Mental Disorders Common, Persistent in US Adolescents

Megan Brooks

December 09, 2011

December 9, 2011 — New data from a national survey confirm that mental health disorders are "highly prevalent and persistent" in adolescents in the United States and that most adult mental disorders first present in childhood and adolescence.

These findings "provide a strong rationale for continuing to prioritize research to understand the development of major mental disorders during the first 2 decades of life," Ronald C. Kessler, PhD, from the Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, and colleagues conclude.

The report was published online December 5 in the Archives of General Psychiatry.

The data stem from the National Comorbidity Survey–Adolescent Supplement (NCS-A), the first US national survey to assess a broad range of Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) disorders in a nationally representative sample of adolescents.

"Only limited" epidemiological data exist on the prevalence and correlates of adolescent mental disorders in the United States. The NCS-A was designed and carried out to fill this gap, Dr. Kessler and colleagues note.

More than 10,000 adolescents aged 13 to 17 years were administered the Composite International Diagnostic Interview, which was modified with simplified language and the use of examples relevant to adolescents. Supplemental parent questionnaires were also used. The researchers assessed the prevalence of DSM-IV disorders during 3 periods: the last 12 months, the last 30 days, and lifetime (persistence).

The prevalence estimate for any DSM-IV disorder was 40.3% at 12 months and 23.4% at 30 days. Anxiety disorders were the most common class of disorders, with a prevalence estimate of 24.9% at 12 months and 14.9% at 30 days. Social phobia and specific phobia were the most common types of anxiety disorders.

After anxiety disorders, the most common disorders were behavior, mood, and substance disorders. The 12-month and 30-day prevalence estimates for behavior disorders were 16.3% and 7.6%, for mood disorders they were 10.0% and 3.1%, and for substance disorders they were 8.3% and 2.6%.

Anxiety, Behavior Disorders More Chronic

The data also suggest that "most disorders are highly persistent during adolescence," the investigators say.

Although the prevalence of these disorders was "quite stable over time," 30-day and 12-month prevalence ratios were higher for anxiety (60.1% and 77.9%) and behavior disorders (46.8% and 72.1%) than for mood (31.5% and 69.8%) and substance (31.2% and 73.3%) disorders. This, the researchers say, suggests that anxiety and behavior disorders are more chronic than mood or substance disorders.

However, the finding that 30-day to 12-month prevalence ratios were generally lower than 12-month to lifetime ratios is consistent with the possibility that high disorder persistence may be more the result of recurrence than chronicity, the researchers note.

The authors say the sociodemographic correlates of DSM-IV disorders in adolescents were largely consistent with previous research and mirror those seen in adults.

These findings build on initial findings from the NCS-A published in 2010 (J Am Acad Child Adolesc Psychiatry. 2010;49:980-989) and reported by Medscape Medical News at that time.

Arch Gen Psych. Published online December 5, 2011. Full article

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