Developmental Neuropsychiatry Program, Academic Child Psychiatry Unit, Department of Paediatrics, The University of Melbourne, The Royal Children's Hospital Melbourne, Parkville, VIC, Australia.
Wadja Aboriginal Family Place, The Royal Children's Hospital Melbourne, Parkville, VIC, Australia.
Aust N Z J Psychiatry. 2022 Nov;56(11):1455-1462. doi: 10.1177/00048674211063819. Epub 2021 Dec 7.
Increased point prevalence rates of oppositional defiant disorder and conduct disorder have been reported in American Indian and Canadian First Nations children and adolescents. To date, in Australia, there has been no published examination of standardized mental disorder diagnoses in First Nations children and adolescents, determined after addressing key cultural methodological issues.
In all, 113 First Nations children and adolescents and 217 non-First Nations young people, aged 6-16 years, age, gender, mental disorder symptom severity, symptom-linked distress and impairment matched were recruited in a case control study. Also, 112 typically developing non-First Nations participants, age and gender matched to the other two clinical groups as a second comparison group were recruited. mental disorder diagnoses via semi-structured clinical interview, social adversity status and full scale IQ were determined in all participants with cultural validity and reliability of the impairing patterns of symptoms in First Nations young people determined by First Nations mental health staff and Aboriginal Health Liaison Officers. Full scale IQ and social adversity status were appropriately controlled in the Logistic Regression analyses of mental disorder diagnoses between the two clinical groups.
Oppositional defiant disorder was the only diagnostic and statistical manual mental disorder diagnosis that differed between the First Nations and non-First Nations clinical groups, adjusting for confounding by social adversity status and full scale IQ in the multivariable model. The point prevalence of oppositional defiant disorder was 2.94 times higher (95% confidence interval: 1.14-7.69) among the First Nations compared to the non-First Nations clinical group.
Key known risk factors for oppositional defiant disorder can be identified early and holistically managed in First Nations young people. This will prevent oppositional defiant disorder decreasing their access to mental health services and increasing their involvement in the criminal justice system. In addition, the resilience building aspects of oppositional defiant disorder that may enhance self-respect need to be nurtured.
越来越多的研究报告显示，美国印第安人和加拿大第一民族的儿童和青少年中对立违抗性障碍和品行障碍的现患率有所增加。迄今为止，澳大利亚还没有对第一民族儿童和青少年进行标准化精神障碍诊断的研究，这些研究是在解决了关键的文化方法问题后得出的。
在这项病例对照研究中，共招募了 113 名第一民族儿童和青少年以及 217 名非第一民族的年轻人，年龄在 6-16 岁之间，性别、精神障碍症状严重程度、与症状相关的痛苦和损伤相匹配。此外，还招募了 112 名通常发育正常的非第一民族参与者，他们的年龄和性别与其他两个临床组相匹配，作为第二个对照组。通过半结构化临床访谈确定所有参与者的精神障碍诊断、社会逆境状况和全量表智商，第一民族心理健康工作人员和土著联络官员确定了第一民族年轻人症状损害模式的文化有效性和可靠性。在对两个临床组之间的精神障碍诊断进行的逻辑回归分析中，适当控制了全量表智商和社会逆境状况。
在调整了多变量模型中的社会逆境状况和全量表智商混杂因素后，只有对立违抗性障碍是第一民族和非第一民族临床组之间存在差异的诊断和统计手册精神障碍诊断。与非第一民族临床组相比，第一民族的对立违抗性障碍现患率高 2.94 倍（95%置信区间：1.14-7.69）。
可以早期识别对立违抗性障碍的关键已知风险因素，并对第一民族年轻人进行全面管理。这将防止对立违抗性障碍降低他们获得心理健康服务的机会，并增加他们参与刑事司法系统的机会。此外，还需要培养对立违抗性障碍可能增强自尊心的韧性建设方面。
