* Department of Community Psychiatric Medicine, Shiga University of Medical Science Department of Psychiatry, Shiga University of Medical Science *

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Presentation transcript:

* Department of Community Psychiatric Medicine, Shiga University of Medical Science ** Department of Psychiatry, Shiga University of Medical Science *** Japanese Red Cross Society Nagahama Hospital Early intervention for mental disorders in child and adolescent psychiatry (CAP) is of the greatest importance. In Japan, all youngsters come to us with their parents. Therefore, in order to shorten the duration of untreated illness (DUI) and to intervene before further aggravation, we consider it important to reduce any stigmas parents harbor. We assessed every patient who consulted us about DUI, quality of life (QOL), parental stigma and their symptoms. We investigated the relationship of DUI and QOL at initial diagnosis with parental stigma by retrospective survey. I declare no conflict of interest directly relevant to the contents of this presentation. Disclosure of research funding; The Government of Shiga Prefecture, Japan National Mutual Insurance Federation of Agricultural Cooperatives Shionogi & Co., Ltd Otsuka Pharmaceutical Co., Ltd Shiga University of Medical Science The Shiga Medical Science Association for International Cooperation From January, 2014, we measured the DUI and QOL (by Peds QL TM ) 1 of all our new patients (from 10 to 18 years old), and parental stigma with the Devaluation-Discrimination Scale (DDS) 2. Their symptoms were measured using the Child Behavior Checklist (CBCL) 3 and The Global Assessment of Functioning (GAF). The number of patients who consulted us from January to October, 2014, was cases were excluded from analysis because they were diagnosed as developmental disorders and their DUIs were much longer than other cases. We show the basic statistics of the 75 cases in Table 1. We analyzed DDS scores as they correlated with other factors using Spearman`s rank correlation coefficient. (Table 2) Correlation with DDS and DUI was not significant. Also, there were no correlation between DDS and total score of Ped-QL TM by parent, total score of Ped-QL TM by patient and CBCL. However, some sub scores showed correlation with DDS. (Fig. 1-3) Table 1; basic analysis data 1(N=75) AgeMean = 15.0, SD = 2.14, Median = 16.0 SexBoys = 39, Girls = 36 GAFMean = 40.8, SD = 13.7, Median = 38.0 DUI (months)Mean = 21.2, SD = 22.3, Median = 12.0 Ped-QL TM by parent(%)Mean = 61.9, SD = 15.9, Median = 64.1 Physical Functioning Mean = 70.8, SD = 21.3, Median = 75.0 Emotional Functioning Mean = 52.9, SD = 18.9, Median = 55.0 Social Functioning Mean = 67.4, SD = 20.0, Median = 65.0 School Functioning Mean = 51.2, SD = 19.7, Median = 50.0 Ped-QL TM by patient(%)Mean = 64.5, SD = 16.1, Median = 64.1 Physical Functioning Mean = 72.3, SD = 19.4, Median = 78.1 Emotional Functioning Mean = 48.5, SD = 23.3, Median = 45.0 Social Functioning Mean = 74.1, SD = 21.6, Median = 80.0 School Functioning Mean = 58.4, SD = 19.6, Median = 60.0 CBCLMean = 44.6, SD = 25.5, Median = 46.0 Withdrawn/ Depressed Mean = 5.56, SD = 3.83, Median = 5.0 Somatic Complaints Mean = 3.69, SD = 3.38, Median = 3.0 Anxious/ Depressed Mean = 8.67, SD = 5.50, Median = 8.0 Social Problems Mean = 3.19, SD = 2.88, Median = 3.0 Thought Problems Mean = 1.52, SD = 1.71, Median = 1.0 Attention Problems Mean = 5.95, SD = 3.75, Median = 5.0 Rule-Breaking Behaviors Mean = 2.64, SD = 3.35, Median = 2.0 Aggressive Behaviors Mean = 7.19, SD = 6.69, Median = 5.0 Table 2; Correlation with DDS (Spearman`s rank correlation coefficient) N=75 rSp DUI0.094N.S. GAF-0.23N.S. Ped-QL TM by parent(%)-0.21N.S. Physical Functioning -0.20N.S. Emotional Functioning -0.17N.S. Social Functioning -0.31P=0.007 School Functioning N.S. Ped-QL TM by patient(%)-0.17N.S. Physical Functioning -0.24P=0.03 Emotional Functioning N.S. Social Functioning N.S. School Functioning N.S. CBCL0.19N.S. Withdrawn/ Depressed 0.16N.S. Somatic Complaints 0.20N.S. Anxious/ Depressed 0.17N.S. Social Problems 0.27P=0.02 Thought Problems 0.087N.S. Attention Problems 0.10N.S. Rule-Breaking Behaviors 0.041N.S. Aggressive Behaviors 0.051N.S. DDS Ped-QL TM by parent Sub score of Social Functioning rS=-0.31, P=0.007 DDS Ped-QL TM by patient Sub score of Physical Functioning rS=-0.24, P=0.03 DDS CBCL Sub score of Social Problems rS=-0.27, P=0.02 In Japan the mean and median of DUI was 21.2 months and 12.0 months. Against our expectations, DDS did not show significant correlation with DUI. Franz, et. al, suggested that stigma may result in a raised threshold for treatment initiation according to their experience. 4 Our results did not accord with their suggestion. But in their research the median DUI was 22.3 weeks: remarkably shorter than our results. In our investigation DUI was abnormally long compared with past reports. The tendency may be different in countries other than Japan. In both Peds-QL TM by parent and CBCL, both are assessments by the parent, it was shown that social problems were severs, so DDS was high. This result means that parents who harbor substantial stigma tend to endure or underestimate the social problems their child is having. The Peds-QL TM by patient shows that physical malfunctioning was severe when their parents’ DDS was high. Because parental assessment of physical function in the child did not correlate with DDS, it can be said that parents who harbor major stigma tend not to consider that a mental disorder is a cause of the physical symptom. At all events, to intervene in children and adolescences before aggravation, it is important to reduce parental stigma.