The detection of psychiatric illness by questionnaire

This meta-analysis of 172 studies (N = 2,263 anxious, N = 1,768 nonanxious) examined the boundary conditions of threat-related attentional biases in anxiety. Overall, the results show that the bias is reliably demonstrated with different experimental paradigms and under a variety of experimental conditions, but that it is only an effect size of d = 0.45. Although processes requiring conscious perception of threat contribute to the bias, a significant bias is also observed with stimuli outside awareness. The bias is of comparable magnitude across different types of anxious populations (individuals with different clinical disorders, high-anxious nonclinical individuals, anxious children and adults) and is not observed in nonanxious individuals. Empirical and clinical implications as well as future directions for research are discussed.

/pdf/threat-related-attentional-bias-in-anxious-and-nonanxious-2pi60mj0pt.pdf

Threat-related attentional bias in anxious and nonanxious individuals: a meta-analytic study.

https://www.ecnp.eu/~/media/Files/ecnp/communication/reports/ECNP%20EBC%20Report.pdf

The size and burden of mental disorders and other disorders of the brain in Europe 2010

Mental health of young people: a global public-health challenge

Background
The literature on the prevalence of mental disorders affecting children and adolescents has expanded significantly over the last three decades around the world. Despite the field having matured significantly, there has been no meta-analysis to calculate a worldwide-pooled prevalence and to empirically assess the sources of heterogeneity of estimates.

Methods
We conducted a systematic review of the literature searching in PubMed, PsycINFO, and EMBASE for prevalence studies of mental disorders investigating probabilistic community samples of children and adolescents with standardized assessments methods that derive diagnoses according to the DSM or ICD. Meta-analytical techniques were used to estimate the prevalence rates of any mental disorder and individual diagnostic groups. A meta-regression analysis was performed to estimate the effect of population and sample characteristics, study methods, assessment procedures, and case definition in determining the heterogeneity of estimates.

Results
We included 41 studies conducted in 27 countries from every world region. The worldwide-pooled prevalence of mental disorders was 13.4% (CI 95% 11.3–15.9). The worldwide prevalence of any anxiety disorder was 6.5% (CI 95% 4.7–9.1), any depressive disorder was 2.6% (CI 95% 1.7–3.9), attention-deficit hyperactivity disorder was 3.4% (CI 95% 2.6–4.5), and any disruptive disorder was 5.7% (CI 95% 4.0–8.1). Significant heterogeneity was detected for all pooled estimates. The multivariate metaregression analyses indicated that sample representativeness, sample frame, and diagnostic interview were significant moderators of prevalence estimates. Estimates did not vary as a function of geographic location of studies and year of data collection. The multivariate model explained 88.89% of prevalence heterogeneity, but residual heterogeneity was still significant. Additional meta-analysis detected significant pooled difference in prevalence rates according to requirement of funcional impairment for the diagnosis of mental disorders.

Conclusions
Our findings suggest that mental disorders affect a significant number of children and adolescents worldwide. The pooled prevalence estimates and the identification of sources of heterogeneity have important implications to service, training, and research planning around the world.

Annual Research Review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents

Background: We estimated the 6-month prevalence of psychiatric disorders among Dutch adolescents, using standardized, internationally available, and replicable assessment procedures, and assessed sex differences and comorbidity of diagnoses. Methods: In phase 1, the parent, self-report, and teacher versions of the Child Behavior Checklist screened a sample representative of 13- to 18-year-olds from the Dutch general population. In phase 2, the parent (P) and child (C) versions of the Diagnostic Interview Schedule for Children (DISC) provided DSM-III-R diagnoses for a selected subsample of 780 subjects. Results: The prevalence of any disorder was 21.5% for the DISC-C and 21.8% for the DISC-P. There was little overlap between subjects identified as having a disorder by the DISC-P and the DISC-C; only 4% met the criteria for any disorder on both. The most common disorders were simple phobia, social phobia, and conduct disorder. The most frequent comorbid diagnoses were anxiety and mood disorders. Conclusions: Although prevalences of more than 21% for DISC-C—and DISC-P—derived diagnoses seem high, many adolescents with DSM-III-R diagnoses functioned quite well. The prevalence of any DSMIII-R diagnosis based on the DISC-C or DISC-P, in combination with the criterion for a definite case, was 7.9%.

The prevalence of DSM-III-R diagnoses in a national sample of Dutch adolescents.

Rates of co-morbid psychiatric conditions in children with Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS) are hardly available, although these conditions are often considered as more responsive to treatment than the core symptoms of PDD-NOS. Ninety-four children with PDD-NOS, aged 6-12 years were included. The DISC-IV-P was administered. At least one co-morbid psychiatric disorder was present in 80.9% of the children; 61.7% had a co-morbid disruptive behavior disorder, and 55.3% fulfilled criteria of an anxiety disorder. Compared to those without co-morbid psychiatric disorders, children with a co-morbid disorder had more deficits in social communication. Co-morbid disorders occur very frequently in children with PDD-NOS, and therefore clinical assessment in those children should include assessment of co-morbid DSM-IV disorders.

