Lifetime Prevalence of Mental Disorders in U.S. Adolescents: Results from the National Comorbidity Survey Replication-Adolescent Supplement (NCS-A)
01 Oct 2010-Journal of the American Academy of Child and Adolescent Psychiatry (Elsevier)-Vol. 49, Iss: 10, pp 980-989
TL;DR: Estimates of the lifetime prevalence of DSM-IV mental disorders with and without severe impairment, their comorbidity across broad classes of disorder, and their sociodemographic correlates are presented to provide the first prevalence data on a broad range of mental disorders in a nationally representative sample of U.S. adolescents.
Abstract: Objective To present estimates of the lifetime prevalence of DSM-IV mental disorders with and without severe impairment, their comorbidity across broad classes of disorder, and their sociodemographic correlates. Method The National Comorbidity Survey–Adolescent Supplement NCS-A is a nationally representative face-to-face survey of 10,123 adolescents aged 13 to 18 years in the continental United States. DSM-IV mental disorders were assessed using a modified version of the fully structured World Health Organization Composite International Diagnostic Interview. Results Anxiety disorders were the most common condition (31.9%), followed by behavior disorders (19.1%), mood disorders (14.3%), and substance use disorders (11.4%), with approximately 40% of participants with one class of disorder also meeting criteria for another class of lifetime disorder. The overall prevalence of disorders with severe impairment and/or distress was 22.2% (11.2% with mood disorders, 8.3% with anxiety disorders, and 9.6% behavior disorders). The median age of onset for disorder classes was earliest for anxiety (6 years), followed by 11 years for behavior, 13 years for mood, and 15 years for substance use disorders. Conclusions These findings provide the first prevalence data on a broad range of mental disorders in a nationally representative sample of U.S. adolescents. Approximately one in every four to five youth in the U.S. meets criteria for a mental disorder with severe impairment across their lifetime. The likelihood that common mental disorders in adults first emerge in childhood and adolescence highlights the need for a transition from the common focus on treatment of U.S. youth to that of prevention and early intervention.
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TL;DR: Eating disorders and subthreshold eating conditions are prevalent in the general adolescent population and their impact is demonstrated by generally strong associations with other psychiatric disorders, role impairment, and suicidality.
Abstract: Context Eating disorders are severe conditions, but little is known about the prevalence or correlates of these disorders from population-based surveys of adolescents. Objectives To examine the prevalence and correlates of eating disorders in a large, reprefentative sample of US adolescents. Design Cross-sectional survey of adolescents with face-to-face interviews using a modified version of the Composite International Diagnostic Interview. Setting Combined household and school adolescent samples. Participants Nationally representative sample of 10 123 adolescents aged 13 to 18 years. Main Outcome Measures Prevalence and correlates of eating disorders and subthreshold conditions. Results Lifetime prevalence estimates of anorexia nervosa, bulimia nervosa, and binge-eating disorder were 0.3%, 0.9%, and 1.6%, respectively. Important differences were observed between eating disorder subtypes concerning sociodemographic correlates, psychiatric comorbidity, role impairment, and suicidality. Although the majority of adolescents with an eating disorder sought some form of treatment, only a minority received treatment specifically for their eating or weight problems. Analyses of 2 related subthreshold conditions suggest that these conditions are often clinically significant. Conclusions Eating disorders and subthreshold eating conditions are prevalent in the general adolescent population. Their impact is demonstrated by generally strong associations with other psychiatric disorders, role impairment, and suicidality. The unmet treatment needs in the adolescent population place these disorders as important public health concerns.
1,351 citations
Cites methods from "Lifetime Prevalence of Mental Disor..."
...Attempts to minimize such biases were built into the methods of the CIDI.28,51 In fact, growing evidence from prospective cohort studies suggests that retrospective recall yields underestimates as opposed to overestimates of the true prevalence of psychiatric disorders.52,53 Therefore, the estimates in this article may be a lower bound of the true prevalence of eating disorders....
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...Attempts to minimize such biases were built into the methods of the CIDI.(28,51) In fact, growing evidence from prospective cohort studies suggests that retrospective recall yields underestimates as opposed to overestimates of the true prevalence of psychiatric disorders....
