Child and adolescent mental disorders: the magnitude of the problem across the globe

Youth mental health in a populous city of the developing world: results from the Mexican Adolescent Mental Health Survey

BACKGROUND

Because the epidemiologic data available for adolescents from the developing world is scarce, the objective is to estimate the prevalence and severity of psychiatric disorders among Mexico City adolescents, the socio-demographic correlates associated with these disorders and service utilization patterns.

METHODS

This is a multistage probability survey of adolescents aged 12 to 17 residing in Mexico City. Participants were administered the computer-assisted adolescent version of the World Mental Health Composite International Diagnostic Interview by trained lay interviewers in their homes. The response rate was 71% (n = 3005). Descriptive and logistic regression analyses were performed considering the multistage and weighted sample design of the survey.

RESULTS

One in every eleven adolescents has suffered a serious mental disorder, one in five a disorder of moderate severity and one in ten a mild disorder. The majority did not receive treatment. The anxiety disorders were the most prevalent but least severe disorders. The most severe disorders were more likely to receive treatment. The most consistent socio-demographic correlates of mental illness were sex, dropping out of school, and burden unusual at the adolescent stage, such as having had a child, being married or being employed. Parental education was associated with treatment utilization.

CONCLUSIONS

These high prevalence estimates coupled with low service utilization rates suggest that a greater priority should be given to adolescent mental health in Mexico and to public health policy that both expands the availability of mental health services directed at the adolescent population and reduces barriers to the utilization of existing services.

Situação de crianças e adolescentes brasileiros em relação à saúde mental e à violência

Este artigo reflete sobre as violências cometidas contra crianças e adolescentes brasileiros e suas repercussões sobre a saúde mental, propondo um debate sobre a necessidade das políticas públicas de saúde priorizarem temáticas de tamanha relevância. No país, tem-se verificado que a discussão dos temas "violência e problemas de saúde mental em crianças e adolescentes" vem ocorrendo de forma fragmentada e pouco consistente. Este trabalho traz uma seleção não sistemática de estudos epidemiológicos desenvolvidos em escolas e comunidades brasileiras sobre o assunto. A ampla variedade e a prevalência da violência familiar e comunitária e dos problemas de saúde mental são apontadas, ressaltando-se as diferenças metodológicas dos métodos de aferição e a concentração de estudos nas regiões sul e sudeste do país. A ainda escassa rede de atendimento para os problemas aqui tratados é sinalizada, assim como a falta de preocupação com a prevenção do transtorno mental e com a promoção da saúde mental.

Universelle Prävention kindlicher Verhaltensstörungen mithilfe einer elternzentrierten Maßnahme

Zusammenfassung. Theoretischer Hintergrund: Psychische Probleme bei Kindern sind weit verbreitet und durch psychotherapeutische Interventionen alleine nicht zu reduzieren. Prävention ist daher dringend notwendig, aber es ist unklar, wie wirksam solche Maßnahmen sein können, vor allem langfristig. Fragestellung: Kann eine elternzentrierte universelle Präventionsmaßnahme, die kurzfristig effektiv ist, auch langfristig bedeutsame Effekte erzielen? Methode: Eltern wurden gemäß ihrer Kitazugehörigkeit zufällig der Durchführung eines Präventionsprogramms (Elterntraining Triple P, EG) oder einer Kontrollgruppe (KG) zugewiesen. Die langfristige Wirksamkeit wurde nach drei Jahren mithilfe von Fragebogen sowohl aus Sicht der Mütter als auch der Väter überprüft. Ergebnisse: Beide Eltern berichten auch drei Jahre später noch über signifikante Reduktionen im dysfunktionalen Erziehungsverhalten. Darüber hinaus zeigt sich erstmalig auch ein Effekt im positiven Erziehungsverhalten aus Sicht der Mütter. Die zuvor berichteten positiven Auswirkungen auf das kindliche Problemverhalten finden sich nicht mehr. Allein erziehende Mütter der EG erzielen hingegen keine signifikant besseren Effekte als alleinerziehende Mütter der KG, was sich vor allem durch die unerwartet hohen positiven Effekte der allein erziehenden Mütter in der KG ergibt. Schlussfolgerungen: Die Ergebnisse unterstützen die langfristige Wirksamkeit des Triple P-Gruppenprogramms als universelle Maßnahme in der Änderung des Erziehungsverhaltens für Zwei-Eltern-Familien, aber nicht eindeutig für allein erziehende Mütter. Eine Auswirkung auf kindliches Problemverhalten ist nach drei Jahren nicht mehr eindeutig nachzuweisen.

Clinical research in adolescents: challenges and opportunities using obesity as a model

Adolescent medicine is relatively young, compared to paediatric or adult medicine. Descriptive and observational studies have dominated the adolescent literature, including those studies published in the International Journal of Obesity. In addition, many studies have combined child and adolescent age groups, making it difficult to determine adolescent-specific outcomes. It is important that high quality intervention studies in adolescents occur. Adolescence is a time of extraordinary plasticity. Habits, attitudes and physical morbidity that develop during adolescence set up trajectories that have a profound influence on health and wellbeing for the long term. Overweight and obesity are an excellent example of the need for high quality intervention studies and yet in the last two decades there have been very few randomized, controlled trials of overweight and obesity management in adolescents. There are a number of complexities in adolescent research that create additional challenges to those that accompany any clinical research. These include recruitment and retention, issues around consent and confidentiality and the central role that parents play in supporting the research protocol. Pubertal stage is a potential confounder and needs to be accurately measured. This is certainly true for studies in overweight and obesity where excess adiposity influences pubertal and other hormones. The opportunities to undertake quality research in adolescents are likely to be enhanced by the use of novel approaches which acknowledge the unique features of adolescents and their world.

