Crimes Against Children Research Center, University of New Hampshire, Durham.
Department of Sociology, University of New Hampshire, Durham.
JAMA Netw Open. 2021 Mar 1;4(3):e211435. doi: 10.1001/jamanetworkopen.2021.1435.
Epidemiological literature on children's mental health and children's adverse childhood experiences (ACEs) have consistently pointed to widespread, unaddressed, and treatable high-risk conditions among children.
To estimate the proportion of children with either high levels of ACEs and/or high levels of mental health symptoms who were not receiving services from behavioral health professionals.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study included 11 896 children who participated in 3 National Surveys of Children's Exposure to Violence (NatSCEV), which were nationally representative surveys conducted in 2008, 2011, and 2014. The surveys entailed telephone interviews with youth aged 10 to 17 years and caregivers of children aged 2 to 9 years. Data were analyzed from February to August 2020.
Nationally representative samples were obtained from a mix of random digit dial and address-based sampling methods. The primary outcome was the proportion of children with high ACEs, high distress symptoms, and both who were receiving clinical contact, broken down by demographic characteristics.
Of the 11 896 children, 4045 (34.0%) participated in the 2008 NatSCEV; 4112 (34.6%) in the 2011 NatSCEV; and 3738 (31.4%) in the 2014 NatSCEV; 5532 (46.5%) were aged 2 to 9 years (2785 [50.4%] aged 2-5 years; 2693 [48.7%] girls; 3521 [63.7%] White children), and 6365 (53.5%) were aged 10 to 17 years (3612 [56.7%] aged 14-17 years; 3117 [49.0%] female participants; 4297 [67.5%] White individuals). Among participants aged 2 to 9 years, no clinical contact was reported for 57% (95% CI, 51%-62%) of the high ACE group, 53% (95% CI, 48%-58%) of the high distress symptom group, and 41% (95% CI, 32%-51%) of the group with high levels on both indicators. Among participants aged 10 to 17 years, the group with no clinical contact comprised 63% (95% CI, 56%-69%) of the high ACE group, 52% (95% CI, 46%-57%) of the high distress symptom group, and 62% (95% CI, 51%-71%) of youth scoring high on both indicators. Among racial groups, odds of contact were very low for Black children aged 2 to 9 years with high ACEs compared with non-Hispanic White children with the same age and exposure (odds ratio, 0.26; 95% CI, 0.14-0.49).
In this cross-sectional study combining findings from 3 US national surveys, large portions of children at high risk because of adversity or mental health symptoms were not receiving clinical services. Better ways are needed to find these at-risk populations and help them obtain relevant intervention resources.
儿童心理健康和儿童不良童年经历（ACE）的流行病学文献一直指出，儿童中存在广泛、未得到解决和可治疗的高风险状况。
估计由于 ACE 水平高和/或心理健康症状水平高而未接受行为健康专业人员服务的儿童比例。
设计、地点和参与者：本横断面研究包括参加了 3 项全国儿童暴露于暴力调查（NatSCEV）的 11896 名儿童，这些调查是在 2008 年、2011 年和 2014 年进行的具有全国代表性的调查。这些调查涉及对 10 至 17 岁的青少年和 2 至 9 岁儿童的照顾者进行电话访谈。数据于 2020 年 2 月至 8 月进行分析。
通过随机数字拨号和基于地址的抽样方法相结合，获得了具有全国代表性的样本。主要结果是按人口统计学特征细分的 ACE 水平高、 distress 症状水平高以及两者兼有的儿童接受临床接触的比例。
在 11896 名儿童中，4045 名（34.0%）参加了 2008 年的 NatSCEV；4112 名（34.6%）参加了 2011 年的 NatSCEV；3738 名（31.4%）参加了 2014 年的 NatSCEV；5532 名（46.5%）年龄在 2 至 9 岁之间（2785 名[50.4%]年龄在 2-5 岁之间；2693 名[48.7%]女孩；3521 名[63.7%]白人儿童），6365 名（53.5%）年龄在 10 至 17 岁之间（3612 名[56.7%]年龄在 14-17 岁之间；3117 名[49.0%]女性参与者；4297 名[67.5%]白人个体）。在 2 至 9 岁的参与者中，高 ACE 组中没有临床接触的比例为 57%（95%CI，51%-62%），高 distress 症状组中为 53%（95%CI，48%-58%），两个指标均高的组中为 41%（95%CI，32%-51%）。在 10 至 17 岁的参与者中，没有临床接触的组包括高 ACE 组的 63%（95%CI，56%-69%）、高 distress 症状组的 52%（95%CI，46%-57%）和两个指标均高的组的 62%（95%CI，51%-71%）。在种族群体中，与同龄和暴露情况相同的非西班牙裔白人儿童相比，2 至 9 岁的黑人儿童因逆境或心理健康症状而处于高风险状态的情况下，接触的可能性非常低（比值比，0.26；95%CI，0.14-0.49）。
在这项结合了 3 项美国全国性调查结果的横断面研究中，由于逆境或心理健康症状而处于高风险的大量儿童没有接受临床服务。需要更好的方法来找到这些高危人群，并帮助他们获得相关的干预资源。
