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Debate: Where to next for universal school-based mental health interventions? Addressing the mental health crisis among young people in low- and middle-income countries 辩论:以学校为基础的普遍心理健康干预措施下一步走向何方?解决低收入和中等收入国家年轻人的精神健康危机。
IF 6.8 3区 医学 Q1 PEDIATRICS Pub Date : 2024-12-07 DOI: 10.1111/camh.12752
Bronwyne Coetzee, Maria Loades

In their paper, Birrell et al. (Child and Adolescent Mental Health, 2025) are rightly concerned about the future of universal school-based mental health interventions. They highlight the successes and failings of these interventions and demonstrate that there is still much to learn about their potential in preventing or mitigating the onset of common mental health conditions like anxiety, depression, trauma and substance use. But encouragingly, and thanks in part to the potential these interventions hold for addressing the mental health gap in low and middle-income countries (LMIC), the authors advise that we as researchers need to take a step back in order to take a better step forward. They suggest that instead of abandoning ship altogether, we should critically examine the shortcomings of these interventions in their current format and work more closely with young people themselves to design and deliver interventions, which have long-term benefits for their communities. In this paper, we want to emphasise the urgency with which these interventions, developed in this way, are needed in LMIC. We emphasise the need to co-develop, adapt, test and evaluate school-based interventions, and the potential they hold for reducing the burden of mental health care in resource-constrained settings.

在他们的论文中,Birrell等人(儿童和青少年心理健康,2025)正确地关注了普遍的以学校为基础的心理健康干预的未来。它们突出了这些干预措施的成功和失败,并表明它们在预防或减轻焦虑、抑郁、创伤和药物使用等常见精神健康状况发生方面的潜力仍有很多东西需要学习。但令人鼓舞的是,部分由于这些干预措施在解决低收入和中等收入国家(LMIC)的心理健康差距方面具有潜力,作者建议我们作为研究人员需要退后一步,以便更好地向前迈出一步。他们建议,我们不应该完全放弃,而应该批判性地审视这些干预措施目前形式的缺点,并与年轻人自己更密切地合作,设计和实施对他们的社区有长期利益的干预措施。在本文中,我们想强调的是,这些干预措施,以这种方式发展,是低收入和中等收入国家需要的紧迫性。我们强调需要共同开发、调整、测试和评估以学校为基础的干预措施,以及它们在资源有限的环境中减轻精神卫生保健负担的潜力。
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引用次数: 0
The moderation effect of mental health services use on the relationship between exposures to adverse childhood experiences and mental health outcomes among US adolescents 在美国青少年中,心理健康服务的使用对不良童年经历暴露与心理健康结果之间关系的调节作用。
IF 6.8 3区 医学 Q1 PEDIATRICS Pub Date : 2024-12-05 DOI: 10.1111/camh.12745
Lyoung Hee Kim, Seung Joo Lee, So Young Ahn

Background

The prevailing exposure to Adverse Childhood Experiences (ACEs) among youth is associated with adolescents' mental health. However, few studies have examined whether receiving help from mental health services affects mental health outcomes among adolescents with ACEs. Therefore, this study examines the moderated effects of mental health services use on the relationship between exposures to ACEs and mental health outcomes among US adolescents.

Methods

The sample was restricted to adolescents aged 11–17 using data from the National Health Interview Survey (NHIS) from 2019, 2021, and 2022. Multivariate logistic regressions and descriptive analyses were performed to estimate the moderation effect of mental health services use.

Results

Using mental health services buffered the associations between ACEs and severe anxiety and depressive symptoms. Receiving counseling/therapy moderated the impact of ever living with an individual who had severe anxiety (Adjusted Odds Ratio, AOR: 0.58, p < .05) and depressive symptoms (AOR: 0.38, p < .01) among adolescents. Furthermore, counseling/therapy moderated the effect of ever living with an individual with a history of alcohol or drug abuse on severe depressive symptoms (AOR: 0.49, p < .05) and the effect of being a victim or witness of violence on severe anxiety symptoms (AOR: 0.45, p < .01). In addition, taking prescription medication moderated the effect of the experience of incarcerated family members on severe anxiety symptoms (AOR: 0.41, p < .05).

