Header

UZH-Logo

Maintenance Infos

Interventions to improve children's access to mental health care: a systematic review and meta-analysis


Werlen, Laura; Gjukaj, D; Mohler-Kuo, Meichun; Puhan, Milo A (2019). Interventions to improve children's access to mental health care: a systematic review and meta-analysis. Epidemiology and Psychiatric Sciences:e58.

Abstract

<jats:sec id="S2045796019000544_sec_a1">AimsMental disorders in children are a significant and growing cause of morbidity worldwide. Although interventions to help overcome barriers along the pathway to accessing health care for children with mental disorders exist, there is no overview of randomised controlled trials (RCTs) on these interventions as yet. This study aimed to systematically identify RCTs of interventions to improve access to mental health care for children and synthesise them using a conceptual framework of access to health care.</jats:sec><jats:sec id="S2045796019000544_sec_a2" sec-type="methods">MethodsThis systematic review was performed following a predefined protocol registered with PROSPERO (ID: CRD42018081714). We searched the databases MEDLINE, EMBASE, PsycINFO and CENTRAL for RCTs up to 15 May 2019 using terms related to the concepts ‘young people,’ ‘mental disorders’ and ‘help-seeking interventions’ and scanned reference lists from relevant studies. Two reviewers independently screened all identified articles in a two-stage process, extracted results on outcomes of interest (knowledge, attitudes, intentions, help-seeking, accessing care, mental health outcomes and satisfaction), assessed the risk of bias and conducted meta-analyses where deemed appropriate.</jats:sec><jats:sec id="S2045796019000544_sec_a3" sec-type="results">ResultsAfter screening 5641 identified articles, 34 RCTs were eligible for inclusion. Eighty per cent of universal school-based interventions measuring knowledge (<jats:italic>n</jats:italic> = 5) and 67% measuring attitudes (<jats:italic>n</jats:italic> = 6) reported significantly better results compared with controls on those outcomes, whereas 20% measuring access to care (<jats:italic>n</jats:italic> = 5) and none measuring mental health outcomes (<jats:italic>n</jats:italic> = 7) did. In contrast, 71% of interventions targeting at-risk individuals (<jats:italic>n</jats:italic> = 21) reported better access to care compared with controls, while just 33% (<jats:italic>n</jats:italic> = 6) did for mental health outcomes. For satisfaction with care, this proportion was 80% (<jats:italic>n</jats:italic> = 5). Meta-analyses of interventions measuring initial appointment attendance yielded combined odds ratios of 3.11 (2.07–4.67) for appointment reminder interventions and 3.51 (2.02–6.11) for treatment engagement interventions. The outcomes for universal school-based interventions were heterogeneous and could not be summarised quantitatively through meta-analysis.</jats:sec><jats:sec id="S2045796019000544_sec_a4" sec-type="conclusion">ConclusionsTo have a population-level effect on improving children's access to mental health care, two-stage interventions that identify those in need and then engage them in the health-care system may be necessary. We need more evidence on interventions to target contextual factors such as affordability and infrastructural barriers.</jats:sec>

Abstract

<jats:sec id="S2045796019000544_sec_a1">AimsMental disorders in children are a significant and growing cause of morbidity worldwide. Although interventions to help overcome barriers along the pathway to accessing health care for children with mental disorders exist, there is no overview of randomised controlled trials (RCTs) on these interventions as yet. This study aimed to systematically identify RCTs of interventions to improve access to mental health care for children and synthesise them using a conceptual framework of access to health care.</jats:sec><jats:sec id="S2045796019000544_sec_a2" sec-type="methods">MethodsThis systematic review was performed following a predefined protocol registered with PROSPERO (ID: CRD42018081714). We searched the databases MEDLINE, EMBASE, PsycINFO and CENTRAL for RCTs up to 15 May 2019 using terms related to the concepts ‘young people,’ ‘mental disorders’ and ‘help-seeking interventions’ and scanned reference lists from relevant studies. Two reviewers independently screened all identified articles in a two-stage process, extracted results on outcomes of interest (knowledge, attitudes, intentions, help-seeking, accessing care, mental health outcomes and satisfaction), assessed the risk of bias and conducted meta-analyses where deemed appropriate.</jats:sec><jats:sec id="S2045796019000544_sec_a3" sec-type="results">ResultsAfter screening 5641 identified articles, 34 RCTs were eligible for inclusion. Eighty per cent of universal school-based interventions measuring knowledge (<jats:italic>n</jats:italic> = 5) and 67% measuring attitudes (<jats:italic>n</jats:italic> = 6) reported significantly better results compared with controls on those outcomes, whereas 20% measuring access to care (<jats:italic>n</jats:italic> = 5) and none measuring mental health outcomes (<jats:italic>n</jats:italic> = 7) did. In contrast, 71% of interventions targeting at-risk individuals (<jats:italic>n</jats:italic> = 21) reported better access to care compared with controls, while just 33% (<jats:italic>n</jats:italic> = 6) did for mental health outcomes. For satisfaction with care, this proportion was 80% (<jats:italic>n</jats:italic> = 5). Meta-analyses of interventions measuring initial appointment attendance yielded combined odds ratios of 3.11 (2.07–4.67) for appointment reminder interventions and 3.51 (2.02–6.11) for treatment engagement interventions. The outcomes for universal school-based interventions were heterogeneous and could not be summarised quantitatively through meta-analysis.</jats:sec><jats:sec id="S2045796019000544_sec_a4" sec-type="conclusion">ConclusionsTo have a population-level effect on improving children's access to mental health care, two-stage interventions that identify those in need and then engage them in the health-care system may be necessary. We need more evidence on interventions to target contextual factors such as affordability and infrastructural barriers.</jats:sec>

Statistics

Citations

Dimensions.ai Metrics

Altmetrics

Downloads

11 downloads since deposited on 08 Jan 2020
11 downloads since 12 months
Detailed statistics

Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Psychiatric University Hospital Zurich > Department of Child and Adolescent Psychiatry
04 Faculty of Medicine > Epidemiology, Biostatistics and Prevention Institute (EBPI)
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > Epidemiology
Health Sciences > Public Health, Environmental and Occupational Health
Health Sciences > Psychiatry and Mental Health
Uncontrolled Keywords:Public Health, Environmental and Occupational Health, Epidemiology, Psychiatry and Mental health
Language:English
Date:17 October 2019
Deposited On:08 Jan 2020 10:50
Last Modified:29 Jul 2020 12:12
Publisher:Cambridge University Press
ISSN:2045-7960
OA Status:Hybrid
Publisher DOI:https://doi.org/10.1017/s2045796019000544
Official URL:https://www.cambridge.org/core/services/aop-cambridge-core/content/view/87A33E5BB718F1126A07DF43D2A7D374/S2045796019000544a.pdf/interventions_to_improve_childrens_access_to_mental_health_care_a_systematic_review_and_metaanalysis.pdf
PubMed ID:31619313

Download

Hybrid Open Access

Download PDF  'Interventions to improve children's access to mental health care: a systematic review and meta-analysis'.
Preview
Content: Published Version
Filetype: PDF
Size: 13MB
View at publisher
Licence: Creative Commons: Attribution 4.0 International (CC BY 4.0)