Children and young people’s mental health in the English-speaking Caribbean: a scoping review and evidence map

Liverpool et al. Child and Adolescent Psychiatry and Mental Health https://doi.org/10.1186/s13034-021-00435-w (2021) 15:82 Child and Adolescent Psychiatry and Mental Health Open Access REVIEW Children and young people’s mental health in the English‑speaking Caribbean: a scoping review and evidence map Shaun Liverpool1,2* , Brent Pereira3, Malika Pollard4, Jamal Prescod4 and Catherine Trotman4 Abstract Internationally, there is a wealth of research suggesting that many children and young people experience mental health problems. However, the evidence from low- and middle-income countries and developing nations is generally limited. This scoping review aimed to add to the body of evidence by providing an overview of the available research literature on children and young people’s (CYP’s) mental health in the English-speaking Caribbean region. Seven key online academic databases and grey literature sources were searched until January 2021. Records were screened against predefined criteria and suitable articles retrieved. Relevant information was then charted and summarized. All stages of the review were informed by expert consultations. Ninety-six articles from 7901 records met the inclusion criteria. Most of the studies were conducted in Jamaica, Trinidad and Tobago and Barbados while fewer studies reported findings from St Lucia, The Bahamas and St Kitts and Nevis. Research funding was not frequently reported, and participants were predominantly recruited in education settings. There was a substantial focus on depressive symptoms and behaviour problems. Little or no research was available for younger children (< 12), complex clinical cases or commonly under-represented groups. Four unique interventions were identified of which one intervention showed no significant impact on CYP. Among the commonly used outcome measures only the Jamaican Youth Checklist (teacher-reported), Beck Depression Inventory-II, Brief Screen for Depression, Trinidad and Tobago Youth Survey and Minnesota Multiphasic Personality Inventory had evidence for psychometric validity within this population. We discuss future directions, implications and recommendations for research, practice, policy and training. Keywords: Child, Adolescent, Young adult, Mental health, Caribbean region, Minority groups Background Mental health problems have consistently been identified as one of the main causes of overall disease burden and one of the primary drivers of disability worldwide [1–3]. Among children and young people (CYP), 10–20% experience mental health problems [4–6]. The evidence also suggests that 50% of these mental health problems begin by age 14 and 75% by age 24 [4, 7], with anxiety and *Correspondence: 1 Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK Full list of author information is available at the end of the article behavioural problems being among the most common [6, 8]. In addition, suicide, self-harm and other internalising and externalising problems have continued to increase in recent years [4, 8–10]. Previous studies also suggest that CYP’s mental health problems tend to co-occur with other mental or physical health problems and present adverse outcomes in adulthood [9–11]. To fully develop a global mental health perspective, experts advocate for evidence from specific sub-populations [12]. According to the United Nations statistics around 90% of CYP live in low- and middle-income countries [13]. Researchers have identified several risk factors associated with mental health in these countries. Some risk factors © The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Liverpool et al. Child and Adolescent Psychiatry and Mental Health (2021) 15:82 include problems in physical health and nutritional status of the child, being raised in institutions, severe physical punishment, academic difficulties, bullying in schools and family dysfunction [5]. Although risk factors may be common across low- and middle-income countries, there is potential that mental health prevalence may vary, owing to the influence of culture on the identification and interpretation of symptoms [14, 15]. As a result, further investigations of smaller regions could broaden our understanding with implications for the development and implementation of tailored services [16, 17]. Other well-documented issues affecting this population have been stigma and the lack of resources which limit the chances for mental health difficulties to be identified and treated [18, 19]. However, with the advancement of technology [20] and its acceptance by children and young people [21], this phenomenon could be revisited with new lens. Notably, in the last decade, there has been growing concerns about increasing mental health problems in the Caribbean region [22]. A regional study reporting data from nine Caribbean countries on adolescents age 10–18 indicated that 1 in 6 (17%) adolescents saw themselves as sad, angry or irritated [23]. Country specific data also highlighted a 7.4% rate of depression among CYP in Jamaica [24], and 14% in Trinidad and Tobago [25]. Another study conducted in Jamaica, The Bahamas, St Kitts and Nevis and St Vincent and the Grenadines revealed that among the sample of n = 1955 adolescents nearly half of the sample (52.1%) reported mild to severe symptoms of depression and a further 29.1% reported moderate to severe symptoms [26]. A systematic review of the Caribbean literature also confirmed that the incidence of depression as well as the severity of symptoms and outcomes were more common during early and middle adolescence [27]. Another systematic review on general health, conducted almost a decade ago and concentrated on adolescents 10–19 years, identified 40 articles on adolescent mental health [28]. That study used a multisystem framework and explored risk (e.g., age, presence of chronic illness) and protective (e.g., family, religiosity) factors associated w (...truncated)