Conclusion

Our findings suggest that policy and practice need to encourage access to mental health care for vulnerable adolescents with ACEs to reduce the detrimental effect of their experiences on their mental health problems.

背景:青少年普遍接触不良童年经历(ace)与青少年心理健康有关。然而,很少有研究调查接受心理健康服务的帮助是否会影响ace青少年的心理健康结果。因此,本研究考察了心理健康服务的使用对美国青少年接触不良经历和心理健康结果之间关系的调节作用。方法:样本限于11-17岁的青少年,使用2019年、2021年和2022年全国健康访谈调查(NHIS)的数据。采用多变量logistic回归和描述性分析来估计心理健康服务使用的调节作用。结果:使用心理健康服务可以缓冲不良经历与严重焦虑和抑郁症状之间的关联。结论:我们的研究结果表明,政策和实践需要鼓励有严重焦虑的弱势青少年获得精神卫生保健,以减少他们的经历对他们心理健康问题的有害影响。
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引用次数: 0
Letter to the editor: ‘To seclude or not to seclude, is that the question?’ A commentary on Yurtbasi et al. (2024) 致编辑的信:"隐居还是不隐居,这是一个问题吗?对 Yurtbasi 等人(2024 年)的评论。
IF 6.8 3区 医学 Q1 PEDIATRICS Pub Date : 2024-11-26 DOI: 10.1111/camh.12741
Chaim Huijser, Nick Goddard
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引用次数: 0
Editorial: Advancing equity, diversity and inclusion through culturally sensitive collaboration and training 社论:通过具有文化敏感性的合作与培训促进公平、多样性和包容性。
IF 6.8 3区 医学 Q1 PEDIATRICS Pub Date : 2024-10-24 DOI: 10.1111/camh.12734
Gonzalo Salazar de Pablo
<p>Welcome to the November 2024 issue of <i>Child and Adolescent Mental Health (CAMH)</i> Journal.</p><p><i>Child and Adolescent Mental Health (CAMH)</i> is committed to advancing equity, diversity and inclusion, and improving the mental health of children and young people living in challenging circumstances. The CAMH 2024 Special Issue ‘Equity, Diversity and Inclusion in Child and Adolescent Mental Health’, included a variety of papers on this topic such as the intergenerational consequences of racism (Simela et al., <span>2024</span>), the effect of socioeconomic inequalities (Pearce et al., <span>2024</span>) and the impact of youth disadvantages and vulnerability on social inclusion (Renner, Rowland, Hutchinson, & Toumbourou, <span>2024</span>).</p><p>To further advance knowledge on this field, the current issue includes papers evaluating other vulnerable populations, such as children and adolescents exposed to substance misuse, or suffering from substance use disorders (Carrasco-Garrido et al., <span>2024</span>), and children and adolescents who are transgender or ‘gender diverse’ (Whittle, Moore, & Stallard, <span>2024</span>). In the first study, Carrasco-Garrido et al. (<span>2024</span>) found that the nonmedical use of prescription opioids, novel psychoactive substances and other illicit psychoactive drugs was a risk factor for nonmedical use of benzodiazepines and Z-hypnotics in male and female adolescents; while the use of cannabis predicted the nonmedical use of benzodiazepines and Z-hypnotics in female adolescents only. The second study (Whittle et al., <span>2024</span>) found that being transgender or ‘gender diverse’ was associated with higher rates of self-harm, poorer peer relationships, less prosocial behaviour and greater interference with friendships and leisure activities, and adverse impact in the classroom.</p><p>Mental health services need to be accessible, culturally competent and responsive to the diverse needs of all young people (McGorry et al., <span>2022</span>). While significant progress has been made in understanding the mental health challenges faced by some populations of vulnerable young people, there remains a pressing need for further research and open discussions about the barriers to accessing mental health services and care. These barriers can manifest as practical challenges, including financial constraints, travel difficulties or childcare responsibilities but can also be due to systemic and structural factors. Such challenges are especially significant for those living in poverty, those with vulnerable family circumstances, individuals impacted by racism and discrimination, and those children and adolescents with neurodevelopmental conditions or learning disabilities. Research should focus on addressing these systemic barriers, with a view to developing solutions that make mental health services more accessible to all young people.</p><p>Clinical work and research should be integrated within
