Urben Sébastien, Pihet Sandrine, Graap Caroline, Baier Vanessa, Dyson Chloe, Courosse Swen, Holzer Laurent
URBEN: Research Unit, University Service of Child and Adolescent Psychiatry (USCAP), Lausanne, Switzerland GRAAP and BAIER: Mobile Team for Children and Adolescents, USCAP, Lausanne, Switzerland DYSON and COUROSSE: Psychiatric Inpatient Unit for Adolescents, USCAP, Lausanne, Switzerland HOLZER: Mobile Team for Children and Adolescents and Psychiatric Inpatient Unit for Adolescents, USCAP, Lausanne, Switzerland PINHET: School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, School of Health Sciences, Fribourg.
J Psychiatr Pract. 2015 May;21(3):232-40. doi: 10.1097/PRA.0000000000000071.
The goal of this study was to assess the clinical usefulness of the emotional symptoms (Emo) and externalizing problems (Ext) scales compared with the Total score on the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA).
The HoNOSCA was rated at admission and discharge for 260 adolescent inpatients. The primary outcomes assessed were (a) the sensitivity of the 3 HoNOSCA scores to clinical improvement; and (b) the between diagnoses discriminative value of these scores.
Analyses of variances [2 (time: admission vs. discharge) × 5 (diagnostic groups)] revealed a main effect of time for the 3 scores, a main effect of the diagnostic group for the Total and Ext scores, and an interaction effect between time and diagnosis for the Emo score. A moderate correlation was observed between the change in Ext and Emo scores between admission and discharge.
These 2 new scales of the HoNOSCA demonstrated good clinical utility and the ability to assess different aspects of clinical improvements. A significant discriminative value of both scores was observed.
The clinical utility of the 2 new scales on the HoNOSCA was established. These 2 new scales provided a sensitive measure of clinical outcome for assessing improvement between admission and discharge on a psychiatric inpatient unit for adolescents, regardless of diagnostic group, and captured additional information about clinical improvements. Adolescents with psychosis and conduct disorders presented with higher externalizing symptoms than those with other disorders, as rated on the HoNOSCA, at admission and discharge. The Emo score differentiated between clinical improvement in patients with psychosis versus eating disorders.
The sample in this study represented a homogeneous population of adolescent inpatients, so that further research is needed before these findings can be generalized to outpatients. In addition, the small number of patients in some diagnostic groups did not allow for their inclusion in some of the statistical analyses.
本研究的目的是评估与儿童青少年国家健康结果量表（HoNOSCA）总分相比，情绪症状（Emo）和外化问题（Ext）量表的临床实用性。
对260名青少年住院患者在入院和出院时进行HoNOSCA评分。评估的主要结果为：（a）3个HoNOSCA评分对临床改善的敏感性；（b）这些评分在不同诊断之间的鉴别价值。
方差分析[2（时间：入院与出院）×5（诊断组）]显示，3个评分存在时间主效应，总分和Ext评分存在诊断组主效应，Emo评分存在时间与诊断的交互效应。入院与出院之间，Ext和Emo评分的变化存在中度相关性。
HoNOSCA的这两个新量表显示出良好的临床实用性以及评估临床改善不同方面的能力。观察到两个评分均具有显著的鉴别价值。
确定了HoNOSCA上两个新量表的临床实用性。这两个新量表为评估青少年精神科住院单元入院与出院之间的改善情况提供了一种敏感的临床结果测量方法，无论诊断组如何，并获取了有关临床改善的额外信息。在入院和出院时，根据HoNOSCA评分，患有精神病和品行障碍的青少年比患有其他障碍的青少年表现出更高的外化症状。Emo评分区分了精神病患者与饮食失调患者的临床改善情况。
本研究中的样本代表了青少年住院患者的同质群体，因此在这些发现能够推广到门诊患者之前，还需要进一步研究。此外，一些诊断组中的患者数量较少，无法纳入某些统计分析。
