Home treatment – insbesondere für expansive Jungen?
Alters- und geschlechtsspezifische Wirksamkeit von Home treatment bei internalisierenden vs. externalisierenden Störungen
Abstract
Einleitung: Bisher finden sich wenige aussagekräftige Studien zur spezifischen Indikation und Effektivität von Home treatment (HT) bei kinder- und jugendpsychiatrischen Störungsbildern. Methodik: 92 Patienten, im Alter von 5–17 Jahren, wurden in einer Interventionsstudie (primäre Zielgröße: Verweildauer) in eine Interventions- (verkürzter stationärer Aufenthalt, gefolgt von intensivem HT verbunden mit fakultativ nutzbaren Klinikbehandlungselementen) und eine Kontrollgruppe (stationäre Regelbehandlung) randomisiert. Zielgrößen zu T1 (innerhalb von 14 Tagen nach Randomisierung), T2 (Abschluss der Behandlung) und T3 (∅ 8.4 Monats-Follow-up) waren: das psychosoziale Funktionsniveau (Children’s Global Assessment Scale [CGAS], Health of the Nation Outcome Scales for Children and Adolescents [HoNOSCA]), die Schwere der Symptomatik (Strengths and Difficulties Questionnaire [SDQ]) sowie das Ausmaß der Beeinträchtigung (Columbia Impairment Scale [CIS]). Anhand einer multiplen Regressionsanalyse wurde geprüft, inwiefern Behandlungssetting, Störungsbild, Alter oder Geschlecht Einfluss auf Behandlungseffektivität haben können. Ergebnisse: Bei Kindern überwogen externalisierende Störungsbilder, bei Jugendlichen internalisierende Störungsbilder. Patienten der Interventions- und der Kontrollgruppe benannten gleichermaßen einen positiven Behandlungserfolg von T1 nach T2. HT zeigte sich dabei signifikant effektiver bei Jugendlichen (versus Kindern; SDQ p = .017), Jungen (versus Mädchen; CIS p = .009, SDQ p < .001) und externalisierenden Störungsbildern (SDQ p = .005). Schlussfolgerung: Home treatment sollte bei Jungen mit externalisierenden Störungsbildern als Alternative zur stationären Aufnahme erwogen werden.
Objective: Indications for home treatment for specific diagnoses in child and adolescent psychiatry have not yet been evaluated. Method: In a recent intervention study (primary outcome: length of stay), 92 patients aged 5 to 17 years were randomized into an intervention group (early discharge followed by home treatment in combination with inpatient treatment, where needed) and a control group (regular length inpatient treatment). The aim of this explorative analysis was to retrieve additional information on “what works for whom.” Outcome parameters were as follows: Children’s Global Assessment Scale (CGAS), Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA), Strengths and Difficulties Questionnaire (SDQ) and Columbia Impairment Scale (CIS) at T1 (within 14 days after intake), T2 (end of treatment) and T3 (∅ 8.4-month follow-up). Multiple regression was used to investigate the association between diagnoses, treatment setting, age, sex, and improvement in both groups. Results: In children externalizing disorders were predominant, whereas in adolescents internalizing disorders were prominent. Patients improved equally under both types of treatment. Home treatment, however, was rated by the patients to be significantly more effective in adolescents (SDQ p = .017), boys (CIS p = .009, SDQ p < .001), and with externalizing disorders (SDQ p = .005). Conclusions: Home treatment may be considered an alternative to inpatient treatment, especially in boys with externalizing disorders.
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