Temcheff Caroline E, Martin-Storey Alexa, Lemieux Annie, Latimer Eric, Déry Michèle
Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada.
Département de psychoéducation, Université de Sherbrooke, Sherbrooke, QC, Canada.
Front Psychiatry. 2023 Jan 4;13:915991. doi: 10.3389/fpsyt.2022.915991. eCollection 2022.
Children with conduct problems (CP) have been found to be heavy and costly medical service users in adulthood. However, there is little knowledge on how medical service use develops during childhood and adolescence among youth with and without childhood CP. Knowing whether differences in developmental trajectories of medical service use for specific types of problems (e.g., injuries) are predicted by childhood CP would help clinicians identify developmental periods during which they might intensify interventions for young people with CP in order to prevent later problems and associated increased service use.
Participants were drawn from an ongoing longitudinal study of boys and girls with and without childhood CP as rated by parents and teachers. Medical service use was assessed using administrative data from a public single payer health plan. Latent growth modeling was used to estimate the mean trajectory of four types of medical visits (psychiatric, injury-related, preventative, total visits) across time and evaluate the effect of CP and other covariates.
Support the hypothesis that early CP predicts higher medical service use at nine years old, and that this difference persists in a chronic manner over time, even when controlling the effects of ADHD and family income. Girls had fewer medical visits for psychiatric reasons than boys at baseline, but this difference diminished over time.
Clinicians should be aware that childhood CP already predicts increased medical service use in elementary school. Issues specific to different contexts in which injuries might occur and sex differences are discussed.
有品行问题（CP）的儿童在成年后被发现是医疗服务的大量使用者，且成本高昂。然而，对于有和没有儿童期CP的青少年，在儿童期和青少年期医疗服务使用情况如何发展，人们了解甚少。了解儿童期CP是否能预测特定类型问题（如受伤）的医疗服务使用发展轨迹差异，将有助于临床医生确定他们可能加强对有CP的年轻人进行干预的发育阶段，以预防后期问题及相关的服务使用增加。
参与者来自一项正在进行的纵向研究，该研究涉及经父母和教师评定有和没有儿童期CP的男孩和女孩。使用来自公共单一支付者健康计划的管理数据评估医疗服务使用情况。使用潜在增长模型来估计四种类型医疗就诊（精神科、与受伤相关、预防性、总就诊次数）随时间的平均轨迹，并评估CP和其他协变量的影响。
支持以下假设：早期CP可预测9岁时更高的医疗服务使用，且即使控制了注意力缺陷多动障碍（ADHD）和家庭收入的影响，这种差异也会随着时间以慢性方式持续存在。在基线时，女孩因精神科原因的就诊次数少于男孩，但这种差异随着时间的推移而减小。
临床医生应意识到儿童期CP已可预测小学阶段医疗服务使用增加。文中讨论了受伤可能发生的不同背景下的特定问题以及性别差异。