欢迎阅读《儿童与青少年心理健康(CAMH)期刊》2024 年 11 月刊。儿童与青少年心理健康(CAMH)致力于促进公平、多样性和包容性,改善生活在具有挑战性环境中的儿童和青少年的心理健康。儿童和青少年心理健康》2024 年特刊 "儿童和青少年心理健康中的公平、多样性和包容性 "收录了有关这一主题的多篇论文,如种族主义的代际后果(Simela 等人,2024 年)、社会经济不平等的影响(Pearce 等人,2024 年)和青少年心理健康的影响(Simela 等人,2024 年)、为了进一步促进对这一领域的了解,本期刊物还收录了评估其他弱势人群的论文,如面临药物滥用或患有药物使用障碍的儿童和青少年(Carrasco-Garrido 等人,2024 年),以及变性或 "性别多样 "的儿童和青少年(Whittle、Moore 和 Stallard,2024 年)。在第一项研究中,Carrasco-Garrido 等人(2024 年)发现,非医疗使用处方类阿片、新型精神活性物质和其他非法精神活性药物是男性和女性青少年非医疗使用苯二氮卓类药物和 Z-hypnotics 的风险因素;而使用大麻只预测女性青少年非医疗使用苯二氮卓类药物和 Z-hypnotics 的风险。第二项研究(Whittle 等人,2024 年)发现,变性或 "性别多样化 "与较高的自残率、较差的同伴关系、较少的亲社会行为、对友谊和休闲活动的更大干扰以及对课堂的不利影响有关。虽然在了解一些弱势青少年群体所面临的心理健康挑战方面已经取得了重大进展,但仍迫切需要进一步研究和公开讨论获取心理健康服务和护理的障碍。这些障碍可能表现为实际困难,包括经济拮据、出行困难或照顾孩子的责任,但也可能是系统性和结构性因素造成的。对于那些生活贫困的人、家庭环境脆弱的人、受到种族主义和歧视影响的人,以及有神经发育问题或学习障碍的儿童和青少年来说,这些挑战尤为严峻。临床工作和研究应该结合在一个广泛的、对文化敏感的健康不平等框架内。让年轻人和社区成员参与到评估和决策过程中,找到能够切实改善心理健康结果的解决方案,这一点至关重要。在心理健康环境和心理健康研究中,共同设计被广泛推荐为一种方法,用于对服务使用者进行感同身受的理解,并设计出满足其特定需求的解决方案(Morris 等人,2024 年)。年轻人的参与对于确保各项举措以生活经验为基础至关重要,而生活经验确实会带来更多相关、实用和可操作的见解。定期的焦点小组和反馈会议有助于改进服务,以更好地满足服务对象的独特需求。一种更公平、更包容的心理健康护理方法要求临床和研究人群都能代表更广泛的社 区,尤其是来自服务不足背景的弱势年轻人。在这些咨询小组中,不仅要倾听年轻人的声音,还要确保与其他关键利益相关者的合作,这些利益相关者在可能需要心理健康支持的儿童和青少年的生活中扮演着重要角色。具体来说,与当地社区领袖和代表得不到充分服务或边缘化群体的组织合作,对于确保倡议真正具有包容性和有效性至关重要。与当地组织合作,让社区成员参与到这些项目的设计和实施中来,有助于建立信任,营造一个更具支持性的环境。这反过来又会鼓励年轻人积极地参与到服务中来,对获得心理健康护理充满信心,并参与到包括研究项目在内的活动中来。 这种促进协调、参与和社会包容的做法对青少年的心理健康起着保护作用(Rice, Purcell, &amp; McGorry, 2018)。为了解决可能阻碍参与的系统性障碍,如缺乏文化上适当的参与策略,对心理健康专业人员进行培训也势在必行,使他们既能胜任文化工作,又能对与之共事的青少年的不同背景和经历保持敏感。这种培训应该强调理解不同文化对心理健康的看法的重要性,认识到文化规范和价值观是如何影响症状表达和求助行为的,并学会跨越文化和语言障碍进行有效沟通。总之,在儿童和青少年心理健康护理和研究中推进公平、多样性和包容性,需要对公平做出持续的承诺。要为所有儿童和青少年提供更具包容性和更容易获得的心理健康支持,可以通过合作努力、社区参与、系统变革和培训举措来打破障碍。作者已声明他们与本社论没有竞争性或潜在的利益冲突。
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引用次数: 0
Clinical research updates 临床研究最新进展
IF 6.8 3区 医学 Q1 PEDIATRICS Pub Date : 2024-10-24 DOI: 10.1111/camh.12739
Marinos Kyriakopoulos, Polyvios Christofi, Katerina Tselika, Asimina Paleologou
<p>Polyvios Christofi</p><p>National and Kapodistrian University of Athens</p><p>Attention-deficit hyperactivity disorder (ADHD) and Autism Spectrum Disorder (ASD) are prevalent, lifelong neurodevelopmental disorders associated with significant behavioural, academic, emotional, and adaptive challenges. These conditions are more common in males, exhibit high heritability, and have a complex aetiology. Furthermore, they frequently co-occur with estimates of 30–50% of individuals with ASD having ADHD symptoms, and two-thirds of individuals with ADHD having ASD symptoms. This suggests shared developmental pathways and risk factors that have not been adequately explored as most research addresses these conditions separately.</p><p>Lebeña and colleagues (2024) aimed to identify pre- and perinatal risk factors and, for the first time, consider early environmental psychosocial exposures associated with ADHD, ASD, and their co-occurrence. Data were collected from the ABIS-study (All Babies in Southeast Sweden) cohort, which included 16,365 children born between 1997 and 1999, with a 22-year follow-up period. Diagnoses were obtained from the Swedish National Diagnosis Register. The study found cumulative incidences of 4.6% for ADHD, 1.7% for ASD and 1.1% for their co-occurrence. Being male was a