国外心理健康服务及其启示

在回顾了美国、瑞典等国家心理健康服务概况的基础上提出了以下启示：1．中国心理健康服务体系应以构建和谐社会理论为基础;2．在心理服务的教育与培训中,应当尽量兼顾普及知识与提高专业化水平两个目标;3．政府应当大力支持社区心理健康服务以及包含各种社区可用资源的综合性社区服务;4．中国心理健康服务必须从本国文化与国情出发,因此还需要更多这方面的文献总结与实际诃查工作;5．心理健康服务应当全面而有区别地实施予心理健康水平不同的人群。     

Expanding Mental Health Services to Older High-Utilizing HMO Patients: A Pilot Study

Background: Expanded mental health benefits were offered to older HMO patients who were high medical utilizers. Outcomes of interest were use of services, subjective well-being, and psychopathology. Methods: Sixty-nine (25 male, 44 female) patients age 55 or above seeking frequent outpatient medical care completed the SF-36 health survey and the revised Symptom Check List (SCL-90-R). Patients were assigned to usual care, health education, or expanded mental health benefit conditions. Results: Patients showed high initial levels of psychopathology and distress. Over the 6 months of the study, patients in the expanded benefits group made a mean of 11.5 visits to mental health professionals versus a mean of 3.4 visits by usual care patients. Patients in the expanded benefits group showed significant improvement in SF-36 General Health and Mental Health well-being scores. Patients in the health education group showed no improvement. Patients in the usual care group showed improvements in Vitality scores. Psychopathology summary scores showed improvement for both usual care and enhanced benefit groups. Conclusions: Mental health treatment may improve well-being and reduce psychopathology in older high-utilizing patients. Creativity will be needed in expanding access to mental health services for this population.     

Concordance Between Parent Reports of Children's Mental Health Services and Service Records: The Services Assessment for Children and Adolescents (SACA)

The concordance between parent reports of children's mental health services and medical and administrative service records were assessed in a field test of the Services Assessment for Children and Adolescents (SACA) interview instrument. Service use reports from primary caregivers, usually mothers, for their child's emotional or behavioral problems were compared against inpatient, outpatient, and school records in St. Louis, one of the pilot sites for the Multi-Site Study of Service Use, Need, Outcomes and Costs in Child and Adolescent Populations (UNOCCAP). A global any use service variable, comprised of inpatient, outpatient, and school reports, yielded an overall service use concordance kappa of .76 between parent reports and records. Parent reports of inpatient hospitalization services using the SACA yielded the highest agreement with medical records, with kappa statistics of 1.00 for use of any inpatient hospital care and for medication use. Parent reports of specific inpatient services concurred with medical records more moderately, yielding kappas from .50 to .66. Reports of any outpatient mental health services yielded variable rates of agreement, with kappas ranging from .67 for any use of outpatient care, to .66 for medication use, to negligible kappas for specific treatments. Parent reports of school services were weakly related to records for most services, except for moderate agreement (.48) on placement in special classrooms for emotional or behavioral problems. Family burden or impact discriminated more powerfully than other variables between respondents who concurred with records and those who did not.     

Termination of Mental Health Services for Children

In this paper, we examine the termination of children's mental health services. Analyses were based on the 901 families in the Fort Bragg Evaluation Project who participated at Wave 1 and Wave 2 six months later. The project compared a full continuum of care provided at a demonstration site with traditional care at two comparison sites. The results showed that in most cases families and providers were partners in decisions to terminate treatment. About half of the clients self-terminated or were terminated solely at the discretion of the provider. Providers tended to play a more dominant role in terminating restrictive services; families played a more central role in terminating outpatient care. Regardless of initial psychopathology, children in single-headed households, whose parents were dissatisfied with services, did not expect their child to cooperate with treatment and did not expect treatment to help their child, were more likely to terminate care than others. While the Demonstration site had significantly fewer terminations, the sites did not differ with regard to the reasons for termination, who participated in termination decisions, or the factors that affected the likelihood to terminate care. Of most interest, mental health outcomes among children who had terminated all care did not vary by reasons for termination or by who participated in the termination decision.     