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TL;DR: Examination of rates and sociodemographic correlates of lifetime mental health service use by severity, type, and number of DSM-IV disorders in the National Comorbidity Survey-Adolescent Supplement foundmarked racial disparities in lifetime rates of mental health treatment highlight the urgent need to identify and combat barriers to the recognition and treatment of these conditions.
Abstract: Objective Mental health policy for youth has been constrained by a paucity of nationally representative data concerning patterns and correlates of mental health service utilization in this segment of the population. The objectives of this investigation were to examine the rates and sociodemographic correlates of lifetime mental health service use by severity, type, and number of DSM-IV disorders in the National Comorbidity Survey–Adolescent Supplement. Method Face-to-face survey of mental disorders from 2002 to 2004 using a modified version of the fully structured World Health Organization Composite International Diagnostic Interview in a nationally representative sample of 6,483 adolescents 13 to 18 years old for whom information on service use was available from an adolescent and a parent report. Total and sector-specific mental health service use was also assessed. Results Approximately one third of adolescents with mental disorders received services for their illness (36.2%). Although disorder severity was significantly associated with an increased likelihood of receiving treatment, half of adolescents with severely impairing mental disorders had never received mental health treatment for their symptoms. Service rates were highest in those with attention-deficit/hyperactivity disorder (59.8%) and behavior disorders (45.4%), but fewer than one in five affected adolescents received services for anxiety, eating, or substance use disorders. Comorbidity and severe impairment were strongly associated with service utilization, particularly in youth with behavior disorders. Hispanic and non-Hispanic Black adolescents were less likely than their White counterparts to receive services for mood and anxiety disorders, even when such disorders were associated with severe impairment. Conclusions Despite advances in public awareness of mental disorders in youth, a substantial proportion of young people with severe mental disorders have never received specialty mental health care. Marked racial disparities in lifetime rates of mental health treatment highlight the urgent need to identify and combat barriers to the recognition and treatment of these conditions.
1,334 citations
TL;DR: Differences suggest that distinct prediction and prevention strategies are needed for ideation, plans among ideators, planned attempts, and unplanned attempts.
Abstract: Context Although suicide is the third leading cause of death among US adolescents, little is known about the prevalence, correlates, or treatment of its immediate precursors, adolescent suicidal behaviors (ie, suicide ideation, plans, and attempts). Objectives To estimate the lifetime prevalence of suicidal behaviors among US adolescents and the associations of retrospectively reported, temporally primary DSM-IV disorders with the subsequent onset of suicidal behaviors. Design Dual-frame national sample of adolescents from the National Comorbidity Survey Replication Adolescent Supplement. Setting Face-to-face household interviews with adolescents and questionnaires for parents. Participants A total of 6483 adolescents 13 to 18 years of age and their parents. Main Outcome Measures Lifetime suicide ideation, plans, and attempts. Results The estimated lifetime prevalences of suicide ideation, plans, and attempts among the respondents are 12.1%, 4.0%, and 4.1%, respectively. The vast majority of adolescents with these behaviors meet lifetime criteria for at least one DSM-IV mental disorder assessed in the survey. Most temporally primary (based on retrospective age-of-onset reports) fear/anger, distress, disruptive behavior, and substance disorders significantly predict elevated odds of subsequent suicidal behaviors in bivariate models. The most consistently significant associations of these disorders are with suicide ideation, although a number of disorders are also predictors of plans and both planned and unplanned attempts among ideators. Most suicidal adolescents (>80%) receive some form of mental health treatment. In most cases (>55%), treatment starts prior to onset of suicidal behaviors but fails to prevent these behaviors from occurring. Conclusions Suicidal behaviors are common among US adolescents, with rates that approach those of adults. The vast majority of youth with suicidal behaviors have preexisting mental disorders. The disorders most powerfully predicting ideation, though, are different from those most powerfully predicting conditional transitions from ideation to plans and attempts. These differences suggest that distinct prediction and prevention strategies are needed for ideation, plans among ideators, planned attempts, and unplanned attempts.
