The health and well‐being of children and young people who are looked after: Findings from a face‐to‐face survey in Glasgow

Evidence suggests children and young people who are looked after (LACYP) may have poorer health outcomes than children and young people in the general population, particularly in relation to mental health. This paper discusses findings from a survey of the health and well‐being of LACYP in Glasgow. A structured questionnaire used in the 2010 Glasgow Schools Survey (GSS) was adapted and administered in face‐to‐face interviews with 130 young people aged 11–18 in 2014–2015 to investigate various aspects of health and well‐being including physical activity, diet and sleep, smoking, alcohol and drugs, health feelings and worries, behaviours, attitudes and expectations. LACYP were more likely to report that they had tried drugs, slightly more likely to have scores indicating a high level of difficulties on the Strengths and Difficulties Questionnaire (SDQ) and less likely to report that they ate fruit and vegetables, used active transport methods to get to school and expected to go on to further or higher education; however, reported rates of physical activity, smoking and drinking were similar. LACYP were less likely to report that they had engaged in antisocial behaviour, truancy or bullying or been exposed to environmental tobacco smoke, less likely to worry or have low self‐esteem, and more likely to rate their health positively. There were some variations according to placement type. The findings of this study present a more positive picture of the health and well‐being of LACYP in Glasgow than might have been expected but should be treated with caution due to small sample size. Further research is needed to identify differences in relation to placement type and to determine whether being looked after might be associated with improved health and well‐being outcomes for some children and young people.     

Staff shortages in the mental health workforce: the case of the disappearing approved social worker

Approved social worker (ASW) numbers in England and Wales were compared on the basis of two national surveys conducted in 1992 and 2002. These data were supplemented by reports published by the Employers' Organisation in the intervening years. Although raw numbers suggested a modest absolute increase over this time, rates of ASW's per 100,000 population declined by over 50%. Possible explanations for this dramatic fall are explored. The authors conclude that specific and targeted action needs to be taken by the government and public sector employers to determine the numbers of mental health social workers needed in modernised community mental health services.     

The need to evaluate public health reforms: Australian perinatal mental health initiatives

Objective: To describe the Australian perinatal mental health reforms and explore ways of improving surveillance of maternal mental health morbidity and mortality in this context. Approaches: We reviewed the Australian perinatal (defined as conception to one year postpartum) mental health reforms, in association with an appraisal of the population health methods that could be used for their evaluation. Conclusion: Despite the increasing focus of public health reforms on maternal mental health in the perinatal period, there is currently no national data available to evaluate these reforms or to provide an evidence base for improved health outcomes. National data development and linkage of relevant datasets would go a long way towards enabling such an endeavour. Implications: Inclusion of key mental health items in the Perinatal National Minimum Dataset and use of data linkage techniques will allow for monitoring of trends in maternal mental health morbidity and mortality in response to the Australian reforms. Once this is implemented, cost‐benefit analyses can be undertaken.     

留守儿童心理健康状况的Meta分析

目的 系统评价农村留守儿童的心理健康状况,对比分析留守与非留守儿童的心理健康状况,为提高留守儿童心理健康水平提供科学依据。方法 计算机检索中国学术期刊网全文数据库(CNKI)、重庆维普中文科技期刊全文数据库、万方科技期刊全文数据库和中国生物医学文献数据库,检索时限为1979-2012年。按照纳入标准[公开发表的文献、采用“心理健康诊断测验”(MHT)测查、设立合理的非留守组作为对照、有完整的样本统计量]进行选择文献和提取资料。对纳入的12篇文献进行Mata分析,用RevMan 4.2软件进行异质性检验,应用随机效应模型计算各研究结果合并的加权均数差和95%的可信区间。 结果 统计结果显示,MHT量表中八个维度学习焦虑、对人焦虑、孤独倾向、身体症状、恐怖倾向、冲动倾向、过敏倾向和自责倾向,除最后二者外,其他六个维度的得分留守组均高于非留守组(P=0.000 1~0.03)。 结论 应采取针对性措施,展开对农村留守儿童心理健康教育工作。     

幼儿园儿童心理健康状况及其影响因素分析

对山西省太原市５６２名幼儿园儿童的心理健康状况及其影响因素进行了调查分析。结果表明：女童的心理健康状况好于男童，大班幼儿好于中班。逐步回归分析结果亦显示，影响幼儿心理健康的水平的主要因素有行为总分，班级和性别。     

