Lived Experiences of Diagnostic Shifts in Child and Adolescent Mental Health Contexts: a Qualitative Interview Study with Young People and Parents.

Cliodhna O'Connor, Fiona McNicholas
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引用次数: 8

Abstract

Psychiatric diagnoses are important resources in helping young people and families make sense of emotional or behavioural difficulties. However, the poor reliability of diagnoses in childhood means many young service-users experience their diagnosis being removed, revised or supplemented over time. No previous research has investigated how young service-users experience, understand or respond to alteration of their original diagnosis. The current study adopted a qualitative approach to explore the lived experience of diagnostic shifts in youth mental health contexts. Narrative interviews were conducted with families living in Ireland, who had direct experience of diagnostic shifts. Participants included 21 parents (19 female) and 14 young people (8 female, mean age = 14). Thematic analysis explored the range of interpretations and implications of diagnostic shifts in families' lives, identifying three themes that underpinned participants' narratives. Diverse Trajectories & Experiences outlined the variety of contexts for diagnostic shifts, ways they were communicated to parents and young people, and their clinical consequences. A Process of Readjustment captured processes of emotional and conceptual adaptation that followed a diagnostic shift. Finally, Social Repositioning explored how diagnostic shifts could prompt changes to interpersonal relations, social identity and stigma experiences. The study shows that diagnostic shifts carry significant emotional, social and practical repercussions. While diagnostic shifts may threaten the therapeutic relationship and service-user understanding, they also offer opportunities to enhance young people's self-concept, social relationships and therapeutic engagement. Clinician awareness of the socio-emotional implications of diagnostic shifts is vital to inform sensitive communication and support strategies.

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儿童和青少年心理健康环境中诊断转变的生活经历:一项针对年轻人和父母的定性访谈研究。
精神病诊断是帮助年轻人和家庭理解情绪或行为困难的重要资源。然而,儿童时期诊断的不可靠意味着许多年轻的服务使用者经历了他们的诊断随着时间的推移被删除、修改或补充。以前没有研究调查过年轻的服务使用者如何体验、理解或对他们原来诊断的改变作出反应。本研究采用定性方法探讨青少年心理健康背景下诊断转变的生活经验。叙述性访谈是与生活在爱尔兰的家庭进行的,他们有直接的诊断转变经验。参与者包括21名家长(19名女性)和14名年轻人(8名女性,平均年龄为14岁)。主题分析探讨了家庭生活中诊断转变的一系列解释和影响,确定了支撑参与者叙述的三个主题。不同的轨迹和经验概述了诊断转变的各种背景,他们与父母和年轻人沟通的方式,以及他们的临床后果。“再调整过程”捕捉了诊断转变后的情绪和概念适应过程。最后,社会重新定位探讨了诊断转变如何促进人际关系、社会认同和污名体验的变化。研究表明,诊断的转变会带来重大的情感、社会和实际影响。虽然诊断的转变可能会威胁到治疗关系和服务使用者的理解,但它们也为增强年轻人的自我概念、社会关系和治疗参与提供了机会。临床医生对诊断转变的社会情感影响的认识对于告知敏感的沟通和支持策略至关重要。
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期刊介绍: Research on Child and Adolescent Psychopathology brings together the latest innovative research that advances knowledge of psychopathology from infancy through adolescence. The journal publishes studies that have a strong theoretical framework and use a diversity of methods, with an emphasis on empirical studies of the major forms of psychopathology found in childhood disorders (e.g., disruptive behavior disorders, depression, anxiety, and autism spectrum disorder). Studies focus on the epidemiology, etiology, assessment, treatment, prognosis, and developmental course of these forms of psychopathology. Studies highlighting risk and protective factors; the ecology and correlates of children''s emotional, social, and behavior problems; and advances in prevention and treatment are featured. Research on Child and Adolescent Psychopathology is the official journal of the International Society for Research in Child and Adolescent Psychopathology (ISRCAP), a multidisciplinary scientific society.
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