PONE-D-20-00075-DELPHI-ROUND-III.xlsm

Despite their burden and high prevalence, mental health disorders of children and adolescents remain neglected in many parts of the world. In developing countries, where half of the population is younger than 18 years old, one of every five children and adolescents is estimated to suffer from a mental health disorder. It is then essential to detect these conditions through screening in a timely and accurate manner. But such screening is fraught with considerable ethical, social, and cultural challenges. This study systematically identifies, for the first time, these challenges, along with potential solutions to address them.<br>We report on the results of an international multi- and inter-disciplinary three-round Delphi survey completed by 135 mental health experts from 37 countries. We asked these experts to identify and rank the main ethical, social, and cultural challenges of screening for child and adolescent mental health problems in developing nations, and to propose solutions for each challenge.<br>Thirty-nine significant challenges emerged around eight themes, along with 32 potential solutions organized into seven themes. There was a high degree of consensus among the experts, but a few interesting disagreements arose between members of the panel from high-income countries and those from low- and middle-income nations. The panelists overwhelmingly supported mental health screening for children and adolescents. They recommended ensuring local acceptance and support for screening prior to program initiation, along with careful and comprehensive protection of human rights; integrating screening procedures into primary care; designing and implementing culturally appropriate screening tools, programs, and follow-up; securing long-term funding; expanding capacity building; and task-shifting screening to local non-specialists. <br>These recommendations can serve as a guide for policy and decision-making, resource allocation, and international cooperation. They also offer a novel approach to reduce the burden of these disorders by encouraging their timely and context-sensitive prevention and management.<br><br>

尽管儿童青少年精神障碍负担沉重且患病率居高不下，全球诸多地区仍对其忽视无视。在发展中国家，半数人口年龄未满18岁，据估算每五名儿童及青少年中便有一人罹患精神障碍。因此，通过筛查实现此类病症的及时精准检测至关重要，但此类筛查面临诸多严峻的伦理、社会与文化挑战。本研究首次系统性地梳理了这些挑战，并提出了相应的潜在解决方案。<br>本研究报告了一项国际性多学科交叉三轮德尔菲（Delphi）调查的结果，该调查由来自37个国家的135名精神卫生专家参与完成。研究团队邀请这些专家识别并排序发展中国家儿童青少年精神卫生问题筛查所面临的主要伦理、社会与文化挑战，并为每项挑战提出解决方案。<br>研究最终围绕8大主题梳理出39项显著挑战，同时形成了涵盖7大主题的32项潜在解决方案。专家群体达成了高度共识，但来自高收入国家的专家组与中低收入国家的专家组之间出现了若干值得关注的分歧。全体专家绝大多数支持针对儿童青少年开展精神卫生筛查，并提出如下建议：在项目启动前确保筛查获得当地民众的认可与支持，同时审慎且全面地保护人权；将筛查流程整合至初级保健体系；设计并实施符合文化适配性的筛查工具、项目及随访方案；保障长期资金支持；加强能力建设；将筛查任务转移给当地非专业人员完成。<br>这些建议可为政策制定、决策部署、资源配置及国际合作提供参考依据，同时也为通过鼓励开展贴合场景的及时预防与干预，以减轻此类精神障碍的负担提供了一种全新路径。