New CORC research paper on predicting youth mental health improvement and deterioration

Up to half of adult mental health difficulties originate in adolescence [1] and the negative impact of children’s mental health difficulties on educational attainment, drug use, criminality, physical health and later workforce involvement and financial difficulties have been widely stressed [2345]. As many as 1 in 4 adolescents report difficulties at levels likely to indicate significant mental health problems, and the majority have multiple difficulties which may share common aetiology [167]. Despite this, only about one in five children with mental health difficulties currently access mental health support [8]. The majority of those accessing such services have multiple problems [9].

Following the approach pioneered in early intervention in adult mental health in the UK [9], there is increasing interest in considering improvement or deterioration across multiple domains of functioning, rather than just considering outcomes in one domain. This can provide a more complete picture of outcomes for children. A key metric proposed for use is overall reliable improvement [10].

Of children with mental health problems who access specialist help, 50% show reliable improvement on self-report measures at case closure and 10% reliable deterioration. To contextualise these figures, it is necessary to consider rates of improvement for those in the general population and explore potential predictors of mental health improvement and deterioration for children.

This study looked at rates of reliable improvement and deterioration for 9,074 children (mean age 12, 52% female, 79% white) from 118 secondary schools across England. These children provided self-report mental health using the Strengths and Difficulties Questionnaire (SDQ), quality of life and demographic data (age, ethnicity and Free School Meals) at baseline and 1 year.

2,270 (25%) children and young people scored above threshold for mental health problems at outset, and 27% reliably improved and 9% reliably deteriorated at the 1-year follow up. This is almost one in three children showing reliable improvement at 1 year. 6804 (75%) scoring below threshold at outset, and 4% reliably improved and 12% reliably deteriorated. Greater emotional difficulties at outset were associated with greater rates of reliable improvement for both groups, showing the highest associations with rates of reliable improvement.

This study then looked at these two groups (above and below threshold) to inspect what was associated with the likelihood of reliable improvement or deterioration. Students with a higher baseline quality of life were significantly more likely to reliably improve and significantly less likely to reliably deteriorate. However, being in a receipt of Free School Meals (an index of deprivation) was associated with a reduced likelihood of reliable improvement. In this sample, significant relationships between ethnicity or gender and outcome were not found.

For the group below the threshold, it was found that being female was associated with an increased likelihood of reliable deterioration, while being from a non-white ethnic background was associated with decreased likelihood of reliable deterioration. This aligns with other literature on risk factors for mental health problems being raised for females and reduced for some minority ethnic groups, suggesting the potential to focus on girls for prevention initiatives.

In sum, results highlighted the impact of baseline severity as the key association with change: the more severe at outset, the more improvement seen. Overall nearly one in three children above threshold at time one will have shown reliable improvement at time two. The majority of these have not have accessed specialist support. This research is a first step to trying to consider factors associated with improvement and deterioration in mental health problems in children.

Access the full paper here.