Finnish Institute for Health and Welfare (THL), Helsinki, Finland.
Faculty of Social Sciences, University of Helsinki, Helsinki, Finland.
Eur Child Adolesc Psychiatry. 2022 Nov;31(11):1789-1798. doi: 10.1007/s00787-021-01819-1. Epub 2021 Jun 8.
Comprehensive overviews of the use of psychiatric services among children and adolescents placed in out-of-home care (OHC) by child welfare authorities are scarce. We examine specialized service use for psychiatric and neurodevelopmental disorders among children and adolescents in a total population involving children in OHC. We used the longitudinal administrative data of a complete Finnish birth cohort 1997 (N = 57,174). We estimated risk ratios (RRs) for a range of diagnosed psychiatric and neurodevelopmental disorders among children in OHC. We also estimated RRs for OHC among those with diagnosed disorders. We used descriptive methods to explore the timing of first entry into OHC relative to the first diagnosis. Among children in OHC, 61.9% were diagnosed with any psychiatric or neurodevelopmental disorder, compared with 18.0% among those never in OHC (RR: 3.7; 95% CI 3.6-3.8). The most common diagnosed disorders among children in OHC were depression and anxiety disorders, neurodevelopmental disorders, and oppositional defiant disorder/conduct disorder (ODD/CD). Among all children with any diagnosis, 18.1% experienced OHC, compared with 2.5% among those without a diagnosis (RR: 7.4; 95% CI 6.9-7.9). Of those diagnosed with self-harm and suicidality, ODD/CD, substance-related disorders, and psychotic and bipolar disorders, 43.5-61.2% experienced OHC. Of the children in OHC receiving psychiatric services, half were diagnosed before first placement in OHC. The majority of children with experience in OHC were diagnosed with psychiatric or neurodevelopmental disorders. They comprised a significant proportion of individuals treated for severe and complex psychiatric disorders and self-harm.
儿童福利机构安置的儿童和青少年使用精神卫生服务的综合概述很少见。我们检查了涉及儿童和青少年的总人群中精神和神经发育障碍的专门服务使用情况，这些儿童和青少年处于机构照护中。我们使用了芬兰一个完整出生队列 1997 年的纵向行政数据（N=57174）。我们估计了机构照护中儿童的一系列诊断为精神和神经发育障碍的风险比（RR）。我们还估计了那些被诊断为障碍的人进入机构照护的 RR。我们使用描述性方法来探索首次进入机构照护与首次诊断之间的时间关系。在机构照护中的儿童中，61.9%被诊断出患有任何精神或神经发育障碍，而从未进入机构照护的儿童中这一比例为 18.0%（RR：3.7；95%CI 3.6-3.8）。在机构照护中的儿童中最常见的诊断障碍是抑郁和焦虑障碍、神经发育障碍以及对立违抗性障碍/品行障碍（ODD/CD）。在所有被诊断出任何疾病的儿童中，有 18.1%经历过机构照护，而没有被诊断出疾病的儿童中这一比例为 2.5%（RR：7.4；95%CI 6.9-7.9）。在被诊断出自伤和自杀、ODD/CD、物质相关障碍以及精神病性和双相障碍的儿童中，有 43.5-61.2%经历过机构照护。在接受精神卫生服务的机构照护中的儿童中，有一半是在首次被安置在机构照护之前被诊断出疾病的。有机构照护经历的儿童大多数被诊断出患有精神或神经发育障碍。他们构成了接受严重和复杂精神障碍以及自伤治疗的个体的重要组成部分。
