Around one in five Ontario children have a mental health disorder — about the same percentage as in 1983 — but more people now see a need for professional help, according to a province-wide study out of McMaster University.
The 2014 Ontario Child Health Study, which surveyed 10,802 children aged four to 17, found 18 to 22 per cent of people met criteria for at least one mental disorder.
The study is a follow-up to a pioneering McMaster survey from three decades ago that examined the same questions — called the 1983 OCHS —and which found few children were receiving treatment. That study became the gold standard globally for measuring children's mental health and this is the first attempt to repeat the effort.
The current study "depicts high levels of need," said a perspective piece in the Canadian Journal of Psychiatry, which dedicated its entire issue to the 2014 OCHS results.
Researchers pointed to significant gaps in mental health services, and said the study highlights needs for prevention and treatment programs. One third of young people with mental health disorders had seen a specialized professional in the past six months, the study found.
"I see it as a call to action," said Kathy Georgiades, co-principal researcher. "There's a lot of children and youth in our province that are suffering."
Increase in depression and anxiety
While the overall prevalence of mental disorders has not changed since 1983, the study found "fairly large and concerning" shifts among specific disorders and age groups, she said.
Emotional disorders, including depression and anxiety, rose to 13 per cent among 12 to 16 year-olds, up from nine per cent in the 1980s.
The study found increases in hyperactivity among boys aged 4 to 11, up to 15.7 per cent from 8.9 per cent.
Meanwhile, conduct disorder decreased "substantially" among adolescents — particularly boys — to 2.5 per cent from 7.2 per cent.
More likely to see need for help
People are around three times more likely to perceive a need for professional mental health help now, the study found — 18.9 compared to 6.8 per cent.
The authors said it's unclear whether that's because of factors like reduced stigma, better mental health awareness and more willingness to seek help.
One third have mental health care
Around 30 per cent of young people who suffered from mental health problems had contact with a specialized mental health care provider in the past six months, the authors said.
"That gap is astounding," said Georgiades, making the comparison to specialized care for physical disorders: "I don't think it'd be acceptable if ... only 30 per cent of children with diabetes were seeing an endocrinologist."
Around 60 per cent had any kind of mental health contact, through someone like a nurse or pediatrician, and it was most often through school.
It's important that this "broader net" of health professionals and educators can recognize and address mental health issues, Georgiades said, as not everyone will get to see a specialist.
More common in small to medium communities
The study asked people about mood, anxiety and behavioural disorder symptoms over the last six months. It did not look at all mental health disorders, including eating disorders or substance use disorders.
Therefore it's possible overall mental disorder prevalence is higher than one in five, Georgiades said.
Mental disorders were more common in small to medium sized communities, compared to large urban centres and rural areas, the study found. This is a change from the 1980s, when mental disorders were more common among young people in cities, Georgiades said.
Prevalence was lower among people in immigrant families and higher among children living with one or no biological parents, the recent study found.
However, children in immigrant families were "far less likely" to be accessing mental health-related services, Georgiades said.
They did not find a relationship between poverty and mental health prevelance.
Need for regular data collection
The 2014 OCHS surveyed 6,537 families and 484 neighbourhoods across Ontario, and was lead by researchers at the Offord Centre for Child Studies at McMaster University. Georgiades and Michael Boyle were the co-principal investigators.
The original 1983 study used a similar survey design and looked at 3,294 people aged 4 to 16 and 1,869 families.
Having these up-to-date numbers is critical for the province, said Georgiades, in order to make evidence-based decisions about resources and services.
But it's "concerning" they waited 30 years for this data, she said, stressing a need for regular and systemic data collection.
The $8 million study was funded by the Canadian Institutes of Health Research and the Ontario government.
The current data is open access, and Georgiades said she hopes many people will use it.
The findings "an important advance in the current state of knowledge about child and youth mental health in Ontario," wrote Scott Paten in an editorial in the Canadian Journal of Psychiatry.
In his editorial, Patten called the study "one of the most advanced health surveys ever conducted in Canada" and said it's likely the results could be generalized to other Canadian settings.
An article in the Canadian Journal of Psychiatry, lead-authored by Charlotte Waddell, suggested several policy implications from the findings.
"For far too long, Canadians have tolerated an inadequate patchwork of services—which the public may be unaware of until children develop problems and families try to get help," it said.
Georgiades said there needs to be collaboration across sectors to make sure mental health services are reaching children and we need a better understanding of how services are delivered.