Has the Prevalence of Child and Adolescent Mental Disorders in Australia Changed Between 1998 and 2013 to 2014?

In Latin America, there is limited research on the prevalence of mental disorders in children and adolescents. This Chilean survey is the first national representative survey in the Latin American region to examine the prevalence of diagnostic and statistical manual-IV (DSM-IV) psychiatric disorders in the region in children and adolescents. Subjects aged 4-18 were selected using a stratified multistage design. The diagnostic interview schedule for children version IV (DISC-IV) was used to obtain 12-month DSM-IV diagnoses of affective, anxiety, conduct and substance use disorders, and supplemented with questionnaires examining family risk factors, family income, and service utilization. The parent or the primary caretaker was interviewed for children, aged 4-11, using the DISC-IV; however, adolescents, aged 12-18, were directly interviewed. A sample of 1558 children and adolescents was evaluated. Using the most stringent DISC-IV impairment algorithm, the prevalence rate for any psychiatric disorders was 22.5% (19.3% for boys and 25.8% for girls). The prevalence rate was higher among the children, aged 4-11, in comparison with adolescents, aged 12-18 (27.8% and 16.5%, respectively). Less than half of the subjects in need of services sought some form of assistance. Nearly a quarter of those using services did not present with a psychiatric diagnosis in the past year. Comorbidity was found in 24.8% of those with a disorder, but only 6.3% had three or more diagnoses. The prevalence of psychiatric disorders in Chile is high among children and adolescents. This study highlights the increasing need to reevaluate mental health services provided to children and adolescents in Latin America.

Objective To study the prevalence and socio-demographic correlates of mental disorders in Beijing residents. Methods The multi-stage stratified cluster random sampling method was used,19 874 residents aged 18 or above who had lived for more than six months in Beijing were selected. Face-to-face assessment was conducted by trained investigators by using the Chinese version of the Structured Clinical Interview for DSM-Ⅳ Axis Ⅰ Disorders-Patient Edition (SCID-Ⅰ/P) to find any mental disorders, and the Mini-Mental State Examination (MMSE) to screen for dementia and mental retardation. Those who were positive on MMSE (MMSE ≤ 17 for those who completed elementary education or less, ≤23 for those who completed middle school or above) were further assessed to confirm dementia and mental retardation by using the SCID. Results 16 032 (80.7%) out of 19 874 eligible residents completed the face-to-face assessment. Adjusted by age and gender, the lifetime prevalence of all mental disorders was 120.8‰ (1 937/16 032, 115.8‰-125.9‰), and the top three most common ones were major depressive disorder (527, 32.9‰), alcohol dependence and abuse (311, 19.4‰), and anxiety disorder, NOS (270, 16.8‰). The point prevalence of all mental disorders was 75.3‰ (1 207/16 032, 71.2‰-79.4‰), the top three were specific phobias (187, 11.7‰), anxiety disorder, NOS (186, 11.6‰), and major depressive disorder (162, 10.1‰).The prevalence of mental disorders was significantly higher in the elderly (OR=1.014) , female (OR=1.428) , unemployed (OR=1.096) , people having poor rapports with family (OR=1.686) or others (OR=1.901) , smoking (OR=1.129) or drinking (OR=1.262) . The prevalence of mental disorders was significantly lower in the urban residents (OR=0.840) , people in a higher level of education (OR=0.813) , people who had got married/remarried or who had partner (OR=0.689) , people who had no family history of any mental disorders (OR=0.405) . Conclusions Approximately 12% of Beijing residents may meet at least one diagnosis of mental disorder in their lifetime; The prevalence of mental disorders is associated with older age, female gender, lower level of education, rural dwelling, positive family history of mental disorders, and poor social support system. Key words: Mental disorders; Epidemiology; Prevalence

Prevalence of adolescent mental disorders in Kenya, Indonesia, and Viet Nam measured by the National Adolescent Mental Health Surveys (NAMHS): a multi-national cross-sectional study

