Preventing Mental Disorders in Children: A Public Health Priority
Waddell, Charlotte, McEwan, Kimberley, Peters, Ray DeV, Hua, Josephine M., Garland, Orion, Canadian Journal of Public Health
Background: Mental disorders affect 14% of children, cause significant long-term disability and are arguably the leading health problems that Canadian children face after infancy. Treatment services alone cannot meet children's mental health needs. In addition to treatment, prevention programs hold potential to reduce the number of children with disorders in the population. Effective programs exist for preventing conduct, anxiety and depressive disorders, three of the most prevalent disorders in children. Therefore, we investigated the state of Canadian programs in comparison with prevention programs described in the literature for these three disorders.
Methods: We identified children's mental health and early child development (ECD) programs across Canada with national or provincial/territorial scope and significance and with potential relevance to mental health. We then interviewed policy-makers to determine which programs included goals related to mental health, and incorporated key features from programs known to be effective for preventing the three disorders of interest.
Results: No prevention programs specific to children's mental health were identified. However, 17 ECD programs incorporated generic goals related to mental health and incorporated key features seen in effective prevention programs. Only Ontario's Better Beginnings, Better Futures (BBBF) explicitly included mental health within its major program goals, incorporated multiple features seen in effective (conduct disorder) prevention programs and demonstrated positive child mental health outcomes.
Discussion: The lack of Canadian prevention programs specific to children's mental health is concerning. ECD programs have the potential to improve child mental health outcomes within their wider mandates. BBBF is an exemplar for such programs. However, new investments in implementing (and evaluating) programs that specifically aim to prevent mental disorders are required to improve the mental health of children in the population. Preventing children's mental disorders must be a Canadian public health priority.
MeSH terms: Primary prevention; mental disorders; public health; health policy; infant; child
The burden of illness attributable to mental disorders accounts for 15% of the total disability-adjusted life years associated with all illnesses, second only to cardiovascular illness.1 Direct and indirect costs stemming from mental disorders in Canada are estimated to exceed $14-15 billion annually.2 The immense lifelong impact of mental disorders on all aspects of health, happiness and productivity necessitates a broader public health approach emphasizing "upstream" investments. 3 Accordingly, the World Health Organization has suggested that prevention is the only sustainable approach for reducing the burden of illness associated with mental disorders.4
There is significant unmet need in children's mental health in particular. Mental disorders are arguably the leading health problems that Canadian children face after infancy, given the estimated 14% prevalence rate in children and given the significant associated long-term distress and disability. 5 It is increasingly evident that treatment services alone cannot reduce the burden of illness.4,6 As well, the understanding that many mental disorders arise during childhood has encouraged a shift toward considering prevention.7,8 Preventing mental disorders requires placing children at the centre of a public mental health strategy.
Given the potential importance of prevention for public mental health, we were curious about the state of Canadian prevention programming relevant to children's mental health. Conduct disorder (CD), anxiety and depression are among the most prevalent mental disorders in children and among the most likely to persist. 5,8 These disorders represent a spectrum of behavioural and emotional problems for children. There is also recent randomized controlled trial (RCT) evidence that these disorders are preventable. …