The patient journeys of children and adolescents with depression: a study of electronic health records.
The patient journeys of children and adolescents with depression: a study of electronic health records.
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患有抑郁症的儿童和青少年的患者旅程：电子健康记录的研究。
DOI：
10.1007/s00787-023-02232-6
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发表时间：
2023
影响因子：
6.4
通讯作者：
Wickersham A
中科院分区：
文献类型：
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作者：
Wickersham A
在英国，患有抑郁症的儿童和青少年可以向专门的精神卫生服务机构寻求治疗。我们对他们如何通过这些服务知之甚少，也不知道医疗保健提供者是否收集了足够的数据来准确评估这一点。我们的目标是为两个医疗保健提供者总结儿童和青少年抑郁的途径。这项队列研究使用了从剑桥郡和彼得伯勒NHS基金会信托基金(CPFT)以及南伦敦和莫德斯利NHS基金会信托基金(SLAM)提取的去身份电子健康记录。我们确定了2015至2019年间转诊的患者，在此期间，转诊患者在 <； 18岁时首次被诊断为抑郁症。我们描述了患者的人口学和临床特征，以及转诊的特点。总体而言，n= 296(CPFT)和n= 2502(SLAM)患者的转诊符合资格标准。在这两个地点，与信托基金集水区各自的人口估计相比，患者中女性(CPFT 79.3%；SLAM 69.3%)和白人(CPFT 88.9%；SLAM 57.9%)的比例更高。患者通常在青春期首次被诊断为抑郁症(CPFT中位数为16岁，SLAM中位数为15岁)。最常见的共病是焦虑症。转诊通常是例行公事，转诊到专门从事儿童年龄组的社区团队。通常提到的干预措施包括抗抑郁药物治疗、认知行为治疗和辩证行为治疗。然而，站点内部和站点之间的路径各不相同，一些数据的质量和一致性很差。这些发现概述了患有抑郁症的儿童和青少年所经历的服务途径，但也强调了途径可以根据个人需求和医疗保健提供者的不同而有所不同。对一些数据进行更系统的收集，并对不同提供商使用的记录系统进行标准化，将是有益的。
In England, children and adolescents with depression can seek treatment from specialist mental health services. We know little about how they journey through these services, or whether healthcare providers collect sufficient data to accurately appraise this. We aimed to summarise the child and adolescent depression pathway for two healthcare providers. This cohort study used de-identified electronic health records extracted from Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) and South London and Maudsley NHS Foundation Trust (SLaM). We identified referrals between 2015 and 2019 during which the referred patient received their first depression diagnosis aged < 18 years. We described patient demographic and clinical characteristics, and features of the referral. In total,n= 296 (CPFT) andn= 2502 (SLaM) patients had a referral which met eligibility criteria. In both sites, patients were more frequently female (CPFT 79.3%; SLaM 69.3%) and White ethnicity (CPFT 88.9%; SLaM 57.9%) as compared to respective population estimates for the Trusts’ catchment areas. Patients typically received their first depression diagnosis during adolescence (median ages 16 in CPFT and 15 in SLaM). The most common comorbidity was anxiety disorder. Referrals were usually routine, to community teams specialising in the child age group. Commonly mentioned interventions included antidepressant medication, cognitive behavioural therapy, and dialectical behaviour therapy. However, pathways varied within and between sites, and the quality and consistency of some data was poor. These findings provide an overview of service pathways experienced by children and adolescents with depression, but also highlight that pathways can vary according to individual need and healthcare provider. More systematic collection of some data, and standardisation in record systems used by different providers, would be beneficial.