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Better Mental Health for All: Strengthening Public Health Practice

Better Mental Health for All: Strengthening Public Health Practice Childhood Determinants of Mental Health and Wellbeing Mike Hughes and Chris Nield. Childhood determinants. Influences on mental health in adulthood. Life Course Influences.

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Better Mental Health for All: Strengthening Public Health Practice

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  1. Better Mental Health for All:Strengthening Public Health Practice Childhood Determinants of Mental Health and Wellbeing Mike Hughes and Chris Nield

  2. Childhood determinants

  3. Influences on mental health in adulthood

  4. Life Course Influences 50 % of all diagnosed mental illness has emerged by 14 years of age

  5. The reality In an average class of 30 x15 year old students: • Three could have a mental disorder • Ten are likely to have witnessed their parents separate • One could have experienced the death of a parent • Seven are likely to have been bullied • Six may be self harming

  6. Associated Risk Factors for Poor Mental Health

  7. More risk factors..

  8. Social inequalities as determinants Average rank of test scores at 22, 42, 60 & 120 months by SES of parents and early rank position (Feinstein, 2003)

  9. The impact of childhood living conditions on health in adulthood Lundberg et al (1993) Soc Sci Med; 36:1047-52 Odds ratio Combined model: adjusted for age sex social class

  10. Adverse Childhood Experiences • Abuse • Physical • Verbal • Sexual • Household exposure to • Domestic violence • Mental illness in household • Alcohol abuse • Drug misuse • Incarceration • Parental separation 24.3% : Parental Separation 4.1 % : Drug using household member 47.9%: at least one 1 ACE 17.6%: at least 4 ACEs Bellis et al BMC Medicine 2014

  11. Adverse Childhood Experiences: Cumulative Proportion of Individuals not diagnosed with a Major Disease 35% report major disease • Cancer • Type II Diabetes • Cardio Vascular Disease • Digestive/Liver Disease • Stroke • Respiratory Disease 70% report major disease Aged 18 to 69 (n = 3,885) Bellis et al, Journal of Public Health, 2014 Differences are Independent of Deprivation

  12. Adverse Childhood Experiences - NHS Health Scotland youtube video • https://youtu.be/VMpIi-4CZK0

  13. Perceived level of parental caring and health status in midlife (N=100 Harvard UGs) % sick aged 50 yrs Hi mother Hi father Lo mother Hi Father Hi mother Lo father Lo mother Lo father From Russek and Schwartz Psychosomatic Med 1997 59: 144-149

  14. 1970 cohort: Odds of poor mental health age 26 yrs according to relationship with parents 16 years adjusted for sex, social class and mental health age 16 yrs Nagging/complaining Strict/bossy Don’t understand them Don’t understand me Treat like child Overprotective Generous Helpful Loving/ caring Understanding Allow freedom *** ** *** *** *** *** ** * ***

  15. Early life matters… • Early-life disadvantage has a very long reach throughout life • Clear evidence of reversibility of this phenomenon, by deliberate policies and programs, is hard to find

  16. Why is school readiness important? • Children enter school with marked differences in the cognitive, non-cognitive and social skills needed for success in school environment • Differences predictive of later academic, occupational success • Skills develop cumulatively in a life-long manner- those acquired early form the basis for later skill development

  17. Parenting shapes the emotional and social brain • Epidemiological/ sociological studies • Attachment’ based studies • Neuroscience • Animal studies • Human studies • Mirror neurons • Stress response • Gene expression

  18. How important is very early life? • Most cerebral neurons (100 billion) develop during pregnancy (completed by 18-20 weeks) • Brain development involves synaptic ‘pruning’ - connections compete with one another, least useful die • Most synaptic growth occurs after birth and is much slower than neuron formation • Commences during pregnancy, continues well into 2nd year after birth • 15,000 synapses produced on every neuron in cortex -1.8 million new synapses per second created between two months of gestation and 2 years

