Implementation of a Novel Epidemiological Surveillance System for Children’s Mental Health and Well-Being in France: Protocol for the National “Enabee” Cross-Sectional Study
Authors: Motreff Yvon , Marillier Maude , Saoudi Abdessattar , Verdot Charlotte , Seconda Louise , Pognon Damien , Khireddine-Medouni Imane , Richard Jean-Baptiste , Kovess-Masfety Viviane , Delorme Richard , Decio Valentina , Perrine Anne-Laure , El Haddad Maria , Gallay Anne , Monnier-Besnard Stéphanie , Regnault Nolwenn ,   Enabee Study Group
Published: May 2024

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.

Objective
This study aims to describe the first step of the implementation of a novel surveillance system in France called Enabee (Etude nationale sur le bien-être des enfants), which focuses on the issue of mental health in children. The system aims to (1) 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, (2) explore their major determinants, and (3) assess mental health care use by this population. To do this, Enabee will rely on results from a recurrent national cross-sectional homonymous study. This paper 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 that 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 the type of school. Up to 4 classes per school were then randomly drawn, and finally, all the pupils within each class were selected. The study covered children from preschool and kindergarten (aged 3 to 6 years, US grading system) to fifth grade (aged 6 to 11 years). Children from first to fifth grades provided a self-assessment of their mental health using 2 validated self-administered questionnaires: the Dominic Interactive (DI) and the KINDL. Parents and teachers completed a web-based questionnaire, including the Strengths and Difficulties Questionnaire. 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 May 2, 2022, to July 31, 2022, in 399 schools across metropolitan France. Teachers completed questionnaires for 5721 pupils in preschool and kindergarten and for 15,263 pupils from first to fifth grades. Parents completed questionnaires for 3785 children in preschool and kindergarten and for 9227 children from first to fifth grades. Finally, 15,206 children from first to fifth grades 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.