Department of Child and Adolescent Psychiatry, School of Medicine, Ankara University, Ankara, Turkey.
Eur Child Adolesc Psychiatry. 2010 Feb;19(2):113-24. doi: 10.1007/s00787-009-0047-2. Epub 2009 Jul 31.
The objectives of the study are (i) to describe and compare the epidemiology of emotional/behavioral problems and associated risk/protective factors among nationally representative samples of institutionally reared and similarly aged community-based adolescents brought up in their natural homes by means of youth self-reports, caregiver/parent, and teacher informants; and (ii) to identify mental health service needs and utilization. A cross-sectional survey was conducted between November 2005 through April 2006 using an equal probability cluster sample of 11-18 year old adolescents in institutional care settings (N = 350; 163 males, 187 females) and results were compared with similarly aged community sample of youth living in their natural homes (N = 2,206). The Sociodemographic Information Form, Youth Self Report (YSR), Child Behavior Checklist (CBCL) by caregivers for institutional sample and parents for the community sample, and Teacher's Report Form (TRF) were used to obtain standardized data on demographic characteristics, emotional/behavioral problems, and risk/protective factors. The prevalence of problems behaviors by YSR, caregiver/parent CBCL, and TRF were: 47, 15.1, 20.5% for the institutional versus 10.1, 7.5 and, 9.5% for the community samples, respectively (p < 0.05). Youth self-reports were fourfold, and all informant reports were twofold higher for institutional versus community comparisons. Furthermore, institutional sample had consistently higher rates, not only of Externalizing, but Internalizing, Social Problems, Attention Problems, and Thought Problems, as well as discrete DSM-oriented scales, suggesting that labeling of institutional youth as simply aggressive and delinquent contributes to their further marginalization and does not comprehensively address their mental health needs. In terms of protective factors, we found that: perceived social support, high competency scores, supportive caregiving, getting along well with peers and relatives (positive relationships), and problem solving skills were significantly protective of mental health. On the other hand fatalistic beliefs, cigarette and alcohol use were significantly associated with increased risk for problem behaviors (p < 0.05). The primary reason for institutional placement was family disruption (68.9%), poverty (15.7%), abandonment (8.4%), and physical or sexual abuse (5.4%). Only 31.2% of the youth were in fact true orphans (loss of one or both parents). It is therefore remarkable that in terms of service use, despite consistently high prevalence of problem behaviors across all informant sources, only 2.4% of the youth had received any speciality mental health services during institutional care. In conclusion, there is a pressing need to transform the social and health care policy and to provide family and community-based alternatives for youth currently in institutional care in Turkey. Before this goal is achieved, it is necessary to address their mental health needs urgently and comprehensively. The highest rates of problems by youth self-report also support the view that the youths' own voices ought to be heard and need to inform the reform process regarding their future care.
(i) 通过青少年自我报告、照顾者/父母和教师报告，描述和比较在全国代表性样本中，机构养育和在自然家庭中长大的同龄社区青少年的情绪/行为问题的流行病学及其相关风险/保护因素；(ii) 确定心理健康服务需求和利用情况。2005 年 11 月至 2006 年 4 月期间，采用机构照护环境中 11-18 岁青少年的等概率聚类样本（N=350；男性 163 名，女性 187 名）进行了横断面调查，并将结果与生活在自然家庭中的同龄社区青少年样本（N=2206）进行了比较。采用社会人口信息表、青少年自我报告（YSR）、照顾者为机构样本和父母为社区样本的儿童行为检查表（CBCL）以及教师报告表（TRF），获取人口统计学特征、情绪/行为问题和风险/保护因素的标准化数据。机构样本中，YSR、照顾者/父母的 CBCL 和 TRF 报告的问题行为发生率分别为：47%、15.1%和 20.5%；社区样本分别为：10.1%、7.5%和 9.5%（p<0.05）。与社区相比，青少年自我报告高出四倍，所有报告人报告的发生率都高出两倍。此外，机构样本不仅外化问题、内化问题、社会问题、注意力问题和思维问题，以及离散的 DSM 定向量表的发生率也一直较高，这表明将机构青少年简单地贴上攻击和犯罪的标签，不仅会进一步使他们边缘化，而且不能全面满足他们的心理健康需求。在保护因素方面，我们发现：感知社会支持、高能力得分、支持性照顾、与同龄人及亲属相处融洽（积极关系）和解决问题的能力均对心理健康具有显著的保护作用。另一方面，宿命论信念、吸烟和饮酒与行为问题风险增加显著相关（p<0.05）。机构安置的主要原因是家庭破裂（68.9%）、贫困（15.7%）、被遗弃（8.4%）和身体或性虐待（5.4%）。实际上，只有 31.2%的青少年是真正的孤儿（失去了一个或两个父母）。因此，值得注意的是，尽管所有报告来源的问题行为发生率都很高，但在机构照护期间，只有 2.4%的青少年接受过任何特殊的心理健康服务。总之，土耳其迫切需要改变社会和医疗保健政策，为目前在机构照护中的青年提供家庭和社区为基础的替代方案。在实现这一目标之前，有必要紧急和全面地满足他们的心理健康需求。青少年自我报告的最高问题发生率也支持了这样一种观点，即应该听取青少年的声音，并需要根据他们的未来照护情况告知改革进程。
