Die psychische Gesundheit von Kindern, Jugendlichen und jungen Erwachsenen – Teil 2: Krankheitslast, Defizite des deutschen Versorgungssystems, Effektivität und Effizienz von „Early Intervention Services“

Zusammenfassung

In einer Vielzahl von Geburtskohortenstudien, epidemiologischen Studien und klinischen Beobachtungsstudien wurden psychische Erkrankungen bei Kindern, Jugendlichen und jungen Erwachsenen in Bezug auf Häufigkeit, Ersterkrankungsalter, Belastungsfaktoren, Störungspersistenz, Service-Inanspruchnahme, Behandlungsverzögerung und Krankheitsverlauf untersucht. Eine Vielzahl von Publikationen befasste sich darüber hinaus mit den Konsequenzen psychischer Erkrankungen hinsichtlich der Krankheitslast, den Versorgungsdefiziten sowie der Effektivität und Effizienz von „Early Intervention Services“. Die Ergebnisse zeigen, dass die Mehrzahl aller psychischen Erkrankungen bereits in der Kindheit, Jugend und im jungen Erwachsenenalter erstmals auftreten. Es lassen sich dabei kombinierte und dauerhafte Belastungsfaktoren nachweisen, die das Risiko, (früh und chronisch) psychisch zu erkranken, erhöhen. In der Kindheit und Jugend erstmals aufgetretene psychische Störungen persistieren häufig bis in das Erwachsenenalter. Als wesentliche Ursachen hierfür wurden eine niedrigere Inanspruchnahme von Behandlung und eine lange Behandlungsverzögerung mit verschiedenen negativen Konsequenzen sowie eine allgemein unzureichende Behandlungsqualität bei Kontakt zum Hilfesystem identifiziert. Zahlreiche andere Länder haben dementsprechend begonnen, an der Schnittstelle zwischen Kinder- und Jugend- und Erwachsenenpsychiatrie sog. „Early Intervention Services (EIS)“ zu implementieren. Teil 2 des Reviews befasst sich mit der Krankheitslast inklusive der Kosten psychischer Erkrankungen, Versorgungsdefiziten in Deutschland sowie dem Stand der Forschung zur Effektivität und Effizienz sogenannter „Early Intervention Services“ (EIS).

Abstract

Numerous birth-control studies, epidemiological studies, and observational studies investigated mental health and health care in childhood, adolescence and early adulthood, including prevalence, age at onset, adversities, illness persistence, service use, treatment delay and course of illness. Moreover, the impact of the burden of illness, of deficits of present health care systems, and the efficacy and effectiveness of early intervention services on mental health were evaluated. According to these data, most mental disorders start during childhood, adolescence and early adulthood. Many children, adolescents and young adults are exposed to single or multiple adversities, which increase the risk for (early) manifestations of mental diseases as well as for their chronicity. Early-onset mental disorders often persist into adulthood. Service use of children, adolescents and young adults is low, even lower than in adult patients. Moreover, there is often a long delay between onset of illness and first adequate treatment with a variety of linked consequences for poorer psychosocial prognosis. This leads to a large burden of illness with respect to disability and costs. As a consequence several countries have implemented so-called “early intervention services” at the border of child and adolescent and adult psychiatry. Emerging studies show that these health care structures are effective and efficient. Part 2 of the present review focuses on illness burden including disability and costs, deficits of the present health care system in Germany, and efficacy and efficiency of early intervention services.

Schlüsselwörter

Prävention - psychische Erkrankungen - Jugendliche - junge Erwachsene

Key words

prevention - mental disorders - adolescents - young adults

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