Objective: This study examined the psychiatric and medical characteristics of children and adolescents receiving health protection measures and explored their associations with maltreatment types, self-injurious behaviors, and suicide attempts.
Methods: Medical records of 331 children and adolescents followed under health protection measures at a single tertiary care hospital were retrospectively reviewed. Data were collected using a standardized file review form that included sociodemographic variables, psychiatric diagnoses, child protection characteristics, and risk factors. Psychiatric diagnoses were established according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria. Statistical analyses compared diagnostic distributions across maltreatment subgroups and examined associations with self-injurious behavior and suicide attempts.
Results: Of the 331 included cases, 235 children (71.0%) underwent psychiatric evaluation. Diagnostic distributions were analyzed within this subgroup. Among children exposed to neglect (n=161), intellectual disability (29.8%), attention-deficit/hyperactivity disorder (28.6%), and conduct disorder (24.2%) were the most prevalent diagnoses. Major depressive disorder was significantly more common among children exposed to physical abuse (50.0%; p<0.001), whereas major depressive disorder (37.5%; p=0.008) and social anxiety disorder (18.8%; p=0.003) were more frequent in the extrafamilial sexual abuse group. Self-injurious behaviors and suicide attempts were observed across maltreatment groups, with significant associations between self-injury and intrafamilial sexual abuse and between suicide attempts and physical and emotional abuse. Girls exhibited higher rates of both self-injurious behavior and suicide attempts than boys (p<0.01). Neurological (26.0%) and endocrine (8.5%) disorders were the most common non-psychiatric medical conditions.
Conclusion: Children referred to a tertiary care facility under health protection measures demonstrated a high burden of psychiatric morbidity. Diagnostic patterns varied according to maltreatment type, highlighting the need for trauma-informed, multidisciplinary care.