JMIR Publications

ABSTRACT

Background:

Children’s mental health - including their well-being - is a major public health concern, as the burden of related disorders may last throughout one’s life. Although epidemiological mental health surveillance systems for children and adolescents have been implemented in several countries, they are sorely lacking in France. This article describes the first step of the implementation of a novel surveillance system in France called Enabee which focuses on the issue of mental health in children.

Objective:

The system aims to i) describe the temporal trends in the population-based prevalence of the main mental health disorders and well-being in children aged 3 to 11 years old, ii) explore their major determinants, and iii) assess mental health care utilization by this population. To do this, Enabee will rely on results from a homonymous national recurrent cross-sectional study. This article presents the protocol for the first edition of this study (called Enabee 2022), as well as initial results regarding participation.

Methods:

Enabee 2022 is a national cross-sectional study which was implemented in French schools in 2022. It used a probabilistic, multistage, stratified, and balanced sampling plan, as follows: first, schools were randomly drawn and stratified according to type of school. Up to four classes per school were then randomly drawn, and finally, all the pupils within each class were selected. The study covered children from pre-school / kindergarten (3 to 6 years old, US grading system) to 5th grade (6 to 11 years). Children from 1st to 5th grade provided a self-assessment of their mental health using two validated self-administered questionnaires: the Dominic Interactive and the KINDL®. Parents and teachers completed a web–based questionnaire including the Strengths and Difficulties Questionnaire (SDQ). Parents also answered additional questions about their parenting attitudes, their own mental health, known social, economic and environmental determinants of mental health in children, and their child’s life habits. Health, education, and family stakeholders were involved in designing and implementing the study as part of a large consultation group.

Results:

Data were collected from 2 May 2022 to 31 July 2022 in 399 schools across metropolitan France. Teachers completed questionnaires for 5,721 pupils in pre-school/kindergarten and for 15,263 pupils from 1st to 5th grade. Parents completed questionnaires for 3,785 children in pre-school/kindergarten and for 9,227 children from 1st to 5th grade. Finally, 15,206 children from 1st to 5th grade completed the self-administered questionnaire.

Conclusions:

Enabee 2022 constitutes the first milestone in the development of a novel national epidemiological surveillance system, paving the way for improved children’s mental health policies in France. The study design, which collected data not only from parents and teachers, but also from children, guarantees the robustness of the study.