significant predictor for all three outcomes with a male-to-female ratio of 2:1 for both ADHD and ASD, compared to 3:1 reported in previous studies. ADHD showed significant associations with a family history of autoimmune diseases, preterm birth, lower birth weight, younger parental age, low-parental education, single-parent households, low-household income, maternal smoking and tobacco exposure at one year of age. There were significant associations with serious life events during pregnancy, and shorter breastfeeding duration compared to both control and ASD groups. Statistically independent ADHD predictors were being male, lower household income, lower maternal education, younger mother, maternal smoking, serious life events during pregnancy, lower paternal education and short breastfeeding duration. ASD was associated with maternal disease, infections during pregnancy, vaginal delivery compared to caesarean section, maternal age over 36 years, low-maternal education and low-household income. Statistically independent ASD predictors were being male, lower household income, and lower maternal education together with paternal Swedish nationality. The co-occurrence group was associated with higher prevalence of autoimmune diseases in the family, preterm births, low-parental education, single parent, low-household income, lack of support during pregnancy, lack of security for mother and child, maternal smoking and serious life events at 1 year of age. Statistically independent predictors of the co-occurrence were being male, lower household income and family history of autoimmune disorders.</p><p>The study's strengths included its large, population-based sample and l
样本中排除了 8 个月大时被诊断为残疾的儿童(这可能会影响他们以后的语言发展),也排除了英语水平不足以完成问卷的家长。儿童共接受了 11 次评估(8 个月至 13 岁),在本次研究中,第 1-4 次评估用于确定语言预测因素(8、12、24 和 36 个月)。每个年龄段都采用了不同的调查问卷,内容涉及儿童行为、象征性游戏、语言使用、家庭环境和父母压力。11 岁时,有 839 名儿童留了下来,并使用语言基础临床评估第四版澳大利亚版(CELF-4)对他们的语言能力进行了评估。该分析有 1990 个变量,其中 182 个是 8 个月时的变量,644 个是 12 个月时的变量,916 个是 24 个月时的变量,248 个是 36 个月时的变量。随机森林、基于树的机器学习方法分别用于每个收集波段,以估计变量的重要性。在 24 个月时,与词汇、符号游戏、语用和行为有关的 7 个预测因子对 11 岁时语言能力低下的预测灵敏度为 73%,特异度为 77%。在 36 个月时,与语法、词汇、亲子互动和父母压力有关的 7 个预测因子对同一结果的灵敏度为 75%,特异度为 85%。在 8 个月和 12 个月时,没有发现准确性令人满意的测量指标。这项调查的重要性在于,在孩子很小的时候,由家长在不到一分钟的时间内回答两组简短的问题,可能会准确预测儿童后期的语言能力。这项研究有很多优点,包括结果的适用性、问卷的快速发放、可靠的抽样方法、大量的参与者以及在不同群体中复制的可能性。不足之处包括参与者的保留率较低,以及使用家长报告问卷可能存在固有的主观性。 参考文献 Gasparini, L., Shepherd, D. A., Bavin, E. L., Eadie, P., Reilly, S., Morgan, A. T., &amp; Wake, M. (2023).使用机器学习方法识别早期生活中预测 11 年语言结果的因素。Asimina PaleologouNational and Kapodistrian University of Athens抑郁症是儿童和青少年中普遍存在的精神障碍。更好地了解抑郁症与认知障碍之间的关系,对于预防、管理和长期治疗受抑郁症影响的人非常重要。Schumacher 及其同事(2024 年)进行了一项系统回顾和荟萃分析,旨在概述有关抑郁儿童和青少年认知功能的现有文献。该研究严格遵循了包括乔安娜-布里格斯研究所系统综述指南和系统综述和荟萃分析首选报告项目(PRISMA)清单在内的指导方针。研究对象只包括根据标准化的有效诊断标准(《国际疾病分类》、《精神疾病诊断与统计手册》)确诊患有临床抑郁症的儿童(18 岁以下)。作者确定了 17 项符合纳入标准的研究,包括横断面研究(15 项)、纵向研究(1 项)或干预性研究(1 项),共有 13,567 名儿童(平均年龄为 13.8 ± 2.2 岁;60% 为女性)参与了这些研究。大多数研究侧重于记忆力和注意力。研究发现,与对照样本相比,患有抑郁症的儿童和青少年在认知功能测试中得分较低,特别是在工作记忆、长期记忆、注意力、执行功能和语言测试中。本系统综述和荟萃分析报告的优点包括:特别关注儿童和青少年,研究规模和样本量大。不足之处包括:认知领域是根据文献指南选择的,这可能会导致认知领域之间的结果重叠;不同的研究缺乏共同认可的认知测试;排除了合并神经系统疾病或智力障碍的受试者。 总之,这项研究强调,患有抑郁症的儿童和青少年有可能出现多种认知障碍。有必要更好地研究儿童和青少年抑郁与认知功能之间的联系。了解它们之间的相互联系可能有助于开发更有效的治疗方法,不仅考虑抑郁症的情感症状,也考虑其认知症状。 参考文献 Schumacher, A.、Campisi, S.C.、Khalfan, A.F.、Merriman, K.、Williams, T.C.、Korczak, D.J (2024)。儿童和青少年抑郁症患者的认知功能:系统综述与荟萃分析》。欧洲神经精神药理学》(European Neuropsychopharmacology),79, 49-58。这些更新无需伦理批准。
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引用次数: 0
Debate: Bridging the gap – role of nonspecialists in child and adolescent mental health care 辩论:缩小差距--非专业人员在儿童和青少年心理保健中的作用。
IF 6.8 3区 医学 Q1 PEDIATRICS Pub Date : 2024-10-11 DOI: 10.1111/camh.12736
Aisha Sanober Chachar, Ayesha I. Mian

