[Children's Psychiatric Hospital Dr. Juan N. Navarro: 50 years of attention to the mental health of children and adolescents in Mexico]

Mental health needs and accessing specialised healthcare in Mexican children with mental disorders: gender- and diagnosis-dependent differences

BACKGROUND

Access describes factors that influence the initial contact or use of services, emphasising both the characteristics of patients and the health resources that influence the use of health services.

AIMS

To compare Mexican boys and girls with mental disorders, with respect to primary diagnosis, symptom onset, and seeking and accessing specialised mental health services (SMHS).

METHOD

Longitudinal data were collected from primary caregiver-reported assessments of 397 child-caretaker dyads (child mean age 12.17 years, range 5-18 years, 63% male) that were obtained in two psychiatric hospitals specialising in child mental healthcare. Student t-tests and χ2-tests were applied to compare boys and girls regarding their diagnosis and variables associated with the seeking of and access to SMHS.

RESULTS

Hyperkinetic disorder was the most prevalent diagnosis in boys, whereas depressive disorder and anxiety disorder were most prevalent in girls. The mean age at symptom onset for boys was 7 years, compared with 10 years for girls. Hyperkinetic disorder had the earliest symptom onset (mean 5.9 years), followed by depressive disorder (mean 9.8 years) and anxiety disorder (mean 12 years). Delayed access to SMHS was associated with initially seeking care from a psychologist, whereas quicker access was associated with affiliation with the (now defunct) Popular Insurance, a programme that served low-income and uninsured individuals.

CONCLUSIONS

Programmes aimed at children's mental health education and early intervention should consider gender- and diagnosis-related differences in symptom onset and trajectory. Access to SMHS might be improved by rapid identification by parents, educators, primary-care physicians and psychologists.

A cross-sectional study on the characteristics and factors associated with the clinical course of child and adolescent patients hospitalized in a public child and adolescent psychiatric unit of Chile

Introduction

Patients of the Short-stay Child and Adolescent Unit of the Del Salvador Psychiatric Hospital (Valparaíso, Chile) exhibit different clinical and social characteristics compared to literature reports of other national centers, although published data are scarce.

Objectives

To describe the operation of the Unit, the socio-familial and clinical characteristics of its patients and analyze factors associated with their clinical evolution.

Methods

We performed a cross-sectional study to describe the patients hospitalized over a three-year period. Variables were registered in an anonymized database. Clinical evolution was evaluated over the year following hospital discharge.

Results

The Unit's model of care can be described as involving biomedical, psychodynamic, and ecological components. We included 98 patients, of which 70.4% were male, and the average age was 11.5 ± 2.3 years. 82.6% were of low socioeconomic status, and 35.7% did not attend school; 98.9% presented family dysfunction, and 91.8% of parents had a history of psychopathology. The most frequent reason for admission was the risk of harm to self or others. The most frequent discharge diagnoses were behavioral, depressive, and personality development disorders. The average length of stay was 41.8 ± 31.1 days. The most commonly used pharmacological agents were antipsychotics and mood stabilizers. Regarding clinical evolution in the first year post-discharge, 47% were evaluated as positive, 27% regular, and 26% unsatisfactory. The factor associated with an unsatisfactory clinical course was having had in-patient antidepressants. Re-admission during the first year post-discharge was associated with comorbid substance use disorder. Treatment noncompliance was associated with a history of behavioral disorder at hospital discharge and having parents with a history of suicide or consummated suicide.

Conclusions

The patient profile is one of low socioeconomic status, severe psychopathology, maladaptive behavior, family dysfunction, and parental psychopathology. Substance use disorder is also associated with readmission.