Renaissance School of Medicine, Stony Brook University, New York.
Renaissance School of Medicine, Stony Brook University, New York.
J Am Acad Child Adolesc Psychiatry. 2023 Jul;62(7):764-776. doi: 10.1016/j.jaac.2022.12.016. Epub 2023 Jan 3.
While studies have focused on identifying potential school shooters, little is known about the mental health and other characteristics of students who make threats. This study aimed to describe these students and factors prompting psychiatric interventions and treatment recommendations.
Child and adolescent psychiatry threat assessment evaluations of 157 consecutive school-referred youths in grades K-12 between 1998 and 2019 were reviewed for demographics, reasons for referral, nature of threat, psychiatric diagnosis, and psychiatric and educational recommendations. Predictors of recommendations for psychiatric interventions were modeled using multivariable logistic regression as a function of above-mentioned covariates.
Mean (SD) age of referred students was 13.37 (2.79) years; 88.5% were male; 79.7%, White; 11.6%, Hispanic; 10.1%, Black; 2.5%, Asian. Of students, 51.6% were receiving special education services. Verbal threat was made by 80%, and 29.3% brought a weapon to school. History included being bullied in 43.4%, traumatic family events in 52.2%, physical abuse in 5.1%, sexual abuse in 5.7%, and verbal abuse in 36.3%. Frequently encountered psychiatric diagnoses were attention-deficit/hyperactivity, learning, depressive, anxiety, and autism spectrum disorders, usually in combinations. History of medication treatment was reported in 79 (50.3%) and psychotherapeutic interventions in 57 (36.3%). Recommendations to return the student to their prior schools were made for 63.1%. Recommendations for psychotherapy were made for 79.9%, medication for 88.5%, and both for 70.1%. Therapeutic school setting or psychiatric hospitalization was more likely recommended (with statistical significance) with a prior threat history (odds ratio [OR] 5.47, 95% CI 1.91-15.70), paranoid symptoms (OR 5.72, 95% CI 1.55-21.14, p = .009), autism spectrum disorders (OR 3.45, 95% CI 1.32-9.00), mood disorder (OR 5.71, 95% CI 1.36-23.96), personality disorder (OR 9.47, 95% CI 1.78-50.55), or with psychotherapy recommendation (OR 4.84, 95% CI 1.08-21.75).
Students who make threats have diverse psychiatric profiles and warrant treatments. A trauma and/or abuse history is common. Evaluations of youths who make threats need to go beyond simply assessing the threat itself and should include identifying underlying psychiatric problems. Psychiatric evaluation of students who issue threats of any type can lead to revelations about psychiatric diagnoses and crucial treatment and educational recommendations.
DIVERSITY & INCLUSION STATEMENT: The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.
虽然已有研究集中于识别潜在的校园枪手，但鲜少关注发表威胁的学生的心理健康和其他特征。本研究旨在描述这些学生以及促使进行精神科干预和治疗建议的因素。
对 1998 年至 2019 年期间 K-12 年级的 157 名连续接受学校转介的青少年进行儿童和青少年精神病学威胁评估，评估内容包括人口统计学特征、转诊原因、威胁性质、精神诊断以及精神科和教育建议。使用多变量逻辑回归，根据上述协变量，对精神科干预建议的预测因素进行建模。
转介学生的平均（SD）年龄为 13.37（2.79）岁；88.5%为男性；79.7%为白人；11.6%为西班牙裔；10.1%为黑人；2.5%为亚洲人。其中 51.6%的学生正在接受特殊教育服务。80%的学生进行了口头威胁，29.3%的学生将武器带到了学校。既往史包括 43.4%的学生曾遭受过欺凌，52.2%的学生经历过创伤性家庭事件，5.1%的学生遭受过身体虐待，5.7%的学生遭受过性虐待，36.3%的学生遭受过言语虐待。常见的精神科诊断包括注意力缺陷/多动障碍、学习障碍、抑郁障碍、焦虑障碍和自闭症谱系障碍，通常是多种障碍的组合。79（50.3%）名学生有药物治疗史，57（36.3%）名学生有心理治疗史。建议将学生送回原学校的占 63.1%。建议进行心理治疗的占 79.9%，药物治疗的占 88.5%，两者都建议的占 70.1%。有既往威胁史（比值比 [OR] 5.47，95%可信区间 [CI] 1.91-15.70）、偏执症状（OR 5.72，95% CI 1.55-21.14，p=0.009）、自闭症谱系障碍（OR 3.45，95% CI 1.32-9.00）、心境障碍（OR 5.71，95% CI 1.36-23.96）、人格障碍（OR 9.47，95% CI 1.78-50.55）的学生更有可能被推荐进行治疗性学校设置或精神病院住院治疗（具有统计学意义），或有心理治疗建议（OR 4.84，95% CI 1.08-21.75）的学生也更有可能被推荐进行治疗性学校设置或精神病院住院治疗。
发表威胁的学生有不同的精神科特征，需要进行治疗。常见创伤和/或虐待史。对发表威胁的青少年的评估不仅要评估威胁本身，还应包括识别潜在的精神问题。对发表任何类型威胁的学生进行精神科评估，可以揭示精神科诊断和重要的治疗及教育建议。
本文的作者包括来自研究地点和/或社区的贡献者，他们参与了数据收集、设计、分析和/或解释工作。
