Tegethoff Marion, Stalujanis Esther, Belardi Angelo, Meinlschmidt Gunther
Department of Psychology, Division of Clinical Psychology and Psychiatry, University of Basel, Basel, Switzerland.
Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland; Faculty of Medicine, Ruhr-University Bochum, Bochum, Germany.
PLoS One. 2014 Jun 9;9(6):e99675. doi: 10.1371/journal.pone.0099675. eCollection 2014.
School mental health services are important contact points for children and adolescents with mental disorders, but their ability to provide comprehensive treatment is limited. The main objective was to estimate in mentally disordered adolescents of a nationally representative United States cohort the role of school mental health services as guide to mental health care in different out-of-school service sectors.
Analyses are based on weighted data (N = 6483) from the United States National Comorbidity Survey Replication Adolescent Supplement (participants' age: 13-18 years). Lifetime DSM-IV mental disorders were assessed using the fully structured WHO CIDI interview, complemented by parent report. Adolescents and parents provided information on mental health service use across multiple sectors, based on the Service Assessment for Children and Adolescents.
School mental health service use predicted subsequent out-of-school service utilization for mental disorders i) in the medical specialty sector, in adolescents with affective (hazard ratio (HR) = 3.01, confidence interval (CI) = 1.77-5.12), anxiety (HR = 3.87, CI = 1.97-7.64), behavior (HR = 2.49, CI = 1.62-3.82), substance use (HR = 4.12, CI = 1.87-9.04), and eating (HR = 10.72, CI = 2.31-49.70) disorders, and any mental disorder (HR = 2.97, CI = 1.94-4.54), and ii) in other service sectors, in adolescents with anxiety (HR = 3.15, CI = 2.17-4.56), behavior (HR = 1.99, CI = 1.29-3.06), and substance use (HR = 2.48, CI = 1.57-3.94) disorders, and any mental disorder (HR = 2.33, CI = 1.54-3.53), but iii) not in the mental health specialty sector.
Our findings indicate that in the United States, school mental health services may serve as guide to out-of-school service utilization for mental disorders especially in the medical specialty sector across various mental disorders, thereby highlighting the relevance of school mental health services in the trajectory of mental care. In light of the missing link between school mental health services and mental health specialty services, the promotion of a stronger collaboration between these sectors should be considered regarding the potential to improve and guarantee adequate mental care at early life stages.
学校心理健康服务是患有精神障碍的儿童和青少年的重要接触点，但其提供全面治疗的能力有限。主要目的是评估在美国一个具有全国代表性的队列中患有精神障碍的青少年中，学校心理健康服务在不同校外服务部门作为心理健康护理指南的作用。
分析基于美国国家共病调查复制青少年补充调查的加权数据（N = 6483）（参与者年龄：13 - 18岁）。使用完全结构化的世界卫生组织综合国际诊断访谈评估终生DSM-IV精神障碍，并辅以家长报告。青少年和家长根据儿童和青少年服务评估提供了跨多个部门使用心理健康服务的信息。
学校心理健康服务的使用预测了随后在医学专科部门中患有情感障碍（风险比（HR）= 3.01，置信区间（CI）= 1.77 - 5.12）、焦虑障碍（HR = 3.87，CI = 1.97 - 7.64）、行为障碍（HR = 2.49，CI = 1.62 - 3.82）、物质使用障碍（HR = 4.12，CI = 1.87 - 9.04）和饮食障碍（HR = 10.72，CI = 2.31 - 49.70）以及任何精神障碍（HR = 2.97，CI = 1.94 - 4.54）的青少年的校外服务利用情况；以及在其他服务部门中患有焦虑障碍（HR = 3.15，CI = 2.17 - 4.56）、行为障碍（HR = 1.99，CI = 1.29 - 3.06）和物质使用障碍（HR = 2.48，CI = 1.57 - 3.94）以及任何精神障碍（HR = 2.33，CI = 1.54 - 3.53）的青少年的校外服务利用情况，但在心理健康专科部门中则不然。
我们的研究结果表明，在美国，学校心理健康服务可能作为校外精神障碍服务利用的指南，特别是在医学专科部门针对各种精神障碍，从而突出了学校心理健康服务在心理护理轨迹中的相关性。鉴于学校心理健康服务与心理健康专科服务之间存在缺失环节，应考虑促进这些部门之间加强合作，以提高并保证在生命早期阶段提供充分的心理护理。
