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REL Midwest Ask A REL Response

January 2018

Question:

What does the research say about the prevalence of trauma and mental health concerns across racial and socioeconomic groups for students?



Response:

Following an established Regional Educational Laboratory (REL) Midwest protocol, we conducted a search for research reports and descriptive studies on the prevalence of student trauma and student mental health concerns across racial and socioeconomic groups. For details on the databases, sources, keywords, and selection criteria used to create this response, please see the Methods section at the end of this memo.

Below, we share a sampling of the publicly accessible resources on this topic. The search conducted is not comprehensive; other relevant references and resources may exist. We have not evaluated the quality of references and resources provided in this response, but offer this list to you for your information only.

Research References

Bethell, C. D., Newacheck, P., Hawes, E., & Halfon, N. (2014). Adverse childhood experiences: Assessing the impact on health and school engagement and the mitigating role of resilience. Health Affairs, 33(12), 2106–2115. Retrieved from https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2014.0914

From the abstract: “The ongoing longitudinal Adverse Childhood Experiences Study of adults has found significant associations between chronic conditions; quality of life and life expectancy in adulthood; and the trauma and stress associated with adverse childhood experiences, including physical or emotional abuse or neglect, deprivation, or exposure to violence. Less is known about the population-based epidemiology of adverse childhood experiences among US children. Using the 2011–12 National Survey of Children’s Health, we assessed the prevalence of adverse childhood experiences and associations between them and factors affecting children’s development and lifelong health. After we adjusted for confounding factors, we found lower rates of school engagement and higher rates of chronic disease among children with adverse childhood experiences. Our findings suggest that building resilience—defined in the survey as ‘staying calm and in control when faced with a challenge,’ for children ages 6–17—can ameliorate the negative impact of adverse childhood experiences. We found higher rates of school engagement among children with adverse childhood experiences who demonstrated resilience, as well as higher rates of resilience among children with such experiences who received care in a family-centered medical home. We recommend a coordinated effort to fill knowledge gaps and translate existing knowledge about adverse childhood experiences and resilience into national, state, and local policies, with a focus on addressing childhood trauma in health systems as they evolve during ongoing reform.”

Bloom, B., Cohen, R. A., & Freeman, G. (2009). Summary health statistics for U.S. children: National Health Interview Survey, 2008. Vital and Health Statistics, 10(244). Retrieved from https://www.cdc.gov/nchs/data/series/sr_10/sr10_244.pdf

From the Introduction: “This report is one in a set of reports summarizing data from the 2008 National Health Interview Survey (NHIS), a multipurpose health survey conducted by the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS). This report provides national estimates for a broad range of health measures for the U.S. civilian noninstitutionalized population of children under 18 years of age. Two other reports in this set provide estimates of selected health measures for the U.S. population and for adults. These three volumes of descriptive statistics and highlights are published for each year of NHIS, and since 1997 have replaced the annual, one-volume Current Estimates series. Estimates are presented for asthma, allergies, learning disability, attention deficit hyperactivity disorder (ADHD), prescription medication use, respondent-assessed health status, school-loss days, usual place of health care, time since last contact with a health care professional, selected measures of health care access and utilization, and dental care.”

Briggs-Gowan, M. J., Ford, J. D., Fraleigh, L., McCarthy, K., & Carter, A. S. (2010). Prevalence of exposure to potentially traumatic events in a healthy birth cohort of very young children in the northeastern United States. Journal of Traumatic Stress, 23(6), 725–733. Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/jts.20593/full

From the abstract: “Prevalence estimates of very young children’s exposure to potentially traumatic events (PTEs) are limited. The study objective was to estimate the lifetime prevalence and correlates of noninterpersonal PTEs and violence exposure in a representative healthy birth cohort (ages 1–3 years) from an urban–suburban region of the United States (37.8% minority, 20.2% poverty). Parents completed 2 surveys approximately 1-year apart. By 24–48 months of age, the prevalence of exposure was 26.3% (14.5% noninterpersonal, 13.8% violence). Exposure was common among children living in poverty (49.0% overall, 19.7% noninterpersonal, 33.7% violence). The most consistent factors associated with exposure were poverty, parental depressive symptoms, and single parenting. Findings underscore the potential for prevention and intervention in early childhood to advance public health and reduce morbidity.”

