Research Update Review
10-Year Research Update Review: The Epidemiology of Child and Adolescent Psychiatric Disorders: I. Methods and Public Health Burden

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ABSTRACT

Objective

To review recent progress in child and adolescent psychiatric epidemiology in the area of prevalence and burden.

Method

The literature published in the past decade was reviewed under two headings: methods and findings.

Results

Methods for assessing the prevalence and community burden of child and adolescent psychiatric disorders have improved dramatically in the past decade. There are now available a broad range of interviews that generate DSM and ICD diagnoses with good reliability and validity. Clinicians and researchers can choose among interview styles (respondent based, interviewer based, best estimate) and methods of data collection (paper and pencil, computer assisted, interviewer or self-completion) that best meet their needs. Work is also in progress to develop brief screens to identify children in need of more detailed assessment, for use by teachers, pediatricians, and other professionals. The median prevalence estimate of functionally impairing child and adolescent psychiatric disorders is 12%, although the range of estimates is wide. Disorders that often appear first in childhood or adolescence are among those ranked highest in the World Health Organization's estimates of the global burden of disease.

Conclusions

There is mounting evidence that many, if not most, lifetime psychiatric disorders will first appear in childhood or adolescence. Methods are now available to monitor youths and to make early intervention feasible.

Section snippets

WHAT IS EPIDEMIOLOGY?

Epidemiology is the study of patterns of disease in human populations (Kleinbaum et al., 1982). Patterns are nonrandom distributions, and patterns of disease distribution occur in both time and space. Whenever we observe a nonrandom distribution, we have the opportunity to identify causal factors that influence who gets a disease and who does not. For example, we observe that depression rises rapidly after puberty in girls, but not to the same extent in boys (Angold and Worthman, 1993). This

EPIDEMIOLOGICAL METHODS: ASSESSING CHILD AND ADOLESCENT PSYCHIATRIC DISORDERS IN NONCLINICAL SAMPLES

Counting cases is an important first step toward measuring the social burden caused by a disease and the effectiveness of prevention. For most diseases, simply counting the number of individuals presenting for treatment will produce estimates that are seriously biased by referral practices, ability to pay, and other factors; a particular problem in child psychiatry because parents, teachers, and pediatricians all serve as “gatekeepers” to treatment (Horwitz et al., 1998). Community surveys are

SURVEILLANCE FOR CHILD AND ADOLESCENT PSYCHIATRIC DISORDERS: ESTIMATING THE BURDEN OF DISEASE

In the past decade, progress has been made not only in epidemiological methods but also in using them to assess the prevalence of child psychiatric disorder. In a world of scarce healthcare resources, it is important to understand the size of the burden to the community caused by these disorders. Burden, in terms of numbers affected, have an impact on the individual, and cost to the community is a crucial factor in the battle for resources for treatment and prevention. One of the most important

CONCLUSIONS: WHAT HAVE WE LEARNED IN THE PAST DECADE ABOUT THE BURDEN OF CHILD AND ADOLESCENT PSYCHIATRIC DISORDERS?

From the public health viewpoint, child and adolescent psychiatric epidemiology in the past decade can be said to have come to terms with reality. It has stopped agonizing over how many children have this or that disorder as if there were a “true” answer to the question. It is now clear that measures of psychopathology, whether they take the form of interviews, questionnaires, or so-called objective tests, can be set to generate a wide range of prevalence estimates, depending on the severity of

REFERENCES (162)

  • LJ Cassidy et al.

    Approaches to recognition and management of childhood psychiatric disorders in pediatric primary care

    Pediatr Clin North Am

    (1998)
  • H Dubowitz

    Costs and effectiveness of interventions in child maltreatment

    Child Abuse Negl

    (1990)
  • MK Dulcan et al.

    The pediatrician as gatekeeper to mental health care for children: do parents' concerns open the gate?

    J Am Acad Child Adolesc Psychiatry

    (1990)
  • F Earls

    Epidemiology and child psychiatry: historical and conceptual development

    Compr Psychiatry

    (1979)
  • JM Ellen et al.

    Primary care physicians' screening of adolescent patients: a survey of California physicians

    J Adolesc Health

    (1998)
  • A Erkanli et al.

    Optimal Bayesian two-phase designs

    J Stat Planning Inference

    (1998)
  • T Ford et al.

    The British Child and Adolescent Mental Health Survey 1999: the prevalence of DSM-IV disorders

    J Am Acad Child Adolesc Psychiatry

    (2003)
  • RM Giaconia et al.

    Major depression and drug disorders in adolescence: general and specific impairments in early adulthood

    J Am Acad Child Adolesc Psychiatry

    (2001)
  • S Glied et al.

