Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Australia.
Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Australia.
J Affect Disord. 2020 Nov 1;276:327-334. doi: 10.1016/j.jad.2020.07.086. Epub 2020 Jul 20.
Minimally adequate treatment (MAT) is intended to represent treatment minimally sufficient for common mental health problems. For children, MAT has been defined over a twelve-month period as either eight or more mental health visits, or four to seven visits plus relevant medication. MAT is used to identify those missing out on adequate care, but it is unknown whether MAT improves children's outcomes.
This paper examines whether MAT is associated with improved outcomes for children. It uses survey data from the nationally representative Longitudinal Study of Australian children on 596 children with mental health problems based on the Strengths and Difficulties Questionnaire at ages 8-15 years, linked to health service administrative data from 2012 to 2016. Statistical analysis examines the association of MAT with later quality of life (Pediatric Quality of Life Inventory), using a lagged dependent variable model to account for time-varying unobserved confounding.
Compared to children with lower levels of treatment, those who received MAT between baseline and follow up had no statistically significant improvement in either quality of life or mental health symptoms.
The observational data provide insight into real-world practice but require statistical methods to account for selection into treatment.
While clinical trials show mental health treatments can be efficacious, this study shows no evidence that children receiving MAT in routine practice have better outcomes. These findings demonstrate the need for better understanding of the nature and impact of children's mental health care as it is delivered and received in routine practice.
最低充分治疗（MAT）旨在代表针对常见心理健康问题的最低充分治疗。对于儿童来说，MAT 在一年的时间内被定义为八次或更多的心理健康就诊次数，或四次到七次就诊次数加上相关药物治疗。MAT 用于识别那些未得到充分治疗的人群，但尚不清楚 MAT 是否能改善儿童的治疗效果。
本文研究了 MAT 是否与儿童治疗效果的改善有关。它使用了澳大利亚全国代表性的纵向儿童研究的调查数据，该研究基于 8 至 15 岁儿童的《长处和困难问卷》，对 596 名有心理健康问题的儿童进行了研究，并将其与 2012 年至 2016 年的卫生服务行政数据进行了关联。统计分析使用滞后因变量模型来检验 MAT 与随后生活质量（儿童生活质量问卷）之间的关系，以考虑时间变化的未观察到的混杂因素。
与治疗水平较低的儿童相比，在基线和随访期间接受 MAT 的儿童，其生活质量或心理健康症状均无显著改善。
观察性数据提供了对真实世界实践的深入了解，但需要使用统计方法来考虑治疗的选择。
虽然临床试验表明心理健康治疗可能有效，但本研究并未表明在常规实践中接受 MAT 的儿童有更好的治疗效果。这些发现表明，需要更好地了解儿童心理健康护理的性质和影响，因为它是在常规实践中提供和接受的。