1,244 citations
TL;DR: Prevalence of a history of ADHD, current ADHD, medicated ADHD, and moderate/severe ADHD increased significantly from 2007 estimates, suggesting an increasing burden of ADHD on the U.S. health care system.
Abstract: Objective Data from the 2003 and 2007 National Survey of Children's Health (NSCH) reflect the increasing prevalence of parent-reported attention-deficit/hyperactivity disorder (ADHD) diagnosis and treatment by health care providers. This report updates these prevalence estimates for 2011 and describes temporal trends. Method Weighted analyses were conducted with 2011 NSCH data to estimate prevalence of parent-reported ADHD diagnosis, current ADHD, current medication treatment, ADHD severity, and mean age of diagnosis for U.S. children/adolescents aged 4 to 17 years and among demographic subgroups. A history of ADHD diagnosis (2003–2011), as well as current ADHD and medication treatment prevalence (2007–2011), were compared using prevalence ratios and 95% confidence intervals. Results In 2011, 11% of children/adolescents aged 4 to 17 years had ever received an ADHD diagnosis (6.4 million children). Among those with a history of ADHD diagnosis, 83% were reported as currently having ADHD (8.8%); 69% of children with current ADHD were taking medication for ADHD (6.1%, 3.5 million children). A parent-reported history of ADHD increased by 42% from 2003 to 2011. Prevalence of a history of ADHD, current ADHD, medicated ADHD, and moderate/severe ADHD increased significantly from 2007 estimates. Prevalence of medicated ADHD increased by 28% from 2007 to 2011. Conclusions Approximately 2 million more U.S. children/adolescents aged 4 to 17 years had been diagnosed with ADHD in 2011, compared to 2003. More than two-thirds of those with current ADHD were taking medication for treatment in 2011. This suggests an increasing burden of ADHD on the U.S. health care system. Efforts to further understand ADHD diagnostic and treatment patterns are warranted.
1,042 citations
Cites methods from "Lifetime Prevalence of Mental Disor..."
...7%.(22) However, direct assessment of children in communities is resource intensive, and it is not an efficient method for monitoring prevalence over time....
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1,011 citations
References
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TL;DR: Logistic regression analysis documented that consideration of CIDI symptom-level data significantly improved prediction of some K-SADS diagnoses, and generally good concordance was found with blinded clinical diagnoses.
Abstract: Objective To report results of the clinical reappraisal study of lifetime DSM-IV diagnoses based on the fully structured lay-administered World Health Organization Composite International Diagnostic Interview (CIDI) Version 3.0 in the U.S. National Comorbidity Survey Replication Adolescent Supplement (NCS-A). Method Blinded clinical reappraisal interviews with a probability subsample of 347 NCS-A respondents were administered using the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS) as the gold standard. The DSM-IV /CIDI cases were oversampled, and the clinical reappraisal sample was weighted to adjust for this oversampling. Results Good aggregate consistency was found between CIDI and K-SADS prevalence estimates, although CIDI estimates were meaningfully higher than K-SADS estimates for specific phobia (51.2%) and oppositional defiant disorder (38.7%). Estimated prevalence of any disorder, in comparison, was only slightly higher in the CIDI than K-SADS (8.3%). Strong individual-level CIDI versus K-SADS concordance was found for most diagnoses. Area under the receiver operating characteristic curve, a measure of classification accuracy not influenced by prevalence, was 0.88 for any anxiety disorder, 0.89 for any mood disorder, 0.84 for any disruptive behavior disorder, 0.94 for any substance disorder, and 0.87 for any disorder. Although area under the receiver operating characteristic curve was unacceptably low for alcohol dependence and bipolar I and II disorders, these problems were resolved by aggregation with alcohol abuse and bipolar I disorder, respectively. Logistic regression analysis documented that consideration of CIDI symptom-level data significantly improved prediction of some K-SADS diagnoses. Conclusions These results document that the diagnoses made in the NCS-A based on the CIDI have generally good concordance with blinded clinical diagnoses.
