Canning E H, Hanser S B, Shade K A, Boyce W T
Department of Psychiatry and Behavioral Sciences, Stanford University, CA.
Pediatrics. 1992 Nov;90(5):692-6.
Mental disorders affect 18% to 20% of children and adolescents. The rate in children with chronic illness is probably higher. This study of chronically ill children addresses the discrepancy between parent and child reports of child psychiatric disorders and the extent to which pediatricians agree with reports by children and parents regarding such problems. Eighty-three subjects, aged 9 to 18 (mean = 12.6), were recruited; they had the following diagnoses: cystic fibrosis, diabetes, inflammatory bowel disease, and cancer. Subjects and one parent were interviewed separately, using the Diagnostic Interview Schedule for Children (DISC-2.1). The subject's physician completed a questionnaire asking about the presence of a range of mental disorders. Forty-one (49%) subjects reached threshold criteria for a psychiatric diagnosis, using both parent and child as informants. Psychiatric disorders were identified in only 22 subjects (54%) by the child and in 28 (68%) by parent alone. Thus, reliance on one informant resulted in failure to identify one third to one half of psychiatric disorders. Physicians' ratings agreed significantly with children's reports but not with parental reports, suggesting that physicians are sensitive to children's concerns but may underestimate the value and importance of parents' reports. Clinical and research evaluations of chronically ill children, as well as clinician identification of mental health problems, will be influenced by the choice of informant.
精神障碍影响着18%至20%的儿童和青少年。慢性病患儿的这一比例可能更高。这项针对慢性病患儿的研究探讨了父母与孩子关于儿童精神障碍报告之间的差异，以及儿科医生在多大程度上认同孩子和父母关于此类问题的报告。招募了83名年龄在9至18岁（平均年龄 = 12.6岁）的受试者；他们被诊断患有以下疾病：囊性纤维化、糖尿病、炎症性肠病和癌症。分别使用儿童诊断访谈量表（DISC - 2.1）对受试者及其一名家长进行访谈。受试者的医生填写了一份关于一系列精神障碍存在情况的问卷。以父母和孩子作为信息提供者时，41名（49%）受试者达到了精神疾病诊断的阈值标准。仅由孩子识别出22名（54%）受试者患有精神障碍，仅由家长识别出28名（68%）。因此，仅依赖一方信息提供者会导致三分之一到二分之一的精神障碍未被识别。医生的评分与孩子的报告显著一致，但与家长的报告不一致，这表明医生对孩子的担忧很敏感，但可能低估了家长报告的价值和重要性。慢性病患儿的临床和研究评估，以及临床医生对心理健康问题的识别，将受到信息提供者选择的影响。
