Functional outcomes of child and adolescent mental disorders. Current disorder most important but psychiatric history matters as well

BACKGROUND

Various sources indicate that mental disorders are the leading contributor to the burden of disease among youth. An important determinant of functioning is current mental health status. This study investigated whether psychiatric history has additional predictive power when predicting individual differences in functional outcomes.

METHOD

We used data from the Dutch TRAILS study in which 1778 youths were followed from pre-adolescence into young adulthood (retention 80%). Of those, 1584 youths were successfully interviewed, at age 19, using the World Health Organization Composite International Diagnostic Interview (CIDI 3.0) to assess current and past CIDI-DSM-IV mental disorders. Four outcome domains were assessed at the same time: economic (e.g. academic achievement, social benefits, financial difficulties), social (early motherhood, interpersonal conflicts, antisocial behavior), psychological (e.g. suicidality, subjective well-being, loneliness), and health behavior (e.g. smoking, problematic alcohol, cannabis use).

RESULTS

Out of the 19 outcomes, 14 were predicted by both current and past disorders, three only by past disorders (receiving social benefits, psychiatric hospitalization, adolescent motherhood), and two only by current disorder (absenteeism, obesity). Which type of disorders was most important depended on the outcome. Adjusted for current disorder, past internalizing disorders predicted in particular psychological outcomes while externalizing disorders predicted in particular health behavior outcomes. Economic and social outcomes were predicted by a history of co-morbidity of internalizing and externalizing disorder. The risk of problematic cannabis use and alcohol consumption dropped with a history of internalizing disorder.

CONCLUSION

To understand current functioning, it is necessary to examine both current and past psychiatric status.

Untreated Remission of Adolescents’ Mental Health Problems: Challenging the Treatment Gap?

Introduction

Mental health problems are highly prevalent and are associated with a high burden, but such problems are often left untreated. This is referred to as the “treatment gap”. The question of who is most likely to remit from their mental health problems without treatment has received surprisingly little attention. A few studies do suggest that untreated remission is common in the general population, but these are in particular limited by short follow-up times.

Objectives

The aims of this study are to describe untreated remission of mental health problems in adolescence, and to assess the extent to which mental health problems recur after untreated remission.

Methods

Data from the Dutch community-based cohort study TRacking Adolescents’ Individual Lives Survey (TRAILS) were used. Depressive and anxiety problems were assessed using the Youth Self-Report at ages 11, 13, and 16, and the Adult Self-Report at ages 19 and 22.

Results

Preliminary analyses show high rates of untreated remission (approximately 80% over all waves). However, a substantial proportion of remitted cases still report sub clinical levels of mental health problems at follow-up. More elaborate analyses are ongoing, and will be presented at the conference.

Conclusions

First results suggest that untreated remission is common in adolescents. The presence of residual symptoms may point towards an elevated risk of recurrence in adolescents who remit without treatment. Further knowledge about untreated remission is of vital importance for an accurate assessment of the treatment gap, and for prevention and early intervention programmes.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Predicting Secondary Mental Health Care Use in Adolescence using Self-, Parent- and Teacher-reported Problem Behavior in a Community-based Record-linkage Study

Introduction

In adolescence, help-seeking is affected by different actors. The influence of each actor on help-seeking is often studied in isolation, or, if multiple informants are included, using only few assessments of adolescents’ mental health.

Objectives

The aim of this study is to determine the extent to which self-, parent- and teacher-reported problem behavior predict secondary care in adolescence and to what extent the informants’ relative importance changes over time.

Methods

Data from the Dutch community-based cohort study tracking adolescents’ individual lives survey (TRAILS) were linked to administrative records of secondary care from 2000 (age 9) to 2011 (age 21). Internalizing and externalizing problems were assessed using the youth self-report, child behavior checklist and teacher checklist of psychopathology at ages 11, 13 and 16, and the adult self-report at age 19.

Results

The annual incidence of secondary care fluctuated between 1.3% and 2.4%. In Cox regression analyses that adjusted for sociodemographic covariates and problem behavior, internalizing problems but not externalizing problems predicted secondary care. Secondary care between the ages 11 to 13 years was predicted best by teachers, between the ages 13 to 16 by parents, and between the ages 16 to 21 by adolescents.

Conclusions

The relative importance of informants for predicting secondary care shifts over time, which suggests that each informant is the driving force behind secondary care at a different phase of adolescence. The treatment gap may be reduced by improving problem recognition of teachers in secondary education and by educating young adults about mental health problems.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Mental health in Dutch adolescents: a TRAILS report on prevalence, severity, age of onset, continuity and co-morbidity of DSM disorders

BACKGROUND

With psychopathology rising during adolescence and evidence suggesting that adult mental health burden is often due to disorders beginning in youth, it is important to investigate the epidemiology of adolescent mental disorders.

METHOD

We analysed data gathered at ages 11 (baseline) and 19 years from the population-based Dutch TRacking Adolescents' Individual Lives Survey (TRAILS) study. At baseline we administered the Achenbach measures (Child Behavior Checklist, Youth Self-Report) and at age 19 years the World Health Organization's Composite International Diagnostic Interview version 3.0 (CIDI 3.0) to 1584 youths.

RESULTS

Lifetime, 12-month and 30-day prevalences of any CIDI-DSM-IV disorder were 45, 31 and 15%, respectively. Half were severe. Anxiety disorders were the most common but the least severe whereas mood and behaviour disorders were less prevalent but more severe. Disorders persisted, mostly by recurrence in mood disorders and chronicity in anxiety disorders. Median onset age varied substantially across disorders. Having one disorder increased subjects' risk of developing another disorder. We found substantial homotypic and heterotypic continuity. Baseline problems predicted the development of diagnosable disorders in adolescence. Non-intact families and low maternal education predicted externalizing disorders. Most morbidity concentrated in 5-10% of the sample, experiencing 34-55% of all severe lifetime disorders.

CONCLUSIONS

At late adolescence, 22% of youths have experienced a severe episode and 23% only mild episodes. This psychopathology is rather persistent, mostly due to recurrence, showing both monotypic and heterotypic continuity, with family context affecting particularly externalizing disorders. High problem levels at age 11 years are modest precursors of incident adolescent disorders. The burden of mental illness concentrates in 5-10% of the adolescent population.

Intracranial cavity volumes: a new method and its potential applications

Variations of brain weights and volumes often reflect pathological states. However, these parameters are more meaningful when related to intracranial volume. The most useful derived parameter is the difference between intracranial volume and brain volume expressed as a percentage (potential intracranial space). In patients with cerebral atrophy the potential intracranial space will be large, whereas in patients with space occupying lesions or brain swelling the potential intracranial space will shift towards 0%. Previously described techniques to determine intracranial volume have been unsatisfactory for routine application in the autopsy room. The technique described herein is based on the production of a permanent polyurethane cast of the cranial cavity. The casts can be formed in about 20 min with little modification of standard autopsy technique. Duplicate casts were made in twenty-seven unselected cases and in all cases there was less than 2% error in duplicate cast volumes. The cast provides a permanent record of the size and shape of the cranial cavity and can be used to determine intracranial volume or other intracranial dimension. The usefulness of the derived parameter, potential intracranial space, is evident in some of the cases studied.