Shivram Raghuram, Bankart John, Meltzer Howard, Ford Tamsin, Vostanis Panos, Goodman Robert
Child Psychiatry, University of Leicester, Leicester, UK.
Eur Child Adolesc Psychiatry. 2009 Sep;18(9):555-63. doi: 10.1007/s00787-009-0012-0. Epub 2009 Apr 8.
Children with conduct disorders (CD) and their families are in contact with multiple agencies, but there is limited evidence on their patterns of service utilization. The aim of this study was to establish the patterns, barriers and correlates of service use by analysing the cohort of the 2004 Great Britain child mental health survey (N = 7,977). Use of social services was significantly higher by children with CD than emotional disorders (ED) in the absence of co-morbidity, while use of specialist child mental health and paediatric was significantly higher by children with hyperkinetic disorders (HD) than CD. Children who had comorbid physical disorders used more primary healthcare services compared to those without physical disorders. Utilization of specialist child mental heath and social services was significantly higher among children with unsocialized CD than socialized CD and oppositional defiant disorders. Services utilization and its correlates varied with the type of service. Overall, specialist services use was associated with co-morbidity with learning disabilities, physical and psychiatric disorders. Several correlates of services use in CD appeared non-specific, i.e. associated with use of different services indicating the possibility of indiscriminate use of different types of services. The findings led to the conclusion that there is the need for effective organization and co-ordination of services, and clear care pathways. Involvement of specialist child mental health services should be requested in the presence of mental health co-morbidity.
患有品行障碍（CD）的儿童及其家庭与多个机构有接触，但关于他们服务利用模式的证据有限。本研究的目的是通过分析2004年英国儿童心理健康调查队列（N = 7,977）来确定服务使用的模式、障碍及相关因素。在无共病的情况下，患有CD的儿童使用社会服务的比例显著高于患有情绪障碍（ED）的儿童，而患有多动障碍（HD）的儿童使用专科儿童心理健康服务和儿科服务的比例显著高于患有CD的儿童。与没有身体疾病的儿童相比，患有共病身体疾病的儿童使用更多的初级医疗服务。在未社会化的CD儿童中，专科儿童心理健康服务和社会服务的利用率显著高于社会化的CD儿童和对立违抗障碍儿童。服务利用及其相关因素因服务类型而异。总体而言，专科服务的使用与学习障碍、身体和精神疾病的共病有关。CD中服务使用的几个相关因素似乎是非特异性的，即与不同服务的使用有关，这表明可能存在对不同类型服务的滥用。研究结果得出结论，需要对服务进行有效的组织和协调，并明确护理途径。在存在心理健康共病的情况下，应要求专科儿童心理健康服务机构参与。