The impact of 'statutory duties' on mental health social workers in the UK

In the UK, applications for involuntary admission to psychiatric units are made mainly by specially trained approved social workers (ASWs). Proposed changes in the legislation will permit other professionals to undertake these statutory duties. This study aimed to examine how ASW status impacts upon work pattern and workload stresses by comparing ASWs with other mental health social workers who did not carry statutory responsibilities. A multimethod design was adopted that included a cross-sectional national survey of mental health social workers (n=237, including 162 ASWs), and a telephone survey of mental health service managers (n=60). Data were collected using a semistructured questionnaire and diary, the content of which was derived from focus-group work and standard measures. Features of job content, working patterns and conditions were described and their association with stress, burnout and job satisfaction examined. ASWs were older and had been qualified longer than non-ASWs. The working patterns and conditions of the two groups did not differ, although ASWs did more hours on duty. ASWs received less support at work, particularly from supervisors and their role afforded less decision latitude than that of non-ASWs. ASW status was related to an elevated GHQ score, particularly among males. Emotional exhaustion was very high (over two-thirds in both groups) but ASWs and non-ASWs did not differ in this or any other feature of burnout, only 8% of the sample were actually 'burnt-out', being more common among ASWs. ASWs were more dissatisfied and were more likely than non-ASWs to want to leave their job. Given that ASW status increased stress and job dissatisfaction, especially for men, and was related to a desire to leave one's current job, it seems likely that extending statutory duties to other professionals will increase levels of stress, burnout and dissatisfaction in these groups also. In turn, this might have consequences for staff recruitment and retention.     

留守儿童心理健康状况与人格特征关系

目的探讨留守儿童心理健康状况与人格特征的关系,为心理辅导提供依据。方法采用心理健康诊断测验(MHT)量表和艾森克人格问卷,对江西省4所中小学随机抽取的412名中小学生进行匿名问卷调查,并对留守儿童的心理健康水平及人格特征应用SPSS 11.5软件进行分析。结果留守儿童与非留守儿童的总体心理健康水平差异无统计学意义,留守儿童表现出高度的学习焦虑,其中总焦虑倾向及学习焦虑的均分分别为39.52和8.51分,学习焦虑阳性检出率为70.20%;留守儿童的精神质、内外向、掩饰性量表得分均显著低于同龄常模,神经质量表得分留守男性儿童与同龄常模差异无统计学意义,但留守女性儿童的神经质量表得分显著高于同龄常模;留守儿童MHT量表的各内容量表与艾森克人格问卷各维度呈显著相关。结论留守儿童心理健康水平与人格特征关系密切。     

Medicaid managed care and the unmet need for mental health care among children with special health care needs

OBJECTIVE: To determine the association between Medicaid managed care pediatric behavioral health programs and unmet need for mental health care among children with special health care needs (CSHCN). DATA SOURCE: The National Survey of CSHCN (2000-2002), using subsets of 4,400 CSHCN with Medicaid and 1,856 CSHCN with Medicaid and emotional problems. Additional state-level sources were used. STUDY DESIGN: Multilevel models investigated the association between managed care program type (carve-out, integrated) or fee-for-service (FFS) and reported unmet mental health care need. DATA COLLECTION/EXTRACTION METHODS: The National Survey of CSHCN conducted telephone interviews with a sample representative at both the national and state levels. PRINCIPAL FINDINGS: In multivariable models, among CSHCN with only Medicaid, living in states with Medicaid managed care (odds ratio [OR]=1.81; 95 percent confidence interval: 1.04-3.15) or carve-out programs (OR=1.93; 1.01-3.69) were associated with greater reported unmet mental health care need compared with FFS programs. Among CSHCN on Medicaid with emotional problems, the association between managed care and unmet need was stronger (OR=2.48; 1.38-4.45). CONCLUSIONS: State Medicaid pediatric behavioral health managed care programs were associated with greater reported unmet mental health care need than FFS programs among CSHCN insured by Medicaid, particularly for those with emotional problems.     

Changes in mental health status amongst children of migrants to Australia: a longitudinal study

Abstract This paper examines the mental wellbeing of children of Australian migrants. Migration can be viewed as a natural experiment in which persons of one culture have their beliefs, values and behaviours challenged by the host culture. Such a process could be expected to lead to impaired mental health amongst migrants and their children. This paper investigates the relationship between migrants’ region of origin, length of stay in Australia and indicators of impaired mental health. The data were taken from the Mater‐University of Queensland Study of Pregnancy (MUSP), a longitudinal study of mothers and children which started in Brisbane, Australia, in 1981. The study comprises a cohort of over 5,000 women interviewed at their first ante‐natal clinic visit and followed up at 3–5 days, six months, 5 and 14 years after the baby was born. Results showed no significant differences between the mental health of ‘second generation’ children and their Australian counterparts. Length of stay in Australia was not associated with internalising symptoms (anxiety and depression). There was a positive association, however, between the length of stay in Australia and increased externalising problems (aggression and delinquency) amongst the children at both 5‐ and 14‐years follow‐up. We conclude that children of migrants do not differ from comparable children of Australian‐born parents in their mental health. Children of migrant parents have fewer symptoms of some behaviour problems in the years after their arrival in Australia, but these rates increase to the Australian level over time.     

