Grupp-Phelan Jacqueline, Delgado Sergio V, Kelleher Kelly J
Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati Ohio, USA.
BMC Emerg Med. 2007 Aug 15;7:12. doi: 10.1186/1471-227X-7-12.
Recognition of mental illness in the pediatric emergency department (PED) followed by brief, problem oriented interventions may improve health-care seeking behavior and quality of life. The objective of this study was to compare the frequency of mental health follow up after an enhanced referral compared to a simple referral in children presenting to the PED with unrecognized mental health problems.
A prospective randomized control trial comparing an enhanced referral vs. simple referral in 56 families of children who were screened for mental health symptoms was performed in a large tertiary care PED. Children presenting to the PED with stable medical problems were approached every fourth evening for enrollment. After consent/assent was obtained, children were screened for a mental health problem using both child and parent reports of the DISC Predictive Scales. Those meeting cutoffs for a mental health problem by either parent or child report were randomized to 1) simple referral (phone number for mental health evaluation by study psychiatrist) or 2) enhanced referral (short informational interview, appointment made for child, reminder 2 days before and day of interview for an evaluation by study psychiatrist). Data analysis included descriptive statistics and Chi-Square test to calculate the proportion of children with mental health problems who completed mental health follow-up with and without the enhanced referral.
A total of 69 families were enrolled. Overall 56 (81%) children screened positive for a mental health problem as reported by either the child (self report) or mother (maternal report of child mental health problem). Of these, 33 children were randomized into the enhanced referral arm and 23 into the simple referral arm. Overall, only 6 families with children screening positive for a mental health problem completed the psychiatric follow up evaluation, 2 in the enhanced referral arm and 4 in the simple referral arm (p = .13).
Children screened in the ED for unrecognized mental health problems are very unlikely to follow-up for a mental health evaluation with or without an enhanced referral. Understanding the role of ED based mental health screening and the timing of an intervention is key in developing ED based mental health interventions.
在儿科急诊科（PED）识别出精神疾病并随后进行简短的、以问题为导向的干预措施，可能会改善就医行为和生活质量。本研究的目的是比较在PED就诊且未被识别出有精神健康问题的儿童中，强化转诊与简单转诊后心理健康随访的频率。
在一家大型三级医疗PED中，对56名有心理健康症状筛查的儿童家庭进行了一项前瞻性随机对照试验，比较强化转诊与简单转诊。每四个晚上接触一次因医疗问题稳定而到PED就诊的儿童以进行入组。在获得同意/赞成后，使用儿童和家长对DISC预测量表的报告对儿童进行心理健康问题筛查。那些通过家长或儿童报告达到心理健康问题临界值的儿童被随机分为1）简单转诊（由研究精神科医生进行心理健康评估的电话号码）或2）强化转诊（简短的信息访谈、为儿童预约、在访谈前两天和当天提醒由研究精神科医生进行评估）。数据分析包括描述性统计和卡方检验，以计算有心理健康问题的儿童在有或没有强化转诊情况下完成心理健康随访的比例。
共招募了69个家庭。总体而言，56名（81%）儿童经儿童（自我报告）或母亲（儿童心理健康问题的母亲报告）报告筛查出心理健康问题呈阳性。其中，33名儿童被随机分配到强化转诊组，2名被分配到简单转诊组。总体而言，只有6个有心理健康问题筛查呈阳性儿童的家庭完成了精神科随访评估，强化转诊组2个，简单转诊组4个（p = 0.13）。
在急诊科筛查出未被识别出有心理健康问题的儿童，无论有无强化转诊，都极不可能进行心理健康评估随访。了解基于急诊科的心理健康筛查的作用和干预时机是制定基于急诊科的心理健康干预措施的关键。
