Commentary: 'Diseases of the world': from epidemiology to etiology of child and adolescent psychopathology--a commentary on Polanczyk et al. (2015)

Mental Health and Well-being Measures for Mean Comparison and Screening in Adolescents: An Assessment of Unidimensionality and Sex and Age Measurement Invariance

Adolescence is a period of increased vulnerability for low well-being and mental health problems, particularly for girls and older adolescents. Accurate measurement via brief self-report is therefore vital to understanding prevalence, group trends, screening efforts, and response to intervention. We drew on data from the #BeeWell study (N = 37,149, aged 12-15) to consider whether sum-scoring, mean comparisons, and deployment for screening were likely to show bias for eight such measures. Evidence for unidimensionality, considering dynamic fit confirmatory factor models, exploratory graph analysis, and bifactor modeling, was found for five measures. Of these five, most showed a degree of non-invariance across sex and age likely incompatible with mean comparison. Effects on selection were minimal, except sensitivity was substantially lower in boys for the internalizing symptoms measure. Measure-specific insights are discussed, as are general issues highlighted by our analysis, such as item reversals and measurement invariance.

Recognition and management of children and adolescents with conduct disorder: a real-world data study from four western countries

BACKGROUND

Conduct disorders (CD) are among the most frequent psychiatric disorders in children and adolescents, with an estimated worldwide prevalence in the community of 2-4%. Evidence-based psychological outpatient treatment leads to significant improvement in about two-thirds of cases. However, there seems to be considerable variation in rates of CD diagnoses and implementation of evidence-based interventions between nations. The aim of this study was to compare administrative prevalence and treatment patterns for CD in children and adolescents seen in health care systems across four Western countries (Denmark, Germany, Norway, and the USA).

METHODS

Cross-sectional observational study using healthcare data to identify children and adolescents (aged 0-19 years) with an ICD-10 code for CD within the calendar year 2018. Within each country's study population, the prevalence of CD, psychiatric comorbidity, psychopharmacological treatment, and psychiatric hospitalisation was calculated.

RESULTS

The prevalence of diagnosed CD differed 31-fold between countries: 0.1% (Denmark), 0.3% (Norway), 1.1% (USA) and 3.1% (Germany), with a male/female ratio of 2.0-2.5:1. The rate of psychiatric comorbidity ranged from 69.7 to 86.1%, with attention-deficit/hyperactivity disorder being most common. Between 4.0% (Germany) and 12.2% (USA) of youths with a CD diagnosis were prescribed antipsychotic medication, and 1.2% (Norway) to 12.5% (Germany) underwent psychiatric hospitalisation.

CONCLUSION

Recognition and characteristics of youths diagnosed with CD varied greatly by country. In some countries, the administrative prevalence of diagnosed CD was markedly lower than the average estimated worldwide prevalence. This variation might reflect country-specific differences in CD prevalence, referral thresholds for mental health care, diagnostic tradition, and international variation in service organisation, CD recognition, and availability of treatment offers for youths with CD. The rather high rates of antipsychotic prescription and hospitalisation in some countries are remarkable, due to the lack of evidence for these therapeutic approaches. These findings stress the need of prioritising evidence-based treatment options in CD. Future research should focus on possible reasons for inter-country variation in recognition and management of CD, and also address possible differences in patient-level outcomes.

The influence of minority stress-related experiences on mental wellbeing for trans/gender-diverse and cisgender youth: a comparative longitudinal analysis

Trans and gender-diverse (TGD) adolescents are likely to experience poorer mental health and wellbeing than their cisgender peers. Minority stress theory has developed as a possible explanation for some of this disadvantage: factors such as increased bullying and discrimination lead to excess stress and reduced wellbeing. However, the evidence base remains limited. This study drew on secondary data analysis of the #BeeWell longitudinal cohort over 2 years (N = 26 042, aged 12-13 at time one, T1). We report two unregistered hypotheses relating to T1 (autumn 2021) data which was available at the time of stage-one submission: H1, mean differences in T1 wellbeing; H2, mean differences in T1 minority-related stressors. These are followed by two registered hypotheses relating to T2 (autumn 2022) data: H3, replication of T1 mean differences in T2 wellbeing; H4, predictions were made about the strength of the association between T1 minority-related stressors, controlling for sexuality and T2 wellbeing across T1 gender identity groups. At both time points cis-females, TGD and those who preferred not to say their gender had lower wellbeing than cis-males (CM), with the largest effect evident for the TGD group. TGD adolescents also showed the largest disadvantage (mean difference) compared with CM for minority stressors. Counter to H4 and minority stress theory, gender was not found to moderate the effect of minority stressors on later wellbeing. Our findings highlight the vulnerability of the TGD group in terms of wellbeing and minority stressors and are discussed with relevance for policy and future research.

