Center for Social Innovation in Needham, MA; Harvard Medical School, Boston, MA.
Center for Social Innovation in Needham, MA.
J Am Acad Child Adolesc Psychiatry. 2015 Feb;54(2):86-96.e2. doi: 10.1016/j.jaac.2014.11.008. Epub 2014 Nov 22.
The numbers of children experiencing homelessness have increased. To develop responsive interventions, we must understand their mental health/behavioral needs. The purpose of this systematic review was to update the evidence base by identifying, appraising, and summarizing studies on the prevalence of mental health issues among homeless children, comparing these individuals to low-income-housed children, and discussing research, practice, and policy implications.
We searched 3 electronic databases and included empirical studies investigating the prevalence of mental illness in homeless children in the United States (1990-2014). Retrieved publications were screened, data extracted, and study quality appraised by independent reviewers. Evidence synthesis was based on qualitative and quantitative analyses. Prevalence odds ratios (OR) of individual studies were pooled using an inverse-variance random effects model.
Twelve studies were included and reviewed. Overall, 10% to 26% of homeless preschoolers had mental health problems requiring clinical evaluation. This proportion increased to 24% to 40% among homeless school-age children, a rate 2 to 4 times higher than poor children aged 6 to 11 years in the National Survey of America's Families. According to our meta-analyses, the difference in prevalence measured by Child Behavior Checklist (CBCL) Total Problems (T score ≥60-64) was not significantly different between homeless and housed preschool children (OR = 1.49; 95% CI = 0.97-2.28). School-age homeless children compared to housed children were significantly more likely to have a mental health problem as defined by the CBCL Total Problems subscale (T score ≥60; OR = 1.78; 95% CI = 1.19-2.66).
Evidence-based mental health interventions for children experiencing homelessness are long overdue. Universal screening, treatment plan development, and support of adaptive systems that focus on positive parenting and children's self-regulation are essential.
无家可归儿童的人数有所增加。为了制定应对措施，我们必须了解他们的心理健康/行为需求。本系统评价的目的是通过确定、评估和总结有关无家可归儿童心理健康问题的研究，更新证据基础，将这些人与低收入住房儿童进行比较，并讨论研究、实践和政策的影响。
我们检索了 3 个电子数据库，纳入了在美国开展的关于无家可归儿童精神疾病患病率的实证研究（1990-2014 年）。由独立评审员对检索到的出版物进行筛选、提取数据和评估研究质量。证据综合基于定性和定量分析。使用逆方差随机效应模型对个体研究的患病率比值比（OR）进行汇总。
纳入并评价了 12 项研究。总体而言，10%-26%的学龄前无家可归者存在需要临床评估的心理健康问题。这一比例在学龄期无家可归者中增加到 24%-40%，是年龄在 6-11 岁的国家美国家庭调查中贫困儿童的 2-4 倍。根据我们的荟萃分析，用儿童行为检查表（CBCL）总问题（T 分≥60-64）衡量的患病率差异在无家可归和有住房的学龄前儿童之间没有显著差异（OR=1.49；95%CI=0.97-2.28）。与有住房的儿童相比，学龄期无家可归的儿童更有可能出现 CBCL 总问题子量表（T 分≥60；OR=1.78；95%CI=1.19-2.66）定义的心理健康问题。
为无家可归儿童提供基于证据的心理健康干预措施已迫在眉睫。普遍筛查、制定治疗计划以及支持注重积极养育和儿童自我调节的适应性系统至关重要。
