Abstract:  By highlighting four conclusions from the 2014 OCHS study and describing their relationship to the broader policy context for children’s mental health services, this paper proposes six next steps for Canadian policymakers with a view to improving children’s mental health.

Abstract:  The 2014 OCHS study describes and brings into public awareness the current gaps in children’s mental health services.   By examining these gaps this paper argues that to provide a strong foundation for policy decision-making: core measures of child mental health be collected in the general population at regular intervals; they be administered on all children at baseline and follow-up; and the collection of identical information in both the general population and community-based child mental health agencies is necessary. 

Abstract

Objective: To describe the methodology of the 2014 Ontario Child Health Study (OCHS)—a province-wide, cross-sectional, epidemiologic study of child health and mental disorder among 4 to 17 year olds living in household dwellings.

Method: Implemented by Statistics Canada, the 2014 OCHS was led by academic researchers at the Offord Centre for Child Studies (McMaster University). Eligible households included families with children 4 to 17 years old listed on the 2014 Canadian Child Tax Benefit File. The survey design included area and household stratification by income and 3-stage cluster sampling of areas and households to yield a probability sample of families.

Results: The 2014 OCHS included 6,537 responding households (50.8%) with 10,802 4 to 17 year olds. Lower income families living in low-income neighbourhoods were less likely to participate. In addition to measures of child mental disorder assessed by the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) and OCHS Emotional Behavioural Scales (OCHS-EBS), the survey contains measures of neighbourhoods, schools, families and children, and includes administrative data held by the Ministries of Education and Health and Long-Term Care.

Conclusions: The complex survey design and differential non-response of the 2014 OCHS required the use of sampling weights and adjustment for design effects. The study is available throughout Canada in the Statistics Canada Research Data Centres (RDCs). We urge external investigators to access the study through the RDCs or to contact us directly to collaborate on future secondary analysis studies based on the OCHS. 

Abstract

Objectives: To present the 6-month prevalence and socio-demographic correlates of mental disorders and mental health-related service contacts in a sample of children (4 to 11 years) and youth (12 to 17 years) in Ontario.

Methods: The 2014 Ontario Child Health Study is a provincially representative survey of 6,537 families with children aged 4 to 17 years in Ontario. DSM-IV-TR mental disorders were assessed using the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) and included mood (major depressive episode), anxiety (generalized anxiety, separation anxiety, social phobia, specific phobia) and behaviour disorders (attention-deficit/hyperactivity disorder, oppositional-defiant disorder, conduct disorder).The MINI-KID was administered independently to the primary caregiver and youth aged 12 to 17 years in the family’s home.

Results: Past 6-month prevalence of any mental disorder ranged from 18.2% to 21.8% depending on age and informant. Behaviour disorders were the most common among children and anxiety disorders were the most common among youth. Among children and youth with a parent-identified mental disorder, 25.6% of children and 33.7% of youth had contact with a mental health provider. However, 60% had contact with one or more of the providers or service settings assessed, most often through schools.

Conclusions:  Between 18 to 22% of children and youth in Ontario met criteria for a mental disorder but less than one-third had contact with a mental health provider. These findings provide support for strengthening prevention and early intervention efforts and enhancing service capacity to meet the mental health needs of children and youth in Ontario.

Abstract

Objectives: To examine: 1) changes in the prevalence of mental disorders and perceived need for professional help among children (age 4 to 11) and youth (age 12 to 16) between 1983 and 2014 in Ontario, and 2) whether these changes vary by age and sex, urban-rural residency, poverty, lone-parent status, and immigrant background.

Methods: The 1983 (n = 2,836) and 2014 (n = 5,785) Ontario Child Health Studies are provincially representative cross-sectional surveys with identical self-report checklist measures of conduct disorder, hyperactivity, and emotional disorder, and perceived need for professional help, assessed by integrating parent and teacher responses (age 4 to 11) and parent and youth responses (age 12 to 16).