264 citations
"Lifetime Prevalence of Mental Disor..." refers methods in this paper
...Psychiatric disorders derived from the modfied CIDI showed good concordance with a clinical eappraisal subsample.(19) Impairment criteria embedded in DSM-IV required ndorsement of some/a lot/extreme levels of impairent or moderate/severe/very severe levels of symp-...
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TL;DR: These findings indicate that large-scale epidemiological surveys of mental disorders and mental health service use involving lengthy interviews in the homes of unscreened population-based samples of youths and their adult caretakers are acceptable to the community and can achieve good response rates.
Abstract: Objective A collaborative study was conducted to develop methods for surveys of mental disorder and service utilization in unscreened population-based samples of children and adolescents. Method Probability household samples of youths 9 through 17 years of age were selected at four sites and interviews were conducted with a total of 1,285 pairs of youths and their adult caretakers in their homes. Lay interviewers administered a computer-assisted version of the NIMH Diagnostic Interview Schedule for Children Version 2.3 and structured interviews to assess demographic variables, functional impairment, risk factors, service utilization, and barriers to service utilization. Results More than 7,500 households were enumerated at four sites, with enumeration response rates above 99%. Across sites, 84% of eligible youth–caretaker pairs were interviewed for about 2 hours each. Ninety-five percent of both youths and caretakers found the interview to be acceptable enough to recommend to a friend. Conclusions These findings indicate that large-scale epidemiological surveys of mental disorders and mental health service use involving lengthy interviews in the homes of unscreened population-based samples of youths and their adult caretakers are acceptable to the community and can achieve good response rates. The other reports in this Special Section address the reliability and validity of the various survey instruments and other key findings.
232 citations
TL;DR: The NCS-A is a rich nationally representative dataset that will substantially increase understanding of the mental health and well-being of adolescents in the United States and show that the use of replacement schools for originally selected schools that refused to participate did not introduce bias into prevalence estimates.
Abstract: Objective To present an overview of the design and field procedures of the National Comorbidity Survey Replication Adolescent Supplement (NCS-A) Method The NCS-A is a nationally representative face-to-face household survey of the prevalence and correlates of DSM-IV mental disorders among US adolescents (aged 13–17 years) that was performed between February 2001 and January 2004 by the Survey Research Center of the Institute for Social Research at the University of Michigan The sample was based on a dual-frame design that included 904 adolescent residents of the households that participated in the National Comorbidity Survey Replication (response rate 859%) and 9,244 adolescent students selected from a representative sample of 320 schools in the same nationally representative sample of counties as the National Comorbidity Survey Replication (response rate 747%) Results Comparisons of sample and population distributions on census sociodemographic variables and, in the school sample, school characteristics documented only minor differences that were corrected with poststratification weighting Comparisons of DSM-IV disorder prevalence estimates among household versus school sample respondents in counties that differed in the use of replacement schools for originally selected schools that refused to participate showed that the use of replacement schools did not introduce bias into prevalence estimates Conclusions The NCS-A is a rich nationally representative dataset that will substantially increase understanding of the mental health and well-being of adolescents in the United States
228 citations
"Lifetime Prevalence of Mental Disor..." refers methods in this paper
...These weighting procedures are discussed in more detail elsewhere.(18,20) Socio-demographic variables assessed in the NCS-A include age (in years), sex, race/ethnicity, parent education, urbanicity, and marital status of parents....
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...The NCS-A was carried out in a dual-frame sample that included a household subsample and a school subsample.(18,20,21) The overall NCS-A adolescent response rate combining the two subsamples was 82....
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TL;DR: The analysis does suggest that income differences cannot explain all the effect or perhaps even as much as half of the effect of parental education, but better nutrition among the children of the more educated has been well-documented.
217 citations
"Lifetime Prevalence of Mental Disor..." refers background in this paper
...Our finding of a prominent effect of parental education on mental disorders has been well-documented for both child physical and mental health outcomes.(39,40) Divorce was often associated with mental disorders in youth, particularly anxiety, behavior, and substance use disorders....
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TL;DR: Prevalences in a large metropolitan area in the US and the association of DSM-IV diagnoses to functional impairment and selected demographic correlates are presented, suggesting commonality of prevalences and associated factors in diverse study settings, including urban and rural areas.
216 citations