Reijneveld Sijmen A, Brugman Emily, Verhulst Frank C, Verloove-Vanhorick S Pauline
TNO (Netherlands Organisation of Applied Scientific Research) Prevention and Health, Leiden, The Netherlands.
Soc Psychiatry Psychiatr Epidemiol. 2005 Jan;40(1):18-23. doi: 10.1007/s00127-005-0850-0.
We examined the association of area deprivation with the occurrence of psychosocial problems among children aged 4-16 in a representative national sample of children based on standardised measures of parent-reported problems and diagnoses made by doctors and nurses working in child healthcare (child health professionals, CHPs).
The study comprised 4480 children aged 4-16 years, eligible for a routine health assessment (response: 90.1 %), in 19 Child Healthcare Services across the Netherlands that routinely provided preventive child healthcare to nearly all school-aged children. Parents completed the Child Behaviour Checklist (CBCL). CHPs examined the child and interviewed parents and child during their routine health assessments. Main outcome measures concerned psychosocial problems as reported by parents (i. e. a clinical score on the CBCL) and as identified by CHPs.
Prevalence rates of psychosocial problems were 8.6% for parent-reported problems and 10.1 % for CHP-identified problems. They were much higher in the most deprived third of the areas. Odds ratios (95 % confidence intervals) compared with the least deprived third were 1.93 (1.41-2.64) regarding parent-reported problems and 1.76 (1.30-2.38) regarding CHP-identified problems. Regarding parent reports, associations were slightly stronger for behavioural problems than for emotional problems. Less than a quarter of the area differences could be explained by individual and family characteristics.
Child psychosocial problems occur more frequently in deprived areas. Both preventive and curative health services should be better equipped for this concentration of child and adolescent morbidity in deprived areas.
我们基于家长报告问题的标准化测量以及儿童保健工作的医生和护士（儿童健康专业人员，CHPs）做出的诊断，在一个具有全国代表性的儿童样本中，研究了地区贫困与4至16岁儿童心理社会问题发生之间的关联。
该研究纳入了荷兰19个儿童保健服务机构中4480名4至16岁符合常规健康评估条件的儿童（应答率：90.1%），这些机构为几乎所有学龄儿童提供常规预防性儿童保健服务。家长完成儿童行为量表（CBCL）。儿童健康专业人员在常规健康评估期间对儿童进行检查，并与家长和儿童进行访谈。主要结局指标涉及家长报告的心理社会问题（即CBCL上的临床评分）以及儿童健康专业人员识别出的问题。
家长报告问题的心理社会问题患病率为8.6%，儿童健康专业人员识别出问题的患病率为10.1%。在最贫困的三分之一地区，患病率要高得多。与最不贫困的三分之一地区相比，家长报告问题的优势比（95%置信区间）为1.93（1.41 - 2.64），儿童健康专业人员识别出问题的优势比为1.76（1.30 - 2.38）。关于家长报告，行为问题的关联略强于情绪问题。不到四分之一的地区差异可由个体和家庭特征解释。
儿童心理社会问题在贫困地区更频繁发生。预防性和治疗性卫生服务都应更好地应对贫困地区儿童和青少年发病率的这种集中情况。