BackgroundChildren and adolescents are more vulnerable to the affects of war and violence than adults. At the time of initiation of this study, nothing was known about the prevalence of childhood and early adolescence mental disorders. The aim of the present study is to measure the point prevalence of mental disorders among children of 1–15 years age in the city of Mosul, Iraq.MethodsA cross-sectional study design was adopted. Four primary health care centers were chosen consecutively as a study setting. The subjects of the present study were mothers who came to the primary health care center for vaccination of their children. The chosen mothers were included by systematic sampling randomization. All children (aged 1–15) that each mother had were considered in the interview and examination.ResultsOut of 3079 children assessed, 1152 have childhood mental disorders, giving a point prevalence of 37.4%, with a male to female ratio of to 1.22:1. The top 10 disorders among the examined children are post-traumatic stress disorder (10.5%), enuresis (6%), separation anxiety disorder (4.3%), specific phobia (3.3%) stuttering and refusal to attend school (3.2% each), learning and conduct disorders (2.5% each), stereotypic movement (2.3%) and feeding disorder in infancy or early childhood (2.0%). Overall, the highest prevalence of mental disorders was among children 10–15 years old (49.2%) while the lowest was among 1–5 year olds (29.1%). Boys are more affected than girls (40.2% and 33.2%, respectively).ConclusionChildhood mental disorders are a common condition highly prevalent amongst the children and early adolescents in Mosul. Data from the present study mirrors the size of the problem in local community. Several points deserve attention, the most important of which include giving care at the community level, educating the public on mental health, involving communities and families, monitoring community mental health indicators, and providing treatment at primary health care level.

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

Children younger than 7years can develop mental disorders that might manifest differently than in older children or adolescents. However, little is known about the prevalence of mental disorders at this early age. We systematically searched the literature in the databases Web of Science, PsycINFO, PSYNDEX, MEDLINE, and Embase to identify epidemiological studies of community samples published between 2006 and 2020. A series of meta-analyses was conducted to estimate the pooled worldwide prevalence of mental disorders in general, specific mental disorders, and comorbidity in young children. A total of ten epidemiological studies reporting data on N=18,282 children (12-83months old) from eight countries met the inclusion criteria. The pooled prevalence of mental disorders in general was 20.1%, 95% CI [15.7, 25.4]. Most common disorders were oppositional defiant disorder (4.9%, 95% CI [2.5, 9.5]) and attention-deficit hyperactivity disorder (4.3%, 95% CI [2.5, 7.2]). The prevalence of any anxiety disorders was 8.5%, 95% CI [5.2, 13.5], and of any depressive disorders was 1.1%, 95% CI [0.8, 1.6]. Comorbidity was estimated at 6.4%, 95% CI [1.3, 54.0]. The literature search reveals that the epidemiology of mental disorders in children younger than 7years is still a neglected area of research. The findings also indicate that there are a significant number of young children suffering from mental disorders who need appropriate age-adapted treatment.

Mental disorders are the leading cause of disability among children worldwide. Sociological research on child mental disorders focuses on their social causes and consequences using general population studies. Sociologists have examined the sociodemographic correlates of child mental disorders and disparities in the prevalence of child mental disorders across social groups and strata. This research reveals that children in the most disadvantaged and marginalized positions in the social hierarchy are at elevated risk for mental disorders. Sustained investment in large‐scale representative general population studies is necessary to generate evidence to inform the development of policies and interventions to reduce social disparities in the prevalence of child mental disorders. Emerging directions in the sociological study of children's mental health include assessing the impact of contextual, ambient, and macrolevel stressors, including climate change and the COVID‐19 pandemic.

Mental disorders are the leading cause of disability among children worldwide. Sociological research on child mental disorders focuses on their social causes and consequences using general population studies. Sociologists have examined the sociodemographic correlates of child mental disorders and disparities in the prevalence of child mental disorders across social groups and strata. This research reveals that children in the most disadvantaged and marginalized positions in the social hierarchy are at elevated risk for mental disorders. Sustained investment in large‐scale representative general population studies is necessary to generate evidence to inform the development of policies and interventions to reduce social disparities in the prevalence of child mental disorders. Emerging directions in the sociological study of children's mental health include assessing the impact of contextual, ambient, and macrolevel stressors, including climate change and the COVID‐19 pandemic.

