Nolan T, Zvagulis I, Pless B
Lancet. 1987 Aug 22;2(8556):411-5. doi: 10.1016/s0140-6736(87)90955-x.
Children with chronic illnesses have a doubled risk of becoming psychosocially maladjusted, and social-work support and counselling are commonly used to reduce this secondary morbidity. A randomised controlled trial of this type of intervention was conducted in 345 children with chronic physical disorders cared for in eleven specialty clinics at a children's hospital. Four months after a six-month period of social-work services, no significant difference was found between social-work and control groups in overall prevalence of maladjustment. There was no evidence to support a preventive or therapeutic effect of social work on child behaviour disorder or social dysfunction on the principal outcome measure, the Child Behaviour Checklist. Nor was there any detectable effect on child self-esteem, on maternal psychological function, or on the impact of the child's illness on the family. Furthermore, no patient subgroup could be shown to benefit from the intervention, and restriction of the analysis to individuals who received the intervention did not alter the results.
患有慢性疾病的儿童出现心理社会适应不良的风险会增加一倍，社会工作支持和咨询通常用于降低这种继发性发病率。在一家儿童医院的11个专科诊所对345名患有慢性身体疾病的儿童进行了此类干预的随机对照试验。在为期6个月的社会工作服务4个月后，社会工作组和对照组在适应不良的总体患病率上没有发现显著差异。没有证据支持社会工作对儿童行为障碍或社会功能障碍（主要结局指标为儿童行为清单）具有预防或治疗作用。对儿童自尊、母亲心理功能或儿童疾病对家庭的影响也没有可检测到的影响。此外，没有任何患者亚组显示从干预中受益，并且将分析限制在接受干预的个体上并没有改变结果。
