Barron-Linnankoski Sarianna, Raaska Hanna, Bergman Paula, Närvänen Eija, Elovainio Marko, Laasonen Marja
Department of Child Psychiatry, Helsinki University Hospital and University of Helsinki, P.O. Box 827, 00029 Helsinki, Finland.
The Social Insurance Institution of Finland, P.O. Box 450, 00056 Helsinki, Finland.
Children (Basel). 2022 Oct 22;9(11):1602. doi: 10.3390/children9111602.
Our study addressed the gap in research on the effectiveness of cognitive behavioral therapy (CBT) in treating children with mixed psychiatric disorders. We examined the immediate and long-term effects of group CBT (GCBT), delivered in naturalistic clinical settings, on reducing internalizing and externalizing symptoms in children with mixed psychiatric disorders. Further, we compared the effectiveness of cost-effective, manualized GCBT to treatment as usual (TAU) consisting of individually tailored psychiatric outpatient services delivered by mental health care specialists.
Children aged 6-12 years ( = 103) diagnosed with psychiatric disorders, more than 70% with psychiatric comorbidity, were assigned either directly to GCBT (GCBT group; = 52) or TAU for approximately 3 months, after which they received GCBT (TAU + GCBT group; = 51). Internalizing and externalizing symptoms were assessed using parent- and teacher-report questionnaires (Child Behavior Checklist and Teacher Report Form) at referral to treatment, pre-treatment, post-treatment, and six-month follow-up.
Parent- and teacher-rated internalizing symptoms and parent-rated externalizing symptoms were reduced immediately after GCBT. Long-term GCBT gains were prominent for parent-rated externalizing symptoms. No differences were observed between the effectiveness of GCBT and TAU.
Our results suggest that GCBT and TAU services are equally effective in treating internalizing and externalizing symptoms in children with mixed psychiatric disorders, providing support for the broader use of cost-effective manualized GCBT. Manualized GCBT, which requires relatively short training, can also be delivered at primary healthcare levels. Our results are of relevance to cost-effectiveness and global mental health staff shortages.
我们的研究填补了认知行为疗法（CBT）治疗患有混合性精神障碍儿童有效性研究的空白。我们考察了在自然临床环境中实施的团体认知行为疗法（GCBT）对减轻患有混合性精神障碍儿童内化和外化症状的即时和长期效果。此外，我们将具有成本效益的标准化GCBT与常规治疗（TAU）的有效性进行了比较，常规治疗由精神卫生保健专家提供的个体化定制精神科门诊服务组成。
103名年龄在6至12岁、被诊断患有精神障碍且超过70%患有精神共病的儿童，被直接分配到GCBT组（52名）或接受约3个月的常规治疗，之后接受GCBT（常规治疗+GCBT组；51名）。在转诊治疗时、治疗前、治疗后以及六个月随访时，使用家长和教师报告问卷（儿童行为检查表和教师报告表）评估内化和外化症状。
GCBT后，家长和教师评定的内化症状以及家长评定的外化症状立即减轻。长期来看，家长评定的外化症状GCBT效果显著。GCBT和常规治疗的有效性之间未观察到差异。
我们的结果表明，GCBT和常规治疗服务在治疗患有混合性精神障碍儿童的内化和外化症状方面同样有效，为更广泛使用具有成本效益的标准化GCBT提供了支持。标准化GCBT所需培训相对较短，也可在初级卫生保健层面实施。我们的结果与成本效益和全球精神卫生工作人员短缺相关。
