PMV Research Group at the Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Cologne, Herderstr. 52, 50931, Cologne, Germany.
Scientific Research Institute of the AOK (WIdO), Berlin, Germany.
Eur Child Adolesc Psychiatry. 2017 Apr;26(4):433-444. doi: 10.1007/s00787-016-0900-z. Epub 2016 Sep 14.
Children and adolescents with mental health problems need effective and safe therapies to support their emotional and social development and to avoid functional impairment and progress of social deficits. Though psychotropic drugs seem to be the preferential treatment, psychotherapy and psychosocial interventions are essential in mental health care. For Germany, current data on the utilization of psychotherapy and psychosocial interventions in children with mental health problems is lacking. To analyse why certain children and adolescents with mental or behavioural disorders do and others do not receive non-drug treatment, we assessed predictors associated with specific non-drug psychiatric/psychotherapeutic treatment including psychosocial interventions, psychotherapy and other non-drug treatments. The study is based on data of two large German health insurance funds, AOK and TK, comprising 30 % of the German child and adolescent population. Predictors of non-drug psychiatric/psychotherapeutic treatment were analysed for 23,795 cases and two controls for every case of the same age and sex in children aged 0-17 years following a new diagnosis of mental or behavioural disorder in 2010. Predictors were divided according to Andersen's behavioural model into predisposing, need and enabling factors. The most prominent and significant predictors positively associated with non-drug psychiatric/psychotherapeutic treatment were the residential region as predisposing factor; specific, both ex- and internalizing, mental and behavioural disorders, psychiatric co-morbidity and psychotropic drug use as need factors; and low area deprivation and high accessibility to outpatient physicians and inpatient institutions with non-drug psychiatric/psychotherapeutic department as enabling factors. In conclusion, the present study suggests that the residential region as proxy for supply of therapist and socioeconomic situation is an influencing factor for the use of psychotherapy. The analysis sheds further light on predisposing, need and enabling factors as predictors of non-drug psychotherapeutic/psychiatric treatment in children and adolescents with mental or behavioural health disorders in Germany. More research is needed to further understand the factors promoting the gap between the need and utilization of mental health care.
儿童和青少年精神健康问题需要有效和安全的治疗方法，以支持他们的情感和社会发展，并避免功能障碍和社会缺陷的进展。虽然精神药物似乎是首选治疗方法，但心理治疗和心理社会干预在精神保健中至关重要。对于德国来说，目前缺乏关于儿童精神健康问题患者使用心理治疗和心理社会干预的数据。为了分析为什么某些患有精神或行为障碍的儿童和青少年接受而非不接受非药物治疗，我们评估了与特定非药物精神病/心理治疗相关的预测因素，包括心理社会干预、心理治疗和其他非药物治疗。该研究基于两个德国大型健康保险公司 AOK 和 TK 的数据，这两个保险公司涵盖了德国 30%的儿童和青少年人口。在 2010 年对 0-17 岁儿童进行新的精神或行为障碍诊断后，对 23795 例病例和每例病例的两名年龄和性别相同的对照进行了分析，以确定非药物精神病/心理治疗的预测因素。预测因素根据安德森行为模型分为倾向因素、需求因素和促成因素。与非药物精神病/心理治疗呈正相关的最显著和最重要的预测因素是居住地作为倾向因素；特定的、内外向的、精神和行为障碍、精神共病和精神药物使用作为需求因素；以及低区域贫困和高获得门诊医生和非药物精神病/心理治疗部门的住院机构作为促成因素。总之，本研究表明，居住地作为治疗师供应和社会经济状况的代表是影响心理治疗使用的因素。该分析进一步阐明了德国患有精神或行为健康障碍的儿童和青少年非药物心理治疗的倾向、需求和促成因素预测因素。需要进一步研究以进一步了解促进精神卫生保健需求与利用之间差距的因素。
