Williamson Anna, Skinner Adam, Falster Kathleen, Clapham Kathleen, Eades Sandra J, Banks Emily
The Sax Institute, Sydney, NSW, Australia.
School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia.
BMJ Open. 2018 Nov 28;8(11):e023544. doi: 10.1136/bmjopen-2018-023544.
The aim of the current study is to quantify mental health-related emergency department (ED) presentations and hospitalisations, and associated child and family characteristics, in children recruited through four Aboriginal Community Controlled Health Organisations.
Four Aboriginal Community Controlled Health Services that deliver primary care. All services were located in urban or large regional centres in New South Wales, Australia.
1476 Aboriginal children aged 0-17 years at recruitment to the Study of Environment on Aboriginal Resilience and Child Health.
ED presentations and hospital admissions with a primary mental health diagnosis obtained via linkage to population health datasets.
Over a median of 6-year follow-up, there were 96 ED presentations affecting 62 children (10.7/1000 person-years) and 49 hospitalisations affecting 34 children (5.5/1000 person-years) for mental health conditions. Presentations/admissions increased with age. ED presentation was increased with: living in foster versus parental care (adjusted rate ratio (RR)=3.97, 95% CrI 1.26 to 11.80); high versus low baseline child emotional/behavioural problems (adjusted RR=2.93, 95% CrI 1.50 to 6.10); and caregiver chronic health conditions versus none (adjusted RR=2.81, 95% CrI 1.31 to 6.63). Hospitalisations were significantly increased with caregiver unemployment versus home duties (adjusted RR=4.48, 95% CrI 1.26 to 17.94) and caregiver chronic health problems versus none (adjusted RR=3.83, 95% CrI 1.33 to 12.12).
Tertiary care for mental health issues was relatively common among participating Aboriginal children, with risk elevated for those living in foster care, with prior mental health and behavioural problems and with carers with chronic illness and/or unemployment. While this study suggests high rates of serious mental health events among children from participating communities, the optimum means for reducing these rates, and the need for tertiary care, has not yet been determined. Such information is urgently required to inform policy and programmes to support Aboriginal child and adolescent mental health.
本研究旨在对通过四个原住民社区控制卫生组织招募的儿童中与心理健康相关的急诊科就诊和住院情况以及相关的儿童和家庭特征进行量化。
提供初级保健服务的四个原住民社区控制卫生服务机构。所有服务机构均位于澳大利亚新南威尔士州的城市或大区域中心。
在招募参加原住民复原力与儿童健康环境研究时年龄在0至17岁的1476名原住民儿童。
通过与人口健康数据集建立联系获得的以心理健康诊断为主要诊断的急诊科就诊和住院情况。
在中位6年的随访期内，有96次急诊科就诊，涉及62名儿童（10.7/1000人年），49次住院，涉及34名儿童（5.5/1000人年）患有心理健康疾病。就诊/住院次数随年龄增加而增加。急诊科就诊情况在以下情况时增加：与亲生父母抚养相比，由寄养机构抚养（调整后的率比（RR）=3.97，95%置信区间1.26至11.80）；基线时儿童情绪/行为问题严重程度高与低相比（调整后的RR=2.93，95%置信区间1.50至6.10）；照顾者有慢性健康状况与无慢性健康状况相比（调整后的RR=2.81，95%置信区间1.31至6.63）。住院情况在以下情况时显著增加：照顾者失业与在家做家务相比（调整后的RR=4.48，95%置信区间1.26至17.94）；照顾者有慢性健康问题与无慢性健康问题相比（调整后的RR=3.83，95%置信区间1.33至12.12）。
在参与研究的原住民儿童中，心理健康问题的三级护理相对常见，对于那些生活在寄养机构、有先前心理健康和行为问题以及照顾者患有慢性病和/或失业的儿童，风险更高。虽然本研究表明参与研究社区的儿童中严重心理健康事件发生率较高，但降低这些发生率的最佳方法以及三级护理的必要性尚未确定。迫切需要此类信息为支持原住民儿童和青少年心理健康的政策和项目提供依据。
