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      Identifying the determinants of perceived quality in outpatient child and adolescent mental health services from the perspectives of parents and patients

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          Prior juvenile diagnoses in adults with mental disorder: developmental follow-back of a prospective-longitudinal cohort.

          If most adults with mental disorders are found to have a juvenile psychiatric history, this would shift etiologic research and prevention policy to focus more on childhood mental disorders. Our prospective longitudinal study followed up a representative birth cohort (N = 1037). We made psychiatric diagnoses according to DSM criteria at 11, 13, 15, 18, 21, and 26 years of age. Adult disorders were defined in the following 3 ways: (1) cases diagnosed using a standardized diagnostic interview, (2) the subset using treatment, and (3) the subset receiving intensive mental health services. Follow-back analyses ascertained the proportion of adult cases who had juvenile diagnoses and the types of juvenile diagnoses they had. Among adult cases defined via the Diagnostic Interview Schedule, 73.9% had received a diagnosis before 18 years of age and 50.0% before 15 years of age. Among treatment-using cases, 76.5% received a diagnosis before 18 years of age and 57.5% before 15 years of age. Among cases receiving intensive mental health services, 77.9% received a diagnosis before 18 years of age and 60.3% before 15 years of age. Adult disorders were generally preceded by their juvenile counterparts (eg, adult anxiety was preceded by juvenile anxiety), but also by different disorders. Specifically, adult anxiety and schizophreniform disorders were preceded by a broad array of juvenile disorders. For all adult disorders, 25% to 60% of cases had a history of conduct and/or oppositional defiant disorder. Most adult disorders should be reframed as extensions of juvenile disorders. In particular, juvenile conduct disorder is a priority prevention target for reducing psychiatric disorder in the adult population.
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            Internationally Comparable Measures of Occupational Status for the 1988 International Standard Classification of Occupations

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              A meta-analytic review on treatment dropout in child and adolescent outpatient mental health care.

              A large proportion (28% up to 75%) of the treatments in youth mental health care results in premature termination (dropout). It is important to gain knowledge of the determinants of dropout because it can have very severe consequences. The aim of our meta-analytic review was to provide an overview of findings from empirical studies on this subject. We structured the often contradicting results from two perspectives. First, we compared studies with efficacy and effectiveness designs. Second, we compared studies which used a dropout definition based on the opinion of therapists, with those that took the number of predetermined completed sessions as a criterion. Third, we studied three groups of predictors, i.e., pre-treatment child variables, pre-treatment family or parent variables, and treatment and therapist variables or treatment participation barriers. The meta-analytic review showed that dropout percentages were strongly influenced by study design: Percentages were lower in efficacy than in effectiveness studies. Within effectiveness studies, the dropout percentages were lower when the therapist's opinion was used rather than when the number of sessions was used as a criterion. In efficacy studies on the contrary, the dropout percentages were similar for studies using the first or the second criterion. With respect to dropout predictors, results were less clear. Some of the dropout predictors were influenced by study design or dropout definition, but for most predictors this influence could not be analyzed because they were not studied in all groups of studies or because the effect sizes were small or non-significant. Treatment and therapist variables or experienced treatment participation barriers were overall stronger dropout predictors than the pre-treatment child variables and pre-treatment family or parent variables, although some strong predictive pre-treatment variables emerged as well.
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                Author and article information

                Journal
                European Child & Adolescent Psychiatry
                Eur Child Adolesc Psychiatry
                Springer Science and Business Media LLC
                1018-8827
                1435-165X
                October 2017
                April 5 2017
                October 2017
                : 26
                : 10
                : 1269-1277
                Article
                10.1007/s00787-017-0985-z
                28382545
                3305689b-0af4-4d67-8eb6-2260863af920
                © 2017

                http://www.springer.com/tdm

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