University College Dublin, Dublin 4, Ireland.
Clanwilliam Institute, Dublin 2, Ireland.
Trauma Violence Abuse. 2020 Jul;21(3):484-497. doi: 10.1177/1524838018777788. Epub 2018 May 20.
The aim of the systematic review described in this article was to determine the outcomes for individuals exposed to severe neglect in congregate care institutions such as orphanages. In this context, severe neglect refers to failure to meet children's basic physical, developmental, and emotional needs due to inadequate resources. In this systematic review of previous systematic reviews and meta-analyses, searches of 10 databases were conducted, 18 papers that met inclusion and exclusion criteria were selected for review, their quality was assessed, and data were extracted and synthesized. The 550 primary studies included in the 18 systematic reviews and meta-analyses were relatively well designed, allowing confidence to be placed in their results. Severe neglect was associated with a wide range of problems in the domains of physical development, cognitive development, attachment, and mental health. The severity of adverse outcomes was partly influenced by the duration and severity of deprivation and a constellation of risk and protective factors. Prevention policies should aim to eliminate large underresourced congregate care institutions for infants. In taking steps toward this, policies should aim to adequately resource congregate care institutions to meet children's developmental needs for nutrition, stimulation, and attachment to a stable primary caregiver with adequate parenting skills and training. Early placement in adoptive or foster families, with access to routine physical and mental health-care service available in developed countries, is the most viable effective intervention for child survivors of severe neglect.
本文所描述的系统评价旨在确定在机构集中照料环境（如孤儿院）中遭受严重忽视的个体的结局。在此背景下，严重忽视是指由于资源不足，未能满足儿童的基本身体、发育和情感需求。在对先前的系统评价和荟萃分析进行的系统综述中，对 10 个数据库进行了检索，选择了 18 篇符合纳入和排除标准的论文进行综述，评估了其质量，并提取和综合了数据。这 18 篇系统评价和荟萃分析中包含的 550 项主要研究设计相对较好，因此可以对其结果有信心。严重忽视与身体发育、认知发展、依恋和心理健康等领域的广泛问题有关。不良结局的严重程度部分受到剥夺的持续时间和严重程度以及一系列风险和保护因素的影响。预防政策应旨在消除资源不足的大型机构集中照料机构，为婴儿提供服务。在采取这一措施时，政策应旨在为集中照料机构提供充足的资源，以满足儿童在营养、刺激和与有足够育儿技能和培训的稳定主要照顾者建立依恋方面的发展需求。对于严重忽视的儿童幸存者，最可行的有效干预措施是早期安置在领养或寄养家庭中，并可获得发达国家提供的常规身心健康保健服务。