Measuring general mental health in early-mid adolescence: A systematic meta-review of content and psychometrics

Background

Adolescent mental health is a major concern and brief general self-report measures can facilitate insight into intervention response and epidemiology via large samples. However, measures' relative content and psychometrics are unclear.

Method

A systematic search of systematic reviews was conducted to identify relevant measures. We searched PsycINFO, MEDLINE, EMBASE, COSMIN, Web of Science, and Google Scholar. Theoretical domains were described, and item content was coded and analysed, including via the Jaccard index to determine measure similarity. Psychometric properties were extracted and rated using the COSMIN system.

Results

We identified 22 measures from 19 reviews, which considered general mental health (GMH) (positive and negative aspects together), life satisfaction, quality of life (mental health subscales only), symptoms, and wellbeing. Measures were often classified inconsistently within domains at the review level. Only 25 unique indicators were found and several indicators were found across the majority of measures and domains. Most measure pairs had low Jaccard indexes, but 6.06% of measure pairs had >50% similarity (most across two domains). Measures consistently tapped mostly emotional content but tended to show thematic heterogeneity (included more than one of emotional, cognitive, behavioural, physical and social themes). Psychometric quality was generally low.

Conclusions

Brief adolescent GMH measures have not been developed to sufficient standards, likely limiting robust inferences. Researchers and practitioners should attend carefully to specific items included, particularly when deploying multiple measures. Key considerations, more promising measures, and future directions are highlighted. PROSPERO registration: CRD42020184350 https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020184350.

Common mental health problems among adolescents in sub-Saharan Africa: A systematic review and meta-analysis

Background and aim: This review examined the prevalence of mental health problems among adolescents in sub-Saharan Africa.Methods: The review included studies indexed in the MEDLINE, EMBASE, and PsycINFO databases, supplemented by a search on Google Scholar and tracking of references from articles identified. A total of 725 articles were found, of which 28 met the inclusion criteria. Finally, 22 eligible studies were reviewed.Findings: The pooled current prevalence of mental health problems was 23% (95% CI: 18; 28, I2 = 99.41%). Any depression, 19% (95% CI: 9; 30, I2 = 99.64%), and anxiety, 20% (95% CI: 01; 31, I2 = 99.64%), were the most common mental health problems reported. Attention deficit hyperactivity disorder, 5% (95% CI: 3; 7, I2 = 97.60%), and conduct disorders, 15% (95% CI: 8; 22, I2 = 99.58%), were also significant mental health problems among adolescents in the region.Conclusion: About one in five adolescents in sub-Saharan Africa suffer from one or more mental health problems. The findings have important implications for policy and practice as they indicate that mental health problems are a major public health issue among adolescents in sub-Saharan Africa and that there is a need for effective and context-specific interventions that address mental health.

Sociodemographic Correlates and Mental Health Comorbidities in Adolescents With Social Anxiety: The Young-HUNT3 Study, Norway

