of Cantonese-speaking Hong Kong citizens aged 18 or above during 2017. Of the 1004 individuals surveyed, 55% (552) agreed that a portion of the government budget should be allocated to the DRF and 37% (372) disagreed. The mean and the median amount of the government budget suggested to be allocated were 5.1% and 2.4% respectively. However only 16% (164) supported the government giving foreign aid for social development, with 79% (793) not supporting, and 5% (47) undecided. The suggested portions of government budget that should be allocated for this purpose were 1.5% (mean) and 0.0% (median). The degree of support for DRF and foreign aid for social development was associated with both age (DRF P < 0.0005; foreign aid for social development P < 0.0005) and education (DRF P = 0.010; foreign aid for social development: P < 0.0005). There was little support for foreign aid for social development amongst the Hong Kong public, in contrast to similar surveys in other countries, but this could be related to the lack of a local tradition of providing ODA to foreign countries. Most respondents supported the current DRF and would like to see a greater proportion of government budget allocated.
| S-EPMC6279225 | biostudies-literature
Project description:ObjectivesParanoia is most likely to emerge in adolescence. In adolescents with mental health disorders, the disruptive effect of paranoia on social relationships could worsen outcomes. However, little is known about clinical presentations of paranoia at this age. We therefore explored the development, experience, and impact of paranoia in adolescent patients.DesignA qualitative interview design with interpretative phenomenological analysis was used.MethodTwelve adolescents (11-17 years) with paranoia attending child and adolescent mental health services were interviewed.ResultsAdolescents described a journey starting with their awareness of paranoia beginning to a paranoid experience of mistrust and fear of others, and, subsequently, their adjustment to paranoia in daily life. Paranoia onset was rooted in the discovery of interpersonal threat and personal vulnerability, shaped by challenging peer interactions, becoming aware of danger in the world, and personal adverse experiences. The paranoia experience included a struggle to trust friends, anticipating threat with intense fear, and using defensive strategies to keep safe. Adolescents described how the paranoia experience was confusing, negatively impacted self-concept, held them back from teenage life, and caused disconnection from friends. Longer-term responses to paranoia reflected a tension between reluctantly resigning to the experience and trying to resist the impact.ConclusionsThe journey of paranoia in adolescence involves navigating multiple tensions, with young people balancing independence with vulnerability, trust with mistrust, and the desire to socialise with a fear of danger and deception. Decisions about how to respond to paranoia are likely to determine the next stage of their journey.
| S-EPMC9304248 | biostudies-literature