The aim was to identify subgroups within an inpatient cohort (N=296) of youths (age 16-20 years) characterized by psychiatric disorders combined with severe disruptive behavior, based on the age... Show moreThe aim was to identify subgroups within an inpatient cohort (N=296) of youths (age 16-20 years) characterized by psychiatric disorders combined with severe disruptive behavior, based on the age of onset of their disruptive behavior. It was examined whether the distinction in early-onset (EO) disruptive behavior and adolescent-onset (AO) disruptive behavior was relevant in clinical practice for predicting severity of problems and treatment outcome. The subgroups were compared on proximal (i.e., dropout, and psychosocial functioning at discharge) and distal outcomes (i.e., social functioning 18 months after discharge). It was found that the distinction between EO and AO, together with the other predictors (i.e., cannabis use prior to treatment, male sex), was mainly relevant in the relation to dropout. Individuals with EO disruptive behavior had higher chance at dropout, however individuals with EO disruptive behavior who completed treatment reported similar outcome as those with AO disruptive behavior. Show less
This thesis focuses on differences between ethnic groups in youth mental health care (YMHC). Three subjects are elaborated: utilization of YMHC, given diagnoses in YMHC, and premature termination ... Show moreThis thesis focuses on differences between ethnic groups in youth mental health care (YMHC). Three subjects are elaborated: utilization of YMHC, given diagnoses in YMHC, and premature termination (dropout) of therapy in YMHC. The utilization of YMHC services is unequally distributed over different ethnic, gender and age groups, and the percentage of youth in treatment is strongly associated with the ethnic composition of the district they live in. As for given diagnoses, ethnic minority patients receive co-morbid diagnoses less often compared to native Dutch patients, while they more often receive V-codes only. Regarding dropout, treatment/therapist variables are overall stronger dropout predictors than pre-treatment child/parent variables. It depends on the specific ethnic background of the minority patient whether they have a higher chance to dropout than ethnic majorities. Also, an increase in quality of the therapeutic relationship during therapy is associated with therapy completion, while a decrease is associated with dropout. It is advised that YMHC institutions implement measures to heighten their accessibility. Second, gaining insight in the cultural background of the patient, and improving the cross-cultural validity and reliability of the diagnostic process is necessary. Third, therapists should pay attention to factors that increase the dropout risk for their patients Show less
