Serious Emotional Disturbance Affects 10% of US Children

Megan Brooks

September 13, 2017

One in 10 children in the United States suffer from serious emotional disturbance (SED) and are likely to require treatment or referral to appropriate mental health services, a finding that speaks to the larger problem of the shortage of child psychiatrists.

"The large numbers of youth and families affected by SED, the significant long-term consequences of these conditions, and the considerable costs and complexity of treating these disorders underscore the need for comprehensive and effective prevention and treatment services," Nathaniel Williams, PhD, from Boise State University, Idaho, and colleagues write.

The study was published online September 1 in Psychiatric Services.

Who Will Provide Care?

The findings stem from a systematic review and meta-analysis of 12 population-based US studies that estimated the prevalence of youths with SED, as defined by the Substance Abuse and Mental Health Services Administration. Most studies were performed from 1989 to 2015 and assessed 8- to 17-year-olds.

The pooled prevalence of SED with domain-specific impairment was 10.06% (95% confidence interval [CI], 8.60% - 11.51%). This estimate is based on 10 studies involving 32,015 youths. The prevalence of SED with global impairment was 6.36% (95% CI, 5.78% - 6.93%). This estimate is based on eight studies with 38,939 youth.

"These estimates of SED are sufficiently precise to meaningfully guide clinical decision making, mental health policy, and consideration of child psychiatry workforce needs in the United States," Dr Williams and colleagues write.

An area of concern raised by these estimates is the shortage of child psychiatrists in the community, they add. Roughly 8700 child psychiatrists deliver services in the United States, implying an "untenable 620:1 ratio of youths with SED per child psychiatrist," they point out.

The situation is exacerbated by the low number of child psychiatry residents and fellows in the United States, who numbered just 869 in 2015, and by an uneven distribution of child psychiatrists across the country, with shortages most marked in more rural and impoverished areas. "Increasing workforce capacity is critical to improving access to mental health services for youths with SED," Dr Williams and colleagues write.

"Critically Important" Research

Commenting on the findings for Medscape Medical News, Victor Fornari, MD, director of child and adolescent psychiatry, Zucker Hillside Hospital, Glen Oaks, New York, and Cohen Children's Medical Center, New Hyde Park, New York, said, "This critically important review of the literature demonstrates what Sir Michael Rutter taught us over 50 years ago in his landmark Isle of Wight study, that childhood is often not the carefree, happy time we wish it would be. Indeed...there is now a much clearer, serious appreciation of the true prevalence of serious emotional disturbance in youth up until the age of 18 years.

"Recognition of the prevalence of these disorders is critical for early intervention in order to try and prevent and/or minimize impairment," said Dr Fornari.

"We recognize today that most of the serious psychopathology often associated with adulthood has its antecedents and prodromal syndromes in adolescence. For this reason, there is need for much greater attention at identification of early prodromal symptoms in order to identify and intervene with these high-risk youth in an effort to prevent the development of the full syndromes."

He added, "Because serious stigma and gross lack of adequate resources remain as significant barriers to access to mental health care for youth, education of the primary care providers is essential in order to attempt for them to begin to meet the huge unmet needs of our youth. Innovative programs are now aimed at collaborating with the primary care provider and are increasing in popularity. In addition, public policy makers and government leaders need to recognize the scope of the unmet needs in order to develop strategies to meet the workforce shortage and address the mental health needs of our youth."

The study had no commercial funding. The authors have disclosed no relevant financial relationships.

Psychiatr Serv. Published online September 1, 2017. Abstract


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