流动儿童心理健康状况家庭环境影响因素分析

目的 了解家庭环境对流动儿童心理健康状况的影响。方法 采用整群抽样方法,选择辽宁省沈阳市4所学校的858名流动儿童为调查对象,采用心理健康诊断测验(MHT)对研究对象进行心理健康状况调查,采用家庭环境量表中文版(FES-CV)对研究对象进行家庭环境调查。结果 流动儿童存在心理健康问题,以学习焦虑最常见,发生率为48.50%;健康组与不健康组的家庭环境不同,不健康组儿童家庭的亲密度(6.61±2.29)分、组织性(4.95±1.86)分均低于健康组的(7.16±1.92)、(5.31±1.76)分,而矛盾性得分为(3.06±2.46)分高于健康组的(2.43±1.98)分,差异均有统计学意义(P<0.01);2组儿童的知识性得分分别为(3.54±2.06)、(3.56±1.92)分差异无统计学意义(P>0.05);家庭环境与心理健康状况有相关性(P<0.01)。结论 流动儿童存在心理健康问题,以学习焦虑、自责倾向为主,家庭环境影响流动儿童的心理健康状况。     

Enhancing social networks: a qualitative study of health and social care practice in UK mental health services

People with severe mental health problems such as psychosis have access to less social capital, defined as resources within social networks, than members of the general population. However, a lack of theoretically and empirically informed models hampers the development of social interventions which seek to enhance an individual's social networks. This paper reports the findings of a qualitative study, which used ethnographic field methods in six sites in England to investigate how workers helped people recovering from psychosis to enhance their social networks. This study drew upon practice wisdom and lived experience to provide data for intervention modelling. Data were collected from 73 practitioners and 51 people who used their services in two phases. Data were selected and coded using a grounded theory approach to depict the key themes that appeared to underpin the generation of social capital within networks. Findings are presented in four over‐arching themes – worker skills, attitudes and roles; connecting people processes; role of the agency; and barriers to network development. The sub‐themes which were identified included worker attitudes; person‐centred approach; equality of worker–individual relationship; goal setting; creating new networks and relationships; engagement through activities; practical support; existing relationships; the individual taking responsibility; identifying and overcoming barriers; and moving on. Themes were consistent with recovery models used within mental health services and will provide the basis for the development of an intervention model to enhance individuals’ access to social capital within networks.     

农村留守儿童心理健康状况分析

目的探讨农村留守儿童心理健康状况及影响因素。方法随机分层整群抽取江苏省徐州市沛县地区5所小学4~6年级共748名留守儿童,采用自行设计的调查问卷及心理健康诊断测验量表(MHT)进行现况调查。结果不同性别留守儿童在恐怖症状和总焦虑倾向得分差异有统计学意义(P0.05);监护人中72.5%为母亲照顾,20.9%为(外)祖父母,1.4%为父亲,5.2%为其他人监护。监护人文化程度构成中文盲占10.8%,小学占40.4%,初中占34.4%,高中及以上占14.4%;以监护人不同文化程度分组,留守儿童在学习焦虑、自责倾向、恐怖症状和总焦虑倾向得分差异有统计学意义(P0.05);父母不同外出打工时间,留守儿童在自责倾向、身体症状及冲动倾向得分差异有统计学意义(P0.05)。结论女生、监护人文化程度较低或父母外出打工时间较长,农村留守儿童心理健康状况相对较差。     

Health challenges of mothers with special needs children in Pakistan and the importance of integrating health social workers

ABSTRACT

There is concern that mothers of special needs children in developing countries like Pakistan are neglected populations facing hidden health challenges. The aim of this study was to investigate the kinds of health challenges mothers experience and to highlight the role of health social workers in supporting the needs of mothers. Twenty-one mothers were sampled across three cities and findings were analyzed through a thematic content analysis approach. Findings revealed that mothers faced significant and salient challenges under eight sub-categories of mental health and six sub-categories of physical health. We recommend that health social workers collaborate with healthcare practitioners to improve health services for mothers and also coordinate with other social workers, community members, and policymakers for improving both social and structural support for special needs families.     

