CHILDREN’S MENTAL HEALTH PROBLEMS IN RHODE ISLAND: THE PREVALENCE AND RISK FACTORS

1. CHILDREN’S MENTAL HEALTH PROBLEMS IN RHODE ISLAND: THE PREVALENCE AND RISK FACTORS Hanna Kim, PhD and Samara Viner-Brown, MS Rhode Island Department of Health 12th Annual Maternal and Child Health Epidemiology Conference Atlanta, GA December 8, 2006 1

2. BACKGROUND • One in five children and adolescents in the US experiences a mental health problem, and the number is growing. • Children’s psychosocial problems are considered the most common chronic condition in childhood. • Serious mental, emotional, and behavioral problems in children and adolescents can lead to school failure, alcohol or illicit drug use, violence, or suicide. 2

3. BACKGROUND • Children’s mental health is an important public health issue. • The prevalence and risk factors of children’s mental health problems were not investigated previously in RI due to lack of proper population based data. 3

4. STUDY QUESTION • What is the prevalence of mental health problems in RI children and adolescents? • What factors are associated with mental health problems in RI children and adolescents? 4

5. METHODS DATA • Source: The 2003 National Survey of Children’s Health (NSCH) • Sponsored by Maternal and Child Health Bureau of the HRSA • Conducted by CDC’s National Center for Health Statistics • Telephone survey of parents of children <18 years of age • Used state-specific sampling frame for 50 states and D.C. • Data were collected from Jan. 2003 to July 2004 • About 2,000 interviews were completed from each state • Intended to produce national and state-based estimates of health and well-being of children 5

6. METHODSRhode Island Data • Overall RI data : 2,019 interviews were completed with a weighted response rate of 57.1%. • This study used RI data for children 6-17 years of age (n=1,326). 6

7. Study PopulationRI Children 6-17 Years of Age (n=1,326) • Child Characteristics: • Age: 59% 6-12 yrs, 41% 13-17 yrs • Gender: 51% Male • Race: 86% White, 7% Black, 5% Multiple race, 3% Other race • Ethnicity: 13% Hispanic, 87% non-Hispanic 7

8. Family/Parent Characteristics: • Education: 8% <HS, 26% HS grad, 66% >HS • Income: 33% <200% FPL, 37% 200-<400% FPL, 29% >=400%FPL • Family Structure: 61% two parents/bio or adopt, 10% stepfamily, 30% single mother • Fulltime Employment: 11% no one in HH • # Children in HH: 62% 1-2 kids, 38% >2 kids • Mother’s Mental Health: 9% poor or fair • Father’s Mental Health: 5% poor or fair • Parental Stress Level: 16% high level 8

9. METHODS ANALYSIS: • Descriptive statistics were performed to assess the prevalence of children’s mental health problems and its relationship with possible risk factors. • Multivariate logistic regression models were constructed to identify significant risk factors for children’s mental health problems, controlling for other covariates in the model. • SUDAAN software was used to account for complex survey design and weighting. 9

10. METHODDefining Mental Health ProblemChildren were classified as having a mental health problem if their parents answered “yes” to one of the following: • Does the child have any kind of emotional, developmental or behavioral problem for which he/she needs treatment or counseling? • Has a doctor or health professional ever told you that the child has attention deficit disorder or attention deficit hyperactive disorder, that is ADD or ADHD? • Has a doctor or health professional ever told you that the child has depression or anxiety problems? • Has a doctor or health professional ever told you that the child has behavioral or conduct problems? 10

11. RESULTSMental Health Problems Among Children 6-17 Years of Age in Rhode Island 11

12. Children’s Mental Health ProblemsRhode Island vs. United States, 2003 Percent 12

13. Bivariate Analyses(Chi-square Tests) • Child Characteristics: • Family/Parent Characteristics: 13

14. Children’s Mental Health Problems by Child Age and GenderRhode Island, 2003 Percent 6-12 13-17 Female Male Age (P < 0.05) Gender (P < 0.01) 14

15. Children’s Mental Health Problems Rhode Island, 2003 • Child Characteristics Not Significant: • Race • Ethnicity 15

16. Children’s Mental Health Problems by Family IncomeRhode Island, 2003 Percent <200% 200-399% >=400% • Federal Poverty Level (P < 0.05) 16

17. Children’s Mental Health Problems by Family StructureRhode Island, 2003 Percent 2 Parents, 2 Parents, Single Bio/adopt Stepfamily Mother Family Structure (P < 0.001) 17

18. Children’s Mental Health Problems by Parent’s Employment StatusRhode Island, 2003 Percent Yes No Anyone in HH Employed Fulltime (P < 0.05) 18

19. Children’s Mental Health Problems by Mother’s Mental HealthRhode Island, 2003 Percent Good/Excellent Poor/Fair Mother’s Mental Health (P < 0.001) 19

20. Children’s Mental Health Problems by Father’s Mental HealthRhode Island, 2003 Percent Good/Excellent Poor/Fair Father’s Mental Health (P = NS) 20

21. Children’s Mental Health Problems by Parental Stress LevelRhode Island, 2003 Percent High Low Parental Stress Level (P < 0.001) 21

22. Children’s Mental Health Problems Rhode Island, 2003 • Family/Parent Characteristics Not Significant: • Education • # Children in HH • Father’s mental health 22

23. Logistic Regression Model • Outcome Variable: • Children’s Mental Health Problems • Potential Risk Factors: • Child’s Age, Gender, Race, Ethnicity, Parent’s education, Family Income, Family structure, Employment status, # Children in HH, Mother’s mental health, Parental stress level 23

24. Logistic Regression: Results Association of Risk Factors with Children’s Mental Health Problems *p<0.05; **p<0.01; ***p<0.001 Reference groups are shown in parentheses 24

25. Logistic Regression: Results (continued) Association of Risk Factors with Children’s Mental Health Problems *p<0.05; **p<0.01; ***p<0.001 Reference groups are shown in parentheses 25

26. SUMMARY • One in five (19.0%) RI children and adolescents experienced mental health problems. • Many family factors were significantly associated with children’s mental health problems: • High parental stress and Poor mother’s mental health were the most significant risk factors. • Stepfamily, Single mother family, and Low-income family were also significant risk factors. 26

27. SUMMARY (continued) • Male children, teens, and children with multiple races also had increased odds of having mental health problems. • Parent’s education, # of children in HH, and ethnicity of the child were insignificant factors. 27

28. Limitations • The prevalence of mental health problems in children may be underestimated. • Some groups had small sample sizes that made it difficult to produce reliable results (e.g., Blacks, Multiple and Other races, < high school education, etc). • Generalizability of the study is limited: this study used RI specific data and may not reflect children in other parts of the US. 28

29. Public Health Implications • To effectively address the issues of children’s mental health, we must consider the issues of mother’s mental health, parental stress, and family environment. • This study may provide important information for the development of mental health policy and service planning in Rhode Island. 29