Effectiveness of School-Based Mental Health Services for Children: A 10-Year Research Review

A review of the literature from 1985 to 1995 on school-based mental health services for children was conducted using a computerized data-base search. Of the 5,046 references initially identified, 228 were program evaluations. Three inclusion criteria were applied to those studies: use of random assignment to the intervention; inclusion of a control group; and use of standardized outcome measures. Only 16 studies met these criteria. Three types of interventions were found to have empirical support for their effectiveness, although some of the evidence was mixed: cognitive-behavioral therapy, social skills training, and teacher consultation. The studies are discussed with reference to the sample, targeted problem, implementation, and types of outcomes assessed, using a comprehensive model of outcome domains, called the SFCES model. Future studies of school-based mental health services should (a) investigate the effectiveness of these interventions with a wider range of children's psychiatric disorders; (b) broaden the range of outcomes to include variables related to service placements and family perspectives; (c) examine the combined effectiveness of these empirically-validated interventions; and (d) evaluate the impact of these services when linked to home-based interventions.     

残疾儿童心理健康对家长亲职压力的影响:有调节的中介效应

为探讨残疾儿童心理健康与家长亲职压力的关系,揭示亲社会行为在残疾儿童情绪行为问题与家长亲职压力之间的中介作用,以及问题影响程度的调节效应,本研究采用短式亲职压力量表、长处和困难问卷分别对199名残疾儿童及其家长进行问卷调查,结果发现：（1）残疾儿童情绪行为问题对家长的亲职压力有显著的正向预测作用;（2）亲社会行为在残疾儿童情绪行为问题与亲职压力之间起着部分中介的作用;（3）问题影响程度能够调节该中介效应,当问题影响程度越小时,中介效应越显著。可见,亲社会行为能够缓冲残疾儿童情绪行为问题对家长亲职压力的负向影响,并且问题影响程度越小,这种缓冲作用越明显。     

学习不良儿童心理健康的特点研究

考察学习不良儿童心理健康（学习、自我、人际关系、社会生活适应）的特点。被试为小学3～5年级83名儿童。结果发现：学习不良儿童与一般儿童的心理健康存在显著差异;学习不良儿童的学习、自我、社会生活适应等方面显著低于一般儿童。在学习各维度上,学习不良儿童与一般儿童的自我满足感、体脑协调性、学习习惯之间存在显著差异;在自我各维度上,学习不良儿童与一般儿童的社会自我、学术自我、自我认同之间存在显著差异;在社会生活适应各维度上,学习不良儿童与一般儿童的亲社会行为、居家能力存在显著差异。     

Mental Health Problems of Children in Foster Care

We compared the rates of mental health problems in children in foster care across three counties in California. A total of 267 children, ages 0 to 17, were assessed two to four months after entry into foster care using a behavioral screening checklist, a measure of self-concept and, in one county, an adaptive behavior survey. Results confirmed previous research and indicated consistently high rates of mental health problems across the three counties. Behavior problems in the clinical or borderline range of the CBCL were observed at two and a half times the rate expected in a community population. Fewer children fell within the clinical range on the self-concept measure. No significant differences in rates between the three county foster care cohorts were observed, despite the different demographic characteristics of the counties. On the adaptive behavior scale, the mean scores for children in foster care were more than one standard deviation below the norm. Our findings suggest that the most important mental health screening issue with children in foster care is to identify what specific mental health problems need to be addressed so that the most effective treatment services can be provided.     

Mapping Men's Mental Health

The central theme of this paper is that men are at one and the same time both damaged and damage-doing. The process of being damaged through the agency of masculinity predisposes men to exploit, dominate and abuse—not only as boys, as partners and fathers, but as priests, teachers, therapists, lawyers, nurses, psychologists and psychiatrists. Mental health services need to see both aspects of this male equation: a focus on male abuse alone leads to punishment, containment and, very likely, the continuation of abuse; a focus on male damagedness alone preserves the ideology of male unaccountability. However, evidence reviewed here suggests that most traditional psychiatric services fail to acknowledge the impact of inequalities on men's mental health as comprehensively as they fail to acknowledge the impact of these inequalities on the mental health of women. This is a significant problem, and we suggest ways that a gendered analysis of masculinity can be used to help address this deficit. This analysis is used to develop a map of men's mental health that not only accommodates traditional categories of mental health difficulty, but other important consequences of the close association between masculinity and sexuality inequality, especially the use of violence and the capacity to do harm. This analytical framework also invites consideration of the invisibility of male distress, the disallowing and desensitizing of ‘vulnerability, and their submersion in a kind of psychology of entitlement. Finally, we consider the implications of this mapping exercise for mental health services and for working with men.     