The first point of contact for patients and families seeking professional help for health problems is often in nonspecialist community healthcare settings that vary widely across the countries in funding sources, resources and support from specialist services. They typically involve general practitioners, family physicians, general and community paediatricians, and nonphysician health workers such as nurses, social workers and public health professionals. This article discusses the role of nonspecialists in addressing the challenges of limited resources in Child and Adolescent Mental Health (CAMH) care services as healthcare systems struggle to meet the high demand. Stakeholders and decision-makers need to reconsider traditional healthcare models and service delivery. Integrating nonspecialist community care can be a potential solution but is beset with ethical, geopolitical, practical and economic challenges. The urgency and complexity of the issue are highlighted, emphasising the need for global discussion around CAMH care.

病人和家庭因健康问题寻求专业帮助的第一接触点往往是非专科的社区医疗机构,这些机构在资金来源、资源和专科服务支持方面在各国存在很大差异。这些机构通常包括全科医生、家庭医生、普通儿科医生和社区儿科医生,以及护士、社会工作者和公共卫生专业人员等非医师卫生工作者。本文讨论了在医疗保健系统努力满足高需求的情况下,非专科医生在应对儿童和青少年心理健康(CAMH)护理服务资源有限的挑战中所扮演的角色。利益相关者和决策者需要重新考虑传统的医疗保健模式和服务提供方式。整合非专科社区医疗服务可能是一个潜在的解决方案,但也面临着伦理、地缘政治、实践和经济方面的挑战。我们强调了这一问题的紧迫性和复杂性,并强调有必要围绕心理、精神和健康护理开展全球性讨论。
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引用次数: 0
Self-harm, suicidal ideation, depression and peer relationships in transgender and gender diverse adolescents accessing specialist mental health services 接受专科心理健康服务的变性和性别多元化青少年的自残、自杀意念、抑郁和同伴关系。
IF 6.8 3区 医学 Q1 PEDIATRICS Pub Date : 2024-10-07 DOI: 10.1111/camh.12738
Kathryn Whittle, Emma Moore, Paul Stallard

