EBPU (Evidence Based Practice Unit), UCL and Anna Freud Centre, London, UK.
Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
BMC Psychiatry. 2021 Jul 23;21(1):366. doi: 10.1186/s12888-021-03364-2.
Children and adolescents' mental health problems have been largely assessed with conventional symptom scales, for example, Strengths and Difficulties Questionnaire (SDQ) given that it is one of the mostly widely used measures in specialist Child and Adolescent Mental Health Services (CAMHS). However, this emphasis on symptom scales might have missed some important features of the mental health challenges that children and young people experience including day to day functioning and life satisfaction aspect (i.e. qualify of life).
The study examined longitudinal association between a young person's self-perceptions of quality of life and mental health difficulties and referral to specialist CAMHS service using a population cohort study (Targeted Mental Health in Schools service data) nested within a large-scale linkage between school (National Pupil Data base) and child mental health service administrative data (South London and Maudsley NHS Foundation Trust children and adolescent mental health services health records). Cox proportional hazard regression to estimate crude and adjusted hazard ratios (HRs) for the association between participant psychopathology, and incidence of CAMHS referral.
Pupils experiencing more behavioural difficulties, had an increased incidence of CAMHS referral (adjusted hazard ratio 1.1, 95% confidence interval 1.0-1.2). However, pupils who reported higher health related quality of life had a lower incidence of CAMHS referral over the follow-up period (adjusted hazard hario 0.94, 95% confidence interval 0.9-0.98).
Children and young people's perception of their quality of life should be considered at the stages of a clinical needs assessment.
儿童和青少年的心理健康问题主要通过传统的症状量表进行评估，例如，长处和困难问卷（SDQ），因为它是在专科儿童和青少年心理健康服务（CAMHS）中使用最广泛的措施之一。然而，这种对症状量表的重视可能忽略了儿童和年轻人所经历的心理健康挑战的一些重要特征，包括日常功能和生活满意度方面（即生活质量）。
该研究使用人群队列研究（靶向心理健康学校服务数据），在学校（国家学生数据库）和儿童心理健康服务管理数据（南伦敦和莫兹利 NHS 基金会信托儿童和青少年心理健康服务健康记录）之间进行大规模链接，检查了年轻人自我感知的生活质量和心理健康困难与向专科 CAMHS 服务转介之间的纵向关联。使用 Cox 比例风险回归来估计参与者精神病理学与 CAMHS 转介发生率之间的关联的粗和调整危险比（HRs）。
表现出更多行为困难的学生，CAMHS 转介的发生率增加（调整后的危险比 1.1，95%置信区间 1.0-1.2）。然而，报告健康相关生活质量较高的学生在随访期间 CAMHS 转介的发生率较低（调整后的危险比 0.94，95%置信区间 0.9-0.98）。
在临床需求评估阶段，应考虑儿童和年轻人对生活质量的看法。
