Bansema C H, Vermeiren R R J M, Nijland L, de Soet R, Roeleveld J, van Ewijk H, Nooteboom L A
LUMC Curium-Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Post Box 15, 2300 AA, Leiden, The Netherlands.
Youz, Parnassia Group, The Hague, The Netherlands.
Eur Child Adolesc Psychiatry. 2024 Jul;33(7):2365-2375. doi: 10.1007/s00787-023-02325-2. Epub 2023 Dec 26.
A group of youth with severe and enduring mental health problems (SEMHP) falls between the cracks of the child-and-adolescent psychiatry (CAP) system. An insufficient understanding of these youth's mental health problems results in a failure to accurately identify and provide support to these youth. To gain a deeper understanding, the aim of this study is to explore characteristics of youth with SEMHP in clinical practice based on the experiences of youth and clinicians in CAP. This qualitative study consisted of 20 semi-structured interviews with 10 youth with lived experience and 10 specialized clinicians in CAP. Both a thematic and content analysis was conducted to identify, assess, and report themes associated with youth with SEMHP. Themes were individual characteristics such as trauma, masking, self-destructive behavior, interpersonal distrust as well as environmental and systematic characteristics including parental stressors, social isolation and societal stressors, which go beyond the existing classifications. These characteristics profoundly impact youth's daily functioning across various life domains, creating an interactive process, ultimately leading to elusive mental health problems and overwhelming feelings of hopelessness. The authors recommend proper assessment of characteristics in all life domains affected and their perpetuating effect on SEMHP during diagnostics in CAP. Engaging in a dialogue with youth themselves is crucial due to the nature of youth's characteristics, which frequently transcend traditional classifications and may not be immediately discernible. It also requires an integrated care approach, entailing collaborations between educational institutions and mental healthcare providers, and attention to potential indicators of deficits in the healthcare system and society.
一群患有严重且持续性心理健康问题（SEMHP）的青少年处于儿童和青少年精神病学（CAP）系统的缝隙之中。对这些青少年心理健康问题的理解不足导致无法准确识别并为他们提供支持。为了更深入地理解，本研究的目的是基于CAP领域青少年和临床医生的经验，探索临床实践中患有SEMHP的青少年的特征。这项定性研究包括对10名有实际经历的青少年和10名CAP领域的专业临床医生进行的20次半结构化访谈。进行了主题分析和内容分析，以识别、评估和报告与患有SEMHP的青少年相关的主题。主题包括个体特征，如创伤、伪装、自我毁灭行为、人际不信任，以及环境和系统特征，包括父母压力源、社会孤立和社会压力源，这些超出了现有的分类。这些特征深刻影响着青少年在各个生活领域的日常功能，形成一个互动过程，最终导致难以捉摸的心理健康问题和压倒性的绝望感。作者建议在CAP诊断过程中，对所有受影响生活领域的特征及其对SEMHP的持续影响进行适当评估。由于青少年特征的性质，经常超越传统分类且可能无法立即识别，与青少年自身进行对话至关重要。这还需要一种综合护理方法，需要教育机构和精神卫生保健提供者之间的合作，并关注医疗系统和社会中缺陷的潜在指标。