    Service system finance: implications for children with depression and manic depression

    Biol Psychiatry

    (2001)
  • PJ Leaf et al.

    Mental health service use in the community and schools: results from the four-community MECA study

    J Am Acad Child Adolesc Psychiatry

    (1996)
  • JC Ablow et al.

    The Berkeley Puppet Interview (BPI): Interviewing and Coding System Manuals

    (1993)
  • TM Achenbach

    Child Behavior Checklist: Teacher's Report Form

    (1991)
  • Alcohol and Drug Defense Program

    Alcohol and Other Drug Use Patterns Among Students in North Carolina Public Schools Grades 7-12: Results of a 1991 Student Survey

    (1991)
  • American Psychiatric Association

    Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM-III)

    (1980)
  • American Psychiatric Association

    Diagnostic and Statistical Manual of Mental Disorders, 3rd edition- revised (DSM-III-R)

    (1987)
  • American Psychiatric Association

    Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV)

    (1994)
  • A Angold et al.

    Puberty and depression: the roles of age, pubertal status, and pubertal timing

    Psychol Med

    (1998)
  • A Angold et al.

    The Young Adult Psychiatric Assessment (YAPA)

    (1999)
  • A Angold et al.

    Psychiatric diagnosis in preschool children

  • A Angold et al.

    Psychiatric disorder, impairment, and service use in rural African American and white youth

    Arch Gen Psychiatry

    (2002)
  • A Angold et al.

    Interviewer-based interviews

  • A Angold et al.

    Perceived parental burden and service use for child and adolescent psychiatric disorders

    Am J Public Health

    (1998)
  • P Armbruster et al.

    Attrition in child psychotherapy

  • L Bickman et al.

    Evaluating Managed Mental Health Services: The Fort Bragg Experiment

    (1995)
  • BJ Burns et al.

    Children's mental health service use across service sectors

    Health Aff

    (1995)
  • BJ Burns et al.

    Insurance coverage and mental health service use by adolescents with serious emotional disturbance

    J Child Fam Stud

    (1997)
  • BJ Burns et al.

    Effective treatment for mental disorders in children and adolescents

    Clin Child Fam Psychol Rev

    (1999)
  • JV Campo et al.

    Somatization in pediatric primary care: association with psychopathology, functional impairment, and use of services

    J Am Acad Child Adolesc Psychiatry

    (1999)
  • G Canino et al.

    Assessing functional impairment and social adaptation for child mental health services research: a review of measures

    J Ment Health Serv

    (1999)
  • G Canino et al.

    The DSM-IV rates of child and adolescent disorders in Puerto Rico

    Arch Gen Psychiatry

    (2004)
  • AS Carter et al.

    The Infant-Toddler Social and Emotional Assessment (ITSEA): factor structure, reliability, and validity

    J Abnorm Child Psychol

    (2003)
  • A Caspi et al.

    Role of genotype in the cycle of violence in maltreated children

    Science

    (2002)
  • A Caspi et al.

    Influence of life stress on depression: moderation by a polymorphism in the 5-HTT gene

    Science

    (2003)
  • MA Cohen et al.

    The cost and consequences of violent behavior in the United States

  • CK Conners et al.

    Revision and restandardization of the Conners Teacher Rating Scale (CTRS-R): factor, structure, reliability, and criterion validity

    J Abnorm Child Psychiatry

    (1998)
  • E Costello et al.

    Psychiatric disorders among American Indian and White youth in Appalachia: The Great Smoky Mountains Study

    Am J Public Health

    (1997)
  • EJ Costello et al.

    The Great Smoky Mountains Study of Youth: functional impairment and severe emotional disturbance

    Arch Gen Psychiatry

    (1996)
  • EJ Costello et al.

    The Great Smoky Mountains Study of Youth: goals, designs, methods, and the prevalence of DSM-III-R disorders

    Arch Gen Psychiatry

    (1996)
  • EJ Costello et al.

    Service utilization and psychiatric diagnosis in pediatric primary care: the role of the gatekeeper

    Pediatrics

    (1988)
  • EJ Costello et al.

    The prevalence of serious emotional disturbance: a re-analysis of community studies

    J Child Fam Stud

    (1998)
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    Work on this paper was supported in part by grants06937, 01002, and 01167fromthe National Institute of Mental Health, grants011301 and 016977fromthe National Institute on Drug Abuse, and a Pfizer Faculty Scholar Award in Clinical Epidemiology to Dr. Egger.

    Disclosure: Dr. Egger holds a Pfizer Foundation Faculty Scholar Award in Clinical Epidemiology. The other authors have no financial relationships to disclose.

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