Children & Mental Health: Part Two

HOST:  We now continue our conversation with Ben Zablotsky, health statistician with the Division of Health Interview Statistics on children’s mental health in the United States.

HOST:  You mentioned social media and the Internet – what about more traditional environmental issues that might contribute to mental health issues among children, such as family structure.  Does NCHS have any data on how family structure, including maybe divorce, might impact mental health?

BEN ZABLOTSKY:  So in the past, the National Survey of Children’s Health was run out of our center, and we did have some questions about family structure as it relates to whether a parent had divorced or separated.  And we looked at this within kind of the lens of “stressful life event.”  And we do know generally that, yes, children who experience the stressful life events which can include changes to the family structure have been associated with higher rates of mental health conditions.  But other things that we can look at now right within the NHIS have to do with general adversity that a child might be dealing with as it relates to food security or the availability of health resources.  And so those items are also associated with mental health and actually in 2021, we have a longer list of stressful life events that are being asked of parents that can then be looked at in the lens of health.  And that could be something that is worth exploring further.

HOST:  In a general sense, are there any groups of children at higher risk than others at developing mental illness?

BEN ZABLOTSKY:   So I would certainly say again that older children are more likely to experience some of these internalizing mental health disorders that talked about in terms of depression and anxiety.  Certainly there are children who are dealing with a more adverse living situation who have a higher chance of developing a mental health disorder, but some conditions genetically are actually more likely to occur in boys than girls.  So you see that autism spectrum disorder is an example of that, you see higher rates of ADHD among boys versus girls.  And generally when someone has accessibility to services, you might see higher rates of diagnosis because they are able to see someone who can actually say “Oh yes, that is what this child has.  Here’s a treatment plan we can move forward with.”

HOST:  You mentioned autism and ADHD.  Thirty, forty years ago you didn’t really hear about these conditions.  There’s some that might think that this might be over-diagnosed since they’re relatively new conditions.  Do you have any data about that?

BEN ZABLOTSKY:   So the prevalence of autism spectrum disorder has changed over the years because the criteria for defining the condition itself has changed.  So a lot of the increase you saw in some more recent years have actually been just that – that it wasn’t necessarily as difficult to get a diagnosis based on the criteria of the DSM – but I think there’s also a lot to be said about the awareness of these conditions.  And there have been campaigns within the CDC itself to increase awareness of developmental disabilities generally, and I think that also attributes quite a bit to the increased rate that we’ve seen.

HOST:   And we can certainly have a whole separate podcast on those topics alone – maybe we’ll wait till your next publication on that.  Are there any other topics you’d like to discuss before we sign off?

BEN ZABLOTSKY:   When we’re talking about mental health I think it’s certainly worth talking about mental health within the context of COVID-19 and how the NHIS can capture that.  I think one of the challenges of the NHIS is that it is a very large survey, but it’s also cross-sectional so it’s not possible to follow children longitudinally.  But what we can do is look at estimates that come out of 2019 and come out of 2020 and start to get a picture of how things might be changing for children in this age of COVID-19.  And some things we can look at or just access to care and potentially the use of telemedicine to receive services.  You know, I’ve talked a lot about treatment generally – a lot of the treatment in 2019, you know looking at the 2019 data, was face-to-face treatment that these individuals were receiving.  But a lot of times, you know, a lot of treatment is received through the schools and with schools being virtual, it’s quite likely that some children have lost out in some of the care they normally receive.  So I want to certainly look at that avenue of research moving forward because there’s a lot that’s happened obviously and one thing we don’t want to lose sight of is how children’s mental health have been affected.

HOST:  Well you raise a good point, because with the shuttering of schools and the isolation felt by some children and the disadvantages some children have, are you planning to directly look at the correlation between virtual learning and mental health issues that were tied to the pandemic?

BEN ZABLOTSKY:   So that’s one thing that’s tricky to look at within our survey ’cause we don’t have a lot of data on the specific schools the children are attending and the resources they had prior to COVID and receiving.  But I certainly think that understanding various services – and we ask questions about special education-related services – we have to understand how those might have changed and certainly will have changed when we are dealing with something like virtual schooling.

HOST:  Well that also would be a great topic for its own podcast so thanks very much Ben.

BEN ZABLOTSKY:   No problem – my pleasure.