Prevalence of mental health and behaviour problems among adolescents in the English-speaking Caribbean: systematic review and meta-analysis

Objective

Children and young people (CYP) from low-and-middle-income and developing countries are at risk of poor mental health and wellbeing. Yet these regions are generally under-resourced in terms of mental health services. As a first step to inform service planning and delivery in the English-speaking Caribbean we pooled the available evidence to estimate the prevalence of common mental health problems.

Methods

A comprehensive search of CINAHL, Cochrane Library, EMBASE, MEDLINE, PsycINFO, LILACS, and Web of Science databases, supplemented by grey literature searches was performed until January 2022. Studies conducted in the English-speaking Caribbean that reported prevalence estimates of mental health symptomology or diagnoses in CYP were included. The Freeman-Tukey transformation was applied to calculate the weighted summary prevalence under a random-effects model. Subgroup analyses were also performed to observe emerging patterns in the data. Studies were quality assessed using the Joanna Briggs Institute Prevalence Critical Appraisal Checklist and the GRADE approach. The study protocol was registered with PROSPERO, CRD42021283161.

Results

33 publications from 28 studies representing 65,034 adolescents from 14 countries met the eligibility criteria. Prevalence estimates ranged from 0.8 to 71.9% with most subgroup estimates between 20 and 30%. The overall pooled prevalence of mental health problems was 23.5% (95% CI 0.175-0.302; I2 = 99.7%). There was limited evidence of significant variation in prevalence estimates among subgroups. The quality of the body of evidence was judged as moderate.

Conclusion

It is estimated that between 1 in 4 and 1 in 5 adolescents in the English-speaking Caribbean experience symptoms of mental health problems. These findings highlight the importance of sensitisation, screening, and provision of appropriate services. Ongoing research identifying risk factors and validating outcome measures is also needed to inform evidence-based practice.

Supplementary Information

The online version contains supplementary material available at 10.1007/s44192-023-00037-2.

Factors associated with children and young people's mental health in the English-speaking Caribbean region: Systematic review and narrative synthesis

BACKGROUND

Studies conducted in regions consisting of low and middle income and developing countries often report high prevalence of mental health problems among children and young people (CYP). To identify some of the contributing factors we examined the available evidence from research in one such setting.

METHODS

Multiple academic databases and grey literature sources were searched until January 2022. We then identified primary research focusing on CYP's mental health in the English-speaking Caribbean region. Data was extracted and summarized to form a narrative synthesis of the factors associated with CYP's mental health. The synthesis was then organised according to the social-ecological model. The Joanna Briggs Institute's critical appraisal tools were used to examine the quality of the reviewed evidence. The study protocol was registered with PROSPERO, CRD42021283161.

RESULTS

From 9684 records, 83 publications representing CYP ages 3 to 24 years from 13 countries met our inclusion criteria. The evidence was varied in quality, quantity and consistency for 21 factors associated with CYP's mental health. Adverse events and negative peer to peer and sibling relationships were consistently associated with mental health problems, while helpful coping strategies were associated with better mental health. There were mixed findings for age, sex/gender, race/ethnicity, academic level, comorbidity, positive affect, health risks behaviours, religion/prayer, parent history, parent to parent and parent to child relationships, school/employment, geography and social status. There was also some limited evidence for associations between sexuality, screen time and policies/procedures and CYP's mental health. At least 40% of the evidence contributing to each of the factors was judged as high quality.

CONCLUSION

Individual, relationship, community and societal factors may influence CYP's mental health outcomes in the English-speaking Caribbean. Knowledge of these factors is useful to inform early identification and early interventions. More research is needed to explore inconsistent findings and understudied areas.

Children and young people's mental health in the English-speaking Caribbean: a scoping review and evidence map

Internationally, there is a wealth of research suggesting that many children and young people experience mental health problems. However, the evidence from low- and middle-income countries and developing nations is generally limited. This scoping review aimed to add to the body of evidence by providing an overview of the available research literature on children and young people's (CYP's) mental health in the English-speaking Caribbean region. Seven key online academic databases and grey literature sources were searched until January 2021. Records were screened against predefined criteria and suitable articles retrieved. Relevant information was then charted and summarized. All stages of the review were informed by expert consultations. Ninety-six articles from 7901 records met the inclusion criteria. Most of the studies were conducted in Jamaica, Trinidad and Tobago and Barbados while fewer studies reported findings from St Lucia, The Bahamas and St Kitts and Nevis. Research funding was not frequently reported, and participants were predominantly recruited in education settings. There was a substantial focus on depressive symptoms and behaviour problems. Little or no research was available for younger children (< 12), complex clinical cases or commonly under-represented groups. Four unique interventions were identified of which one intervention showed no significant impact on CYP. Among the commonly used outcome measures only the Jamaican Youth Checklist (teacher-reported), Beck Depression Inventory-II, Brief Screen for Depression, Trinidad and Tobago Youth Survey and Minnesota Multiphasic Personality Inventory had evidence for psychometric validity within this population. We discuss future directions, implications and recommendations for research, practice, policy and training.