Note: REL Midwest was unable to locate a link to the full-text version of this resource. Although REL Midwest tries to provide publicly available resources whenever possible, it was determined that this resource may be of interest to you. It may be found through university or public library systems.

Federal Interagency Forum on Child and Family Statistics. (2017). America’s children: Key national indicators of well-being, 2017. Washington, DC: U.S. Government Printing Office. Retrieved from https://eric.ed.gov/?id=ED577338

From the foreword:America’s Children: Key National Indicators of Well-Being, 2017 is a compendium of indicators about our Nation’s young people. The report, the 20th produced by the Forum, presents 41 key indicators on important aspects of children’s lives. These indicators are drawn from our most reliable Federal statistics, are easily understood by broad audiences, are objectively based on substantial research, are balanced so that no single area of children’s lives dominates the report, are measured often to show trends over time, and are representative of large segments of the population rather than one particular group.

The report continues to present key indicators in seven domains: family and social environment, economic circumstances, health care, physical environment and safety, behavior, education, and health.”

Goodman, R. D., Miller, M. D., & West-Olatunji, C. A. (2012). Traumatic stress, socioeconomic status, and academic achievement among primary school students. Psychological Trauma: Theory, Research, Practice, and Policy, 4(3), 252–259. Retrieved from http://psycnet.apa.org/record/2011-18534-001

From the abstract: “Students from lower socioeconomic status (SES) families continue to underachieve within the educational setting; however, little research has examined how psychological trauma may be related to this problem. Using a sample of 5th-grade students from the nationally representative Early Childhood Longitudinal Study, Kindergarten Class of 1998–99 database, we used regression analyses to determine whether traumatic stress and SES influenced achievement. Results showed that low SES and traumatic stress predicted lower educational outcomes. This study has implications for counselors and educators because trauma is often overlooked or misunderstood in children.”

Note: REL Midwest was unable to locate a link to the full-text version of this resource. Although REL Midwest tries to provide publicly available resources whenever possible, it was determined that this resource may be of interest to you. It may be found through university or public library systems.

Jimenez, M. E., Wade, R., Lin, Y., Morrow, L. M., & Reichman, N. E. (2016). Adverse experiences in early childhood and kindergarten outcomes. Pediatrics, 137(2). Retrieved from http://pediatrics.aappublications.org/content/early/2016/01/13/peds.2015-1839

From the abstract: “OBJECTIVE: To examine associations between adverse childhood experiences (ACEs) in early childhood and teacher-reported academic and behavioral problems in kindergarten. METHODS: We conducted a secondary analysis of data from the Fragile Families and Child Wellbeing Study, a national urban birth cohort. Subjects with primary caregiver-reported information on ACE exposures ascertained at 5 years and teacher-reported outcomes at the end of the child’s kindergarten year were included. Outcomes included teacher ratings of academic skills, emergent literacy skills, and behavior. We included 8 ACE exposures on the basis of the original Centers for Disease Control and Prevention Kaiser study and created an ACE score by summing individual adversities. We examined the associations between teacher-reported academic and behavioral outcomes and ACE scores by using logistic regression. RESULTS: In the study sample, 1007 children were included. Fifty-five percent had experienced 1 ACE and 12% had experienced ≥ 3. Adjusting for potential confounders, experiencing ≥ 3 ACEs was associated with below-average language and literacy skills (adjusted odds ratio [AORs]: 1.8; 95% confidence interval [CI]: 1.1–2.9) and math skills (AOR: 1.8, 95% CI: 1.1–2.9), poor emergent literacy skills, attention problems (AOR: 3.5, 95% CI: 1.8–6.5), social problems (AOR: 2.7, 95% CI: 1.4–5.0), and aggression (AOR: 2.3, 95% CI: 1.2–4.6). CONCLUSIONS: In this study of urban children, experiencing ACEs in early childhood was associated with below-average, teacher-reported academic and literacy skills and behavior problems in kindergarten. These findings underscore the importance of integrated approaches that promote optimal development among vulnerable children.”

