The crisis caused by the COVID-19 pandemic has highlighted a pressing need and strong demand—from healthcare and education professionals, as well as parents and young people—for prevention, support, and care regarding the decline in well-being among children and adolescents. Furthermore, monitoring conducted by Santé publique France in hospital emergency departments during the health crisis confirmed a higher number of admissions of children and adolescents for psychological disorders.

It is against this backdrop that the President of the Republic announced in the spring of 2021 the launch of a national study on children’s well-being. The study was designed for children under 11, for whom data on the subject was lacking or very limited. It thus complements existing epidemiological surveillance systems for adolescents and young adults (EnCLASS, i-Share, etc.).

The objectives of the Enabee study are:

• To acquire new scientific knowledge on the subject and fill a data gap

• To produce results useful for improving public policies on prevention and care, and ultimately to provide a living environment conducive to children’s well-being, extending into their adult lives.

A need highlighted in November 2021 by Ombudswoman Claire Hédon in her annual report on children’s rights: Children’s Mental Health: The Right to Well-being “The mental health of young people must no longer be a taboo.”

This study is also part of a much broader work program focused on mental health, a priority area for Santé publique France that has intensified with the emergence of COVID-19. As a reminder, the initial work began as early as the first lockdown (COVIPREV mental health study, Conféado study), and was expanded with the monthly publication of bulletins dedicated to “Mental Health” and the launch of a prevention campaign targeting adults with a focus on adolescents.

Adolescent mental health was a central theme throughout 2022 (the #JenParleA campaign).

Objectives

This study on children’s well-being is intended to be repeated at regular intervals. It will enable us to measure and describe the various dimensions of mental well-being and the difficulties encountered, and to identify the circumstances and associated factors.

The study will enable the regular production of health indicators for children aged 3 to 11 in France in order to:

• estimate the level of children’s well-being;

• to estimate the prevalence (number of children affected) of the various mental health challenges encountered (emotional, oppositional, inattention/hyperactivity);

• to describe associated risk factors and protective factors, including social determinants;

This study will support public authorities in implementing strategies for the prevention and care of children.

Study Population

The study includes children enrolled in elementary school (from kindergarten to fifth grade) in public and private schools under contract with the state, in mainland France for this first edition. More specific mental health issues, such as certain intellectual developmental disorders or autism spectrum disorders, are excluded from the scope of the study. These are addressed by other information systems that already help identify care needs and better understand the mechanisms underlying the onset of these disorders.

Study Methodology

Schools, and then classrooms, were randomly selected from the DIAPRE survey database (Anonymous Individual Data from the First Level of the National Education System). All students in the randomly selected classrooms were invited to participate.

To provide the most accurate assessment of children’s well-being and the factors that may affect it, the study is based on responses from the three pillars: “Child,” “Parents,” and “Teacher.”

• Children in grades 1 through 5 participated in a classroom session led by two authorized and trained interviewers. Their interactive questionnaire focused on their well-being, their reactions to certain situations, any anxieties they might have, and their relationships with other children. The teacher also completed a short questionnaire regarding their perception of the strengths and challenges of each child participating in the study, as well as certain aspects of their learning. Finally, a parent or adult living with the child on a daily basis was invited to complete a questionnaire online or by phone regarding their health and that of their child, their lifestyle (such as extracurricular activities), their family environment (siblings, etc.), and their perception of the COVID-19 pandemic…

• For preschool-aged children, only parents and teachers were surveyed.

Study Results

Mental health of children aged 6 to 11

Obtained by cross-referencing information from three sources (parents, teachers, and children), the Enabee results show that 13% of elementary school children have a probable mental health disorder (probable emotional disorder, probable oppositional defiant disorder, or probable attention-deficit/hyperactivity disorder). The prevalence rate is comparable to those observed in other European countries for the same age group in 2010 and 2017. These initial baseline indicators, which will be supplemented by further analyses in the coming months, enable better monitoring of children’s mental health and well-being and thus contribute to the development of public policies.