Status of mental health in South Asian countries

Adolescents comprise a fifth of the population of India, but there is little research on their mental health. We conducted an epidemiological study in the state of Goa to describe the current prevalence of mental disorders and its correlates among adolescents aged between 12 and 16 years. To estimate the prevalence and correlates of mental disorders in adolescents. Population-based survey of all eligible adolescents from six urban wards and four rural communities which were randomly selected. We used a Konkani translation of the Development and Well-Being Assessment to diagnose current DSM-IV emotional and behavioural disorders. All adolescents were also interviewed on socio-economic factors, education, neighbourhood, parental relations, peer and sexual relationships, violence and substance use. Out of 2,684 eligible adolescents, 2,048 completed the study. The current prevalence of any DSM-IV diagnosis was 1.81%; 95% CI 1.27-2.48. The most common diagnoses were anxiety disorders (1.0%), depressive disorder (0.5%), behavioural disorder (0.4%) and attention-deficit hyperactivity disorder (0.2%). Adolescents from urban areas and girls who faced gender discrimination had higher prevalence. The final multivariate model found an independent association of mental disorders with an outgoing 'non-traditional' lifestyle (frequent partying, going to the cinema, shopping for fun and having a boyfriend or girlfriend), difficulties with studies, lack of safety in the neighbourhood, a history of physical or verbal abuse and tobacco use. Having one's family as the primary source of social support was associated with lower prevalence of mental disorders. The current prevalence of mental disorders in adolescents in our study was very low compared with studies in other countries. Strong family support was a critical factor associated with low prevalence of mental disorders, while factors indicative of adoption of a non-traditional lifestyle were associated with an increased prevalence.

The global prevalence of mental disorders is high and has an increasing trend. In Nepal, there is dearth in literature on prevalence of mental disorders based on national representative sample. In this study, we aim to present the findings on the prevalence of mental disorders from the pilot study of National Mental Health Survey, Nepal. A cross-sectional study was conducted among 1647 participants aged 13 years and above in three districts of Nepal: Dhanusha, Bhaktapur and Dolakha each representing three ecological regions. Mini International Neuropsychiatric Interview (MINI) standard version 7.0.2 for DSM-5 was used for adults (aged 18 years and above), and kid version of the same tool was used for children (aged 13-17 years) in Nepali language. Separate sets of questions were added for epilepsy and dissociative conversion disorder that were not in the Mini International Neuropsychiatric Interview tool. Prevalence of assessed mental disorders was reported separately for adults and children. The current prevalence of mental disorders among adults and children were 13.2% and 11.2% respectively. Substance use disorder, dissociative conversion disorder, major depressive disorder, alcohol use disorder and psychotic disorder were common among adults. Similarly, psychotic disorder, agoraphobia, major depressive disorder, and anxiety disorders were common among children. Current suicidality was present among 10.9% adults and 8.7% children. Our findings from the pilot study have given insight into the prevalence of different mental disorders in the survey areas. These findings can be utilized for planning the National Mental Health Survey, Nepal.

Chapter 1 - Prevalence, risk factors, and disease burden of child and adolescent mental disorders: Taiwanese and global aspects

