Prevention of mental health problems: rationale for a universal approach

Jordana K Bayer ^1*, Harriet Hiscock ², Elise Morton-Allen ¹, Obioha C Ukoumunne ¹ and Melissa Wake ²

¹ Murdoch Childrens Research Institute, Australia
² Centre for Community Child Health, Royal Children's Hospital Melbourne, Australia

^* To whom correspondence should be addressed. E-mail: jordana.bayer{at}mcri.edu.au.

Accepted 7 August 2006

Abstract

Objective: Mental health problems comprise a public health issue affecting up to 20% of children in modern communities. Risk factors for externalising and internalising problems occur in infancy. Infants at high risk live in stressed families with parent mental health problems, substance misuse, relationship conflict, social isolation, financial problems, or infant temperamental difficulty. While current prevention programs target services to high risk groups, targeting can stigmatise families and miss many children in need. The addition of universal prevention programs for all families could address these concerns. This survey assessed prevalence of infants at risk attending a primary care service as a delivery point for universal prevention.

Design: Survey of mothers of six month old infants attending well-child clinics across six government areas of Melbourne, Australia in August- September 2004. A brief survey measured sociodemographic characteristics and the following family risks: maternal depression, anxiety, stress, substance misuse, home violence, social isolation, and infant temperamental difficulty.

Results: The survey was completed by 733 mothers, representing 69% of infant births attending the primary care service. Of these, 39% of infants were classified as at risk for developing mental health problems. The percentage of infants classified at risk was not markedly dissimilar across socioeconomic levels (low 42%, middle 40%, high 35%).

Conclusions: A substantial number of infants attending routine universal primary care are at risk of developing mental health problems. This primary care setting could provide an ideal platform for preventing early externalising and internalising problems, via a universally offered, evidence-based parenting program.

Keywords: child preschool, mental health, primary health care, primary prevention

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