• Learn more about the results

Mental health of children aged 3 to 6

Based on a representative sample of over 2,600 school-aged children in mainland France, combining the perspectives of parents and teachers, the study reveals that 8.3% of children aged 3 to 6 exhibit at least one type of probable mental health difficulty that impacts their daily lives.

These findings confirm that, starting in early childhood—a critical period of child development—it is essential to strengthen the psychosocial skills that will serve as levers to promote mental health. This objective is part of the national multisectoral strategy for developing psychosocial skills in all children and youth, launched in 2022.

• Learn more about the findings

Bullying and Aggressive Behaviors Among Children Aged 6 to 11

The objective of this summary is to describe the individual and contextual characteristics associated with behaviors that may constitute bullying among elementary school children in mainland France.

• Read the results

• Read the press release

Screen time among children aged 3 to 11

New analyses of screen exposure among children aged 3 to 11 attending preschool and elementary school in mainland France provide, for the first time, a representative overview of children’s screen exposure during their leisure time. While screens can offer many opportunities, their excessive use and the impact of this use on children’s health and development raise concerns. The results show that in 2022, nearly all children aged 3 to 11 were exposed to at least one type of screen, and screen time increased with age. They also highlight the role of parents in managing children’s screen exposure and the impact of social inequalities. The data collected helps shed light on the extent of children’s screen use and confirms the importance of preventive measures and parenting support.

• Learn more about the findings

• Read the press release

Seeking care for mental health issues, including learning difficulties

These Enabee 2022 data provide the first documentation in mainland France of healthcare utilization for mental health issues, including learning difficulties, among children aged 6 to 11. Our findings reveal frequent use of mental health and rehabilitation specialists for these issues, with more than one in five children in the overall sample having consulted a professional due to these difficulties in the year preceding the survey. However, our findings highlight that approximately half of the children identified by the study as having probable mental health difficulties did not seek care, and that this access to care is socially unequal. Our findings call for a necessary improvement in access to mental health care for children aged 6–11.

• Read the survey results: Access to care for mental health difficulties, including learning difficulties, among schoolchildren in grades 1 through 5 in mainland France

Feedback on the consultation process

As part of the launch of the National Study on Children’s Well-being (Enabee), Santé publique France organized a consultation process with stakeholders involved in the study and its implementation (healthcare professionals, parent-teacher associations, teachers’ unions, school principals, and teachers).

• Learn more: National Study on Children’s Well-being (Enabee) “Feedback on the consultation process for the first edition of the study, from December 2021 to June 2023

Regulatory Framework and Data Rights

The study has obtained:

• A favorable opinion from the Ethics and Scientific Committee for Research, Studies, and Evaluations in the Health Sector (CESREES) (decision of 10/14/21)

• Authorization from the National Commission on Informatics and Liberties (CNIL) (decision DR-2022-009 of January 7, 2022)

• A favorable opinion from the National Council for Statistical Information (CNIS)

• The compliance opinion and the label of general interest and statistical quality, awarded by the Label Committee by delegation from the President of the CNIS.

Participation in the Enabee study is not mandatory, and refusal to participate has no impact on relations with participants or the French Ministry of National Education. In accordance with Articles 49 et seq. of Law No. 78-17 of January 6, 1978, on Information Technology, Data Files, and Civil Liberties, participants have the right to access, rectify, and erase their data, as well as the right to object to and restrict its processing.

Survey Timeline

The study was launched in 2022. A pilot phase of the study was conducted in January 2022 in approximately twenty schools across four departments within the Tours-Orléans and Créteil school districts. The study was rolled out across mainland France between May and July 2022.

Two governance bodies

The design, implementation, and analysis of the study’s results are supported by two governing bodies.

A scientific committee

This committee is tasked with defining the objectives, the methodological framework, and the synergy with existing studies. It is composed of child psychiatrists, psychologists, physicians, and specialists in child development and learning disabilities, as well as epidemiologists, statisticians, and specialists in education and social sciences.