Kerns, C. M., Newschaffer, C. J., Berkowitz, S., & Lee, B. K. (2017). Brief report: Examining the association of autism and adverse childhood experiences in the National Survey of Children’s Health: The important role of income and co-occurring mental health conditions. Journal of Autism and Developmental Disorders, 47(7), 2275–2281. Retrieved from https://eric.ed.gov/?id=EJ1144386

From the ERIC abstract: “Adverse childhood experiences (ACEs) are risk factors for mental and physical illness and more likely to occur for children with autism spectrum disorder (ASD). The present study aimed to clarify the contribution of poverty, intellectual disability and mental health conditions to this disparity. Data on child and family characteristics, mental health conditions and ACEs were analyzed in 67,067 youth from the 2011-2012 National Survey of Children’s Health. In an income-stratified sample, the association of ASD and ACEs was greater for lower income children and significantly diminished after controlling for child mental health conditions, but not intellectual disability. Findings suggest that the association of ACEs and ASD is moderated by family income and contingent on co-occurring mental health conditions.”

Note: REL Midwest was unable to locate a link to the full-text version of this resource. Although REL Midwest tries to provide publicly available resources whenever possible, it was determined that this resource may be of interest to you. It may be found through university or public library systems.

Larson, S., Chapman, S., Spetz, J., & Brindis, C. D. (2017). Chronic childhood trauma, mental health, academic achievement, and school-based health center mental health services. Journal of School Health, 87(9), 675–686. Retrieved from https://eric.ed.gov/?id=EJ1150153

From the ERIC abstract: “Background: Children and adolescents exposed to chronic trauma have a greater risk for mental health disorders and school failure. Children and adolescents of minority racial/ethnic groups and those living in poverty are at greater risk of exposure to trauma and less likely to have access to mental health services. School-based health centers (SBHCs) may be one strategy to decrease health disparities. Methods: Empirical studies between 2003 and 2013 of US pediatric populations and of US SBHCs were included if research was related to childhood trauma’s effects, mental health care disparities, SBHC mental health services, or SBHC impact on academic achievement. Results: Eight studies show a significant risk of mental health disorders and poor academic achievement when exposed to childhood trauma. Seven studies found significant disparities in pediatric mental health care in the US. Nine studies reviewed SBHC mental health service access, utilization, quality, funding, and impact on school achievement. Conclusion: Exposure to chronic childhood trauma negatively impacts school achievement when mediated by mental health disorders. Disparities are common in pediatric mental health care in the United States. SBHC mental health services have some showed evidence of their ability to reduce, though not eradicate, mental health care disparities.”

Merikangas, K. R., He, J.-P., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., … & Swendsen, J. (2010). Lifetime prevalence of mental disorders in U.S. adolescents: Results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry, 49(10), 980–989. Retrieved from https://eric.ed.gov/?id=EJ944614

From the ERIC abstract: “Objective: To present estimates of the lifetime prevalence of ‘DSM-IV’ mental disorders with and without severe impairment, their comorbidity across broad classes of disorder, and their sociodemographic correlates. Method: The National Comorbidity Survey-Adolescent Supplement NCS-A is a nationally representative face-to-face survey of 10,123 adolescents aged 13 to 18 years in the continental United States. ‘DSM-IV’ mental disorders were assessed using a modified version of the fully structured World Health Organization Composite International Diagnostic Interview. Results: Anxiety disorders were the most common condition (31.9%), followed by behavior disorders (19.1%), mood disorders (14.3%), and substance use disorders (11.4%), with approximately 40% of participants with one class of disorder also meeting criteria for another class of lifetime disorder. The overall prevalence of disorders with severe impairment and/or distress was 22.2% (11.2% with mood disorders, 8.3% with anxiety disorders, and 9.6% behavior disorders). The median age of onset for disorder classes was earliest for anxiety (6 years), followed by 11 years for behavior, 13 years for mood, and 15 years for substance use disorders. Conclusions: These findings provide the first prevalence data on a broad range of mental disorders in a nationally representative sample of U.S. adolescents. Approximately one in every four to five youth in the U.S. meets criteria for a mental disorder with severe impairment across their lifetime. The likelihood that common mental disorders in adults first emerge in childhood and adolescence highlights the need for a transition from the common focus on treatment of U.S. youth to that of prevention and early intervention.”