Social anxiety is highly prevalent in adolescents and is often associated with great individual suffering and functional impairment. Psychiatric comorbidity is common and further adds to this burden. The purposes of this study were: (1) to describe the occurrence of diagnosed and self-reported social anxiety among 8,199 Norwegian adolescents aged 13–19 years who participated in the population-based Young-HUNT3 study (2006–2008); (2) to examine associations between sociodemographic characteristics and different subgroups of social anxiety; and (3) to describe the psychiatric health comorbidities among adolescents diagnosed with social anxiety disorder (SAD). In total, 388 (5.9%) of the adolescents screened positive for SAD and were invited into a diagnostic interview, performed by professional nurses, using Anxiety Disorders Interview Schedule for DSM IV: child version (ADIS-C) (response rate = 54.6%). A SAD diagnosis was indicated in 106 individuals (50% of the interview subjects), and more than two-thirds of the adolescents diagnosed with SAD had one or more comorbid psychiatric disorders. Higher mean scores of self-reported social anxiety symptoms, poor self-rated health, sleep problems, poor family economic situation, low physical activity, and having sought professional help within the last year were associated with higher odds of being in the screening positive subgroup. Screening positive subjects who did not meet for a diagnostic interview did not differ notably from the rest of the screening positive group in terms of these sociodemographic characteristics. Based on our results and the fact that individuals with social anxiety often fear interview situations, the use of ADIS-C, screening questions and self-reports seem to be sufficient when aiming to identify epidemiologically representative cohorts of adolescents at risk of social anxiety.

A profile of social, separation and generalized anxiety disorders in an Australian nationally representative sample of children and adolescents: Prevalence, comorbidity and correlates

OBJECTIVE

To examine (1) the 12-month prevalence of social anxiety disorder (SOC), separation anxiety disorder (SEP) and generalized anxiety disorder (GAD) in a large, nationally representative sample of Australian youth; (2) patterns of comorbidity between these disorders; (3) demographic and socio-environmental correlates and (4) the psychosocial impact and service use associated with each condition.

METHOD

Data are from the 2013/2014 Australian national, face-to-face household Young Minds Matter survey of mental health and wellbeing. Informants were parents or carers reporting on 6310, 4- to 17-year-olds (55% of eligible households). The presence of each of the three anxiety disorders was determined based on the Diagnostic Interview Schedule for Children-Version IV.

RESULTS

In the past 12 months, 6.6% of youth had experienced at least one of SOC, SEP or GAD, with rates of 2.3% for SOC, 4.3% for SEP and 2.3% for GAD. Rates did not differ by gender but were significantly higher for SOC and GAD and lower for SEP in 12- to 17-year-olds than 4- to 11-year-olds. Comorbidity between these disorders was high, although lower for SEP. Having SOC, SEP or GAD was associated with not living with both biological parents, having a parent with a mental health problem, elevated negative family events, low carer employment and peer victimization. The association with family risk factors was greater for SEP than for SOC and GAD. Although the majority of anxious youth had received professional help, this was less likely in the younger cohort.

CONCLUSION

Social, separation and generalized anxiety disorders in young people are relatively common and impairing, with a high level of comorbidity. There are both commonalities and differences in socio-environmental correlates. The majority of anxious youth received some form of professional assistance, although the rate was lower among children compared to adolescents.

Key findings from the second Australian Child and Adolescent Survey of Mental Health and Wellbeing

OBJECTIVE

To estimate the prevalence of mental disorders in children and adolescents in Australia, and the severity and impact of those mental disorders.

METHOD

Seven mental disorders were assessed using the parent- or carer-completed version of the Diagnostic Interview Schedule for Children Version IV, and major depressive disorder was also assessed using the youth self-report version of the Diagnostic Interview Schedule for Children Version IV. Severity and impact were assessed using an extended version of the Diagnostic Interview Schedule for Children Version IV impact on functioning questions, and days absent from school due to symptoms of mental disorders. Data were collected in a national face-to-face survey of 6310 parents or carers of children and adolescents aged 4-17 years, with 2969 young people aged 11-17 years also completing a self-report questionnaire.

RESULTS

Twelve-month prevalence of mental disorders was 13.9%, with 2.1% of children and adolescents having severe disorders, 3.5% having moderate disorders and 8.3% having mild disorders. The most common class of disorders was attention-deficit/hyperactivity disorder followed by anxiety disorders. Mental disorders were more common in step-, blended- or one-parent families, in families living in rented accommodation and families where one or both carers were not in employment. Mental disorders were associated with a substantial number of days absent from school particularly in adolescents.

CONCLUSION

Mental disorders are common in children and adolescents, often have significant impact and are associated with substantial absences from school. Child and adolescent mental disorders remain an important public health problem in Australia. Accurate information about prevalence and severity of child and adolescent mental disorders is an essential prerequisite for effective mental health policy and service planning.