The Social Insurance Institution of Finland (Kela), Helsinki, Finland.
PLoS One. 2022 Nov 28;17(11):e0278198. doi: 10.1371/journal.pone.0278198. eCollection 2022.
Mental health is one of the most important contributors to the global burden of disease in children and adolescents. Mental health conditions are associated with lower quality of life in adulthood. These conditions have an early onset and typically first occur in childhood. However, little is known about how these conditions are related to service utilization before the initial diagnosis, or about the significance of the diagnosis on later service utilization. To study this, register data on 5-15-year-old children in the city of Oulu, Finland, covering the years 2013-2018 were used. To identify the association of mental health and behavioral conditions with service utilization, counterfactuals were constructed from children who were similarly diagnosed three years later. Event study regressions on several health care and service utilization outcomes were estimated. The findings showed that primary and specialized health care utilization increased sharply before the initial diagnosis and peaked during the time of diagnosis. Primary care utilization started decreasing slowly after, while specialized health care utilization remained high for two years after the diagnosis. Probability of visiting a mental health professional, use of rehabilitation services, psychiatric medication, and utilization of child protection services increased significantly after the diagnosis. The results highlighted the importance of outpatient health care in detecting and treating the conditions in children. In a fragmented system, knowledge on utilization trajectories in different services may be of help in allocating resources to improve the health of these children.
心理健康是导致儿童和青少年全球疾病负担的最重要因素之一。心理健康状况与成年后的生活质量较低有关。这些状况发病较早，通常在儿童期首次出现。然而，人们对这些状况在初始诊断之前与服务利用之间的关系，以及诊断对后期服务利用的意义知之甚少。为了研究这一点，使用了芬兰奥卢市 2013 年至 2018 年期间 5 至 15 岁儿童的登记数据。为了确定心理健康和行为状况与服务利用之间的关联，从三年后同样被诊断出患有这些疾病的儿童中构建了反事实。对几种医疗保健和服务利用结果进行了事件研究回归估计。研究结果表明，初级和专科医疗保健的利用在初始诊断前急剧增加，并在诊断期间达到高峰。此后，初级保健的利用开始缓慢下降，而专科保健的利用在诊断后仍保持高位两年。访问心理健康专业人员、使用康复服务、精神科药物以及儿童保护服务的概率在诊断后显著增加。研究结果强调了在门诊医疗保健中发现和治疗儿童疾病的重要性。在一个分散的系统中，了解不同服务中的利用轨迹可能有助于分配资源，以改善这些儿童的健康状况。
