Clinical and sociodemographic characteristics of children and adolescents under health measure

Abstract

Purpose: The aim of this study was to retrospectively examine the reasons for the health measures applied to children and adolescents who applied to the Child and Adolescent Psychiatry Outpatient Clinic, whether additional measures were applied, sociodemographic characteristics, diagnoses and treatments.
Materials and methods: The files of 150 children and adolescents who applied to the outpatient clinic with a health measure decision between 01.01.2023 and 31.12.2024 were retrospectively reviewed.
Results: The most common diagnosis was depressive disorder (35%), and antipsychotics (44%) and antidepressants (35%) were the most commonly used treatments. Sexual abuse was significantly higher in females and being a child dragged into crime was significantly higher in males (p=0.002). Substance abuse was significantly higher in children who did not continue their education (p=0.022). The diagnosis of ADHD and conduct disorder was significantly higher in males and depressive disorder was significantly higher in females (p<0.001; p=0.005; p<0.001). Intellectual disability was found to be significantly higher in children dragged into crime (p<0.001). A significant correlation was found between the diagnosis of anxiety disorder and regular outpatient follow-up, and substance use disorder and not attending regular follow-up (p=0.031; p=0.034).
Conclusion: The study has allowed us to evaluate the sociodemographic and clinical characteristics of cases with health measures and better understand the importance and impact of mental health support and follow-up for children. More comprehensive and longitudinal studies in this field are important for strengthening the child protection system.

Keywords

• Health measure
• child protection law (CPL)
• child and adolescent psychiatry

Sağlık tedbiri ile izlenen çocuk ve ergenlerin klinik ve sosyodemografik özellikleri

Abstract

Amaç: Bu çalışmanın amacı, Çocuk ve Ergen Psikiyatrisi Polikliniğine başvuran çocuk ve ergenlerde uygulanan sağlık tedbirlerinin nedenlerini, ek tedbir alınıp alınmadığını, olguların sosyodemografik özellikleri, tanıları ve tedavilerini retrospektif olarak incelemektir.
Gereç ve yöntem: 01.01.2023 ile 31.12.2024 tarihleri arasında sağlık tedbiri kararı ile polikliniğe başvuran 150 çocuk ve ergenin dosyaları retrospektif olarak incelenmiştir.
Bulgular: En yaygın tanı depresif bozukluktur (%35) ve en sık kullanılan tedavi antipsikotikler (%44) ve antidepresanlar (%35) olmuştur. Cinsel istismar, kadınlarda anlamlı derecede daha yüksek ve suça sürüklenen çocuk olma durumu erkeklerde anlamlı derecede daha yüksek bulunmuştur (p=0,002). Madde bağımlılığı, eğitimine devam etmeyen çocuklarda anlamlı derecede daha yüksek saptanmıştır (p=0,022). Dikkat eksikliği ve hiperaktivite bozukluğu ve davranış bozukluğu tanıları erkeklerde anlamlı derecede daha yüksek ve depresif bozukluk tanısı kadınlarda anlamlı derecede daha yüksek bulunmuştur (p<0,001; p=0,005; p<0,001). Entelektüel yetersizlik suça sürüklenen çocuklarda anlamlı derecede daha yüksek bulunmuştur (p<0,001). Anksiyete bozukluğu tanısı ile düzenli poliklinik takibi arasında anlamlı bir ilişki bulunurken, madde kullanımı bozukluğu ile düzenli takibe gelmeme arasında anlamlı bir ilişki bulunmuştur (p=0,031; p=0,034).

Sonuç: Çalışma, sağlık tedbiri bulunan olguların sosyodemografik ve klinik özelliklerini değerlendirmemize olanak sağlamış ve çocuklar için ruh sağlığı desteği ve takibinin önemini ve etkisini daha iyi anlamamıza yardımcı olmuştur. Bu alanda daha kapsamlı ve uzun dönemli çalışmalar, çocuk koruma sistemini güçlendirmek için önemlidir.