Prevalence and Correlates of Depression, Anxiety, and Suicidality Among High School Students: A National Study

The current study aimed to estimate the prevalence of depression, anxiety, and suicidality and their correlated factors among high school students in Jordan. A descriptive cross-sectional correlational research design was used. Data were collected using self-reported questionnaires completed by students attending high schools in Jordan. Data show that anxiety and depression are prevalent among adolescents and are associated with higher risk of suicide and disease prevalence. Twenty-seven percent of the variance in suicidality is explained by anxiety and depression. This finding indicates that the most significant predictor of suicidality is anxiety and depression among high school students. Results show that mental health issues are a genuine general health issue among high school students. Health care professionals should routinely screen for mental health problems among young people. Mental health and well-being advancement programs should be coordinated and directed by all parties involved in youth mental health. [Journal of Psychosocial Nursing and Mental Health Services, 59(8), 43-51.].

A psycho-social analysis of depression, anxiety and student engagement: Effects of parenting practices

The extent to which students' level of depressive and anxiety symptoms and student engagement were predicted by parental emotional support, monitoring and harsh parenting was investigated using a series of multiple regression analyses. Grade six students from public primary schools (n = 293; 49% females, 51% males; mean age = 10 years) in Barbados completed the Revised Children's Anxiety and Depression Scale, a Parenting Questionnaire and an adapted Student Engagement scale. Students' level of depressive symptoms were predicted by parental emotional support and harsh parenting, but not by parental monitoring. With the exception of harsh parenting, neither parental emotional support nor parental monitoring were significant predictors of the anxiety levels of students. Student engagement was predicted by all three types of parenting practices. Limitations, recommendations for future research and practical implications of the study are discussed.

Validation of the Kutcher Adolescent Depression Scale in a Caribbean student sample

BACKGROUND

Research on depression among Caribbean children has been limited by a lack of valid and reliable measures. We addressed this problem by exploring the internal consistency reliability and the concurrent and discriminant validity of the Kutcher Adolescent Depression Rating Scale (KADS) among a wide cross-section of the student population attending elementary schools in Jamaica and Barbados.

METHODS

Students enrolled in grade 6 in a cross-section of schools in Jamaica and Barbados were invited to participate in the study. Schools included a balance of government-funded public schools and privately funded preparatory schools. All schools that were invited to participate accepted, and all grade 6 classrooms in each school were sampled. The following instruments were administered to the students during the fall semester of 2015: KADS, Adolescent Depression Rating Scale (ADRS), major depression disorder subscale of the Revised Children's Anxiety and Depression Scale (RCADS), and state and trait anxiety visual analogue scales.

RESULTS

In total, 759 children (376 girls [49.5%] and 363 boys [47.8%]; in 20 cases [2.6%], sex was missing) with a mean age of 10.7 (standard deviation 0.66) years (median 11.0 yr) took part in the study. Overall, the KADS had an acceptable degree of reliability (α = 0.76). The instrument had reasonably good concurrent validity, as evidenced by strong correlations with scores on the ADRS (r = 0.62) and the major depression disorder subscale of the RCADS (r = -0.61). It had acceptable discriminant validity, as shown through low correlations with the state and trait anxiety visual analogue scales (r = 0.21 and 0.18, respectively). This pattern of results suggests that a large part (37%) of the variance underlying the KADS assesses depression, and a smaller degree of the variance (3%-4%) measures a conceptually similar but distinct concept.

INTERPRETATION

The KADS is a reliable and valid measure for assessing depressive symptoms among Jamaican and Barbadian elementary school students. The sample may not be representative of all Caribbean children.

Help-Seeking Among Jamaican Adolescents

Underutilization of mental health resources is a well-documented problem. Little is known about the help-seeking attitudes of Jamaican adolescents. The aim of this study was to examine predictors of psychological help-seeking attitudes among Jamaican adolescents ( N = 339). The individual determinants of health service utilization model suggests that several factors contribute to health care attitudes and utilization, including illness factors (beliefs about etiology of mental health issues and level of somatization), predisposing factors (gender, age, and opinions about mental illness), and enabling factors (socioeconomic status and geographical location). Data were analyzed using hierarchical multiple regression. Results indicated that for this population, predisposing factors predict attitudes toward seeking professional mental health care. Specifically, increased age, decreased authoritarian beliefs, and increased benevolence predicted more positive attitudes toward seeking psychological help. After controlling for gender, these predisposing factors accounted for 14.6% of the variance. Interestingly, neither illness factors nor enabling factors predicted help-seeking attitudes. Practical implications for public health policy, education, and stigma reduction programs are discussed.