Background：There has been a lack of prevalence estimates of DSM-5 mental disorders in child populations at the national level worldwide. Little is known about the disease burden of child mental disorders. Taiwan’s National Epidemiological Study of Child Mental Disorders (TNESCMD) was designed to address these research gap. This study reported the methodology of the TNESCMD and the lifetime and six-month prevalence of mental disorders according to the DSM-5 diagnostic criteria in Taiwanese children. I further compared the prevalence and estimated disease burden from the TNESCMD with Taiwan National Health Insurance Research Database (TNHIRD). Methods: The TNESCMD used stratified cluster sampling to select 69 schools in Taiwan resulting in a nationally representative sample. Among all 10118 eligible children selected via our sampling method, 9560 (94.4%) children, 6846 (67.6%) parents, and 9759 (96.3%) teachers participated in this study and completed the questionnaires. Among them, 4816 children in grades 3 (n=1352), 5 (n=1297), and 7 (n=2167) further underwent face-to-face psychiatric interviews using the Kiddie-Schedule for Affective Disorders and Schizophrenia-Epidemiological (K-SADS-E) version, modified for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Clinical questionnaires for attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), emotional and behavioral problems included the Chinese version of the Swanson, Nolan, and Pelham IV scale, Social Responsiveness Scale, and Child Behavior Checklist were used to examine the convergent and divergent validity with K-SADS-E. Risk factor analysis for mental disorders included sex, age, urban/rural and community income. 1,389,372 participants aged 8 to 14 were randomly selected from the 2016 TNHIRD claims dataset. The disease burden was calculated regarding years lived with disability (YLDs) with adjustment for comorbidity. YLDs and their 95% uncertainty intervals (UI) were reported. A rates ratio (RR) was reported to depict the strength of YLDs difference between TNESCMD and TNHIRD. Results: The K-SADS-E showed satisfactory inter-rater reliability (prevalence adjusted bias adjusted kappa = .80-1.00) among eight interviewers. The diagnoses of K-SADS-E demonstrated good convergent and divergent validity with most corresponding clinical questionnaires. The weighted lifetime and 6-month prevalence rates for overall mental disorders were 32.3% and 25.8%, respectively. The most prevalent mental disorders (lifetime, 6-month) were anxiety disorders (15.1%, 13.5%) and ADHD (10.5%, 9.0%), followed by sleep disorders, tic disorder, oppositional defiant disorder, and ASD. New DSM-5 mental disorders, avoidant/restrictive food intake disorder and disruptive mood dysregulation disorder, were also found with current low prevalence (<1%). Boys were more likely to have neurodevelopmental disorders and disruptive and impulse-control, and conduct disorders, whereas girls were more likely to develop anxiety disorders, depressive disorder and anorexia nervosa. Depressive disorder and suicide-related problems were more prevalent in Grade 7 children. The participants living in urban areas and low socioeconomic communities had increased risks for mental disorders. The overall YLD from all mental disorders in the TNESCMD was 5.24 times (95% UI: 4.15-6.70) more than that in TNHIRD, with the lowest and highest YLDs RR for autism spectrum disorder (ASD; RR: 2.24 and 95% UI: 1.28-3.93) and anxiety disorders (RR: 351.00 and 95% UI: 175.05-703.80), respectively. Unlike ADHD and ASD, the total proportions explained by anxiety disorders and conduct disorder/oppositional defiant disorder were significantly lower in TNHIRD than those in the TNESCMD and Global Burden of Disease 2016. Conclusions: Our findings suggest that the Mandarin version of the K-SADS-E for DSM-5 is a reliable and valid instrument for diagnosing child and adolescent mental disorders based on DSM-5. Similar to the DSM-IV prevalence rates reported in Western countries, indicate that DSM-5 mental disorders are common in the Taiwanese child population. The comparatively higher estimate of the disease burden of mental disorders in children from community-based setting might provide the preparation of future financial resource allocation, development and management of medical service, and human resource for mental health care in the clinic-based settings. For disorders with a significant difference in disease burden between the community-based and clinic-based settings, they may need more mental health promotion and prevention.