High Rates of Psychiatric Co-Morbidity in PDD-NOS

Background: Limited information is available on gender differences and young-adult poor outcome in children and adolescents following distinct developmental trajectories of depressive symptoms. Methods: Parent information on depressive symptoms of 4- to 18-year-olds from an ongoing Dutch community-based longitudinal multiple-cohort study (N ¼ 2,076) was used to estimate trajectories from semi-parametric mixture models. The identified trajectories were used to predict depressive problems, general mental health problems, referral to mental health care, and educational attainment in young adulthood. Results: In both genders six distinct developmental trajectories were identified. Gender differencesexistednotonlyinlevel,butalsoinshapeandtimingofonsetofdepressiveproblems.Onlyingirls wasachronictrajectoryofearlychildhood-onsetdepressionidentified.Inbothboysandgirlsagroupwith increasing levels of depressive symptoms was identified that reached a high level around adolescence, although boys showed an earlier onset. Two decreasing trajectories were found in boys, one reaching normative levels of depressive symptoms around late childhood and one around mid-adolescence, while none was found for girls. Individuals who followed elevated trajectories during their whole childhood or starting at adolescence had significantly more depressive and other mental health problems in young adulthood compared to those who followed normative trajectories. Boys in these elevated trajectories showed lower educational attainment, while girls were more likely to have been referred to mental health care. Conclusions: This study shows the value of estimating growth-mixture models separately for boys and girls. Girls with early childhood or adolescence-onset depressive problems and boys with depressive problems during childhood or starting in adolescence are especially at risk for poor outcome as young adults and should be considered candidates for intervention. Keywords: Depressive symptoms, growth mixture model, developmental trajectories, depression, child development, sex differences, longitudinal studies, Child Behavioral Checklist (CBCL), adolescence, adult outcome. Abbreviation: BIC: Baysian Information Criterion. Many studies on depression in childhood and adolescence use a static approach to identify a priori defined distinctive subtypes. Groups are, for example, based on DSM-IV diagnostic criteria (APA, 1994). General conclusions based on such studies are that about one-third of the children and adolescents with elevated levels of depressive symptoms continue to show similar levels of problems later in life. These studies also showed that during adolescence, girls start having more depressive problems than boys (Angold, Erkanli, Silberg, Eaves, & Costello, 2002; Fleming & Offord, 1990; Hankin et al., 1998; Twenge & Nolen-Hoeksema, 2002; Wade, Cairney, & Pevalin, 2002). Other studies use dimensional depressive symptom scores. A metaanalysis of 310 samples of 8- to 16-year-olds revealed that females’ depression scores start to increase from age 12 on, while males’ scores remain stable after age 13 (Twenge & Nolen-Hoeksema,

Developmental trajectories of depressive symptoms from early childhood to late adolescence: gender differences and adult outcome

Objective To study the relationship between child psychiatric disorders and quality of life (QoL). Method In a sample of 310 children (ages 6–18 years) referred for psychiatric problems, children, parents, and clinicians reported on psychopathology and subjective and objective QoL indicators. Results Six diagnostic categories were distinguished: attention-deficit and disruptive behavior disorders, anxiety disorders, pervasive developmental disorders, mood disorders, other disorders, and no diagnosis. In overall QoL, no differences were found between the diagnostic categories, except in clinician's ratings, who rated children with pervasive developmental disorder as having a poorer QoL than children with other diagnoses. In each diagnostic category specific QoL subdomains were affected: for children with attention-deficit and disruptive behavior disorder, school functioning and social functioning; for children with anxiety disorder, emotional functioning; for children with pervasive developmental disorder, social functioning; and for children with mood disorder, emotional functioning. Conclusions Across multiple raters, the distinguished child psychiatric disorders had a different impact on QoL. Knowledge about domains of QoL that are affected in specific child psychiatric disorders can help clinicians to focus on particular QoL domains during the diagnostic process and to define adequate treatment goals.

Quality of life in children with psychiatric disorders: self-, parent, and clinician report.

Objective: This study investigated the stability of behavioral and emotional problems from adolescence into young adulthood. Method: Subjects from the general population (N=459), aged 13-1 6 years, were evaluated initially with the Child Behavior Checklist (completed by parents) and 8 years later with the Young Adult Self-Report. The scoring format and factor structure of the two assessment instruments are similar; syndromes constructed from the two instruments are based on parents’, teachers’, and self-report information derived from large clinical samples. Signs of maladjustment also were assessed at follow-up through interviews. Results: Ofthe individuals with totaiproblem scores in the deviant range on the Child Behavior Checklist, 27.3% had totalproblem scores in the deviant range on the Young Adult Self-Report at follow-up. The probability ofhaving a total problem score in the deviant range at follow-up was raised 7.4-fold by having deviant-range scores on the Child Behavior Checklist somatic complaints and anxious/depressed syndromes (simultaneously) at the initial assessment. Ref erral to mental health services was predicted by deviant-range scores on the anxious/depressed syndrome, while suicide attempts were predicted by deviance on the withdrawn syndrome. Conclusions: Adolescent problems tended to persist into young adulthood to a moderate degree. High rates ofwithdrawal from social contacts, anxiety or depression, somatic complaints without known medical origin, social problems, attention problems, delinquent behavior, and aggressive behavior during adolescence were risk factors for specific types of psychopathology and maladjustment at 8-year follow-up. The presence of psychopathology in adolescence should not be regarded as normative. (Am J Psychiatry 1995; 152:1586-1594)

Robert F. Ferdinand

Papers

The prevalence of DSM-III-R diagnoses in a national sample of Dutch adolescents.

High Rates of Psychiatric Co-Morbidity in PDD-NOS

Developmental trajectories of depressive symptoms from early childhood to late adolescence: gender differences and adult outcome

Quality of life in children with psychiatric disorders: self-, parent, and clinician report.

Psychopathology from adolescence into young adulthood : an 8-year follow-up study