Faculty of Medicine, Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland.
Faculty of Medicine, Research Unit of Population Health, University of Oulu, Oulu, Finland.
Eur Child Adolesc Psychiatry. 2024 Oct;33(10):3459-3470. doi: 10.1007/s00787-024-02406-w. Epub 2024 Mar 2.
Neurodevelopmental disorders (NDDs) are among the most common health issues in childhood and adolescence. Psychiatric disorders are known to be overrepresented among children using child welfare services and placed in out-of-home care (OHC). Child- and parent-related determinants for OHC among a national population with NDDs were evaluated utilising longitudinal register data from the national Finnish Birth Cohort 1997 (n = 58,802) from birth to 18 years (1997-2015). The cohort members with NDDs (n = 5,143, 9% of total cohort) formed our study population. Based on their history of OHC, cohort members with NDD were categorised to OHC (n = 903) and non-OHC groups (n = 4,240). Of all cohort members with NDDs, 17.6% had a history of OHC. Within NDDs, a significant excess of ADHD diagnosis was observed in the OHC group compared to the non-OHC group (49% vs. 26%). The OHC group with NDDs was significantly characterised by having comorbid psychiatric diagnosis for conduct and oppositional disorders (adj. RR 2.21), substance use disorders (adj. RR 1.61) and depression and anxiety disorders (adj. RR 1.60). Of all parent-related determinants, the most prevailing in the OHC group compared to the non-OHC group, was social assistance received by parent (88% vs. 44.5%). The longer the period (in years) for received social assistance, the greater the likelihood for OHC (adj. RRs range from 2.41 for one year to 5.24 for over 4 years). Further, significantly associating determinants for OHC were parental psychiatric disorders (adj. RR 1.42) and parental death (adj. RR 1.23). Our findings from the population-based cohort of children and adolescents with NDDs highlight the importance of screening and assessment of family situation. Also, effective prevention and treating of comorbid psychiatric disorders, especially conduct and oppositional disorders is essential.
神经发育障碍 (NDD) 是儿童和青少年中最常见的健康问题之一。众所周知，在使用儿童福利服务和安置在家庭外照顾 (OHC) 的儿童中，精神障碍的比例过高。本研究利用全国芬兰出生队列 1997 年 (n=58802) 的纵向登记数据，从出生到 18 岁 (1997-2015 年)，评估了儿童和父母相关因素对全国 NDD 人群中 OHC 的影响。我们的研究人群是患有 NDD 的队列成员 (n=5143，占总队列的 9%)。根据他们的 OHC 史，患有 NDD 的队列成员分为 OHC (n=903) 和非 OHC 组 (n=4240)。在所有患有 NDD 的队列成员中，有 17.6%有 OHC 史。在 NDD 中，与非 OHC 组相比，OHC 组 ADHD 诊断的比例显著增加 (49% vs. 26%)。患有 NDD 的 OHC 组的特征是患有共病行为和对立障碍 (adj. RR 2.21)、物质使用障碍 (adj. RR 1.61) 和抑郁和焦虑障碍 (adj. RR 1.60) 的精神科诊断。在所有与父母相关的决定因素中，与非 OHC 组相比，在 OHC 组中最常见的是父母接受社会援助 (88% vs. 44.5%)。接受社会援助的时间 (年)越长，接受 OHC 的可能性越大 (adj. RR 范围从 1 年的 2.41 到 4 年以上的 5.24)。此外，与 OHC 显著相关的决定因素还有父母的精神障碍 (adj. RR 1.42) 和父母死亡 (adj. RR 1.23)。我们对患有 NDD 的儿童和青少年的基于人群的队列的研究结果强调了筛查和评估家庭情况的重要性。此外，有效预防和治疗共病精神障碍，特别是行为和对立障碍，也是至关重要的。
