ACQ_Vol_11_no_3_2009

that refugee children and young people’s responses to extremely adverse situations may be normal are also raised. It is suggested that the child and adolescent refugee population has high rates of poor psychological outcomes, including depression, anxiety, and post-traumatic stress disorder, but the reported rates vary across different studies. Some studies reviewed in this article argued that, despite these poor psychological outcomes, many of the refugee children functioned well at school in their new country and demonstrated resilience during all stages of the migration process. A positive relationship with at least one parent and environmental support from teachers are identified as protective factors for positive mental health outcomes. Risk factors for poor mental health outcomes included separation from caregivers, combat experience or inability of parents to cope with stress. The author discusses the importance of supporting families in the early stages of resettlement and discusses four types of interventions to address mental health needs. Investigation of risk factors for mental health problems in preschool children Robinson, M., Oddy, W. H., Li, J., Kendall, G. E., DeKlerk, N. H., Silburn, S. R., et al. (2008). Pre and postnatal influences on preschool mental health: A large-scale cohort study. Journal of Child Psychology and Psychiatry , 49 (10), 1118–1128. Kate Desborough This article investigates risk factors for mental health problems among pre-school children. The authors utilised behavioural data from the Western Australian Pregnancy Cohort Study to examine a range of antenatal, perinatal and postnatal risk factors and their influence on problem behaviours in early childhood. The multiple risk factors for childhood behavioural problems were analysed together within a prospective pregnancy cohort to eliminate issues of bias, reliability and validity. Almost 2,870 children were available for longitudinal follow-up, with 69% of children participating at 2 years and 76% participating at 5 years of age. Research data were collected at 18 and 34 weeks gestation, at birth, and at 1, 2, 3 and 5 years of age. Child mental health was assessed using the Child Behaviour Checklist (CBCL), which provided measures of overall behaviour in addition to internalising and externalising behaviours. Results indicated that multiple stress events, such as smoking, ethnicity, and economic hardship during pregnancy were significant antenatal risk factors for child mental health. Lower gestational age and male gender, as well as the presence of “baby blues” in mothers postnatally were found to indicate greater risk of mental health morbidity. Some protective effect on children’s mental health status included having more siblings and access to breastfeeding for longer periods. These results provide a greater understanding of the determinants of child mental health problems and highlight the need to intervene in the antenatal, perinatal and postnatal periods to support positive mental health in early childhood.

Childhood predictive factors in adult depression McCarty, C. A., Alex Mason, W. A., Kosterman, R., Hawkins, J, D., Lenguna, L. J., McCauley, E. (2008). Adolescent school failure predicts later depression among girls. Journal of Adolescent Health , 43 , 180–187. Angela Clarke and Camille Vickerson This article outlines a study that traced the origins and permutations of depression in 808 participants from age 10 to 21. Participants were mainly from low socioeconomic and high crime areas, and almost half the group came from single-parent homes. The retention rate to age 21 was 95%. The authors selected a “cascade” model to map factors that may contribute to adult depression. This model proposes that a dysfunction in one domain of adaptive behaviour spills over to influence another domain and so on. The potential depressive factors that were initially considered were depression, low school achievement, and social and conduct problems at the age of 10. The authors assessed maladaptive factors evident in adolescence, including school failure, delinquency, and social problems, and determined their contribution to a major depressive episode (MDE) in early adulthood. Questionnaires were used as assessment tools. The cascade effect for depression was found in girls but not in boys. For girls, depression and low academic achievement at age 10 predicted poor schooling in adolescence, with high school failure leading to MDE at age 21. However, the cascade model did not explain the findings that, for girls, conduct problems at age 10 directly correlated with MDE at age 21. For boys, early childhood factors were predictive of maladaptive adolescent behaviours such as school failure, delinquency and social problems – but these did not contribute to MDE at age 21. The authors proposed two possible explanations for the identified gender differences in the risk for depression. As conduct problems and school failure are relatively atypical and less accepted for girls than for boys, when present they may signal more impaired functioning and hence have more severe consequences. It is possible that both boys and girls with conduct problems and school failures have vulnerability. However girls become more prone to internalising problems while boys’ vulnerability manifests more broadly in externalising behaviours, substance use, etc. In contrast to findings from other studies, the authors did not identify a link between early social problems and MDE in adulthood. The study also found no link in boys between early conduct disorders and MDE in adulthood, even though many studies have found early conduct problems in boys to be predictive of later depression. From a speech pathologist’s perspective, a major limitation of this study is that there was no investigation of the role of language impairment on the development of depression, low academic achievement, conduct problems or social problems. The authors only broadly acknowledged this by suggesting that alternative constructs or measures could account for the relationship between poor adaptation in childhood and adolescence, and depressive symptoms in young adulthood.

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ACQ Volume 11, Number 3 2009

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