Factors associated with children and young people’s mental health in the English-speaking Caribbean region: Systematic review and narrative synthesis

PLOS ONE RESEARCH ARTICLE Factors associated with children and young people’s mental health in the English-speaking Caribbean region: Systematic review and narrative synthesis Shaun Liverpool ID1,2*, Yasmin Draoui1, Judea Tucker1, Brent Pereira3, Jamal Prescod4, Michael Owen1, Catherine Trotman4 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, United Kingdom, 2 Evidence Based Practice Unit, Anna Freud National Centre for Children and Families, London, United Kingdom, 3 Department of Counselor Education, The Chicago School of Professional Psychology, Chicago, IL, United States of America, 4 Faculty of Social Sciences, University of the West Indies, Cave Hill, St Michael, Barbados * Abstract OPEN ACCESS Citation: Liverpool S, Draoui Y, Tucker J, Pereira B, Prescod J, Owen M, et al. (2023) Factors associated with children and young people’s mental health in the English-speaking Caribbean region: Systematic review and narrative synthesis. PLoS ONE 18(3): e0282666. https://doi.org/ 10.1371/journal.pone.0282666 Editor: A. K. M. Alamgir, Access Alliance Multicultural Health and Community Services: Access Alliance, CANADA Received: December 12, 2022 Accepted: February 20, 2023 Published: March 8, 2023 Copyright: © 2023 Liverpool et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the manuscript and its Supporting Information files. Funding: The author(s) received no specific funding for this work. Competing interests: The authors have declared that no competing interests exist. Background Studies conducted in regions consisting of low and middle income and developing countries often report high prevalence of mental health problems among children and young people (CYP). To identify some of the contributing factors we examined the available evidence from research in one such setting. Methods Multiple academic databases and grey literature sources were searched until January 2022. We then identified primary research focusing on CYP’s mental health in the English-speaking Caribbean region. Data was extracted and summarized to form a narrative synthesis of the factors associated with CYP’s mental health. The synthesis was then organised according to the social-ecological model. The Joanna Briggs Institute’s critical appraisal tools were used to examine the quality of the reviewed evidence. The study protocol was registered with PROSPERO, CRD42021283161. Results From 9684 records, 83 publications representing CYP ages 3 to 24 years from 13 countries met our inclusion criteria. The evidence was varied in quality, quantity and consistency for 21 factors associated with CYP’s mental health. Adverse events and negative peer to peer and sibling relationships were consistently associated with mental health problems, while helpful coping strategies were associated with better mental health. There were mixed findings for age, sex/gender, race/ethnicity, academic level, comorbidity, positive affect, health risks behaviours, religion/prayer, parent history, parent to parent and parent to child relationships, school/employment, geography and social status. There was also some limited PLOS ONE | https://doi.org/10.1371/journal.pone.0282666 March 8, 2023 1 / 23 PLOS ONE Abbreviations: CYP, Children and young people; YP, Young people. Factors associated with children and young people’s mental health in the English-speaking Caribbean region evidence for associations between sexuality, screen time and policies/procedures and CYP’s mental health. At least 40% of the evidence contributing to each of the factors was judged as high quality. Conclusion Individual, relationship, community and societal factors may influence CYP’s mental health outcomes in the English-speaking Caribbean. Knowledge of these factors is useful to inform early identification and early interventions. More research is needed to explore inconsistent findings and understudied areas. Introduction The mental health and wellbeing of children and young people (CYP) continues to be a global public health concern [1–3]. International evidence suggests that at least 1 in 10 CYP experience symptoms of a mental health problem with 50% of these occurring by age 14 years and 75% by age 24 years [4]. Common internalising and externalising presentations include anxiety, depression and conduct or behaviour problems with high rates of comorbidities among CYP [1, 5]. Notably, some studies highlight disparities in prevalence of mental health problems among CYP identifying as specific minority ethnic groups and those from low and middle income and developing countries [6]. The higher prevalence rates among these groups have mainly been attributed to poverty and social disadvantages but less is known about other risk and protective factors [7, 8]. Although previous reviews suggest some similarities in risk factors for mental health problems in low and middle income and developing countries and those found in high income countries [8, 9], other studies suggest that the factors associated with mental health may be complex and bi-directional and further influenced by culture [10, 11]. Therefore, experts consistently call for more research to provide a deeper understanding of regional differences [12]. The existing literature identified a wide range of demographic, personal, familial, school, social and interpersonal characteristics as key factors associated with CYP’s mental health [13, 14] and subsequent service utilisation [15]. More specifically these factors include age, gender, ethnicity, family composition, urbanisation, family and friend support, social isolation, peer victimization, physical/sexual abuse or emotional neglect and parent psychopathology [16, 17]. In more severe cases additional factors include substance use, comorbid disorders and intellectual disabilities [18, 19]. As for marginalised groups, based on ethnicity or sexuality, experiences of discrimination were also identified as having a negative association with mental health [9, 20]. Conversely, improved self-esteem and optimism have been associated with positive mental health and resilient outcomes [13, 21]. While acknowledging the efforts of researchers in the previous reviews, the evidence from some regions like the English-speaking Caribbean is still under-represented. The English-speaking Caribbean is made up of about 18 countries or territories, of which the majority are classed as low and middle income or developing status [22–24]. Population statistics suggest that this region consists mainly of families of African, mixed-race, Indian or indigenous origins [25, 26]. Studies conducted in the English-speaking Caribbean re (...truncated)