Anahtar Kelimeler
psikiyatrik hizmet katılımı
çocuk refahı sonuçları
ruh sağlığı takibi
çocuk koruma kanunu
Öz
Amaç: Bu çalışma, Türkiye'de çocuk ve ergenlere yönelik mahkeme kararıyla uygulanan sağlık koruma tedbirlerinin süresi ve sonlanmasıyla ilişkili faktörleri belirlemeyi amaçlamıştır.
Yöntem: Ocak 2015 ile Aralık 2024 tarihleri arasında Ordu Üniversitesi Eğitim ve Araştırma Hastanesi Çocuk ve Ergen Psikiyatrisi Kliniğinde izlenen 160 vaka retrospektif olarak analiz edilmiştir. Veriler, mahkeme kararları, psikiyatrik değerlendirme raporları ve sosyal hizmet kayıtlarından elde edilmiştir. Değişkenler sosyodemografik, ailesel, klinik, hizmetle ilişkili ve hukuki olmak üzere beş ana alanda sınıflandırılmıştır. Sonuç değişkenleri vaka durumu (devam eden, sonlandırılan veya devredilen) ve tedbir süresi olarak belirlenmiştir. Analizlerde çok kategorili lojistik regresyon ve Cox orantılı risk modelleri kullanılmıştır.
Bulgular: Düzenli psikiyatrik takip (%57,5), başarılı sonlanma ile güçlü şekilde ilişkili bulunmuştur (aRRR = 6,85, p < 0,001) ve koruyucu tedbir süresinin kısalmasıyla anlamlı düzeyde bağlantılıdır (aHR = 2,91, p < 0,001). Hukuki neden, tedbir yönelimi ve sevk eden kurumun anlamlı bir etkisi bulunmamıştır. Vakaların %49,4’ünde birden fazla psikiyatrik tanı yer almasına rağmen, düzenli takip hem tedbirin sonlandırılma olasılığını (aRRR = 6,85, p < 0,001) hem de sürecin hızını (aHR = 2,91, p < 0,001) anlamlı biçimde artırmıştır. Ayarlanmamış analizlerde depresif semptomların yanı sıra davranım bozukluğu ve sigara kullanımı gibi davranışsal risk etkenlerinin daha uzun süren vakalarla ilişkili olduğu bulunmuştur.
Sonuç: Tutarlı psikiyatrik katılım, koruyucu tedbirlerin sonlandırılmasında tanısal karmaşıklık veya hukuki gerekçeden daha güçlü bir belirleyici olarak öne çıkmıştır. Bu bulgular, kırılgan çocukların iyileşme süreçlerinde sürekli ve yapılandırılmış bakımın önemini vurgulamaktadır.
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