摘要:研究背景與目的台灣目前尚未有任一全國性兒童與青少年精神流行病學研究。本計畫為以學校為主的全國性流行病學調查,其目的在得到台灣的兒童與青少年精神流行病學盛行率與找出在各種精神疾病的心理、個人、環境、家庭之危險因子,包含:學習障礙、干擾性行為 (注意力不足過動症、對立反抗症、行為規範障礙症)、自閉症、情感性疾患 (輕鬱症、憂鬱症、躁鬱症)、焦慮症、畏懼症、飲食障礙、睡眠障礙等。研究方法本計畫參考「國民健康訪問調查」的抽樣架構,使用分層群集抽樣以學校為單位,並根據城鄉區域選出台灣35所學校遍佈15個縣市,總共6000位學童,3、5、7年級各2000位,並對父母同意其會談約2200位至2500位進行臨床會談。本計畫訓練7位專職訪員與一位兼任訪員與兒童專料精神科醫師使用學童版情感疾患和思覺失調症量表 (K-SADS-E) 針對精神疾病診斷與統計手冊第五版的精神疾病進行評估當作臨床會談工作。自填問卷,包含學童與家長的人口學變項、家庭結構、家長自身的情緒狀況、學童的臨床心理特質、家庭與適應狀況與睡眠問題與測謊驗證,整體問卷包含以下:人口學變項、中文版校園霸凌經驗問卷、成人自填量表-焦慮與憂鬱、兒童及青少年社會功能適應量表、社會性溝通問卷、行為檢查表青少年自我報告版、中文版長處及困難量表、情緒反應量表、情緒調節問卷、網路霸凌經驗問卷、華人健康量表、中文版過動量表、社會反應量表、睡眠型態量表、親子關係量表、家庭及親子互動評估家庭功能量表、米蘭多軸度量表效度量表。本計畫另外使用健保資料庫於91年至101年之百萬歸人檔進行全國兒童精神疾病盛行率之估計與田野流行病學之結果進行比較。結果 中文版學童版情感疾患和思覺失調症量表編修根據精神疾病診斷與統計手冊第五版已經完成,並自閉症診斷觀察量表之中文版已翻譯完成。八位訪員與兒童專科精神科醫師已在104年五月完成診斷訓練,104年度共招募15所學校,949位學童及父母簽同意書接受會談,教師版、學童版問卷約共2500位人數,及父母版約共1500位人數。但目前只完成前12所各學校資料的整理,整體教師版問卷為1818位,學童版問卷1830、家長版問卷1374位及會談736位。任一精神疾病陽性診斷的加權終生與目前盛行率為26.9%與23.3%。在所有精神疾病中,最常見之精神疾病為注意力不足過動症,其加權終生盛行率11.7%。最常見學童之終生精神疾病的排序分別為注意力不足過動症 (11.1%)、畏懼症 (6.4%)、夢魘睡眠疾患 (8.8%)、行為規範障礙症 (4.4%)、分離焦慮症 (3.3%)、對立與反抗障礙症(1.9%)、社交畏懼症 (1.8%),自閉症 (1.0%)。自殺意念、自殺計劃、自殺行為,加權盛行率為7.4%、1.5%、1.3%。另一方面,101年健保資料庫之資料發現,該年過動症與自閉症年盛行率為2.44%與0.33%。其他疾病大多皆低於1%以下。以健保資料庫估算之精神疾病盛行率明顯低於流行病學之田野調查。結論根據本年度調查結果顯示,和歐美國家結果相似,有四分之一學童有至少一種精神疾病,相對於健保資料庫所發現的低盛行率顯示進行流行病學之田野調查的重要性。根據本研究結果建議需要提供更多兒童與青少年之精神疾病相關的預防與介入措施,以增進學童之心理健康與褔利。我們會持續不懈地於105年完成流行病學研究與調查每一種精神疾病之盛行率在全國兒童青少年的人口之分佈。這些第一手資料將提供並作為未來國內針對兒童青少年精神疾病的預防與介入計畫的重要資源與定位。
Abstract: Background and ObjectivesThere is no published national epidemiological data on child and adolescent mental disorders in Taiwan. This school-based national epidemiological study on child and adolescent mental disorders aims to obtain the prevalence rate and identify the psychosocial, individual, environmental, and familial risk factors for mental disorders including learning disability, autism spectrum disorder, attention-deficit hyperactivity disorder, oppositional defiant disorder, conduct disorder, mood disorders (major depression, dysthymia, bipolar disorder), anxiety disorders, phobia, obsessive compulsive disorder, sleep disorders, eating disorders, and substance use disorders etc. in Taiwan.MethodsAccording to the sampling structure of the national health survey, we conducted stratified cluster sampling with school as a sampling unit and strata based on the level of urbanization. Thirty-five schools throughout 15 counties in Taiwan were selected. A total of 6000 students, grade, 3, 5, and 7 with 2000 for each grade, and their parents and teachers were invited to participate in the study. Eight interviewers who had received intensive clinical and psychiatric interviews training and several child psychiatrists received the K-SADS-E (Affective Disorders and Schizophrenia for school-age children- Epidemiological version) and ADOS (Autism Diagnostic Observation Schedule) for all DSM-5 psychiatric disorders including autism spectrum disorder. Self-reported questionnaires, including demographics, the Social Adjustment Inventory