As in many other countries, child psychiatry in China has gradually developed from general psychiatry. In the early days of the profession, child psychiatry was considered as psychiatry for "little adults". Child psychiatry in China has gradually developed and expanded since the implementation of Professor Guotai Tao's child psychiatric services in Nanjing in the 1930s. In particular, the profession has developed rapidly since its affiliation with the International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP) in 1998. Child psychiatry has been one of the fastest developing advanced international disciplines over the past 10 years. Pediatric psychiatry mainly focuses on the diagnosis, treatment, and prevention of mental disorders in children, adolescents, and their families. In 1899, the term ''child psychiatry'' (in French) was used as a subtitle in Manheimer 's monograph Les Troubles Mentaux de l'Enfance. The Swiss psychiatrist Moritz Tramer (1882–1963) was probably the first to define child psychiatry, in 1933, in terms of diagnosis, treatment, and prognosis within the medical discipline. In 1934, he founded the Journal of Child Psychiatry (1934–1952), which later became Acta Paedopsychiatrica (1953–1994). The first academic pediatric psychiatry department was established in 1930 at the Johns Hopkins Hospital in Baltimore by Leo Kanner (1894–1981). Since then, the clinical practice, research, and teaching of child psychiatry have gradually developed around the world.1 There have been three stages to the development of children's psychiatry in China. The first is the exploration and development period, which occurred mainly during the 1930s to the 1950s. This period was characterized by the introduction of Western models by experts and the exploratory development of child psychiatric services. Professor Yulin Cheng, Guotai Tao, and Yonghe Ling other professors are the pioneers. The second stage is the initial development period, which occurred from the 1950s to the late 1970s. Child psychiatric clinics and/or wards were established in Nanjing, Shanghai, Beijing, Guangzhou, Sichuan, Hunan and other places and child psychiatric teams were formed. Although there was a pause in the early 1970s, child psychiatric service models continued to be developed. The third period, from the late 1970s to the present, was characterized by rapid progress. The development of child psychiatry has been promoted mainly since the economic reform and opening-up in China, with the transformation of the medical model from a pure biomedical model to a biopsychosocial medical model. Psychiatrists, pediatricians, and psychologists have begun to focus on child mental health and have conducted some interdisciplinary research and practice. Following the establishment of the Nanjing Child Mental Health Research Center, many provinces and cities have established child mental health centers. Psychiatric hospitals or mental health institutes affiliated to major medical universities in Nanjing, Beijing, Hunan, Sichuan, Shanghai and other places have successively established Master's and doctoral training sites for child psychiatry and applied psychology. Relevant disciplines and research institutions such as child health care, behavioral pediatrics, special education schools, and autism training centers have successively joined the ranks of child mental health services. In particular, Professor Guotai Tao founded the Nanjing Child Mental Health Research Center in 1984. In August 1987, the center was appointed by the World Health Organization (WHO) as a scientific research and training cooperation center, and was appointed by the Chinese Ministry of Health (now the National Health Commission) as a child mental health guidance center. Many child psychiatrists and mental health workers have been trained, and academic exchanges have been promoted in China and abroad.2 With the rapid development of disciplines, Chinese child psychiatry has reached an internationally renowned and advanced level. Multidisciplinary participation in child psychiatry is good. For example, the psychology of child development, developmental behavior pediatrics, child neurology, child health care, education, and sociology have begun to attach importance to clinical practice and research on mental health. A growing number of universities and colleges offer degrees for social workers in clinical psychology and childcare. In addition, with more primary care centers in the community, primary care physicians can implement screening and follow-up for children with mental health disorders. However, the primary care providers still need more education and training. To address this problem, the National Health Commission has been advocating multilevel collaboration. Pediatricians and primary care physicians across the country are now being trained in early diagnosis and basic treatment for common mental disorders in children. They are taught to screen patients for signs of developmental disorders by checking, for example, whether a 3-month-old baby's eyes can follow moving objects or whether an 18-month-old child can make eye contact. The problem of the shortage of child psychiatrists has been partially solved.3 Children and adolescent mental health problems are related to a country's development and to global changes. About 20% of children and adolescents worldwide experience mental health disorders. The major challenges for children and adolescents with mental disorders are stigma, isolation, discrimination, and the lack of access to health care and education facilities. Obviously, children and adolescents are vulnerable groups; they have no political power and their mental health problems are complicated. The mental health of children and adolescents requires multisectoral cooperation and the attention of the whole society. In particular, the protection afforded by government actions and policies is crucial. Policies must be designed to ensure that children and adolescents can access even the most basic mental healthcare. However, there are few countries worldwide that provide specific policies for the mental health needs of children and adolescents.4 China has a large population of children. Rapid economic development and social reforms in recent years have had a substantial impact on the mental health of children and adolescents. Increasing social pressures and workers migration, and changes in family planning, have changed