Keywords

• Sağlık tedbiri
• çocuk koruma kanunu (ÇKK)
• çocuk ve ergen psikiyatri

References

1. Güçlü S. Çocuk ve çocukluğun sosyolojisi bağlamında çocuk hakları. J Sociol. 2016;1(special):1-22.
2. Konuk G. Avrupa Birliği'ne uyum sürecinde Türkiye'de çocuk hakları ve çocuk suçluluğu. Yüksek lisans tezi. Marmara Üniversitesi, Avrupa Araştırmaları Enstitüsü, Avrupa Siyaseti ve Uluslararası İlişkiler Anabilim Dalı; İstanbul, 2019.
3. Akarslan M. Ana hatlarıyla çocuk hakları ve çocuk hakları mevzuatı. İstanbul: Alfa; 1998.
4. 15 Temmuz 2005 tarihinde 25876 sayı ile T.C. Resmi Gazete’de yayımlanan 03.07.2005 kabul tarihli 5395 numaralı çocuk koruma kanunu. Available at: https://www.mevzuat.gov.tr/mevzuat?MevzuatNo=5395&MevzuatTur=1&MevzuatTertip=5 Accessed February 25, 2025
5. 27 Mayıs 1983 tarihinde 18059 sayı ile T.C. Resmi Gazete’de yayımlanan 24.05.1983 kabul tarihli 2828 numaralı sosyal hizmet kanunu. Available at: https://cocukhaklari.barobirlik.org.tr/dokuman/mevzuat_kanun/sosyalhizmetler.pdf Accessed February 25, 2025
6. Kardaş Ö, Gümüşsoy AS, Ayaz AMB, et al. Factors associated with substance use in adolescents under legally required health care. Bull Leg Med. 2023;28(3):259-266. doi:10.17986/blm.1673
7. Nasıroğlu S. Mental assessment of child and adolescents in health measure. Cukurova Med J. 2017;42(3):484-489. doi:10.17826/cutf.296421
8. Güller B, Yaylacı F. Sociodemographic and clinical characteristics of children and adolescents followed for court-mandated treatment. Turk J Child Adolesc Ment Health. 2022;29(2):67-74. doi:10.4274/tjcamh.galenos.2021.38257