for Children and Adolescents, Social Communication Questionnaire, Achenbach Youth Self-report short form/Child Behavior Checklist short form, Strengths and Difficulties Questionnaires, Affective Reactivity Index, Emotion Regulation Questionnaire for Children and Adolescent, Cyberbullying Experiences Questionnaire, School Bullying Experience Questionnaire, Adult Self-Report Inventory – Anxiety & Depression, Chinese Health Questionnaire, Swanson, Nolan, and Pelham IV scale, Social responsiveness scale, Sleep Habit Questionnaire, Parental Bonding Inventory, and Family APGAR. The National Health Insurance Research Database (NHIRD) from 2000 to 2012 was used to estimated the treated prevalence of child and adolescent mental disorders, which were compared to the data based on this national survey.ResultsWe have modified the whole K-SADS-E in Chinese according to the newly published DSM-5 diagnostic criteria and translated the ADOS into Chinese. All the eight interviewers and several child psychiatrists have received interview training by May 2015. We finished the first 15 schools and collected questionnaires completed by 2500 students, their teachers (n=2500) and parents (n=1500). Among 2500 students, parents of 949 students provided written informed consent to receive a K-SADS-E (and ADOS, if autism suspected) interview. Because all the researchers are conducting interview and data collection at schools, data only from the first 12 schools were available for data anlaysis for this report (1830 students, 1818 teachers, 1374 parents, 736 K-SADS-E interviews). The weighted lifetime and 6-month prevalence rates of any common mental disorders in children and adolescents were 26.9% and 23.3%, respectively. The weighted lifetime mental disorder prevalence in children and adolescents in order were ADHD (11.1%), nightmare disorder (8.8%), phobia (6.4%), conduct disorder (4.4%), separation anxiety disorder (3.3%), oppositional defiant disorder (1.9%), and social phobia (1.8%) and autism (1.0%). On the other hand, the 1-year nationwide prevalnces for ADHD and atusim were 2.44% and 0.33%, and lower than 1% for other mental disorders in children and adoelscents based on NHIRD in 2012, significantly lower than the figures derived from the current national survey. ConclusionOur preliminary results showed that similar to western studies, around one fourth of children and adolescents suffered from at least one kind of psychiatric disorders, indicating that mental disorders are common in Taiwanese children and adolescents. However, the prevalence rates estimated from the NHIRD were comparatively low, suggesting the importance and need of community epediomolgical study on child and adolescent population. Our results of common mental disorders in child and adolescent population provide strong evidence to support that rescource should be allocated to the prevention and intervention of child and adolescent mental disorders in order to improve the mental health well-being of our young generations.