Children with mental health problems at increased risk of mental disorders as adults

Children with mental health problems were at increased risk of developing a mental disorder as an adult, a new systematic review has found.

The research led by the Murdoch Children's Research Institute and published in Neuroscience and Biobehavioral Reviews, found prevention and early intervention should be targeted at primary school-age children and those who are experiencing symptoms rather than waiting for a diagnosis.

The study found experiencing mental health symptoms before 14 years of age and even as young as five were predictive of mental disorders well into adulthood. Importantly, symptoms rather than a diagnosis in childhood were more strongly linked with having a mental health disorder as an adult. 

The systematic review of 40 studies assessed the influence of mental health problems in childhood and later in adulthood in Australia, the US, New Zealand, The Netherlands, the UK, Finland, France, Brazil and Spain in over 50,000 participants.  

Murdoch Children's Dr Melissa Mulraney said the mental health problems present in childhood were more likely to continue through to adulthood, rather than new disorders being diagnosed. 

The study found children with anxiety were up to 10 times more likely to have an anxiety disorder as an adult and those with mood and depressive symptoms were up to 28 times more likely to have depression as an adult. Similarly, children with behavioural difficulties were at high risk of having ADHD or antisocial personality disorder in adulthood.

The review showed having any psychiatric disorder between nine to 16 years increased the odds of multiple psychiatric disorders in young adulthood sixfold. Children who had bulimia at 13 had 20 times the odds of bulimia as an adult. 

Dr Mulraney said most mental health treatment services were targeted at youth or adults despite symptoms largely emerging in childhood.

One in seven Australian children aged four to 17 years has a mental health disorder. But of these, only half have accessed mental health services. 

Samantha's daughter was diagnosed with severe anxiety, ADHD and autism at age 10.

She said it was a 12-month wait to see a psychologist and occupational and speech therapists and her daughter was still in need of a support worker.

"There is a significant demand for mental health services, which is causing long wait times and delaying treatment," she said. "My daughter would be in a very different place now if she had received medical intervention earlier."

Samantha said it was essential that teachers were better trained to identify mental health problems and more psychologists were needed in schools. 

"Schools aren't properly equipped to support and understand mental health behaviours and triggers," she said.

"Focusing on the early primary school years will much better equip students for the transition to high school. Trying to get my child ready for high school is almost insurmountable now given how late the treatment came."

Murdoch Children's Professor Harriet Hiscock said having a greater understanding of the developmental trajectories of the major mental health disorders from childhood to adulthood was critical to informing the timing of treatment and intervention efforts.

"Given the COVID-19 pandemic has further compounded mental health problems, it's even more vital to assess for mental health problems in young children and to design, evaluate, and implement prevention and early intervention programs for children prior to adolescence," she said.

"Mental health supports for primary school-aged children need strengthening and frontline providers such as GPs, nurses, paediatricians and child psychologists require upskilling to manage child mental health concerns."

Professor Hiscock said a 'community of practice' pilot' in Melbourne's west and north was aiming to improve the capacity of primary and secondary care clinicians to identify and manage infant, child and adolescent mental health presentations, reduce pressure on specialist services and support earlier access to treatment and care.

The findings come after a recent survey by Murdoch Children's found two in five young people experiencing mental health problems and one in five had suicidal thoughts during the COVID-19 pandemic last year in Victoria. School closures also saw four in five teenagers report an increase in school-related stress.

Researchers from the Institute for Social Neuroscience, The University of Melbourne, The Royal Children's Hospital, Deakin University, Women's and Children's Health Network in North Adelaide and the University of Adelaide also contributed to the findings.

Publication

Melissa Mulraney, David Coghill, Caitlin Bishop, Yasemin Mehmed, Emma Sciberras, Michael Sawyer, Daryl Efron and Harriet Hiscock. 'A systematic review of the persistence of childhood mental health problems into adulthood,' Neuroscience and Biobehavioral Reviews. DOI: 10.1016/j.neubiorev.2021.07.030

*The content of this communication is the sole responsibility of Murdoch Children's and does not reflect the views of the NHMRC.

Available for interview

• Dr Melissa Mulraney, Murdoch Children's Group Leader, ISN Innovations
• Professor Harriet Hiscock, Murdoch Children's Group Leader, Health Services
• Samantha, mum of a child with mental health problems 
  
  

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About Murdoch Children's

The Murdoch Children's Research Institute is the largest child health research institute in Australia committed to making discoveries and developing treatments to improve child and adolescent health in Australia and around the world. They are pioneering new treatments, trialling better vaccines and improving ways of diagnosing and helping sick babies, children and adolescents. It is one of the only research institutes in Australia to offer genetic testing to find answers for families of children with previously undiagnosed conditions.

Funding

The study was supported by a project grant (1129957) from the Australian National Health and Medical Research Council (NHMRC). H.H. is supported by an NHMRC Practitioner Fellowship (1136222). E.S. is funded by an NHMRC Career Development Fellowship (1110688) and a veski Inspiring Women's Fellowship. This research was supported by the Victorian Government's Operational Infrastructure Support Program to Murdoch Children's Research Institute.