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 12 th Annual Maternal and Child Health Epidemiology Conference Atlanta, GA December 8, 2006 1

2.  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. BACKGROUND 2

3.  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. BACKGROUND 3

4.  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? STUDY QUESTION 4

5. 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 METHODS 5

6.  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). METHODS Rhode Island Data 6

7. Study Population RI 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 Income: 33% =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. 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. METHODS 9

10. METHOD Defining Mental Health Problem Children 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. RESULTS Mental Health Problems Among Children 6-17 Years of Age in Rhode Island 11

12. Children’s Mental Health Problems Rhode 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 Gender Rhode Island, 2003 6-12 13-17 Female Male Age (P < 0.05) Gender (P < 0.01) Percent 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 Income Rhode Island, 2003 =400% Federal Poverty Level (P < 0.05) Percent 16

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

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

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

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

21. Children’s Mental Health Problems by Parental Stress Level Rhode Island, 2003 High Low Percent 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 Significant Factors Adjusted OR (95% CI) 13-17 yrs (vs. 6-12 yrs)1.55 (1.01-2.38)* Male (vs. female)2.10 (1.30-3.39)** Multiple Race (vs. white only)2.28 (1.03-5.05)* =400%)1.85 (1.00-3.40)* 24

25. Logistic Regression: Results (continued) Association of Risk Factors with Children’s Mental Health Problems Significant Factors Adjusted OR (95% CI) Two parents,stepfamily Single mother family (vs. Two parents, bio/adopt) 2.42 (1.17-4.99)* 1.76 (1.07-2.88)* Poor/fair mom’s mental health (vs. good/excellent) 4.10 (2.10-8.00)*** High parental stress (vs. low)4.52 (2.66-7.67)*** *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