9. Akdağ B. Evaluation of children under health measure from the perspective of child psychiatry: A district sample. Curr Perspect Soc Sci. 2023;27(2):152-159. doi:10.5152/JSSI.2022.22372
10. Kul M, Dağ P, Akdağ B, et al. Psychosocial evaluation results of children and adolescents followed within the scope of health measure. Bull Leg Med. 2023;28(3):267-272. doi:10.17986/blm.1657
11. Er Fazlıoğlu A. Evaluation of psychosocial features of children and their families under treatments in the scope of health precaution in social work perspective. J Int Soc Res. 2019;12:735-742. doi:10.17719/jisr.2019.3394
12. Alikaşifoğlu M. Ergenlerde davranışsal sorunlar. İstanbul Üniversitesi Cerrahpaşa Tıp Fakültesi Sürekli Tıp Eğitimi Etkinlikleri Adolesan Sağlığı II Sempozyum Dizisi. 2008;63:5-59.
13. Cook PJ, Kang S. Birthdays, schooling, and crime: Regression-discontinuity analysis of school performance, delinquency, dropout, and crime initiation. Am Econ J Appl Econ. 2016;8(1):33-57. doi:10.1257/app.20140323
14. Bugbee BA, Beck KH, Fryer CS, et al. Substance use, academic performance, and academic engagement among high school seniors. J Sch Health. 2019;89(2):145-156. doi:10.1111/josh.12723
15. Bachman JG, Schulenberg JE, Freedman-Doan P, O'Malley PM, Johnston LD. The education-drug use connection: How successes and failures in school relate to adolescent smoking, drinking, drug use, and delinquency. New York: Psychology Press; 2008. doi:10.4324/9780203809709
16. Ellickson PL, Martino SC, Collins RL. Marijuana use from adolescence to young adulthood: multiple developmental trajectories and their associated outcomes. Health Psychol. 2004;23(3):299-307. doi:10.1037/0278-6133.23.3.299
17. Homel J, Thompson K, Leadbeater B. Trajectories of marijuana use in youth ages 15-25: implications for postsecondary education experiences. J Stud Alcohol Drugs. 2014;75(4):674-683. doi:10.15288/jsad.2014.75.674
18. Brook JS, Stimmel MA, Zhang C, et al. The association between earlier marijuana use and subsequent academic achievement and health problems: A longitudinal study. Am J Addict. 2008;17(2):155-160. doi:10.1080/10550490701860930
19. Jiang Y, Mermin J, Perry DK, et al. The relationship of multiple, simultaneously occurring health risk behaviors to academic performance of high school students. J Behav Health. 2013;2(1):53-334. doi:10.5455/jbh.20130103102935
20. Gökçen C, Dursun OB. Evaluation of forensic cases referred to the child psychiatry clinic of a research hospital. J Psychiatry Neurol Sci. 2012;25:238-243. doi:10.5350/DAJPN2012250306
21. Berger LM. Income, family characteristics, and physical violence toward children. Child Abuse Negl. 2005;29:107-133. doi:10.1016/j.chiabu.2004.02.006
22. Smith Etxeberria K, Corres Medrano I, Fernandez Villanueva I. Parental divorce process and post-divorce parental behaviors and strategies: examining emerging adult children’s attachment-related anxiety and avoidance. Int J Environ Res Public Health. 2022;19(16):10383. doi:10.3390/ijerph191610383
23. Auersperg F, Vlasak T, Ponocny I, et al. Long-term effects of parental divorce on mental health A meta-analysis. J Psychiatr Res. 2019;119:107-115. doi:10.1016/j.jpsychires.2019.09.011
24. Lau T, Bigio B, Zelli D, et al. Stress-induced structural plasticity of medial amygdala stellate neurons and rapid prevention by a candidate antidepressant. Mol Psychiatry. 2017;22(2):227-234. doi:10.1038/mp.2016.68
25. Stephens MAC, Wand G. Stress and the HPA axis: role of glucocorticoids in alcohol dependence. Alcohol Res Curr Rev. 2012;34(4):468-483. PMID: 23584113
26. Hamm LL, Jacobs RH, Johnson MW, et al. Aberrant amygdala functional connectivity at rest in pediatric anxiety disorders. Biol Mood Anxiety Disord. 2014;4:1-9.
27. Işık Ü, Aktepe E, Şimşek F, et al. Sociodemographic, clinical and family characteristics of victims of sexual abuse in a university hospital in Isparta Province: 2014-2018 data. SDÜ Sağlık Bilimleri Dergisi. 2019;10(1):53-57. doi:10.22312/sdusbed.514228
28. Çakaloz B, Ünlü G, Aktaş Terzioğlu M, et al.Relation of juvenile criminal behavior to sociodemographic features and intelligence. Anatol J Psychiatry. 2016;17(5):411-418. doi:10.5455/apd.210471
29. Aksu H, Karakoç S, Özgür BG, et al. Evaluation of child and adolescent forensic cases within one year in Aydın city, Turkey. Anatol J Psychiatry. 2013;14:369-377. doi:10.5455/apd.43501
30. Gümüştaş F, Yulaf Y, Gökçe S, et al. One-year retrospective analysis of forensic cases referred to child and adolescent psychiatry outpatient clinic in the province of Adıyaman. Cukurova Med J. 2014;39(2):280-289. doi:10.17826/cutf.36075
31. Bilaç Ö, Şentürk Pilan B, Orhon Z, et al. Suça sürüklenen çocukların suç ve tanı dağılımlarının incelenmesi: Kesitsel bir araştırma. Turk J Child Adolesc Ment Health. 2014;21(2):115-122.
32. Harris MB. Aggression, gender and ethnicity. Aggress Violent Behav. 1996;1:123-146. doi:10.1016/1359-1789(95)00012-7
33. Nemeroff CB. Paradise lost: the neurobiological and clinical consequences of child abuse and neglect. Neuron. 2016;89:892-909. doi:10.1016/j.neuron.2016.01.019
34. Garland AF, Hough RL, McCabe KM, et al. Prevalence of psychiatric disorders in youths across five sectors of care. J Am Acad Child Adolesc Psychiatry. 2001;40:409-418. doi:10.1097/00004583-200104000-00009
35. Parker G, Brotchie H. Gender differences in depression. Int Rev Psychiatry. 2010;22(5):429-436. doi:10.3109/09540261.2010.492391
36. Becchetti L, Conzo G. The gender life satisfaction/depression paradox. Social Indicators Res. 2022;160:35-113. doi:10.1007/s11205-021-02740-5
37. Konrad K, Kohls G, Baumann S, et al. Sex differences in psychiatric comorbidity and clinical presentation in youths with conduct disorder. J Child Psychol Psychiatry. 2022;63(2):218-228. doi:10.1111/jcpp.13428
38. Mohr Jensen C, Steinhausen HC. A meta-analysis and systematic review of the risks associated with childhood attention-deficit hyperactivity disorder on long-term outcome of arrests, convictions, and incarcerations. Clin Psychol Rev. 2016;48:32-42. doi:10.1016/j.cpr.2016.05.002
39. Issakidis C, Andrews G. Pretreatment attrition and dropout in an outpatient clinic for anxiety disorders. Acta Psychiatr Scand. 2004;109(6):426-433. doi:10.1111/j.1600-0047.2004.00264.x
40. Dikeç G, Arabacı LB, Bilac Ö. Adherence to prescribed treatment by adolescent outpatients with mental disorders at a regional psychiatric hospital. J Psy Nurs. 2020;11(4):306-314. doi:10.14744/phd.2020.57855
41. Edgcomb JB, Zima B. Medication adherence among children and adolescents with severe mental illness: A systematic review and meta-analysis. J Child Adolesc Psychopharmacol. 2018;28:508-520. doi:10.1089/cap.2018.0040