轻度智力落后学生心理健康问题的研究

本研究使用心理健康诊断测验(MHT)手册对10-16岁(四至九年级)的轻度智力落后学生与智力正常学生间的心理健康水平进行比较研究,结果发现：轻度智力落后学生有不同程度的心理健康问题,随班就读轻度智力落后学生的心理健康问题尤为突出．有待相应有效的教育支持。     

流动儿童自我概念的发展及其与心理健康的关系*

探讨9-15岁流动儿童自我概念的发展及其与心理健康的关系。选取北京市4所打工子弟学校9-15岁流动儿童644名,9-15岁城市普通儿童441名。采用Song-Hattie自我概念量表和心理健康量表（青少年版）分别评估自我概念和心理健康状况。结果发现：（1）流动儿童自我概念自9岁至15岁总体上均呈现下降趋势;（2）流动儿童的自我概念水平显著低于同龄城市普通儿童,但总体发展趋势与普通儿童相似;（3）流动儿童自我概念与心理健康之间存在正相关关系,自我概念各因子对心理健康有很好的预测作用。     

The Role of Schools in Outcomes for Youth: Implications for Children's Mental Health Services Research

We explore the role of schools in children's mental health services research. Recent literature has suggested that schools play an important role in delivering services to children and adolescents with emotional and behavioral problems. Research in services research, though, has taken a fairly narrow view of which dimensions of school environments are relevant for inclusion in studies. We suggest that a broader view of school environments is appropriate and potentially beneficial to the field. Using Bronfenbrenner's ecological model as a guide, we conceptualize schools as microsystems. Such an approach suggests that all aspects of school environments (treatment as well as non-treatment) are likely to influence many of the outcomes that children's mental health services research frequently targets (e.g., behavioral problems, problematic peer relationships, academic achievement, school attendance). We review literature from a variety of disciplines to suggest relevant features of schools, with particular attention to the role of peer dynamics within schools. We conclude with implications of this expanded conceptualization of schools for children's mental health services research.     

流动儿童歧视知觉与心理健康水平的关系及其心理机制

为了探讨流动儿童所感受到的歧视对他们心理健康水平的影响, 以及应对方式和自尊在其中所起的作用, 从北京市公立学校和打工子弟学校选取1164名流动儿童、从公立学校选取525名北京儿童、从流动儿童主要来源地的农村选取568名农村儿童作为被试, 采用问卷调查的形式, 测查了流动儿童感受到的歧视、他们的心理健康水平(社交焦虑、孤独感、抑郁)、应对方式和自尊。研究发现: (1) 流动儿童所感受到的社会歧视在学校类型、流动性上存在显著的差异, 打工子弟学校的流动儿童得分显著高于公立学校的, 流动性高的儿童得分显著高于流动性低的, 但在性别上不存在显著差异, 也不存在学校类型与性别和流动性的交互作用; (2) 流动儿童的心理健康水平在性别、学校类型和流动性上存在显著的差异, 女孩、来自公立学校的流动儿童、流动性高的儿童的心理健康水平显著差于与之相对应的被试, 除在社交焦虑和抑郁上存在学校类型和性别的交互作用外, 在孤独感上不存在学校类型和流动性的交互作用; (3) 不同类别儿童在心理健康水平上存在显著差异, 流动儿童在社交焦虑、孤独感上最差; (4) 除消极应对与自尊、积极应对与抑郁相关不显著外, 歧视、心理健康水平、应对方式、自尊两两之间都相关非常显著; (5) 歧视知觉对心理健康水平有显著的直接影响, 也通过应对方式和自尊对心理健康水平产生显著的影响。自尊不仅在歧视知觉与心理健康水平之间起到显著的部分中介作用, 在应对方式和心理健康水平之间也起到了显著的部分中介作用。     

事实孤儿心理健康的研究进展

论述了事实孤儿的定义及特点、常见心理问题及影响因素和现有事实孤儿心理健康干预及不足等。认为事实孤儿是儿童中的最为脆弱的一类儿童。事实孤儿的心理存在多种健康问题,包括情绪障碍、人际关系不稳定、自我管理能力低下、应对能力减弱。初步探讨和总结了国内外心理健康干预作用于事实孤儿心理健康问题的相关实证研究,并在此基础上提出心理健康干预在事实孤儿领域未来初步的发展方向。以期为相关研究者系统地认识事实孤儿的心理健康问题、开展相应干预措施提供参考。     