父母外出务工对农村留守儿童心理健康的影响研究

目的:了解贫困农村地区留守儿童与非留守儿童心理健康差异并探索其影响因素。方法:在宁夏固原市用分层整群抽样的方法对7所小学的2017名学生进行问卷调查,并通过家长调查获取1474名学生的家庭信息。结果:欠发达地区农村儿童自我意识水平整体偏低;留守儿童心理健康比非留守儿童差,具体表现为自我意识水平较低、孤独感较强、社交焦虑水平较高;父母外出务工是留守儿童心理健康的危险因素,家长对孩子的关心程度、同伴关系和师生关系是影响留守儿童心理健康的三个最主要因素。结论:加强留守儿童家庭中的亲子沟通,提高监护人对留守儿童心理健康的重视,以及老师帮助学生建立融洽的师生和同伴关系是改善留守儿童心理健康状况的有效途径。     

Public drug insurance,moral hazard and children's use of mental health medication: Latent mental health risk-specific responses to lower out-of-pocket treatment costs

Studies have shown that reducing out-of-pocket costs can lead to higher medication initiation rates in childhood. Whether the cost of such initiatives is inflated by moral hazard issues remains a question of concern. This paper looks to the implementation of a public drug insurance program in Québec, Canada, to investigate potential low-benefit consumption in children. Using a nationally representative longitudinal sample, we harness machine learning techniques to predict a child's risk of developing a mental health disorder. Using difference-in-differences analyses, we then assess the impact of the drug program on children's mental health medication uptake across the distribution of predicted mental health risk. Beyond showing that eliminating out-of-pocket costs led to a 3 percentage point increase in mental health drug uptake, we show that demand responses are concentrated in the top two deciles of risk for developing mental health disorders. These higher-risk children increase take-up of mental health drugs by 7–8 percentage points. We find even stronger effects for stimulants (8–11 percentage point increases among the highest risk children). Our results suggest that reductions in out-of-pocket costs could achieve better uptake of mental health medications, without inducing substantial low-benefit care among lower-risk children.     

心理干预对服刑人员未成年子女心理健康影响的实践研究

目的 探讨心理干预对改善服刑人员未成年子女心理健康状况的作用。方法 使用心理健康诊断测验(Mental Health Test,MHT) 对31名服刑人员未成年子女进行测评,将研究对象分为实验组和对照组,对实验组给予为期8周的心理干预,并在干预后再次使用心理健康测验对实验组和对照组进行测评。结果 1)服刑人员未成年子女心理健康问题总分阳性检出率为38.7%,各项检出率由高到低依次顺序为:学习焦虑(67.7%)、身体症状(45.2%)、自责倾向(41.9%)、过敏倾向(22.6%)、恐怖倾向(16.1%)、对人焦虑(6.5%)、冲动倾向(6.5%)。2)实验组与对照组在干预前后心理健康得分的差异有统计学意义(t=6.727,P<0.001)。 结论 服刑人员未成年子女整体心理健康状况较差,主要问题表现为学习焦虑、身体症状和自责倾向。心理干预对改善服刑人员未成年子女心理健康有显著作用。     

具有艺术与体育特长儿童心理健康状况的调查

目的阐明具有艺术与体育特长儿童少年的心理健康状况。方法采用马斯洛(A.H.Maslow)安全感－不安全感问卷(S－I问卷),对武汉市少年合唱团、武汉市少年篮球队88名儿童进行心理健康水平调查,以同济医大附小50名同龄儿童作对照。结果各组问卷均分、正常或不正常率之间差异无显著性。结论具有艺术与体育特长儿童与不具此类特长儿童的心理健康状况差异没有显著性。     

流动儿童的心理健康与自我概念状况及其相关研究

目的 了解流动儿童心理健康、自我概念的特点及二者的相关。方法 分层整群抽取贵阳市流动儿童,采用中小学生心理健康测验和田纳西自我概念量表进行调查,获得有效流动儿童问卷453份。 结果 流动儿童的心理症状检出率高于一般儿童(χ²=78.74,P<0.01),在自责、恐惧、冲动及总分上女生得分高于男生(P<0.05或<0.01),心理健康的部分因素的年级差异有统计学意义(P<0.01);流动儿童的自我概念不如一般儿童,在部分因素上女生得分高于男生(P<0.05或<0.01),自我概念的年级差异都有统计学意义(P<0.01);除心理健康的身体症状和自责外,其它因素及总分与自我概念各因素相关都有统计学意义(P<0.05或<0.01)。 结论 流动儿童的心理健康和自我概念都有性别差异和年级差异,二者存在相关。     

流动儿童心理健康状况与自尊关系的研究

目的 研究流动儿童心理健康状况与自尊的关系,为流动儿童的心理健康教育提供依据。方法 采用整群抽样的方法,选择沈阳市4所学校的858名流动儿童作为调查对象。采用心理健康诊断测验 (mental health test,MHT) 对研究对象进行心理健康状况调查;应用自尊量表(Self-Esteem scale,SES)测定研究对象的自尊水平。结果 流动儿童存在心理健康问题,以学习焦虑最常见,发生率为48.50%。健康组与不健康组的自尊水平不同,不健康组儿童低于健康组(P＜0.01)。流动儿童心理健康问题与自尊水平呈负相关(P＜0.01)。 结论 流动儿童存在心理健康问题,以学习焦虑、自责倾向为主,流动儿童的心理健康状况与其自尊水平存在一定的关联性。