Kroll L, Rothwell J, Bradley D, Shah P, Bailey S, Harrington R C
Manchester Children's Trust, Manchester, UK.
Lancet. 2002 Jun 8;359(9322):1975-9. doi: 10.1016/s0140-6736(02)08829-3.
The mental health needs of children and adolescents in secure care are a matter of concern, but little systematic research has been done. Our aim was to assess the mental health, social, and educational needs of these young people in a prospective, longitudinal study.
We enrolled 97 boys aged 12-17 years who had been admitted to secure care. We assessed their needs (n=97) at the time of admission and 3 months later (n=90) with standardised interviews and psychometric tests.
26 (27%) boys had an intelligence quotient (IQ) of less than 70. The need for psychiatric help was high on admission to a secure unit, with the most frequent disorders being depression and anxiety. There were high rates of aggression, substance misuse, self harm, and social, family, and educational problems, and associated needs. The mean number of needs was 8.5 (SD 2.9) on admission and 2.9 (SD 2.4) after 3 months (mean difference 5.6, 95% CI 5.0-6.3). Areas in which needs were mostly met included education, substance misuse, self care, and diet. Areas where the frequency of need fell substantially, but remained high, were social and family problems, and aggressive behaviours. Psychological needs persisted, with new onsets of depression, anxiety problems, and post-traumatic-stress symptoms shortly after admission. The most frequently required interventions were psychological assessment and cognitive behavioural work.
Boys in secure care have many needs and a high rate of psychiatric morbidity. During the admission period, secure care units address some domains of need, but others remain unchanged or get worse. Psychological and psychiatric provision in secure units need to be improved.
被收容儿童和青少年的心理健康需求令人担忧，但系统性研究较少。我们的目的是通过一项前瞻性纵向研究评估这些年轻人的心理健康、社会和教育需求。
我们招募了97名12至17岁被收容的男孩。在入院时和3个月后（n = 90），我们通过标准化访谈和心理测量测试评估了他们的需求（n = 97）。
26名（27%）男孩的智商低于70。入院时对精神科帮助的需求很高，最常见的疾病是抑郁症和焦虑症。攻击行为、药物滥用、自我伤害以及社会、家庭和教育问题及相关需求的发生率很高。入院时需求的平均数量为8.5（标准差2.9），3个月后为2.9（标准差2.4）（平均差异5.6，95%可信区间5.0 - 6.3）。需求大多得到满足的领域包括教育、药物滥用、自我护理和饮食。需求频率大幅下降但仍很高的领域是社会和家庭问题以及攻击行为。心理需求持续存在，入院后不久出现了新的抑郁症、焦虑症问题和创伤后应激症状。最常需要的干预措施是心理评估和认知行为治疗。
被收容的男孩有许多需求，精神疾病发病率很高。在入院期间，收容机构解决了一些需求领域，但其他领域保持不变或恶化。收容机构的心理和精神科服务需要改进。