贫困对儿童心理健康的影响及其内在机制

儿童贫困问题是世界范围内的一个重大公共卫生问题。近几十年来,国内外的研究发现贫困对儿童的消极心理健康状态和积极心理健康状态均会产生影响。研究者试图从家庭和社会两个层面来解释贫困对儿童心理健康的影响,以揭示其内在影响机制。未来的研究应加强贫困儿童心理健康发展过程中的保护因素研究,探索儿童期贫困对个体心理健康的长期影响及其成因,进一步在我国社会文化背景下开展本土化研究,为实践上的预防和干预提供帮助。     

心理健康培训对医护人员心理健康服务的影响

为探讨医护人员心理健康培训现状以及对心理健康服务的影响,采用《医护人员心理健康教育培训问卷》与《心理健康服务行为量表》对664名医护人员进行问卷调查。结果发现,分别有91.6%、65.2%的医护人员学习过心理健康相关课程或接受过相关培训,70.3%通过科普宣传途径学习心理健康知识;心理健康教育和培训正向预测心理健康服务,能够增加8.5%解释变异量。因此,医护人员接受心理健康教育与培训的内容和途径较为单一,对医护人员加强心理健康相关教育培训,可以增加其心理健康服务。     

Referral Source Differences in Functional Impairment Levels for Children Served in the Comprehensive Community Mental Health Services for Children and Their Families Program

We report one of the first multi-site investigations into referral source variation in functional impairment for children with serious emotional disturbance served in systems of care settings. Baseline data collected as part of the national evaluation for the Comprehensive Community Mental Health Services for Children and Their Families Program was used to assess the comparability of functional status for children referred from traditional mental health versus non-mental health agencies. Results indicate that children referred from child welfare and family groups have significantly lower levels of overall dysfunction than those referred from mental health, while children referred from school and juvenile justice agencies have comparable levels. Clinical and research implications are discussed.     

学习不良儿童的心理行为问题

学习不良儿童的心理行为问题已成为人们关注的一个焦点。从心理健康的角度考察,学习不良儿童心理行为问题主要表现在生活和社会适应、学习和违纪,以及焦虑、抑郁和自杀等方面;造成上述现象的主要原因要有自我概念较低、家庭因素的不良影响,以及社会认知方面存在的缺陷。可以通过干预和矫正学习不良儿童的心理行为问题,从而提高他们的心理健康水平。     

儒家文化对当前中国心理健康服务实践的影响

心理健康服务是以心理学的理论和方法为主导来维护与促进人们心理健康的活动。它与个人的心理因素和社会文化因素有必然联系, 中国心理健康服务植根于中国文化的土壤之中, 它本身就是文化的产物。而儒家文化作为中国社会的主流文化, 它在中国心理健康服务过程中具有表征、构建、指导、唤起功能; 对心理健康服务者和被服务者的人格、应对方式以及服务态度和行为产生直接和间接影响。中国心理健康服务模式与儒家文化传统的关系问题实际上涉及的是心理健康服务与文化的普遍性与特殊性问题。构建适合中国文化土壤的心理健康服务体系需要研究儒家文化传统对心理健康服务模式的观念、理论及实践操作层面的作用和影响。     

Primary Prevention Mental Health Programs for Children and Adolescents: A Meta-Analytic Review

Used meta-analysis to review 177 primary prevention programs designed to prevent behavioral and social problems in children and adolescents. Findings provide empirical support for further research and practice in primary prevention. Most categories of programs produced outcomes similar to or higher in magnitude than those obtained by many other established preventive and treatment interventions in the social sciences and medicine. Programs modifying the school environment, individually focused mental health promotion efforts, and attempts to help children negotiate stressful transitions yield significant mean effects ranging from 0.24 to 0.93. In practical terms, the average participant in a primary prevention program surpasses the performance of between 59% to 82% of those in a control group, and outcomes reflect an 8% to 46% difference in success rates favoring prevention groups. Most categories of programs had the dual benefit of significantly reducing problems and significantly increasing competencies. Priorities for future research include clearer specification of intervention procedures and program goals, assessment of program implementation, more follow-up studies, and determining how characteristics of the intervention and participants relate to different outcomes.