Paula Cristiane S, Bordin Isabel A S, Mari Jair Jesus, Velasque Luciane, Rohde Luis A, Coutinho Evandro S F
Programa de Pós-Graduação em Distúrbios do Desenvolvimento, Universidade Presbiteriana Mackenzie, São Paulo, São Paulo, Brasil ; Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, São Paulo, Brasil.
Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, São Paulo, Brasil.
PLoS One. 2014 Feb 18;9(2):e88241. doi: 10.1371/journal.pone.0088241. eCollection 2014.
Worldwide, a minority of disordered children/adolescents receives mental health assistance. In order to improve service access, it is important to investigate factors that influence the process leading to receiving care. Data on frequency and barriers for mental health service use (MHSU) among Brazilian children/adolescents are extremely scarce and are needed to guide public policy.
To establish the frequency of MHSU among 6-to-16-year-old with psychiatric disorders from four Brazilian regions; and to identify structural/psychosocial/demographic barriers associated with child/adolescent MHSU.
Multicenter cross-sectional-study involving four towns from four out of five Brazilian regions. In each town, a representative sample of elementary public school students was randomly selected (sample: 1,721). Child/adolescent MHSU was defined as being seen by a psychologist/psychiatrist/neurologist in the previous 12 months. Standardized instruments measured: (1) children/adolescent characteristics [(1.1) Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS-PL)-psychiatric disorders; (1.2) Ten Questions Screen-neurodevelopment problems; (1.3) two subtests of WISC-III-estimated IQ; (1.4) Academic Performance Test-school performance)], (2) factors related to mothers/main caregivers (Self-Reporting Questionnaire-anxiety/depression), (3) family (Brazilian Research-Companies-Association's Questionnaire-SES).
Only 19.8% of children/adolescents with psychiatric disorder have used mental health services in the previous 12 months. Multiple logistic regression modeling identified five factors associated with lower rates of MHSU (female gender, adequate school performance, mother/main caregiver living with a partner, lower SES, residing in deprived Brazilian regions) regardless of the presence of any psychiatric disorders/neurodevelopmental problems.
Only a small proportion of children/adolescents with psychiatric disorders had been seen by a mental health specialist in the previous 12 months. Structural/psychosocial/demographic factors were associated with uneven access to service for certain groups of children/adolescents. These results call attention to the urgent need to implement programs to help reduce this large unmet mental health need; inequalities must be considered by policy makers when planning strategies to address barriers for care.
在全球范围内，只有少数患有精神障碍的儿童/青少年能获得心理健康援助。为了改善服务的可及性，调查影响获得护理过程的因素很重要。巴西儿童/青少年心理健康服务使用（MHSU）的频率和障碍数据极为匮乏，而这些数据对于指导公共政策是必要的。
确定巴西四个地区6至16岁患有精神障碍儿童的MHSU频率；并识别与儿童/青少年MHSU相关的结构/心理社会/人口统计学障碍。
多中心横断面研究，涉及巴西五个地区中四个地区的四个城镇。在每个城镇，从公立小学学生中随机抽取一个代表性样本（样本量：1721）。儿童/青少年MHSU定义为在过去12个月内曾接受心理学家/精神科医生/神经科医生诊治。使用标准化工具测量：（1）儿童/青少年特征[（1.1）学龄儿童情感障碍和精神分裂症检查表（K-SADS-PL）——精神障碍；（1.2）十项问题筛查——神经发育问题；（1.3）韦氏儿童智力量表第三版（WISC-III）中的两个分测验——估计智商；（1.4）学业成绩测试——学校表现]，（2）与母亲/主要照料者相关的因素（自我报告问卷——焦虑/抑郁），（3）家庭因素（巴西研究公司协会问卷——社会经济地位）。
在过去12个月中，只有19.8%的患有精神障碍的儿童/青少年使用过心理健康服务。多元逻辑回归模型确定了五个与较低MHSU率相关的因素（女性、学业成绩良好、母亲/主要照料者与伴侣同住、社会经济地位较低、居住在巴西贫困地区）——无论是否存在任何精神障碍/神经发育问题。
在过去12个月中，只有一小部分患有精神障碍的儿童/青少年曾见过心理健康专家。结构/心理社会/人口统计学因素与某些儿童/青少年群体获得服务的不均衡有关联。这些结果提醒人们迫切需要实施相关项目以帮助减少这种大量未得到满足的心理健康需求；政策制定者在规划消除护理障碍的策略时必须考虑到不平等问题
