Time trends in childhood mental health problems: a 40-year cross-cohort comparison

许多人和专业人士担心，近年来儿童心理健康问题变得越来越普遍。例如，与过去相比，现在有更多的孩子被诊断为患有注意力缺陷多动障碍（ADHD）。然而，这可能是由于教师和医生对这种情况有了更好的了解。了解多动症以及其他儿童心理健康问题（如情绪症状和行为问题）的发病率是否在整体人口中有所增加是很重要的。这需要从未选定的具有代表性的国家样本中获得数据，并以相同的方式进行长期评估。在我们之前的研究中，我们已经表明，近年来，青少年的情绪和行为问题实际上变得越来越普遍。目前我们还不知道是否同样适用于青春期前儿童的心理健康问题。该研究将通过使用1965年至2008年间英国5个大型队列中7岁儿童的心理健康数据来回答这个问题。每项研究都使用了相同或相近的儿童心理健康筛查。另一个重要的问题是如何解释儿童心理健康的变化。很少有研究关注这一点，因为在将不同时间的队列组合在一起时，对于同一个人来说，关于可能的促成因素和心理健康的可比信息很少。青少年心理健康趋势的部分原因是父母心理健康问题的比率增加，青少年饮酒和吸毒的变化，以及日益紧张的教育经历。这种类型的研究现在需要在更年幼的儿童中进行。我们将通过测试五个队列中早期已知风险因素的比率是否发生了变化，以及这些变化如何影响儿童心理健康的趋势来做到这一点。我们将重点关注产前和围产期风险（如产前母亲吸烟、早产和低出生体重）、早期神经发育风险因素（如头部损伤和癫痫）和早期家庭逆境（如父母参与、父母离婚和家庭贫困）的变化。我们的第三个主要目的是测试儿童心理健康问题对儿童以后的健康和幸福的影响是否发生了变化。特别是，我们想看看7岁时心理健康问题的增加是否预示着儿童后期和青春期心理健康问题的增加。我们还想研究对儿童心理社会适应的影响，包括他们的同伴关系和教育成就。这是可能的，因为其中三个队列随着年龄的增长而被跟踪。其中两个队列的儿童中期和青春期的信息现在是可用的，之前的评估是在1965年7岁和20世纪90年代末。纵向结果数据也将很快提供给目前正在接受评估的11岁儿童的最新队列。了解儿童心理健康问题的发生率是否发生了变化，儿童心理健康趋势背后的原因，以及对儿童后期发展的影响，具有重要的实际意义。这些信息对于更好地规划服务、影响国家和地方政策和优先事项以及确定干预目标以改善后代儿童的心理健康至关重要。

Many people and professionals are worried that child mental health problems have become more common in recent years. For example, more children today are diagnosed as having Attention Deficit Hyperactivity Disorder (ADHD) than in the past. However, this could be due to better understanding of the condition by teachers and doctors. It is important to understand whether or not rates of ADHD, and of other child mental health problems such as emotional symptoms and behavioural problems, have actually increased in the population as a whole. This requires data from unselected representative national samples assessed in the same way over time. In our previous research we have shown that emotional and behavioural problems in adolescence have in fact become increasingly common in recent years. At present we don't know whether the same holds true for mental health problems in pre-adolescent children. The study will answer this question by using data on the mental health of seven-year-olds from five large UK cohorts studied between 1965 and 2008. Each study has used identical or closely comparable child mental health screens. Another important issue is what might explain any changes in children's mental health. Very few studies have looked at this, because comparable information about possible contributory factors and mental health is only rarely available for the same individuals when combining cohorts across time. Mental health trends in adolescence are partly explained by increasing rates of parental mental health problems, by changes in youth drinking and drug use, and by increasingly stressful educational experiences. This type of research now needs to be undertaken in younger children. We will do this by testing whether rates of early known risk factors have changed across the five cohorts, and how such changes have contributed to trends in child mental health. We will focus on changes in pre- and peri-natal risks (e.g. prenatal maternal smoking, prematurity and low birth weight), in early neurodevelopmental risk factors (e.g. head injury and epilepsy), and early family adversity (e.g. parental involvement, parental divorce and family poverty).Our third main aim is to test whether the impact of child mental health problems on children's later health and wellbeing has changed. In particular, we want to see whether any increases in mental health problems at age seven foreshadow increases in mental health problems in later childhood and adolescence. We also want to examine the consequences for children's psychosocial adaptation, including their peer relationships and educational success. This is made possible because three of the cohorts are being followed as they grow older. Information from middle childhood and adolescence is now available for two of these cohorts, previously assessed at age seven in 1965 and the late 1990s. Longitudinal outcome data will also soon become available for the most recent cohort of children who are currently being assessed at age eleven.Understanding whether rates of child mental health problems have changed, the reasons behind trends in child mental health, and the consequences for children's later development has important practical consequences. This information in crucial for better planning of services, for influencing national and local policy and priorities, and for identifying targets for intervention to improve the mental health of future generations of children.