有特殊健康需求儿童的心理健康障碍：一项基于人群的队列研究，使用来自加拿大曼尼托巴省的关联行政数据。
Mental health disorders among children with special health needs: A population-based cohort study using linked administrative data from Manitoba, Canada.
作者信息
Enns Jennifer E, Reid-Westoby Caroline, Detillieux Gilles R, Brownell Marni, Nickel Nathan C, Gadermann Anne, Guttmann Astrid, Bennett Teresa, Duku Eric, Forer Barry, Gagné Petteni Monique, Georgiades Katholiki, Guhn Martin, Hanlon-Dearman Ana, Poon Brenda T, Janus Magdalena
机构信息
Manitoba Centre for Health Policy, Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.
出版信息
PLoS One. 2025 Jun 25;20(6):e0326672. doi: 10.1371/journal.pone.0326672. eCollection 2025.
OBJECTIVE
An estimated 15-22% of Canadian kindergarten-age children have a special health need (SHN), defined as a clinical diagnosis, a functional need requiring special accommodation at school, or a health condition leading to increased needs. Children with SHN may be more likely to experience mental health disorders than their peers without SHN, placing them at risk for further health and academic challenges. Our objective was to determine the odds of children with SHN identified in kindergarten being diagnosed with a mental health disorder by age 16.
METHODS
In this retrospective cohort study using population-based, linked administrative data, we identified children with SHN born 1995-2020 in Manitoba, Canada, and enrolled in kindergarten from 2006-2011. The SHN designation is derived from the Early Development Instrument. We measured prevalence of common childhood mental health disorders (ADHD, mood/anxiety disorders, conduct disorders) in children with SHN to age 16. Using binary logistic regressions, we calculated crude odds ratios (OR) for children with vs. without SHN being diagnosed with a mental health disorder, then adjusted for age, sex, and neighbourhood-level income.
RESULTS
Among 42,766 children, 13.8% had a SHN designation in kindergarten. Among these, 41.0% were diagnosed with a mental health disorder by age 16. The odds of a mental health diagnosis by SHN category were: special needs designation in kindergarten (OR 1.75, 95%CI 1.53-2.01); learning impairment (OR 1.61, 95%CI 1.39-1.86); behavioural impairment (OR 3.27, 95%CI 2.87-3.72); and emotional impairment (OR 2.01, 95%CI 1.75-2.32). Children with SHN (vs. none) had higher odds of a mental health disorder if they had 1 + impairment (OR 1.67, 95%CI 1.50-1.85). Adjusting for sociodemographic characteristics did not change the estimates.
CONCLUSIONS
The study highlights important kindergarten predictors of future mental health disorders in children, which should be used to inform preventive and supportive strategies for children with SHN and help generate wider mental health supports in schools.
目的
据估计，15%至22%的加拿大幼儿园适龄儿童有特殊健康需求（SHN），特殊健康需求定义为临床诊断、在学校需要特殊照顾的功能需求或导致需求增加的健康状况。与没有特殊健康需求的同龄人相比，有特殊健康需求的儿童可能更易患心理健康障碍，这使他们面临进一步的健康和学业挑战。我们的目的是确定在幼儿园被认定有特殊健康需求的儿童到16岁时被诊断为心理健康障碍的几率。
方法
在这项回顾性队列研究中，我们使用基于人群的关联行政数据，确定了1995年至2020年在加拿大曼尼托巴省出生且于2006年至2011年进入幼儿园的有特殊健康需求的儿童。特殊健康需求的认定源自早期发展工具。我们测量了有特殊健康需求的儿童到16岁时常见儿童心理健康障碍（注意力缺陷多动障碍、情绪/焦虑障碍、品行障碍）的患病率。使用二元逻辑回归，我们计算了有特殊健康需求与无特殊健康需求的儿童被诊断为心理健康障碍的粗比值比（OR），然后对年龄、性别和社区层面收入进行了调整。
结果
在42,766名儿童中，13.8%在幼儿园被认定有特殊健康需求。其中，41.0%到16岁时被诊断为心理健康障碍。按特殊健康需求类别划分，心理健康诊断的几率如下：幼儿园特殊需求认定（比值比1.75，95%置信区间1.53 - 2.01）；学习障碍（比值比1.61，95%置信区间1.39 - 1.86）；行为障碍（比值比3.27，95%置信区间2.87 - 3.72）；以及情绪障碍（比值比2.01，95%置信区间1.75 - 2.32）。有特殊健康需求的儿童（与无特殊健康需求的儿童相比）若有1种及以上障碍，则患心理健康障碍的几率更高（比值比1.67，95%置信区间1.50 - 1.85）。对社会人口学特征进行调整后，估计值未发生变化。
结论
该研究突出了幼儿园阶段儿童未来心理健康障碍的重要预测因素，应用这些因素为有特殊健康需求的儿童制定预防和支持策略提供参考，并有助于在学校提供更广泛的心理健康支持。
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