Pan Wen

BACKGROUND: To describe the prevalence of DSM-IV disorders and comorbidity in a large school-based sample of 6-17 year old children and adolescents in northeast China. METHODS: A two-phase cross-sectional study was conducted on 9,806 children. During the screening phase, 8848 children (90.23%) and their mothers and teachers were interviewed using the Strengths and Difficulties Questionnaire (SDQ). During the diagnostic phase, 1129 children with a positive SDQ and 804 randomly selected children with a negative SDQ (11%), and their mothers and teachers, were interviewed using the Development and Well-Being Assessment (DAWBA). RESULTS: The overall prevalence of DSM-IV disorders was 9.49% (95% CI = 8.10-11.10%). Anxiety disorders were the most common (6.06%, 95% CI = 4.92-7.40), followed by depression (1.32%, 95% CI = 0.91-1.92%), oppositional defiant disorder (1.21%, 95%CI = 0.77-1.87) and attention-deficit hyperactivity disorder (0.84%, 95% CI = 0.52-1.36%). Of the 805 children with a psychiatric disorder, 15.2% had two or more comorbid disorders. CONCLUSIONS: Approximately one in ten Chinese school children has psychiatric disorders involving a level of distress or social impairment likely to warrant treatment. Prevention, early identification and treatment of these disorders are urgently needed and pose a serious challenge in China.

BACKGROUND: To measure the effects of using different combinations of multiple informants and the impact score on the estimated prevalence of mental health problems in Chinese schoolchildren. METHODS: Complete information on the Strengths and Difficulties Questionnaire (SDQ) were obtained from students (S), parents (P), and teachers (T) for 4986 schoolchildren (11-17 years-old). We used 3 criteria to determine the prevalence of mental health problems: SDQ cut-off value (previously established in the United Kingdom), SDQ cut-off value plus an impact score of 1 or more, or plus an impact score of 2 or more. A student was defined as having a mental health problem if any informant (S, P, or T) classified the child as 'abnormal'. We compared the prevalence of mental health problems determined from 1 informant, 2 informants, and 3 informants. RESULTS: The prevalence of overall mental health problems increased with rising number of informants, but decreased with increasing impact score. When the impact score was not considered, the prevalence was 8.2% to 14.2% when rated by 1 informant, 18.8% to 24.7% when rated by 2 informants, and 28.3% when rated by all 3 informants. Failure to measure the impact score led to a two to threefold greater estimate of the prevalence of mental health problems. CONCLUSIONS: The types, number, and combinations of multiple informants and use of the impact score must be considered when comparing the results of different studies. It is preferable to use multiple informants and have the impact score taken the impact into account to reflect the real burden of mental health burden in children and adolescent.

OBJECTIVE: To investigate the occurrence of unintentional injuries among children aged 3 to 12 in China over the past 5 years, and to provide a scientific basis for the prevention and control of such injuries. DESIGN: A systematic review and meta-analysis. A random-effects model was specified a priori to synthesise study estimates given anticipated clinical and methodological heterogeneity across studies. DATA SOURCES: We searched CNKI, WanFang and PubMed for studies published between 1 January 2018 and 30 June 2024. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: We included observational studies conducted in China with children aged 3-12 years, reporting incidence or person-time incidence of unintentional injuries and using clear injury definition criteria. Exclusion criteria included reviews, studies on special populations, duplicated datasets or incomplete data. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers screened studies, extracted data and assessed study quality using Loney's criteria. Heterogeneity was quantified with the I² statistic and Q test. Publication bias was assessed with funnel plots, Egger's regression and fail-safe N. Certainty of evidence for primary outcomes was rated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS: A total of 16 studies involving 37 877 participants were included. The results indicated that the combined effect size of the incidence of unintentional injuries among children aged 3 to 12 in China was 14.0% (95% CI 9.5% to 20.3%), and the person-time incidence was 15.3% (95% CI 8.6% to 25.8%), with falls demonstrating the highest combined effect size. Further subgroup analysis revealed several trends: the incidence of unintentional injuries was higher in boys (16.1%) than in girls (11.2%), among children aged 3-6 years (15.2%) compared with those aged 6-12 years (12.4%), in the western region (14.3%) versus the eastern region (13.1%) and when applying the 1996 injury criteria (17.7%) compared with the 2004 criteria (15.6%). All differences were statistically significant (p<0.05). Study quality (Loney) ranged from 4-6 (median=6); Egger's test showed no evidence of small-study bias (p=0.87). GRADE assessment rated the certainty of evidence for both primary outcomes as very low, primarily due to observational design, high heterogeneity and imprecision. Sensitivity analyses excluding lower quality studies and leave-one-out analyses did not materially change effect direction or conclusions. CONCLUSIONS: The incidence of unintentional injuries among Chinese children aged 3-12 remains high, especially from falls. Injury rates differ significantly by gender, age, region and other factors. Future efforts should prioritise the safety of kindergarten children in western China, with a strong emphasis on preventing falls, which are a common type of injuries among children. PROSPERO REGISTRATION NUMBER: CRD42024604890.

Background: Unintentional injuries are a leading cause of death and disability among children and adolescents worldwide, particularly in economically underdeveloped regions. Guizhou, an impoverished and multi-ethnic region in southwestern China, faces elevated risks due to limited healthcare resources and a high proportion of left-behind children. However, few studies have explored prevention and control needs from the perspective of target populations. Using a qualitative approach, this study adopted a "bottom-up" perspective to investigate the needs of children, caregivers, teachers, and community workers in Guizhou regarding the prevention and control of unintentional injuries among children, aiming to provide a scientific basis for developing precise, culturally adapted intervention strategies. Objective: This study aimed to examine the current status and needs of unintentional injury prevention and control interventions for children aged 3-12 in Guizhou Province. Methods: Participants were selected using purposive sampling. From July 8 to 22, 2024, semi-structured interviews were conducted with children aged 3-12, their caregivers, teachers, and local social workers in Guiyang, Liping County, and Xingyi City, Guizhou Province. These included 31 focus group discussions with children and 121 in-depth interviews with caregivers, teachers, and community workers. Thematic analysis of the data was performed using NVivo 15 software. Results: Data analysis revealed four core themes: existing prevention and control interventions, intervention effectiveness, intervention gaps, and intervention needs. Existing interventions primarily included safety education, joint prevention and control mechanisms, and physical protection measures. While these efforts were reported to improve children's safety awareness and reduced injury incidents, gaps remained, such as inadequate parental supervision, prominent environmental hazards, insufficient publicity, resource shortages, and poor cross-sector collaboration. Vulnerable groups, including left-behind children living alone and children with disabilities, faced higher risks. Participants expressed diverse intervention needs, including environmental modifications, resource support, enhanced publicity, and innovative prevention strategies. Conclusion: The current government-led prevention and control system has achieved certain successes but requires a shift from broad coverage to targeted interventions. Future efforts should strengthen family responsibility, improve multi-sectoral collaboration, and increase resource allocation. Integrating technology and cultural guidance to establish a multi-sectoral prevention network could reduce unintentional injury risk among children and promote health equity.