Background

There are an estimated 25 million transgender and gender diverse (TGD) individuals worldwide, with 1.2%–2.7% of this population being under the age of 18. Community studies describe increased rates of mental health difficulties such as depression, self-harm, suicidal ideation and difficulties with peer relationships for TGD youth over cisgender peers. However, comparatively little is known about the mental health symptomatology of TGD youth attending specialist mental health services (CAMHS) in the UK.

Method

This cross-sectional study explored data from 170 young people participating in the Beating Adolescent Self-Harm (BASH) trial. Baseline data about self-harm, depression, and impact on daily life was compared for those who identified as TGD (n = 18) with those who identified as cisgender (n = 152).

Results

In the transgender group, 18 (100%) scored ≥27 on the MFQ suggesting severe depression and had total scores on the SDQ impact scale of ≥3, in the very high range. In comparison in the cisgender group, 140 (92.1%) scored ≥27 on the MFQ and 103 (67.8%) had total scores on the SDQ impact scale of ≥3. The TGD group reported higher rates of self-harm, poorer peer relationships, less prosocial behaviour and greater interference with friendships and leisure activities and impact in the classroom. Both groups reported similar symptoms of depression.

Conclusions

Whilst this exploratory study has limitations, these results suggest that TGD youth attending CAMHS may experience greater mental health problems than their cisgender peers.