Pastor, P. N., Reuben, C. A., & Duran, C. R. (2012). Identifying emotional and behavioral problems in children aged 4-17 Years: United States, 2001-2007. National Health Statistics Reports. Number 48. Hyattsville, MD: National Center for Health Statistics. Retrieved from https://eric.ed.gov/?id=ED530166

From the ERIC abstract: “Objectives: This report examines two measures that identify children with emotional and behavioral problems: high scores based on questions in the brief version of the Strengths and Difficulties Questionnaire (SDQ) and a single question about serious (definite or severe) overall emotional and behavioral difficulties. Children were classified into four groups, those with: only high scores on the brief SDQ, only serious overall difficulties, both high scores on the brief SDQ and serious overall difficulties, and neither high scores on brief SDQ nor serious overall difficulties. Children's characteristics, conditions, and service use in these four groups were compared. Methods: Data from the 2001-2007 National Health Interview Survey identified the emotional and behavioral problems, characteristics, conditions, and service use of children aged 4-17 years. Results: Approximately 7% of children had either high scores on the brief SDQ or serious overall difficulties, with 2% having only high scores on the brief SDQ, 3% having only serious overall difficulties, and 2% having both high scores on the brief SDQ and serious overall difficulties. Characteristics of the three groups of children identified with emotional and behavioral problems differed from each other and from children without problems. Children in each of the groups with emotional and behavioral problems, compared with children without problems, were more likely to have developmental conditions and to have used services. Additionally, children with serious overall difficulties (either with or without high scores on the brief SDQ) were more likely to have developmental conditions, receive special education, and use mental health services than children with only high scores on the brief SDQ.”

Porche, M. V., Costello, D. M., & Rosen-Reynoso, M. (2016). Adverse family experiences, child mental health, and educational outcomes for a national sample of students. School Mental Health, 8(1), 44–60. Retrieved from https://link.springer.com/article/10.1007/s12310-016-9174-3

From the abstract: “Exposure to adversity in childhood, including domestic violence, parental mental illness, loss, and poverty, is a known risk factor for long-term physical and mental health problems. This secondary data analysis uses the National Survey of Children’s Health 2011/12 to examine the association between exposure to family adversity and academic outcomes, as mediated by child mental health. The analytic sample included 65,680 children between the ages of six and 17, representative of the US child population. Family adversity, as mediated by child mental health status, was negatively associated with school engagement and positively associated with being retained in grade and being on an Individualized Education Program. Male gender, family economic hardship, living in an unsafe neighborhood, and poor caregiver mental health were additional risk factors. Results suggest the need for improved mental health screening for students who exhibit internalizing and externalizing symptoms.”

Note: REL Midwest was unable to locate a link to the full-text version of this resource. Although REL Midwest tries to provide publicly available resources whenever possible, it was determined that this resource may be of interest to you. It may be found through university or public library systems.

Schilling, E. A., Aseltine, R. H., & Gore, S. (2007). Adverse childhood experiences and mental health in young adults: A longitudinal survey. BMC Public Health, 7(1), 30. Retrieved from https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-7-30

From the background: “Adverse childhood experiences (ACEs) have been consistently linked to psychiatric difficulties in children and adults. However, the long-term effects of ACEs on mental health during the early adult years have been understudied. In addition, many studies are methodologically limited by use of non-representative samples, and few studies have investigated gender and racial differences. The current study relates self-reported lifetime exposure to a range of ACEs in a community sample of high school seniors to three mental health outcomes–depressive symptoms, drug abuse, and antisocial behavior–two years later during the transition to adulthood.”

