First National Prevalence Data of Mental Disorders in American Youth Released

Caroline Cassels

November 03, 2010

November 3, 2010 — Approximately 1 in every 4 to 5 youth in the United States meet criteria for a mental disorder with severe impairment across their lifetime, new research shows.

According to investigators, led by Kathleen Ries Merikangas, PhD, National Institute of Mental Health, Bethesda, Maryland, this is the "first lifetime prevalence data on a broad range of mental disorders in a nationally representative sample of U.S. adolescents.

"The prevalence rates reported here closely approximate those of our nationally representative sample of adults using nearly identical methods suggesting that the majority of mental disorders emerge before adulthood," the study authors write.

The findings are published in the October issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

According to the article, the field of child psychiatric epidemiology has grown exponentially during the past 2 decades, with numerous regional US studies reporting that 1 in every 3 to 4 children experiences a mental disorder and approximately 1 in 10 children has "serious emotional disturbance, with few affected youth receiving adequate mental health care."

However, they note that there is a lack of data on the "prevalence and distribution of a wide range of DSM-IV [Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition)] mental disorders from a nationally representative sample of children or adolescents."

They note that such information is critical to establish resource allocation priorities for prevention, treatment, and research.

With the extension of the National Comorbidity Survey to assess a broad range of DSM-IV disorders in a nationally representative sample of youth aged 13 to 18 years, known as the National Comorbidity Survey-Adolescent Supplement, the investigators set out to examine the lifetime prevalence of disorders in youth and the proportion of disorders associated with severe impairment.

In addition, the investigators examined the magnitude or overlap in the major classes of mental disorders and describe individual and family sociodemographic correlates of the disorders.

The survey is a face-to-face survey of 10,123 adolescents living 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.

At 31.9% the investigators found that anxiety disorders were the most common. These were followed by behavior disorders (19.1%), mood disorders (14.3%), and substance use disorders (11.4%). Approximately 40% of study participants with one class of disorder also met criteria for another class of lifetime disorder.

Researchers report 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.)

They found the median age of onset of 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.

"The present data can inform and guide the development of priorities for future research and health policy by providing previously lacking prevalence estimates in a nationally representative sample of U.S. adolescents...Prospective research is now needed to understand the risk factors for mental disorder onset in adolescence, as well as the predictors of the continuity of these disorders into adulthood," the investigators conclude.

The authors have disclosed no relevant financial relationships.

J Am Acad Child Adolesc Psychiatry. 2010;49:980-989.

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