Prevalence of mental health problems among children and adolescents in Germany: results of the BELLA study within the National Health Interview and Examination Survey

BACKGROUND

Over the past decades the public health relevance of mental health conditions in children and adolescents has been of growing concern. However, so far no detailed epidemiological data has been available for a representative national sample in Germany.

OBJECTIVES

The present paper reports prevalence rates of general and specific mental health problems among children and adolescents in Germany and describes the link between symptoms and impairment as well as the treatment situation.

METHODS

The mental health module (BELLA study) examines mental health problems in a representative sub-sample of 2,863 families with children aged 7-17 from the National Health Interview and Examination Survey among Children and Adolescents (KiGGS). Mental health problems were determined using the extended version of the strengths and difficulties questionnaire (SDQ). Further standardised screening measures were employed to screen for anxiety disorders (SCARED), conduct disorder (CBCL), attention deficit-/hyperactivity disorder (FBB-HKS, Conners' Scale) and depressive disorders (CES-DC). Furthermore, substance abuse and suicidal tendencies were assessed. Health-related quality of life (HRQoL) and health care use were determined.

RESULTS

Overall, 14.5% of the children and adolescents aged 7-17 fulfilled the criteria for at least one specific mental health problem associated with impairment, or had an overall mental health problem indicated by an abnormal SDQ score and present impairment. However, high comorbidity was found in the children concerned. Symptoms of overall mental health problems were present in 8.6% of the children and 6.6% of the adolescents. This number was reduced to prevalence rates of 6.3 and 4.9% when additional impairment was taken as a criterion. Irrespective of the type of disorder, fewer than half of the children affected were reported as receiving treatment. However, for those suffering from mental health problems, large impairments in HRQoL were observed.

CONCLUSIONS

The observed prevalence of mental health problems as well as their large impact on well-being and functioning calls for early prevention. This is especially important with regard to the large decrease in HRQoL in the children and adolescents affected.

Risk and protective factors for children's and adolescents' mental health: results of the BELLA study

BACKGROUND

Since prevalence rates of mental health problems in children and adolescents are high and of considerable relevance to public health, determinants of mental health, such as risk and protective factors, are of special interest.

OBJECTIVES

The present paper reports the frequencies and distributions of potential risk and protective factors and analyses their effects on children's mental health.

METHODS

The BELLA study is the mental health module of the German National Health Interview and Examination Survey among Children and Adolescents (KiGGS). Mental health problems and their assumed determinants are examined in a representative sub-sample of 2,863 families with children and adolescents aged 7-17. In order to identify mental health problems, the extended version of the Strengths and Difficulties Questionnaire was administered. Data on psychosocial risk factors as well as on protective factors in terms of personal, familial and social resources were collected by questioning the parents and, from the age of 11 years upwards, the children themselves.

RESULTS

Adverse family climate stands out particularly as a negative contributor to children's mental health. When several risk factors occur simultaneously, the prevalence of mental health problems increases markedly. Conversely, pronounced individual, family and social resources coincide with a reduced occurrence of mental health problems, especially in children with a limited number of risk factors.

CONCLUSIONS

The results suggest that differential prevention strategies are needed depending on the risk level: in the low risk group, to which most children belong, effective prevention programmes should define strengthening resources as a key objective. In the smaller group of children with a high number of risk factors, more complex intervention designs are required, which must consider the reduction of risks as well as strengthening resources.

Evaluation of SHINE — Make Every Child Count: a school‐based community intervention programme

Many barriers to health and emotional well‐being for children are prevalent within inner‐city communities, and often result in negative consequences for education. Health promotion strategies have previously cited mentoring schemes as interventions through which targeted pastoral support can be effectively provided to children. This paper draws on detailed focus group interviews in order to evaluate SHINE ‐ Make Every Child Count, a student‐led charity operating five mentoring programmes across the London boroughs of Southwark and Lambeth. Following content analysis, this paper identifies six themes associated with mentor support: rapport; emotional well‐being and development; social behaviour; enabling; emerging ambition; and attitudinal development. Results show participant children have gained considerable enjoyment from mentor support. Successful friendships are built and emotional well‐being supported, with children actively including mentors as part of their support network. Children recognise the impact of a mentor on relationships with peers, behaviour within the classroom and social responsibility, in addition to direct educational support. Children also show an increased interest in learning, and evidence of considering ‐ often for the first time ‐ their own future aspirations. Findings demonstrate the impact of the mentoring programmes, as perceived by participant children. Evaluation can be used to inform future development of the programmes, as well as expansion to further schools, with the organisation working towards achieving long‐term sustainability.

Editorial review: Shifting views on juvenile bipolar disorder and pervasive developmental disorder

PURPOSE OF REVIEW

To examine the changes in prevalence estimates and concepts of core disorder in two child mental disorders that were once considered rare, and to place these changes in a cultural context.

RECENT FINDINGS

Up to one-quarter of people with bipolar disorder may have experienced onset of symptoms prior to puberty, but the precision of the diagnosis in children is uncertain. An ongoing challenge is differentiating bipolar disorder from other child mental disorders. Reliable markers of persistent bipolarity have yet to be identified. Despite a popular perception, pervasive developmental disorder is unlikely to have increased in the population, but recognition rates have increased as much as ten-fold since 1980. The increase is largely accounted for by shifts in diagnostic practice and in attitudes towards the condition.

SUMMARY

Changes in diagnostic practice and in clinician and public attitude account for much of the apparent variation in the prevalence of child mental disorders.