Concept: Mental Health Indicators for Children

Introduction

This concept identifies and describes a set of mental health indicators that were developed and used to examine the diagnostic prevalence of mental disorders in Manitoba's children, as well as the health and social services use, justice system involvement, and educational outcomes of children with mental disorders. They are also used to examine the relationship between physical health and mental health, as well as the association between parental and child mental health status.

The concept lists and defines the set of mental health indicators used in The Mental Health of Manitoba's Children deliverable by Chartier et al. (2016), and provides links to additional detailed information describing the methods used to operationalize each indicator.

Mental Health Indicators

Three general categories of mental health indicators were developed and used in this research: 1). mental disorders, 2) suicidal behaviours and 3). developmental disorders. An additional category of "No Disorders" was also included. These categories are listed below and links are provided to the corresponding concepts / glossary terms that provide additional detailed information on how these indicators are defined.

1. Mental Disorders

The following list identifies the different categories and components of the mental disorders used in this research:


• Externalizing disorders include at least one of the three following disorders: ADHD, conduct disorder or substance use disorders. See the Externalizing Disorders glossary term for more detailed information.
  
  
  • Attention-Deficit Hyperactivity Disorder (ADHD) is a neurobehavioural developmental disorder that is characterized by a persistent pattern of impulsiveness, hyperactivity and absence of attention in children. See the Attention-Deficit Hyperactivity Disorder (ADHD) concept for more detailed information.
    
  • Conduct disorder is characterized by a repetitive and persistent pattern of dissocial, aggressive or defiant behaviour, which is enduring and more severe than ordinary childish mischief or adolescent rebelliousness. See the Conduct Disorder concept for more detailed information.
    
  • Substance use disorders are characterized by the excess use of and reliance on a drug, alcohol or other chemical that leads to severe negative effects on the user’s health and well-being or the welfare of others. See the Substance Use Disorders / Substance Abuse - Measuring Prevalence concept for more detailed information.
  
  
• Mood and anxiety disorders consist of a broad group of mental disorders including depressive (depressed mood and lack of interest in activities), bipolar (elevated mood and increased energy), and anxiety disorders (excessive fear, anxiety or worry and often avoidance). See the Mood and Anxiety - Measuring Prevalence concept for more detailed information.
  
  
• Psychotic disorders are a broad group of disorders characterized by extreme impairment of the ability to think clearly, respond emotionally, communicate effectively, understand reality and behave appropriately. Included in this group is schizophrenia, delusional and psychotic disorders. See the Psychotic Disorders - Measuring Prevalence concept for more detailed information.
  
  
  • Schizophrenia is characterized by difficulty in distinguishing between real and unreal experiences (delusions and hallucinations), thinking logically, having normal emotional responses to others and behaving appropriately. See the Schizophrenia - Measuring Prevalence concept for more detailed information.
  
  
• Any mental disorder consists of having at least one of the following disorders examined in this report: externalizing disorders (ADHD, conduct disorder, or substance use disorders), mood and anxiety disorders, and psychotic disorders (including schizophrenia). See the Mental Disorder / Mental Health Disorder / Mental Health Illness Classification concept for more detailed information.

2. Suicidal Behaviours

Two indicators are used to investigate suicidal behaviours:


• Suicide is defined as self-inflicted injury or poisoning as the primary cause of death.
  
• Attempted suicide is defined as being hospitalized for accidental poisoning followed by a consult to psychiatry or for self-inflicted injury.

See the Suicide and Attempted Suicide (Intentional Self Inflicted Injury) concept for more detailed information.

3. Developmental Disorders

Children with developmental disorders have greater difficulty than most children with intellectual and adaptive functioning, and having had these difficulties from a very early age. This includes mental retardation, chromosomal anomalies, Fetal Alcohol Spectrum Disorder (FASD) and Autism Spectrum Disorder (ASD). ASD is also examined separately.

See the Intellectual Disability (ID) (Mental Retardation) / Developmental Disability (DD) / Developmental Disorders concept for more detailed information.


• Children with Autism Spectrum Disorder (ASD) have difficulty with social communication and interaction as well as restricted and repetitive patterns of behaviour, interests or activities.
  
  See the Autism Spectrum Disorder (ASD) - Measuring Treatment Prevalence concept for more detailed information.

4. No Disorders

No disorders is defined as not having any of the mental disorders, suicidal behaviours and developmental disorders that are defined above.

Considerations in Defining Mental Health Indicators

There are several important considerations when defining the mental health indicators used in this research:


• The term diagnostic prevalence is used to communicate the fact that the prevalence estimates of mental and developmental disorders are based on diagnoses from medical claims, hospitalization records, and, for some disorders, prescriptions, education data, and the FASD clinic data. These children have been diagnosed by a physician. While the databases at MCHP contain many children with mental health problems, there are still many who will not be included in these analyses, such as children who have never received treatment, children diagnosed by a psychologist (private and publically funded) or children who received services from nurses, social workers, or other counsellors. The MCHP Repository does not have data related to psychologist visits or diagnoses with the possible exception of psychologists who provided a diagnosis to determine special funding in the Education data. Psychologists are highly trained in mental disorders and do provide diagnoses, however, this data is not captured administratively in Manitoba.
  
  
• It should be noted that some disorders are more likely to receive a diagnosis than others. For example, adolescents may not be seeking help from a physician for substance use disorders, but perhaps may be receiving services from the Addictions Foundation of Manitoba, data that are not included in this research.
  
  
• Conduct disorders are more likely to be seen in a school context that may not require special funding and are not captured in this report. As a result, the true prevalence of mental and developmental disorders will be higher than reported in this study.

For more specific information on the considerations used in this research for defining mental health indicators, please see the section in the deliverable titled: Considerations in Defining Mental Health indicators.

Research Findings

In Chartier et al. (2016), , the diagnostic prevalence of each mental health indicator is presented over two time periods - 2005/06-2008/09 and 2009/10-2012/13 - and by age group, health region, Winnipeg community area, sex, and urban and rural income quintiles. A table is also available that presents the comorbidity of children with mental disorders.

The age groups examined depend upon the age of onset of the disorder in question. For substance use disorders, psychotic disorders, schizophrenia, and suicide and attempted suicide, the prevalence is presented for one age group: adolescents aged 13-19. The prevalence of ADHD, conduct disorders, and mood and anxiety disorders is presented for children aged 6-19, 6-12, and 13-19. And finally, for developmental disorders, prevalence is presented for four age groups: children aged 0-19, 0-5, 6-12, and 13-19.

The following list provides links to the specific results of this research, available in the on-line report.

1). Mental Disorders


• Attention-deficit hyperactivity disorder (ADHD)
  
• Conduct disorder
  
• Substance use disorders
  
• Externalizing disorders
  
• Mood and anxiety disorders
  
• Psychotic disorders
  
• Schizophrenia
  
• Any mental disorder

2). Suicidal Behaviours


• Suicide
  
• Attempted suicide

3). Developmental Disorders


• Developmental Disorders
  
• Autism Spectrum Disorder

4). Comorbidity


• Percentage of Children with a Mental Disorder who also had a Comorbid Disorders