Canning E H
Center for Pediatric Psychiatry and Medicine, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, PA 15213.
Psychosom Med. 1994 Mar-Apr;56(2):104-8. doi: 10.1097/00006842-199403000-00005.
Children, like adults and parents, depend on primary care physicians to identify, treat, or refer those with mental disorders. Mental health concerns are also germane to the growing number of chronically ill children in pediatric care. This paper focuses on: 1) the level of agreement between children and parents about the presence of a mental disorder and the impact of informant on case identification; and 2) the extent to which pediatricians agree with reports by chronically ill children and/or their parents regarding such problems. The study sample includes 112 children, ages 9 to 18, with cancer, cystic fibrosis, inflammatory bowel disease, and insulin-dependent diabetes and a control group of 35 healthy subjects. Subject and a parent were interviewed separately using a highly standardized, structured interview that generates DSM-III-R diagnoses by computer algorithms. Pediatricians completed a questionnaire asking about the presence of any mental disorders. Agreement between parent and child was poor for both groups. In the medically ill group, more cases were identified by the parent interview than by child interview alone for all types of disorders. In contrast, children in the comparison group more often reported symptoms sufficient for a diagnosis than did their parents. The difference in prevalence between the two groups was significant only for the parent-identified cases, and physicians were more likely to recognize child-identified disorders. The choice of informant(s) has clear implications for case identification and case recognition in both clinical care and research in pediatric settings.
儿童与成人及家长一样，依赖初级保健医生来识别、治疗或转诊患有精神障碍的患者。心理健康问题也与儿科护理中慢性病患儿数量的增加密切相关。本文重点关注：1）儿童与家长在精神障碍存在与否方面的一致程度以及信息提供者对病例识别的影响；2）儿科医生在多大程度上认同慢性病患儿及其家长关于此类问题的报告。研究样本包括112名9至18岁患有癌症、囊性纤维化、炎症性肠病和胰岛素依赖型糖尿病的儿童以及35名健康受试者组成的对照组。受试者和一名家长分别接受了高度标准化的结构化访谈，该访谈通过计算机算法生成DSM-III-R诊断结果。儿科医生填写了一份关于是否存在任何精神障碍的问卷。两组中家长与孩子之间的一致性都很差。在患病组中，对于所有类型的障碍，通过家长访谈识别出的病例比仅通过孩子访谈识别出的更多。相比之下，对照组中的孩子比他们的家长更常报告足以做出诊断的症状。两组患病率的差异仅在家长识别出的病例中显著，并且医生更有可能识别出孩子识别出的障碍。在儿科临床护理和研究中，信息提供者的选择对病例识别和病例确认具有明确的影响。