Results: The overall prevalence of perceived need for professional help increased from 6.8% to 18.9% among 4 to 16 year olds. An increase in any disorder among children (15.4% to 19.6%) was attributable to increases in hyperactivity among males (8.9% to 15.7%). Although the prevalence of any disorder did not change among youth, conduct disorder decreased (7.2% to 2.5%) while emotional disorder increased (9.2% to 13.2%). The prevalence of any disorder increased more in rural and small-medium urban areas versus large urban areas. The prevalence of any disorder decreased for children and youth in immigrant but not non-immigrant families.

Conclusions: Although there have been decreases in the prevalence of conduct disorder, increases in other mental disorders and perceived need for professional help underscore the continued need for effective prevention and intervention programs.

Abstract

Objectives: To present the 12-month prevalence and correlates of suicidal ideation and attempts in a sample of youth in Ontario.

Methods:  Data come from the 2014 Ontario Child Health Study, a provincially representative survey of families with children in Ontario. Youth aged 14 to 17 years (n = 2,396) completed a computer-assisted self-administered questionnaire in their home to assess the occurrence of suicidal ideation, suicidal attempts, and associated correlates, including non-suicidal self-injury, mental disorders, substance use, peer victimization and exposure to child maltreatment. Socio-demographic information was collected from the parent. Logistic regression models were used to identify correlates that distinguished between youth reporting: 1) no suicidal ideation or attempts, 2) suicidal ideation but no attempts, and 3) suicidal ideation and attempts.

Results: The 12-month prevalence of suicidal ideation and attempts was 8.1% and 4.3%, respectively. All clinical and behavioural correlates were significantly higher among youth reporting suicidal ideation or attempts, compared to non-suicidal youth. In adjusted models, depression and non-suicidal self-injury were each independently associated with elevated odds of suicidal ideation (OR = 4.84 and 4.19, respectively) and suicidal attempt (OR = 7.84 and 22.72, respectively). Among youth who reported suicidal ideation, the only variable that differentiated youth who attempted suicide versus those who did not, in adjusted models, was non-suicidal self-injury (OR = 3.89).

Conclusions: Suicidal ideation and attempts are common among youth in Ontario, often co-occurring with mental disorders and high risk behaviours. These findings underscore the need for effective prevention and intervention strategies, particularly for youth depression and non-suicidal self-injury.

Abstract

 Objective: To estimate the alignment between Ontario Ministry of Children and Youth Services (MCYS) expenditures for children’s mental health services and population need, and to quantify the value of adjusting for need in addition to population size in formula-based expenditure allocations. Two need definitions are used: ‘assessed need’ as presence of mental disorder, and ‘perceived need’ as perception of need for professional help.

Methods: Child mental health need and service contact estimates (from the 2014 Ontario Child Health Study), expenditure data (from government administrative data) and population counts (from the 2011 Canadian Census) were combined to generate formula-based expenditure allocations based on a) population size and b) need (population size adjusted for levels of need). Allocations were compared at the service area and region level and for the 2 need definitions (assessed and perceived).

Results: Comparisons were made for 13 of 33 MCYS service areas and all 5 regions. The percentage of MCYS expenditure reallocation needed to achieve an allocation based on assessed need was 25.5% at the service area level and 25.6% at the region level. Based on perceived need, these amounts were 19.4% and 27.2%, respectively. The value of needs-adjustment ranged from 8.0 to 22.7% of total expenditures, depending on the definition of need.

Conclusion: Making needs-adjustments to population counts by using population estimates of child mental health need (assessed or perceived) provides additional value for informing and evaluating allocation decisions. This study provides much-needed and current information about the match between expenditures and child mental health need.

Abstract

Objectives: To determine if levels of neighbourhood poverty and neighbourhood antisocial behaviour modify associations between household poverty and child and youth mental health problems.

Methods:  Data come from the 2014 Ontario Child Health Study—a provincially representative survey of 6,537 families with 10,802 4 to 17 year olds. Multivariate multilevel modelling was used to test if neighbourhood poverty and antisocial behaviour interact with household poverty to modify associations with child externalizing and internalizing problems based on parent assessments of children (4 to 17 year olds) and self-assessments of youth (12 to 17 year olds).

