青少年创伤性脑损伤后精神卫生服务的使用：一项随机对照试验的二次分析。
Use of Mental Health Services by Adolescents After Traumatic Brain Injury: A Secondary Analysis of a Randomized Controlled Trial.
机构信息
Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN 55905.
Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
出版信息
PM R. 2018 May;10(5):462-471. doi: 10.1016/j.pmrj.2017.10.004. Epub 2017 Oct 31.
BACKGROUND
Mental health problems are common after pediatric traumatic brain injury (TBI). Many patients in need of mental health services do not receive them, but studies have not consistently used prospective and objective methods or followed samples for more than 1 year.
OBJECTIVE
To examine adolescents' use of mental health services after TBI.
DESIGN
Secondary analysis from multicenter prospective randomized controlled trial.
SETTING
Five level 1 U.S. trauma centers.
PARTICIPANTS
Adolescents aged 12-17 years with moderate-to-severe TBI were recruited for a randomized clinical trial (n = 132 at baseline, 124 at 6 months, 113 at 12 months, and 101 at 18 months).
METHODS
Participants were randomly assigned to counselor-assisted problem-solving or Internet resource comparison. Follow-up assessments were completed at 6, 12, and 18 months after baseline. Generalized estimating equations with a logit link were used to examine use of mental health services. Treatment group and participant impairment were examined as predictors of use.
MAIN OUTCOME MEASUREMENTS
Mental health care use was measured with the Service Assessment for Children and Adolescents; daily functioning and clinical outcome with the Child and Adolescent Functional Assessment Scale; behavioral and emotional functioning with the Child Behavior Checklist; and executive dysfunction with the Behavior Rating Inventory of Executive Function.
RESULTS
Use of mental health services ranged from 22% to 31% in the 2 years post-TBI. Participants with impairments were about 3 times more likely than those without impairments to receive services (odds ratio 4.61; 95% confidence interval 2.61-8.14; P < .001). However, 50%-68% of patients identified as impaired had unmet mental health care needs.
CONCLUSIONS
Less than one half of adolescents with behavioral health needs after TBI received mental health services. Future studies are needed to examine barriers associated with seeking services after TBI and psychoeducation as preventive care for this population.
LEVEL OF EVIDENCE
II.
背景
儿童创伤性脑损伤（TBI）后常见心理健康问题。许多需要心理健康服务的患者并未获得服务，但研究并未始终使用前瞻性和客观方法，或对样本进行超过 1 年的随访。
目的
检查 TBI 后青少年使用心理健康服务的情况。
设计
多中心前瞻性随机对照试验的二次分析。
地点
美国 5 家 1 级创伤中心。
参与者
纳入了年龄为 12-17 岁的中度至重度 TBI 青少年，进行了一项随机临床试验（基线时为 132 例，6 个月时为 124 例，12 个月时为 113 例，18 个月时为 101 例）。
方法
参与者被随机分配至辅导员辅助问题解决或互联网资源比较组。在基线后 6、12 和 18 个月进行随访评估。采用对数链接的广义估计方程来检查心理健康服务的使用情况。将治疗组和患者损伤情况作为使用的预测因素进行检查。
主要观察指标
使用儿童和青少年服务评估量表评估心理健康服务的使用情况；使用儿童和青少年功能评估量表评估日常功能和临床结局；使用儿童行为检查表评估行为和情绪功能；使用行为评定量表评估执行功能。
结果
TBI 后 2 年，心理健康服务的使用率在 22%-31%之间。与无损伤者相比，有损伤者接受服务的可能性约为其 3 倍（优势比 4.61；95%置信区间 2.61-8.14；P<.001）。然而，50%-68%的患者存在未满足的心理健康服务需求。
结论
TBI 后有行为健康需求的青少年中，不足一半的人接受了心理健康服务。需要进一步研究以探讨与 TBI 后寻求服务相关的障碍以及该人群的心理教育预防措施。
证据等级
II。
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