Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark.
Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Acta Psychiatr Scand. 2023 Aug;148(2):165-178. doi: 10.1111/acps.13544. Epub 2023 Mar 20.
Emotional dysregulation (ED) is a transdiagnostic phenomenon that has received increased attention, because of its potential ability to explain the development and maintenance of various psychiatric disorders. The identification of ED may serve as a potential target for both preventive and treatment interventions, however, the frequency of transdiagnostic ED among children and adolescents has not previously been evaluated. Our aim was to evaluate the frequency and types of ED in accepted and rejected referrals to the Child and Adolescent Mental Health Center (CAMHC), Mental Health Services, Copenhagen, Denmark, regardless of psychiatric status and across diagnoses. We aimed to evaluate how often ED would be a leading cause in seeking professional help, and whether children with ED not directly reflecting symptoms of known psychopathology would have higher rejection rates than children with more distinct symptoms of psychopathology. Finally, we assessed associations between sex and age with various types of ED.
We examined ED in a retrospective chart review of referrals of children and adolescents aged 3-17 years to the CAMHC between August 1st, 2020, and August 1st, 2021. We ranked problems described in the referral as primary, secondary, and tertiary depending on severity. Further, we examined group differences in the frequency of ED in accepted versus rejected referrals, as well as group differences in types of ED in age and sex distributions, and diagnoses occurring with specific types of ED.
ED was present in 62.3% of the 999 referrals and was assessed as the primary issue in twice as many rejected referrals (11.4%) compared to accepted referrals (5.7%). Boys were significantly more often described with externalizing and internalizing behavior (55.5% vs. 31.6%; 35.1% vs. 26.5%) as well as incongruent affect (10.0% vs. 4.7%), whereas girls were more often described with depressed mood (47.5% vs. 38.0%) and self-harm (23.8% vs. 9.4%). The frequency of different types of ED varied with age.
The present study is the first to evaluate the frequency of ED in children and adolescents referred to mental health services. The study offers insights into the high frequency of ED and the associations between ED and subsequent diagnoses, which may prove to be a method of early identification of risk of psychopathology. Our findings suggest that ED may rightly be considered a transdiagnostic factor, independent of specific psychiatric disorders, and that an ED-centered as opposed to diagnosis-specific approach to assessment, prevention, and treatment could target transversal symptoms of psychopathology in a more holistic manner.
情绪调节障碍（ED）是一种跨诊断现象，因其潜在能力能够解释各种精神疾病的发展和维持而受到越来越多的关注。识别 ED 可能是预防和治疗干预的潜在目标，然而，儿童和青少年跨诊断 ED 的频率以前尚未得到评估。我们的目的是评估丹麦哥本哈根心理健康服务中心（CAMHC）接受和拒绝的儿童和青少年转介的 ED 频率和类型，无论其精神状态和诊断如何。我们旨在评估 ED 是否经常成为寻求专业帮助的主要原因，以及 ED 表现不直接反映已知精神病理学症状的儿童与具有更明显精神病理学症状的儿童相比，拒绝率是否更高。最后，我们评估了性别和年龄与各种类型 ED 之间的关联。
我们通过对 2020 年 8 月 1 日至 2021 年 8 月 1 日期间向 CAMHC 转介的 3-17 岁儿童和青少年的回顾性图表审查，研究了 ED。我们根据严重程度将转介中描述的问题列为主要、次要和次要问题。此外，我们还研究了接受与拒绝转介中 ED 频率的组间差异，以及年龄和性别分布以及与特定类型 ED 一起发生的诊断中 ED 类型的组间差异。
ED 存在于 999 份转介中的 62.3%，在拒绝转介中（11.4%）比接受转介（5.7%）中更被评估为主要问题。男孩更常被描述为外化和内化行为（55.5%比 31.6%；35.1%比 26.5%）以及不一致的情绪（10.0%比 4.7%），而女孩更常被描述为情绪低落（47.5%比 38.0%）和自残（23.8%比 9.4%）。不同类型 ED 的频率随年龄而变化。
本研究首次评估了转介到精神卫生服务的儿童和青少年的 ED 频率。该研究提供了有关 ED 频率以及 ED 与后续诊断之间关联的见解，这可能被证明是识别精神病理学风险的一种方法。我们的研究结果表明，ED 可能被正确地视为一种跨诊断因素，与特定的精神障碍无关，以 ED 为中心而不是以诊断为中心的评估、预防和治疗方法可以更全面地针对精神病理学的横向症状。