Results: Based on parent assessments, neighbourhood poverty and antisocial behaviour modified associations between household poverty and child mental health problems. Among children living in households below the poverty line, levels of mental health problems were: (1) lower when living in neighbourhoods with higher concentrations of poverty and (2) higher when living in neighbourhoods with more antisocial behaviour. These associations were stronger for externalizing versus internalizing problems when conditional on antisocial behaviour and generalized only to youth-assessed externalizing problems.

Conclusion: The lower levels of externalizing problems reported among children living in poor households in low income neighbourhoods identifies potential challenges with integrating poorer households into more affluent neighbourhoods. More importantly, children living in poor households located in neighbourhoods exhibiting more antisocial behaviour are at dramatically higher risk for mental health problems. Reducing levels of neighbourhood antisocial behaviour could have large mental health benefits, particularly among poor children.

Abstract

Objectives: To describe the development and psychometric properties of the 2014 Ontario Child Health Study Emotional Behavioural Scales (OCHS-EBS) for dimensional measurement of 7 disorders based on criteria from the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Methods: Scale items were selected by agreement among 19 child psychologists and psychiatrists rating the correspondence between item descriptions and DSM-5 symptoms. Psychometric evaluation of the item properties and parent/caregiver and youth scales came from a general population study of 10,802 children and youth aged 4 to 17 years in 6537 families. Test-retest reliability data were collected from a subsample of 280 children and their caregivers who independently completed the OCHS-EBS checklist on 2 occasions 7 to 14 days apart. Structural equation modelling was used to assess internal and external convergent and discriminant validity—the latter tested against the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID).

Results: Confirmatory factor analyses exhibited adequate item fit to all scales. Except for conduct disorder and youth-assessed separation anxiety disorder, internal (Cronbach’s α) and test-retest reliability (Pearson’s r) for scale scores were 0.70 or above. Except for youth-assessed conduct disorder, the OCHS-EBS met criteria for internal and convergent and discriminant validity. Compared with the MINI-KID, the OCHS-EBS met criteria for external convergent and discriminant validity.

Conclusions: The OCHS-EBS provide reliable and valid dimensional measurement of 7 DSM-5 disorders assessed by caregivers and youth in the general population. Part II describes use of the OCHS-EBS as a categorical (present/absent) measure of disorder.

Abstract

Objectives: To compare the reliability and convergent validity of parent assessments from the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID—a structured diagnostic interview) and the Ontario Child Health Study Emotional Behavioural Scales (OCHS-EBS) symptom checklist for classifying conduct disorder (CD), conduct disorder or oppositional defiant disorder (CD-ODD), attention-deficit hyperactivity disorder (ADHD), major depressive disorder (MDD), generalized anxiety disorder (GAD), and separation anxiety disorder (SAD) based on DSM-5 criteria.

Methods: Data came from 283 parent-youth dyads aged 9 to 18 years. Parents and youth completed the assessments separately on 2 different occasions 7 to 14 days apart. After converting the OCHS-EBS scale scores to binary disorder classifications, we compare test-retest reliability estimates and use structural equation modelling (SEM) to compare estimates of convergent validity for the same disorders assessed by each instrument.

Results: Average test-retest reliabilities based on κ were 0.71 (MINI-KID) and 0.67 (OCHS-EBS). The average β coefficients for 3 latent measures comprising the following indicators—parent perceptions of youth mental health need and impairment, diagnosis of specific disorders based on health professional communications and youth taking prescribed medication, and youth classifications of disorder based on the MINI-KID—were 0.67 (MINI-KID) and 0.69 (OCHS-EBS).

Conclusion: The OCHS-EBS and MINI-KID achieve comparable levels of reliability and convergent validity for classifying child psychiatric disorder. The flexibility, low cost, and minimal respondent burden of checklists for classifying disorder make them well suited for studying disorder in the general population and screening in clinical settings.