List of members

• Corinne ALBERTI, Research Director – AP-HP, Inserm

• Arnaud CACHIA, Professor of Cognitive Neuroscience – University of Paris

• Julie CHASTANG, General Practitioner, Associate Professor, Sorbonne University

• Laurent CHAZELAS, Psychologist, French Ministry of Education

• Richard DELORME, Child Psychiatrist – AP-HP

• Cédric GALERA, Child Psychiatrist – Bordeaux University Hospital, Inserm

• Christophe GAULD, Child Psychiatrist, Hospices Civils de Lyon

• Emmanuelle GODEAU, Professor and Researcher – University of Toulouse III

• Pascale HAAG, Psychologist - EHESS

• Nicolas HENCKES, Sociologist – CNRS

• Caroline HURON, Member of the Scientific Council of the French Ministry of Education

• Viviane KOVESS, Honorary Professor of Psychiatry

• Gilles LAZIMI, General Practitioner – Romainville Health Center

• Maria MELCHIOR, Research Director - Inserm

• Franck RAMUS, Research Director – CNRS

• Alexandra ROUQUETTE, Associate Professor of Biostatistics, Inserm

• Rebecca SHANKLAND, University Professor of Psychology - Lumière Lyon 2 University

• Xavier THIERRY, Demographer – INED

• Anne VACHEZ-GATECEL, Psychomotor Therapist, AP-HP

• Jaqueline WENDLAND, Professor of Psychology, Paris-Ci University

A steering committee

This committee ensures that the survey’s objectives align with the expectations for informing public policy decisions regarding prevention and the care of children and youth. It also oversees the proper conduct of the study.

It is coordinated by Santé publique France and comprises representatives from Santé publique France, the Directorate General for School Education, the Directorate for Evaluation, Forecasting, and Performance, the Directorate General for Health, the Directorate for Research, Studies, Evaluation, and Statistics, as well as representatives from civil society, particularly parent-teacher associations and teacher representatives.

Establishment of a consultation process

Santé publique France is involving stakeholders from the health, education, and family sectors in this project with the threefold objective of:

• Conduct the survey under the best possible conditions.

• Share the results and discuss the recommendations that may arise regarding support, prevention, and care for children’s mental health.

• Improve the study framework with a view to conducting it on a regular basis.

Three levels of consultation were conducted:

• The study’s design was guided by a steering committee and a scientific committee (see previous paragraph).

• The conditions for conducting and ensuring the success of the survey were developed and discussed with the assistance of a consultation group, comprising key representatives from health sector stakeholders (Afpen, API, SFPEADA, CNGE, Ascomed, SNIES-UNSA Education, SNICS-FSU), national education (SNMSU-UNSA Education, SNALC, SNUipp-FSU, Sgen-CFDT, CGT éduc, SNE), and family (HCFEA, UNAF, Unaape, APEEL, and PEEP).

• The study’s findings are shared with all stakeholders in the consultation process who wish to receive them, as well as with the relevant ministries, to discuss opportunities for improving public policies regarding prevention and care.

What the study is not

The study does not provide individual diagnoses.

The scientifically validated measurement tools used in the questionnaires do not allow for individual medical diagnoses. Therefore, there are no plans to provide individual and systematic feedback to the children or adults surveyed.
However, if the responses of certain children appear to indicate significant vulnerabilities in their emotional well-being, the information will be forwarded to school health services, which can then verify it.

The study is not a means of identifying children’s profiles from early childhood.

The data is pseudonymized, preventing any means of identifying children during the analyses and communications that will be conducted. This is a cross-sectional study; children will be surveyed only once (different children in subsequent rounds). We will then track only medical use, if parents consent.

The study is not a study on children’s well-being in the school setting.

The scope of the Enabee study’s investigation into well-being covers the child’s entire environment: family, school, extracurricular activities, etc. No analysis will be conducted by school. It complements national surveys on the school climate, such as those conducted by the French Ministry of Education.

This study is not a study on academic learning practices.

The National Student ID (INE number) is not collected.
No linkage will be made between the results of the Enabee study and the data on children’s academic skills, as reported by teachers in the national assessments conducted by the French Ministry of Education in first and second grade.

For more information: see the FAQ section on enabee.fr