  19. Early Childhood Development • Brains are built over time ‘from the bottom up’ • Simple neurological circuits and skills provide the scaffolding for more advanced circuits and skills over time • Early experiences create a foundation for lifelong learning, behaviour, and both physical and mental health • Strong foundation in early years increases probability of positive outcomes and vice versa

  20. Attachment • Early development determined by quality of child’s attachment experiences • Inborn biological instinct that motivates infant to seek closeness to caregivers and to establish communication with them • Involves relationship with caregiver in which the immature brain uses the mature functions of the mature brain to organise its own processes • Based on collaborative communication: secure attachment results when caregiver consistently perceives, responds to child's mental states • Attachment relationships form foundation for development of mind and brain: human connections create neuronal connections.

  21. Healthy emotional development and functioning Positive looks, smiles from parents trigger pleasurable neurotransmitters (opiates) that help brain to grow

  22. Effects of Stress in ECD • Excessive stress disrupts neurochemistry and architecture of the developing brain • Stress can damage developing brain architecture, leading to lifelong problems in learning, behaviour, and both physical and mental health • Children whose relationships are insecure or disorganized have higher stress hormone levels which may alter development of brain circuits, make them less capable of coping effectively with stress as they grow up

  23. Findings from Animal Models • Stress due to neglectful care-giving appears to disturb the higher and mid brain circuits that regulate response to psychosocial threat • Neglectful care-giving produces offspring who as adults are more fearful and exhibit persistent physiological abnormalities • As a consequence they have difficulties trusting others and problems making supportive relationships throughout life

  24. Other Mechanisms Mirror Neurons • Epigenetic phenomena • DNA Methylation • Modification of transcriptome

  25. The infant brain is very plastic and parenting/parent-infant relationship quality is very influential in development

  26. Harvard Centre on the Developing Child http://developingchild.harvard.edu/ • Brain architecture is built through reciprocal experience • Toxic stress derails normal development

  27. Dr Stephen Suomi and team University of Maryland

  28. Regulation of Genetic Activity in Mother Reared (MR) and Peer Reared (PR)Macaques Abusive Up-regulated Down - regulated

  29. Poverty & Parenting and social inequalities

  30. Number of Financial Difficulties during Pregnancy and Parenting age 18 months in the ALSPAC cohort % of Families

  31. Early life experience is an important determinant of mental health throughout life courseQuality of early relationships matters more than material circumstances

  32. Parenting as a mediator of the effect of family economic stress on adjustment (boys) Conger, Conger, Elder et al 1992 parental depression -.46(-.40) school performance .68(.58) nurturing, involved parenting .48 (.04) .39(.41) positive adjustment economic pressures self confidence -.31(-.47) marital conflict peer relationships low hostility involved, warm mother (father) discipline

  33. Other Remediable Determinants in Childhood • Exposure to parental conflict and domestic violence • Bullying at school • Impact of bereavement • Social exclusion: because of poverty, income inequality, racism, homophobia etc

  34. A systems approach Parent Infant Adult Social and fiscal policy Mental health of societies

  35. How to help? • Prevention is best, but remediation is necessary • Reducing child poverty • Financial and employment support • Parenting strategies – coaching, conversation • Sleep and nutrition • Boosting the executive functions of a child in the classroom (KIT, GI Jo(e))

  36. Focus on emotional health and wellbeing (EMHWB) to build resilience in Children and Young People (CYP) • Helps CYP understand and express their feelings, build confidence and emotional resilience and therefore their capacity to learn. • EHWB addresses a number of issues including family breakdown, bereavement, bullying, personal safety, exam pressure, getting on with parents, and emotional and mental health problems • Also helps pupils to access help and support.

  37. Summing up • Determining determinants is not a simple process • Different influences on mental illness and mental wellbeing • Parenting is the number one determinant • But primary cause of problem parenting is poor parental mental health

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