U.S. Department of Health and Human Services. (2010). The mental and emotional well-being of children: A portrait of states and the nation. The National Survey of Children’s Health. Washington, DC: Author. Retrieved from https://eric.ed.gov/?id=ED530917

From the ERIC abstract: “Children, like adults, may have mental health problems, including depression and anxiety. They may also have behavioral conditions, such as conduct disorders; cognitive disorders, such as autism spectrum disorder; or neurological conditions, such as Tourette Syndrome. Children may also be affected by delays in their physical, cognitive, or emotional development. The 2007 National Survey of Children’s Health asked parents whether their children had ever been diagnosed with, and currently had, any of these seven conditions. This chart book addresses the health and well-being of the population of children whose parents reported that their children had at least one of these conditions. Note, however, that these data are based entirely on parental reports and have not been independently verified; in addition, they only include children whose parents reported that they have been told that they have one of these conditions by a doctor or other health care provider. This chart book presents a range of indicators on the health and well-being of children who have been diagnosed with emotional, behavioral, or developmental conditions on the national level. For each state, this report shows the prevalence of the seven conditions (grouped together) and the major demographic characteristics of children who have at least one of the conditions. Together, these data paint a picture of a large and diverse population of children with multiple, complex needs. These children and their families may need services—including mental and physical health care, special education, and social services and support—from a variety of systems and providers. These analyses provide a useful first step in delineating the relationships among these conditions, children's socioeconomic characteristics, and access to health care. However, much more research is needed to fully understand these complex relationships.”

Additional Organizations to Consult

Data Resource Center for Child & Adolescent Health – http://www.childhealthdata.org

From the website: “The mission of the Data Resource Center for Child and Adolescent Health (DRC) is to advance the effective use of public data on the status of children’s health and health-related services for children, youth and families in the United States.”

The National Child Traumatic Stress Network – https://www.nctsn.org

From the website: “The NCTSN works to accomplish its mission of serving the nation's traumatized children and their families by:

  • Raising public awareness of the scope and serious impact of child traumatic stress on the safety and healthy development of America’s children and youth.
  • Advancing a broad range of effective services and interventions by creating trauma-informed developmentally and culturally appropriate programs that improve the standard of care.
  • Working with established systems of care including the health, mental health, education, law enforcement, child welfare, juvenile justice, and military family service systems to ensure that there is a comprehensive trauma-informed continuum of accessible care.
  • Fostering a community dedicated to collaboration within and beyond the NCTSN to ensure that widely shared knowledge and skills become a sustainable national resource.”

Methods

Keywords and Search Strings

The following keywords and search strings were used to search the reference databases and other sources:

  • Prevalence of mental health

  • Prevalence of adverse childhood experiences

  • National Health Interview Survey

  • National Survey of Children’s Health

  • “health disparities” “children mental health”

  • “health disparities”

Databases and Search Engines

We searched ERIC for relevant resources. ERIC is a free online library of more than 1.6 million citations of education research sponsored by the Institute of Education Sciences (IES). Additionally, we searched IES and Google Scholar.

Reference Search and Selection Criteria

When we were searching and reviewing resources, we considered the following criteria:

  • Date of the publication: References and resources published over the last 15 years, from 2002 to present, were include in the search and review.

  • Search priorities of reference sources: Search priority is given to study reports, briefs, and other documents that are published or reviewed by IES and other federal or federally funded organizations.

  • Methodology: We used the following methodological priorities/considerations in the review and selection of the references: (a) study types—randomized control trials, quasi-experiments, surveys, descriptive data analyses, literature reviews, policy briefs, and so forth, generally in this order, (b) target population, samples (e.g., representativeness of the target population, sample size, volunteered or randomly selected), study duration, and so forth, and (c) limitations, generalizability of the findings and conclusions, and so forth.
This memorandum is one in a series of quick-turnaround responses to specific questions posed by educational stakeholders in the Midwest Region (Illinois, Indiana, Iowa, Michigan, Minnesota, Ohio, Wisconsin), which is served by the Regional Educational Laboratory (REL Region) at American Institutes for Research. This memorandum was prepared by REL Midwest under a contract with the U.S. Department of Education’s Institute of Education Sciences (IES), Contract ED-IES-17-C-0007, administered by American Institutes for Research. Its content does not necessarily reflect the views or policies of IES or the U.S. Department of Education nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.