Chronic conditions, socioeconomic risks, and behavioral problems in children and adolescents.
Chronic conditions, socioeconomic risks, and behavioral problems in children and adolescents.
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儿童和青少年的慢性病、社会经济风险和行为问题。
作者：
S. Gortmaker;D. Walker;M. Weitzman;A. Sobol
长期以来，患有慢性健康问题的儿童一直被认为具有较高的心理社会发病风险。尽管慢性儿童疾病的患病率越来越高，人们对慢性病患者的生活质量也越来越关注，但针对慢性身体疾病儿童的行为问题进行的基于人群的研究却很少。本报告报告了美国 11,699 名 4 至 17 岁儿童和青少年的全国代表性样本的行为问题流行病学调查结果。数据包括 32 项家长报告的行为问题指数、慢性儿童状况的测量、学校安置和表现的测量以及社会人口统计学变量。分析证实，慢性身体状况是行为问题的一个重要危险因素，与社会人口统计学变量无关。在儿童中，所有分量表中都观察到了这些差异；在青少年中，最大的差异出现在抑郁/焦虑和同伴冲突/社交退缩分量表上。与没有慢性病的儿童相比，患有慢性病的儿童的极端行为问题得分率（前 10 个百分位数）高出 1.55 倍（95% 置信区间为 1.29 至 1.86）。当通过多元逻辑回归引入混杂协变量时，这些独立赔率降低至 1.44。其他独立风险包括没有亲生父母（比值比2.05）、男性（1.53）、家庭收入低与高（1.30）、母亲教育程度低与高（1.51）以及分娩时年轻与高龄（2.57）。慢性健康状况也是进入特殊教育班级和留级的主要风险因素。尽管有证据表明采取了有效的干预措施，但针对慢性病儿童的卫生服务——尤其是心理健康服务——仍然支离破碎，这表明所有照顾儿童的卫生专业人员需要更加关注行为问题及其治疗。
Children with a chronic health condition have long been considered at excess risk for psychosocial morbidity. Despite an increasing prevalence of chronic childhood conditions and heightened concerns for the quality of life of the chronically ill, population-based studies of behavior problems among children with chronic physical conditions are rare. Findings on the epidemiology of behavior problems in a nationally representative sample of 11,699 children and adolescents aged 4 to 17 years in the United States are reported. Data included a 32-item parent-reported behavior problem index, measures of chronic childhood conditions, measures of school placement and performance, and sociodemographic variables. Analyses confirmed that chronic physical conditions were a significant risk factor for behavior problems, independent of sociodemographic variables. Among children these differences were observed across all subscales; among adolescents the largest differences were found for the Depression/Anxiety and Peer Conflict/Social Withdrawal subscales. Rates of extreme behavior problem scores (those in the top 10th percentile) were 1.55 times higher among children with a chronic health condition compared with children without a chronic condition (95% confidence interval 1.29 to 1.86). These independent odds were lowered to 1.44 when covariates for confounding were introduced via a multivariate logistic regression. Other independent risks included the absence of either biologic parent (odds ratio 2.05), male gender (1.53), low vs high family income (1.30), low vs high maternal education (1.51), and young vs old maternal age at childbirth (2.57). Chronic health conditions were also a major risk factor for placement in special education classes and having to repeat grades. Despite evidence for effective interventions, health services for children with chronic conditions--particularly mental health services--remain fragmented, signaling the need for increased attention to behavioral problems and their treatment among all health professionals caring for children.