背景:据估计,全世界有 2,500 万变性人和性别多元化者(TGD),其中 1.2%-2.7% 的变性人和性别多元化者年龄在 18 岁以下。社区研究表明,变性和性别多元化青少年的心理健康问题(如抑郁、自残、自杀念头和同伴关系障碍)发生率高于同性别青少年。然而,人们对英国接受专业心理健康服务(CAMHS)的 TGD 青少年的心理健康症状却知之甚少:这项横断面研究调查了 170 名参加 "战胜青少年自残(Beating Adolescent Self-Harm,BASH)"试验的青少年的数据。结果:在变性人组中,18 名变性人(100%)被诊断为 "抑郁症",而另一名变性人(100%)被诊断为 "抑郁症":在变性人组中,18 人(100%)在 MFQ 中的得分≥27 分,表明患有严重抑郁症,在 SDQ 影响量表中的总分≥3 分,处于非常高的范围。相比之下,顺性别组中有 140 人(92.1%)的 MFQ 得分≥27 分,103 人(67.8%)的 SDQ 影响量表总分≥3 分。TGD组报告的自残率较高,同伴关系较差,亲社会行为较少,对友谊和休闲活动的干扰较大,对课堂的影响也较大。两组的抑郁症状相似:尽管这项探索性研究有其局限性,但这些结果表明,接受儿童青少年心理健康服务的 TGD 青少年可能会比他们的同性别青少年遇到更多的心理健康问题。
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引用次数: 0
Debate: How much should nonspecialists be involved in mental health care for children and young people when resources are limited? Working with police forces to improve mental health crisis care for young people 辩论:在资源有限的情况下,非专业人员应在多大程度上参与儿童和青少年的心理健康护理?与警察部队合作,改善对年轻人的心理健康危机护理。
IF 6.8 3区 医学 Q1 PEDIATRICS Pub Date : 2024-10-07 DOI: 10.1111/camh.12733
Amy McCulloch, Zarah Eve, Sarah Parry

The last few years have seen a mental health crisis for children and young people in the UK, with more young people presenting to services at crisis point. Young people have reported that there is a general lack of support before reaching the point of crisis and police forces in the UK have seen a rise in callouts related to youth mental health problems. We provide an overview of the evidence for joint responses from police and mental health services and highlight the importance of including people with lived experience in the development of crisis services. Most of the available data relates to interventions for adults, with very few studies including children and young people. We outline a new study in the UK aiming to evaluate a joint response for young people experiencing a mental health crisis. Whilst resources for children and young people's crisis services remain limited, joint response models with police forces can help to provide much needed intervention.

在过去的几年里,英国的儿童和青少年出现了心理健康危机,越来越多的青少年在危机关头向服务机构求助。青少年报告说,在到达危机点之前,他们普遍缺乏支持,而英国警方也发现,与青少年心理健康问题相关的出警次数有所增加。我们概述了警方和心理健康服务机构联合应对危机的证据,并强调在危机服务的发展过程中让有亲身经历的人参与其中的重要性。现有数据大多与成人干预措施有关,很少有研究涉及儿童和青少年。我们概述了英国的一项新研究,该研究旨在评估针对经历心理健康危机的青少年的联合应对措施。虽然用于儿童和青少年危机服务的资源仍然有限,但与警察部队的联合应对模式有助于提供急需的干预措施。
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引用次数: 0
Debate: How much should nonspecialists be involved in mental health care for children and young people when resources are limited? 辩论:在资源有限的情况下,非专业人员应在多大程度上参与儿童和青少年的心理保健?
IF 6.8 3区 医学 Q1 PEDIATRICS Pub Date : 2024-09-22 DOI: 10.1111/camh.12737
Lina Gega

From the barber-surgeons of the Middle Ages to the digitally enabled clinical interventions of today, the role of nonspecialists in delivering accessible health care remains relevant and important. Their contribution in developing and supporting appropriate interventions and care pathways in the community can make a big difference for the overwhelming majority of children and young people with diagnosable mental health conditions who are not eligible for specialist treatment or do not seek help. Even if resources for specialist services were unlimited, there are independent benefits in involving nonspecialists in mental health care, albeit not without limitations and concerns. The natural shift over time in the boundaries of specialisms, the omnipresence and omnipotence of digital media in our lives and the vision of ‘no wrong door’ for service users, mean that it is not a question of whether, but of how, nonspecialists should be involved. We need to get past the point of considering them just as alternative providers of mental health interventions and services. Instead, they are best placed to protect children and young people's mental health through ubiquitous everyday actions, which counter the negative and maximise the positive elements in current practices, environments and interactions that influence families and communities.

