Browsing by Subject "Child mental health"

Background: In Kenya, approximately 14.5% of children and youth meet criteria for a mental disorder. Despite this high burden, research is very limited related to mental health problems this population. Research is needed on the measurement of child mental health problems and on the risk and protective factors associated with these conditions.

Objectives: (1) Evaluate a set of survey items, chosen from both standardized measures and locally developed items, to identify those that that best differentiate between children with and without mental health problems. (2) Identify and explore important individual- and family-level influences on child mental health.

Methods: Individual surveys and semi-structured interviews were administered to members (1-2 caregivers, 1 child age 8-17) of 22 families living in Eldoret, Kenya. We evaluated differences in survey item endorsement between children with and without mental health problems to identify the best performing items. We used mixed-methods analysis of semi-structured interview transcripts and associated rating scores to explore differences between children with and without mental health problems on a variety of family-level variables.

Results: Following an extensive cultural adaptation process, fourteen of 26 survey items were successful in differentiating between children with and without mental health problems. Successful survey items were all drawn from standardized measures; no locally developed items were successful. All family-level variables (e.g., overall family functioning, couples’ relationship quality, parent-child relationship quality, and caregiver mental health) were strongly associated with child mental health outcomes, evidenced by large effect sizes ranging from 0.86 to 4.16. Subsequent qualitative analysis identified specific components of these variables likely contributing to the large numerical differences in scores.

Conclusions: The results of this study both suggest that standardized measures are appropriate for use in this population and highlight the importance of cultural adaptation before implementing standardized assessment tools. Additionally, the results indicate that the family environment is a promising target for interventions aiming to reduce mental health problems in Kenyan children.

As health systems continue to implement task shifting models to overcome health access barriers and inequity, it is critical to understand the experiences of lay individuals in these new roles. This is particularly true for lay counselors who provide mental health services. This study sought to understand lay counselor experiences through the lens of identity, stress, motivation, burnout, and self-efficacy. Semi-structured interviews and focus group discussions were conducted with three groups of lay counselors with varying levels of counseling experience from a family therapy program in Eldoret, Kenya. Using thematic analysis, emergent themes were explored to characterize counselor experiences and inform task shifting implementation improvements. Such research provides crucial insight so that future interventions can improve support of lay providers.

Most research on the effects of economic hardship on children and parents has only considered the effects of income poverty, while ignoring the roles of two other dimensions of economic hardship - subjective financial stress and material deprivation. In this dissertation, I fill that gap in the literature by examining the effects of these underexamined dimensions of economic hardship on children's social-emotional outcomes from an international perspective. I also expand on the extant literature by examining the effects of economic hardship on parenting at the community, rather than the family, level. Together, the three chapters of this dissertation add a more nuanced and global perspective to a growing body of literature on the multiple dimensions of economic hardship and their impacts on children and parents.

The first chapter examines the multiple possible manifestations of economic hardship at the family level and their associations with children's social-emotional outcomes. Using data from the Millennium Cohort Study, a nationally representative longitudinal study of children born between 2000 and 2001 in the United Kingdom, I find that half of the families who experienced economic hardship were not income poor, but nevertheless experienced material deprivation, subjective financial stress, or both. Moreover, all manifestations of economic hardship, including those without income poverty, were associated with higher levels of behavior problems for children. I interpret these findings to indicate that income poverty is a necessary but insufficient measure of economic hardship and that future research on the effects of economic hardship should consider all of the possible manifestations of economic hardship.

The second chapter more deeply investigates the association between material deprivation and children's social-emotional outcomes holding income constant. I use data from the Parenting Across Cultures Project to identify whether the association between material deprivation and children's behavior problems found in the first paper is also observable among families in nine diverse countries in Europe, North and South America, Africa, and Asia. I find that even when income remained stable, parents' perceived material deprivation was associated with children's externalizing behavior problems. I also find that parents' disciplinary practices explain a small but significant share of the association between parents' perceived material deprivation and children's behavior problems. There were no differences in these associations between mothers and fathers or between high- and low- and middle-income countries. These results provide further evidence that material deprivation influences children's social-emotional outcomes at any income level and suggest that this association is significant in diverse political, cultural, and economic contexts.

The third chapter examines the effect of economic hardship on parenting behavior at the community, rather than family, level. Using longitudinal state-level US administrative data on mass layoffs and child maltreatment investigations, this chapter tests whether economic shocks at the state level are associated with community-wide increases in child maltreatment. I show that job losses are associated with a significant increase in investigations for physical abuse, but not in the overall rate of investigations. Moreover, job losses also predict an increase in the share of reports that was substantiated. These findings underscore the need to consider economic hardship at the community level in addition to the family level when studying economic disparities in children's outcomes and experiences.