traditional family structures and social support systems.3 As part of development and progress within China, the Chinese government has initiated a series of policies and regulations to promote mental health. Some of these policies are aimed at promoting mental health in children and adolescents; for example, "The Law of the People's Republic of China on the Protection of Minors", "The Law of the People's Republic of China on the Protection of the Rights and Interests of Women and Children", "The Law of the People's Republic of China on the Protection of Disabled Persons", "Mental Health Law of the People's Republic of China", and programmatic documents such as the "Healthy China 2030 Planning Outline", "National Program of Outline for Action for Child Development in China (2011–2020)", "Guidelines for the Prevention and Treatment of Attention-Deficit/Hyperactivity Disorder'', ''Guidelines for the Diagnosis, Treatment and Rehabilitation of Children with Autism'', and ''Technical Specifications for Children's Mental Health Care''.5-10 These reflect how the support of national policies has driven the development of child psychiatry. Major national basic and clinical research projects have invested in child psychiatry research, such as the National Natural Science Foundation of China, which has supported national research and development plans in key health areas. Research by a team led by Professor Zhang Dai has demonstrated that FMR1, DISC1, EN2, and SHANK3 genes are related to autism. Studies by a team led by Professor Kun Xia and Jingping Zhao have shown that XRXN1, GRIN2B, RELN, and DAB1 genes may be antecedents of autism. Such research has been published in several high quality academic journals in recent years.11, 12 Some research of the National "12th and 13th Five-Year Plan" scientific and technological support projects led by Professor Yi Zheng, on "The Epidemiological Study of Child Mental Disorders in China" and "Comprehensive Intervention Strategies for Chronic Non-communicable Diseases with Attention Deficit-Hyperactivity Disorder". These show that Chinese child psychiatry has become a discipline supported by the national key research project. Traditional research group in child psychiatry include the team led by Professor Guotai Tao, Jie Lin and Xiaoyan Ke about autism, mental retardation and childhood schizophrenia; team led by Professor Yufeng Wang on attention deficit hyperactivity disorder; team led by Professor Xiaoling Yang and Jing Liu about autism spectrum disorders; team led by Professor Xuerong Li, Linyan Su and Xuerong Luo on epidemiological surveys and tool scales for child mental disorders; team led by Professor Rene Xin, Yasong Du and Wenhong Chen on epidemiological investigation of children's behavior problems and related research on child psychology and family therapy; team led by Professor Shiji Zhang, Yi Zheng, Yonghua Cui and Fan He on tics and related disorders; and team led by Professor Youhe Shan, Lanting Guo and Yi Huang on behavioral scales and tic disorders. The above studies have published valuable articles in academic journals and won many awards. Child psychiatrists need to be dedicated. The treatment of patients with mental illness is difficult and often daunting, and children's mental health disorders are particularly difficult to treat. Treatment of children with autism or mania requires tackling difficult problems and good practice in basic clinical skills. In China, child psychiatrists experience low returns and low income. The number of child psychiatric inpatients and outpatients is constantly increasing, and their treatment often relies on the dedication of child psychiatrists. To treat such patients, there are now more than 10 centers, nearly 1000 beds, and dozens of special education centers, such as autism rehabilitation centers. To care for left-behind children, children infected with AIDS, children affected by natural disasters such as earthquakes, and children with substance abuse and internet addiction, many child mental health workers and full-time child psychiatrists have formed competent national and local emergency response teams. Child psychiatrists are now available to help children to cope with a variety of social disasters, such as the Wenchuan earthquake or the "3.01" terrorist incident in Kunming. The development of modern child psychiatry in China is interlinked with foreign exchange. Since Professor Guotai Tao's studies in the United States in 1940, Chinese child psychiatry has been continuously introducing and incorporating foreign advanced diagnosis and treatment and research concepts. At present, Professor Tao has discussed diagnostic issues with international authoritative experts in foreign journals and participated in the preparation of the 11th revision of the International Classification of Diseases (ICD-11). Professor Tao was the first international participant in efforts to promote the integration of child and adult psychiatry and the popularization of the notion of the lifelong effects of mental illness, such as the Cross-Strait Summit Forum, and domestic and foreign academic institutions and academic exchanges, such as the Asian Society for Child and Adolescent Psychiatry and Allied Professions (ASCAPAP) and the International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP). Chinese child psychiatrists have attended and contributed to both of the latter societies. Since the 1930s, older generations of individuals, such as Yulin Cheng, Guotai Tao, and Xueshi Chen, have made substantial contributions to the development of the discipline of child psychiatry. In 1989, Professor Jie Lin set up and led the Child Psychiatric Group of the Chinese Medical Association Psychiatry Branch. Professor Guotai Tao served as a consultant of the Group. Almost at the same time, the Chinese Mental Health Association established the Child and Adolescent Professional Committee, with Xuerong Li as director. Xueshi Chen serves as a consultant. Since then, two academic organizations have held annual meetings or training courses. In 1998, Professor Shiji Zhang, Yi Zheng, and Linyan Su participated in the IACAPAP congress and joined this organization, which is the most highly regarded academic organization in international child psychiatry. Chinese child psychiatry is fully in line with international developments in child psychiatry. In 2003, Professor Yi Zheng and Linyan Su attended the WHO Expert Headquarters "Concern for Children and Adolescents with Mental Disorders" meeting as Chinese representatives. In the same year, Professor Yi Zheng participated in the ASCAPAP congress and was elected as an executive member. In 2004, Professor Yi Zheng was appointed onto the IACAPAP executive committee. Professor Yi Zheng created the Cross-Strait Children's Psychiatry Summit Forum, which is held once every 2 years alternately in the mainland of China and Taiwan province, China. The Forum is now in its ninth session and has promoted the rapid development of the discipline. In 2010, the 19th IACAPAP International congress was successfully held in Beijing. This was the first time that this congress had been held in a developing country. Professor Yi Zheng served as Executive Chairman, and Professor Jing Liu served as Chairman of the organizing committee. Xiulian Gu, Zhu Chen, Wenkang Zhang and the country's main health care officials attended the opening ceremony and delivered speeches. More than 1300 foreign scholars and 500 domestic scholars attended the congress. Yi Zheng was elected onto the ASCAPAP executive committee and was elected Chairman, and Jing Liu was elected Vice-Chairman of ASCAPAP. At the 21st IACAPAP Conference held in South Africa in 2014, Professor Yi Zheng was elected Vice-President of IACAPAP and won the International Child Psychiatry Outstanding Contribution Award, indicating that Chinese child psychiatry has played a major role on the international stage.2 China has a population of more than 1.3 billion individuals, of which 238 million are children younger than 15 years of age.13 Though a nationwide prevalence study is lacking, some regional epidemiological studies show that the prevalence of mental health disorders in children is close to the worldwide prevalence of 20%,14-18 indicating that about 50 million children in China require treatment for mental health disorders. However, there is a scarcity of child and adolescent psychiatrists (CAPs) in China, and there are less than 500 full-time CAPs nationwide. Currently, only a national psychiatrist certification system exists, and there is no child psychiatrist certification system. Instead, students must obtain a postgraduate training certificate or a nationally approved Ph.D. or Master 's degree training certificate to become a child psychiatrist. A recent survey showed that training units for CAPs are mainly concentrated in large and medium-sized cities. Moreover, only a small number of medical personnel in China can diagnose and treat children and adolescents with mental health disorders, and these have insufficient training. Currently available training for child psychiatrists contains insufficient scientific, practical, and problem-solving content. Furthermore, current educational training poorly equips child psychiatrists for subsequent teaching and professional scientific research abilities. Therefore, a greater training focus is needed on more comprehensive qualities and abilities, such as dedication. Although CAPs undertake a long process of training, this mainly comprises postgraduate or doctoral Master's degree training; the national specialized certification system for CAPs has only been piloted in major cities. The CAP training system requires further improvements, and more CAPs are needed.19 China still has a shortage of child psychiatrists. To address this, a new type of multilevel collaboration is currently being implemented. Pediatricians and primary care physicians are also receiving training in child psychiatry. In addition, psychotherapists from other countries have been recruited to help train psychiatrists. China is currently exploring all possible ways to strengthen multilevel collaboration to promote the children's physical and mental health.3 The artificial boundary between children and adults with mental health disorders will be removed: more attention and value will be placed upon the treatment of adult attention deficit–hyperactivity disorder (ADHD), adult autism spectrum disorder (ASD), adult tic disorder, and other issues. Gene diagnosis and classification of child neurological and mental development disorders will become a reality: the detection of genes for susceptibility to ASD, ADHD, tic disorders, child schizophrenia, and child bipolar disorder will become possible. The concept of the supremacy of child mental health will gradually be accepted. More and more studies have confirmed that among the main factors for healthy and successful child developmental, child mental health is of paramount importance. As physical health and nutritional issues have been generally resolved in most parts of China, the impact of mental health on the future success of children will be a core health issue. Therefore, mental health should start with children. The multidisciplinary and multisector nature of child mental health will be further improved: medicine, economics, sociology, and other disciplines will pay close attention to child mental health. In particular, the only-child problem, the problems experienced by elderly parents in raising a second child, the problem of left-behind children, AIDS-infected children, Internet addiction problems, youth suicide, and crime prevention problems will become the focus of social attention. There will be new breakthroughs in early diagnosis and interventions for child mental health disorders: the ICD-11 (containing input from Chinese experts) will soon be released. Early warning indicators for child psychological problems and quantitative assessment techniques for child mental health care will be promoted from the national level to the whole country. Like child vaccination, assessments and interventions for child psychological conditions will benefit every child, which will set a global precedent. Treatment methods for child mental health disorders will be qualitatively improved. In addition to the further optimization of the structure and dosage of antipsychotics, research on functional food will make significant progress, and the use of alternative medicine and traditional Chinese medicine for child mental health disorders will be further clarified. In conclusion, the development of child psychiatry in China is still far behind developed countries, but a golden age of rapid development is approaching. Research on prevention and control of major chronic non-communicable diseases in the Ministry of Science and Technology (No: 2016YFC1306100) None.

