Division of Physical Medicine and Rehabilitation, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA.
Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, USA.
Res Child Adolesc Psychopathol. 2021 Apr;49(4):491-501. doi: 10.1007/s10802-020-00737-1. Epub 2021 Jan 6.
Given sparse literature examining receipt of behavioral health service in children and caregivers following traumatic brain injury (TBI), we sought to identify predictors of unmet need. We performed an individual participant data meta-analysis using generalized linear mixed-effect models to examine predictors of behavioral health service use and unmet need. We included 572 children, ages 3 to 18, who were hospitalized overnight following complicated mild to severe TBI between 2002 and 2015. Caregivers completed ratings of depression and distress, child behavior problems, family functioning, and behavioral health service utilization. For children, unmet behavioral health service need was defined as an elevation on one or more child behavior problem scales without receipt of behavioral health services. For caregivers, unmet need was defined as an elevation on either a depression or distress scale without behavioral health service utilization. Among those with behavioral health needs, rates of unmet need were high for both children (77.8%) and caregivers (71.4%). Poorer family functioning was related to more unmet need in children (F(1, 497) = 6.57, p = 0.01; OR = 1.8) and caregivers (F(1, 492) = 17.54, p < 0.001; OR = 2.7). Children with unmarried caregivers also had more unmet behavioral health service need than those with married caregivers (F(1, 497) = 12.14, p < 0.001; OR = 2.2). In conclusion, unmet needs are common after pediatric TBI and relate to family factors. The findings underscore the importance of monitoring service needs following pediatric TBI and point to disparities in service use.
鉴于有关创伤性脑损伤 (TBI) 后儿童和照顾者接受行为健康服务的文献很少，我们试图确定未满足需求的预测因素。我们使用广义线性混合效应模型进行了个体参与者数据荟萃分析，以检查行为健康服务使用和未满足需求的预测因素。我们纳入了 572 名年龄在 3 至 18 岁之间的儿童，这些儿童在 2002 年至 2015 年期间因复杂轻度至重度 TBI 住院过夜。照顾者完成了抑郁和困扰、儿童行为问题、家庭功能和行为健康服务利用的评分。对于儿童，行为健康服务需求未得到满足的定义是一个或多个儿童行为问题量表升高而未接受行为健康服务。对于照顾者，未满足需求的定义是抑郁或困扰量表升高而未利用行为健康服务。在有行为健康需求的人群中，儿童（77.8%）和照顾者（71.4%）的未满足需求率均较高。较差的家庭功能与儿童（F[1,497]=6.57，p=0.01；OR=1.8）和照顾者（F[1,492]=17.54，p<0.001；OR=2.7）的更多未满足需求相关。与已婚照顾者相比，未婚照顾者的儿童也有更多的行为健康服务需求未得到满足（F[1,497]=12.14，p<0.001；OR=2.2）。总之，儿科 TBI 后未满足的需求很常见，与家庭因素有关。研究结果强调了在儿科 TBI 后监测服务需求的重要性，并指出了服务使用方面的差异。
