呼吁提高儿科医生在中国提供儿童和青少年心理健康服务的能力

IF 3.4 3区 医学 Q2 PSYCHIATRY
Meirong Pan, Ni Tang, Jianguang Qi, Zhengjie Zhu, Qingjiu Cao, Tianmei Si
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引用次数: 0

摘要

精神障碍是中国儿童和青少年致残的主要原因,影响了3080万人(Dong et al. 2025)。尽管需求不断升级,但中国的儿童和青少年心理健康服务(CAMHS)面临严重的劳动力短缺,而低层次服务需求未得到满足的系统性效率低下加剧了这一问题(Jiang et al. 2024)。加强儿科医生的CAMHS能力是符合世卫组织阶梯式护理模式的可行解决方案(世卫组织2021年小组)。尽管全球对儿科医生的基本心理健康能力有共识(Foy et al. 2019),但中国在针对性调查和政策框架方面仍然存在显著差距,特别是在儿科医生的儿童和青少年精神病学(CAP)能力发展方面。我们对537名儿科医生的全国调查强调了紧迫性:496名(92.36%)遇到了儿童心理健康病例。其中,75.60%的人在提供CAMHS时报告了中等到高度的压力,主要是由于CAP技能不足。只有32.77%的人接受过cap专项培训,主要是通过自主学习(n = 84, 47.73%)和会议(n = 82, 46.59%)。对于CAMHS的能力发展(n = 517, 96.27%),优先考虑沟通技巧,早期识别心理健康状况和多学科团队合作(图1),存在强烈的共识。为了解决这些差距,我们迫切呼吁立即采取行动,包括:(1)强制性CAP培训,使最佳实践适应当地需求,重点关注沟通技巧和早期疾病识别,以提高儿科医生参与CAMHS的意愿和能力;(2)建立国家CAP电子图书馆,以mhGAP(世界卫生组织2017年)等基础资源为基础,提供标准化内容,减少地域差异,并整合指南、讲座、案例研究和区域资源,以供转诊;(3)国家卫生健康委员会和学术领导的支持,包括政策指示、增加CAMHS资金和CAP轮转质量评估。通过这些步骤提高儿科医生的CAMHS能力,将有助于中国建立一支可持续的CAMHS劳动力队伍,以满足青少年需求,改善结果,并为其他面临类似劳动力短缺并寻求在初级保健框架内扩大CAMHS的亚太国家提供可扩展的模式。潘美荣构思了研究设计,进行了数据收集、提取和分析,并撰写了论文。倪唐构思了研究设计,并进行了数据收集、提取和分析。齐建光构思研究设计并进行数据提取。朱正杰进行数据提取。司天美构思研究设计,进行数据收集、提取和分析;起草并审阅论文。所有作者都审阅了定稿。作者没有什么可报告的。本研究已获得北京大学第六医院伦理与临床研究委员会[(2024)伦理审查号(68)]批准,并按照赫尔辛基宣言和《涉及人体受试者的医学研究法案》(WMO)进行。作者声明无利益冲突。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Call to Enhance Pediatricians' Capacity in Delivering Child and Adolescent Mental Health Services in China

Call to Enhance Pediatricians' Capacity in Delivering Child and Adolescent Mental Health Services in China

Mental disorders are leading causes of disability in children and adolescents in China, affecting 30.8 million individuals (Dong et al. 2025). Despite escalating needs, China's child and adolescent mental health services (CAMHS) face severe workforce shortages, exacerbated by systemic inefficiencies with unmet lower-tier services demands (Jiang et al. 2024). Strengthening pediatricians' CAMHS capacity is a viable solution aligned with WHO's stepped-care model (WHO Team 2021). Despite global consensus on essential mental health competencies among pediatricians (Foy et al. 2019), significant gaps persist in China, both in targeted surveys and policy frameworks, specifically addressing child and adolescent psychiatry (CAP) competency development among pediatricians.

Our national survey of 537 pediatricians highlights urgency: 496 (92.36%) encountered pediatric mental health cases. Of these, 75.60% reported moderate-to-high stress when delivering CAMHS, primarily due to insufficient CAP skills. Only 32.77% received CAP-specific training, primarily through self-directed learning (n = 84, 47.73%) and conferences (n = 82, 46.59%). Strong consensus existed for CAMHS competency development (n = 517, 96.27%), prioritizing communication skills, early recognition of mental health conditions, and multidisciplinary teamwork (Figure 1).

To address the gaps, we urgently call for immediate actions, including: (1) mandatory CAP training adapting best practices to local needs focusing on communication skills and early disorder recognition to boost pediatricians' willingness and competence in CAMHS; (2) a national CAP e-library, grounded on foundational resources like mhGAP (World Health Organization 2017), to provide standardized content, reduce geographic disparities, and integrate guidelines, lectures, case studies, and regional resources for referrals; and (3) support from the National Health Commission and academic leadership, including policy directives, increased CAMHS funding, and CAP rotation quality assessment.

Enhancing pediatricians' CAMHS capacity through these steps will help China build a sustainable CAMHS workforce for youth needs, improve outcomes, and offer a scalable model for other Asia-Pacific nations facing similar workforce shortages and seeking to expand CAMHS within primary care frameworks.

Meirong Pan conceived the study design and performed data collection, extraction, and analysis, and drafted the paper. Ni Tang conceived the study design and performed data collection, extraction, and analysis. Jianguang Qi conceived the study design and performed data extraction. Zhengjie Zhu performed data extraction. Tianmei Si conceived the study design and performed data collection, extraction, and analysis; drafted and reviewed the paper. All authors reviewed the final manuscript.

The authors have nothing to report.

This study has been approved by the Ethics and Clinical Research Committees of Peking University Sixth Hospital [(2024) Ethics review number (68)] and was performed in accordance with the Declaration of Helsinki with the Medical Research Involving Human Subjects Act (WMO).

The authors declare no conflicts of interest.

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来源期刊
CiteScore
7.80
自引率
0.00%
发文量
17
审稿时长
>12 weeks
期刊介绍: Asia-Pacific Psychiatry is an international psychiatric journal focused on the Asia and Pacific Rim region, and is the official journal of the Pacific Rim College of Psychiatrics. Asia-Pacific Psychiatry enables psychiatric and other mental health professionals in the region to share their research, education programs and clinical experience with a larger international readership. The journal offers a venue for high quality research for and from the region in the face of minimal international publication availability for authors concerned with the region. This includes findings highlighting the diversity in psychiatric behaviour, treatment and outcome related to social, ethnic, cultural and economic differences of the region. The journal publishes peer-reviewed articles and reviews, as well as clinically and educationally focused papers on regional best practices. Images, videos, a young psychiatrist''s corner, meeting reports, a journal club and contextual commentaries differentiate this journal from existing main stream psychiatry journals that are focused on other regions, or nationally focused within countries of Asia and the Pacific Rim.
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