BackgroundThe prevalence of psychiatric disorders by demographic characteristics in elderly people is poorly understood, at least in the northwest of Iran. We aimed to estimate the prevalence of various psychiatric disorders in the elderly population in East Azerbaijan Province, Tabriz. A total of 1000 aging people were randomly selected from the general population. Data were collected using valid structured instruments and face-to-face interviews by trained psychologists. The Structured Clinical Interview for DSM-IV-TR (SCID-IV) and Abbreviated Mental Test Questionnaire were used. Chi-square (χ2) test was used for categorized variables, and an independent T-test was carried out for quantitative variables.ResultsOverall, 38.5% of the elderly had at least one mental disorder (47.2% women, 27.3% men). The prevalence of major depressive disorder (MDD) and any anxiety disorders was 16.6% (22.4% female and 9.3% male) and 16.7% (23.1% female and 8.6% male), respectively. Likewise, the overall prevalence of any depressive symptoms, post-traumatic stress disorder (PTSD), general anxiety disorder (GAD), obsessive-compulsive disorder (OCD), and panic disorders were 21.6%, 7%, 5.3%, and 5.9%, respectively. The prevalence of any mental disorder in the first, second, and third quartiles of the socio-economic level was 54.3%, 37%, and 17.8%, respectively. The prevalence of any mental disorders among the marginalized and the non-marginalized population is 55.3 and 31.5%, respectively.ConclusionsWe found 38.5% (47.2% women, 27.3% men) of the elderly people had any mental disorders, and 21.6% of them had any depressive disorders. The prevalence of mental disorders in elders was almost like adults and middle-aged people in this study. However, the prevalence of mental disorders was higher than in marginalized population and low socio-economic status.