从中世纪的理发师到今天的数字化临床干预,非专科医生在提供无障碍医疗保健服务方面的作用仍然具有现实意义和重要性。他们在社区中为制定和支持适当的干预措施和护理路径所做的贡献,可以为绝大多数患有可诊断精神疾病的儿童和青少年带来巨大的改变,因为他们没有资格接受专科治疗或不寻求帮助。即使专科服务的资源是无限的,让非专科医生参与到心理健康护理中来也会带来独立的益 处,尽管这并不是没有局限性和顾虑。随着时间的推移,专科的界限会自然发生变化,数字媒体在我们的生活中无处不在、无所不能,以及对服务使用者 "不走错门 "的愿景,都意味着这不是一个是否应该让非专科医生参与的问题,而是一个如何参与的问题。我们需要摆脱仅仅将他们视为心理健康干预和服务的替代提供者的观念。相反,他们最适合通过无处不在的日常行动来保护儿童和青少年的心理健康,在当前影响家庭和社区的实践、环境和互动中抵制消极因素,最大限度地发挥积极因素。
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引用次数: 0
Debate: How much should nonspecialists be involved in mental health care when resources are limited? A perspective from low- and middle-income countries 辩论:在资源有限的情况下,非专业人员应在多大程度上参与心理保健?中低收入国家的观点。
IF 6.8 3区 医学 Q1 PEDIATRICS Pub Date : 2024-09-19 DOI: 10.1111/camh.12735
Cornelius Ani, Olayinka Omigbodun

Millions of children and young people (CYP) in low- and middle-income countries (LMICs) have no access to mental health care. This huge treatment gap is primarily due to limited availability of trained mental health professionals. We propose task-sharing as a scalable strategy to expand access to child and adolescent mental health (CAMH) interventions in LMICs. Task-sharing involves using the few mental health specialists in LMICs to train and supervise nonspecialists to provided CAMH interventions. There is strong evidence of clinical and cost effectiveness of task-shared mental health interventions for adults in LMICs and promising evidence for CYP. To succeed, task-shared programmes need to be embedded in a balanced system-wide care setting that includes stakeholder involvement. The existing mental health specialists may require additional training in leadership, supervision, mentoring, service design and evaluation in order to meet the additional expectations of managing task-sharing programmes. The nonspecialists to be trained would need assurances about workload, ongoing supervision, clinical back up for cases that exceed their expertise, certification for their training and career progression. CAMH task-sharing offers good promise for increasing CYP's access to mental health interventions in LMICs. However, planners need to be aware of the important practical, ethical and contextual considerations necessary for success and sustainability.

在中低收入国家(LMICs),数百万儿童和青少年(CYP)无法获得心理保健服务。造成这一巨大治疗缺口的主要原因是训练有素的心理健康专业人员有限。我们建议将任务分担作为一种可扩展的策略,以扩大中低收入国家儿童和青少年心理健康(CAMH)干预的可及性。任务分担是指利用低收入国家中为数不多的心理健康专家来培训和指导非专业人员提供儿童和青少年心理健康干预服务。有确凿证据表明,任务分担式心理健康干预措施对低收入和中等收入国家的成人具有临床和成本效益,对儿童青少年也很有希望。要想取得成功,任务分担计划需要嵌入到一个平衡的全系统医疗环境中,包括利益相关者的参与。现有的心理健康专家可能需要在领导、监督、指导、服务设计和评估方面接受额外的培训,以满足管理任务分担计划的额外期望。接受培训的非专业人员需要在工作量、持续监督、超出其专业知识的临床支持、培训认证和职业发展等方面得到保证。在低收入和中等收入国家,儿童心理保健任务分担为增加儿童获得心理保健干预的机会提供了良好的前景。然而,规划者需要注意成功和可持续发展所必需的重要实践、伦理和环境因素。
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引用次数: 0
期刊
Child and Adolescent Mental Health
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