DrPH, MPA, Maternal and Child Health Bureau, Office of Data and Program Development, Parklawn Building, 5600 Fishers Lane, Room 18-41, Rockville, MD 20857, USA.
Pediatrics. 2010 Feb;125(2):e269-77. doi: 10.1542/peds.2009-0622. Epub 2010 Jan 18.
This study provides nationally representative prevalence estimates of internalizing mental health symptoms among children with special health care needs (CSHCN) and identifies significant covariates of these symptoms by using multivariate regression. Internalizing symptoms include feeling anxious and depressed.
Data were obtained from the 2005-2006 National Survey of Children with Special Health Care Needs, a nationally representative, parent-reported, cross-sectional survey of 40 465 CSHCN. The presence of internalizing mental health symptoms was assessed by using 2 binary items capturing whether a child had or experienced difficulty with depression, anxiety, disordered eating, or other emotional problems. The odds of experiencing internalizing symptoms were assessed by using multivariate regression, controlling for sociodemographic, health-related, and burden-related covariates.
A total of 31.9% of CSHCN 3 to 17 years of age experienced internalizing mental health symptoms. Multivariate logistic regression showed internalizing symptoms to be strongly associated with female gender, older age, and frequent activity limitations, as well as externalizing mental health symptoms and conditions with behavioral components. Children with behavior problems had 6 times the odds of internalizing symptoms (adjusted odds ratio [aOR]: 5.95 [95% confidence interval [CI]: 5.30-6.69]), whereas children with autism spectrum disorder had 3 times the odds (aOR: 3.00 [95% CI: 2.39-3.77]). Increased odds of symptoms also were associated with frequent headaches (aOR: 1.76 [95% CI: 1.45-2.13]) and chronic pain (aOR: 1.46 [95% CI: 1.22-1.75]). Odds of symptoms were greater for children living in households that experienced employment changes or financial burdens resulting from the children's needs.
Internalizing mental health symptoms are common among CSHCN. Findings may help caregivers focus screening and prevention efforts for high-risk groups in this heterogeneous population.
本研究通过多元回归分析，提供了具有特殊医疗需求的儿童（CSHCN）中内化心理健康症状的全国代表性患病率估计，并确定了这些症状的重要协变量。内化症状包括焦虑和抑郁。
数据来自 2005-2006 年全国特殊儿童健康需求调查，这是一项具有全国代表性的、由父母报告的、针对 40465 名 CSHCN 的横断面调查。通过使用 2 个捕捉儿童是否存在或经历抑郁、焦虑、饮食失调或其他情绪问题的二分项目，评估内化心理健康症状的存在。通过多元回归，在控制社会人口统计学、健康相关和负担相关协变量的情况下，评估出现内化症状的可能性。
共有 31.9%的 3 至 17 岁 CSHCN 出现内化心理健康症状。多元逻辑回归显示，内化症状与女性性别、年龄较大以及频繁的活动受限，以及外化心理健康症状和具有行为成分的疾病密切相关。有行为问题的儿童出现内化症状的可能性是 6 倍（调整后的优势比 [aOR]：5.95 [95%置信区间 [CI]：5.30-6.69]），而患有自闭症谱系障碍的儿童出现内化症状的可能性是 3 倍（aOR：3.00 [95% CI：2.39-3.77]）。症状发生的几率也与频繁的头痛（aOR：1.76 [95% CI：1.45-2.13]）和慢性疼痛（aOR：1.46 [95% CI：1.22-1.75]）有关。儿童家庭经历因儿童需求而导致的就业变化或经济负担，会增加出现症状的几率。
内化心理健康症状在 CSHCN 中很常见。这些发现可能有助于护理人员关注该异质人群中高危群体的筛查和预防工作。
