Differences in the diagnosis and treatment decisions for children in care compared to their peers: An experimental study on post-traumatic stress disorder

IF 3.8 3区 心理学 Q1 PSYCHOLOGY, CLINICAL British Journal of Clinical Psychology Pub Date : 2022-06-14 DOI:10.1111/bjc.12379
Rosie McGuire, Sarah L. Halligan, Richard Meiser-Stedman, Lucy Durbin, Rachel M. Hiller
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引用次数: 5

Abstract

Objectives

Despite evidence of high rates of diagnosable mental health difficulties in children in care, there remains ongoing debate around the appropriateness of traditional diagnoses and treatments. The aim of this study was to quantitatively explore whether mental health diagnosis and treatment decision-making differed when a young person was identified as being in care, specifically focused on post-traumatic stress disorder (PTSD). PTSD is a trauma-specific mental health disorder with rates substantially higher in children in care versus their peers.

Methods

Participants were 270 UK mental health professionals who completed an online survey. Participants were randomized to receive one of two vignettes, which were identical in their description of a teenage boy experiencing PTSD symptoms, except in one he was in foster care and in the other he lived with his mother. Participants were asked to select a primary diagnosis, treatment approach, and potential secondary diagnosis.

Results

Professionals were twice as likely to choose a primary diagnosis of PTSD and a National Institute for Clinical Excellence (NICE)-recommended PTSD treatment when randomized to the mother vignette versus the foster carer vignette. Selecting PTSD as the primary diagnosis made clinicians three times more likely to select a NICE-recommended treatment for PTSD. Developmental trauma was the most common ‘diagnosis’ for both groups, although this led to different treatment decisions.

Conclusions

In the context of PTSD, we found children in care face diagnosis and treatment decision-making biases. Practice implications are discussed.

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与同龄人相比,护理儿童的诊断和治疗决定的差异:创伤后应激障碍的实验研究
尽管有证据表明,在接受护理的儿童中,可诊断的精神健康困难比例很高,但围绕传统诊断和治疗的适当性仍存在争议。本研究的目的是定量探讨当一个年轻人被确定为创伤后应激障碍(PTSD)的护理时,心理健康诊断和治疗决策是否会有所不同。创伤后应激障碍是一种创伤特异性心理健康障碍,在接受护理的儿童中,其发病率明显高于同龄人。方法参与者是270名英国心理健康专业人员,他们完成了一项在线调查。参与者被随机分成两组,其中一组描述的是一个经历创伤后应激障碍症状的十几岁男孩,除了一组是寄养儿童,另一组是和母亲住在一起。参与者被要求选择初步诊断、治疗方法和潜在的二次诊断。结果:当被随机分为母亲组和寄养组时,专业人员选择PTSD的初步诊断和国家临床卓越研究所(NICE)推荐的PTSD治疗的可能性是前者的两倍。选择创伤后应激障碍作为主要诊断使临床医生选择nice推荐的创伤后应激障碍治疗方法的可能性增加三倍。发展性创伤是两组中最常见的“诊断”,尽管这导致了不同的治疗决定。结论在PTSD背景下,我们发现儿童在护理中面临诊断和治疗决策偏差。讨论了实践意义。
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来源期刊
CiteScore
5.80
自引率
3.20%
发文量
57
期刊介绍: The British Journal of Clinical Psychology publishes original research, both empirical and theoretical, on all aspects of clinical psychology: - clinical and abnormal psychology featuring descriptive or experimental studies - aetiology, assessment and treatment of the whole range of psychological disorders irrespective of age group and setting - biological influences on individual behaviour - studies of psychological interventions and treatment on individuals, dyads, families and groups
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