Prevalence of Psychiatric Disorders in Youths Across Five Sectors of Care

Most youth in detention have 1 or more psychiatric disorders (1). Posttraumatic stress disorder (PTSD) is one of the more prevalent disorders in detention, affecting at least 1 in 10 youth (2–4). One of the more debilitating aspects of PTSD is its tendency to co-occur with other psychiatric disorders (5–7). In a community sample, Giaconia and colleagues (8) found that nearly four-fifths of those with lifetime PTSD also had one or more additional disorders. Studies of detained adolescent males in Russia (9) and detained adolescent females in Australia (10) found that all of the detainees with PTSD had at least 1 comorbid disorder. It is unclear if PTSD increases the vulnerability to other disorders or if there are common genetic or environmental factors underlying the disorders (5,11). Researchers agree, however, that comorbid disorders have an adverse impact on the prognosis and treatment of individuals with PTSD. Youth with PTSD and comorbid disorders have significantly more behavioral and health problems and more impaired interpersonal relationships than those without comorbid disorders (5). Effective treatment planning for detained youth with PTSD requires epidemiologic data on patterns of prevalence and comorbidity. Yet, to our knowledge, no epidemiologic study of detainees in the US has examined PTSD and comorbid psychiatric disorders. In this paper, we administered standardized diagnostic measures to a large, stratified random sample of detained youth to: (a) compare the prevalence of psychiatric disorders among juvenile detainees with and without PTSD and (b) examine the prevalence of PTSD among youth with and without other psychiatric disorders.

Prevalence of Adolescent Substance Use Disorders Across Five Sectors of Care

Mental health care for Latinos: introduction to the special section.

Prevalence of and Gender Differences in Psychiatric Disorders Among Juvenile Delinquents Incarcerated for Nine Months

Despite a marked increase in treatment for bipolar disorder among youths, little is known about their pattern of service use. This article describes mental health service use in the year before and after a new clinical diagnosis of bipolar disorder. Claims were reviewed between April 1, 2004, and March 31, 2005, for 1,274,726 privately insured youths (17 years and younger) who were eligible for services at least one year before and after a service claim; 2,907 youths had new diagnosis of bipolar disorder during this period. Diagnoses of other mental disorders and prescriptions filled for psychotropic drugs were assessed in the year before and after the initial diagnosis of bipolar disorder. The one-year rate of a new diagnosis of bipolar disorder was .23%. During the year before the new diagnosis of bipolar disorder, youths were commonly diagnosed as having depressive disorder (46.5%) or disruptive behavior disorder (36.7%) and had often filled a prescription for an antidepressant (48.5%), stimulant (33.0%), mood stabilizer (31.8%), or antipsychotic (29.1%). Most youths with a new diagnosis of bipolar disorder had only one (28.8%) or two to four (28.7%) insurance claims for bipolar disorder in the year starting with the index diagnosis. The proportion starting mood stabilizers after the index diagnosis was highest for youths with five or more insurance claims for bipolar disorder (42.1%), intermediate for those with two to four claims (24.2%), and lowest for those with one claim (13.8%). Most youths with a new diagnosis of bipolar disorder had recently received treatment for depressive or disruptive behavior disorders, and many had no claims listing a diagnosis of bipolar disorder after the initial diagnosis. The service pattern suggests that a diagnosis of bipolar disorder is often given tentatively to youths treated for mental disorders with overlapping symptom profiles and is subsequently reconsidered.

The objectives of this study were to estimate the prevalence of autism spectrum disorders (ASD) and intellectual disability (ID) among youths active in at least one of five public service systems: mental health (MH), educational services for youth with serious emotional disturbance (SED), child welfare (CW), juvenile justice (JJ), and alcohol and drug services (AD). This study also reports the characteristics and patterns of system involvement among these youths. Results indicate that approximately 12% of a random sample of youths involved in these public service systems had ID or ASD. These disabilities were particularly prevalent in youths in the SED (25%), MH (13%), and CW (13%) systems and were less prevalent in the JJ and AD systems (4% each). Youths with ID or ASD were more likely than other youths to be White, have a higher socioeconomic status, and be more likely to have externalizing psychiatric and other problems. Of those with ASD or ID, approximately one-third were served in more than one service system, with the MH and SED systems most likely to be serving youths with externalizing psychiatric disorders. These findings have important implications for service provision, treatment planning, and workforce development.

Background: There are numerous reports regarding increasing childhood and adolescent mental health problems. The aim of this study was to determine the prevalence of psychiatric disorders in Hamadan Province, west of Iran from July 2016 to May 2017.Study design: A cross-sectional study.Methods: The sample included 1025 Hamadan residents selected using multistage cluster sampling. Psychiatric disorders were assessed by semi-structured psychiatric interview Kiddie-Sads-Present and Lifetime Version (K-SADS-PL). The data were analyzed using the SPSS software. We used the multivariable logistic regression to predict the Odds Ratios (ORs).Results: The prevalence of total psychiatric disorder was 8.6%. Psychiatric disorders in boys were higher than girls (12.6% and 4.9%, respectively). The psychiatric disorders were most prevalent in 6-9 yr old age group (11%). The prevalence of behavioral disorder was 3.8% with attention deficit hyperactivity disorder (ADHD) as the most prevalent case (2.0%). The prevalence of anxiety disorder was 2.8% in which the highest prevalence belonged to separation anxiety disorder (SAD) (1.1%). The prevalence of neurodevelopment disorder was 1.5% with the highest prevalence of 1% observed in epilepsy. The prevalence of mood disorder was 1.1% with the depressive disorder as the most prevalent one (1.0%). The prevalence of enuresis was 2.7%. The most common comorbidities were anxiety and mood disorders 5(50.0%).Conclusion: The prevalence of these disorders in Hamadan was less than the prevalence in other cities of Iran. These findings can be helpful for large-scale planning for children and adolescents.

Background: Children and adolescents are the potential capitals of communities. Therefore, their physical, mental, social, and spiritual health is of great importance. Objectives: This study aimed to evaluate the prevalence of psychiatric disorders among children and adolescents in Southern Khorasan province, Iran. Methods: This cross-sectional descriptive-correlational study was conducted in 2017. Study population consisted of children and adolescents aged 6–18 who lived in Southern Khorasan province, Iran. A sample of 1029 children and adolescents was selected through multistage cluster sampling. Data were collected using the Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL) and analyzed using the SPSS software (v. 19.0) and by conducting the Fisher’s exact test. Results: The overall prevalence of psychiatric disorders among children and adolescents in Southern Khorasan province, Iran, was 15.2%. The prevalence of these disorders among male and female participants was 15.5% and 14.8%, respectively. Moreover, the prevalence was 13.1% in the 6 - 9 age group, 15.5% in the 10 - 14 age group, and 17% in the 15 - 18 age group. In addition, the prevalence of psychiatric disorders among participants who lived in urban and rural areas was 18.9% and 6.3%, respectively. The most prevalent psychiatric disorders were respectively separation anxiety (5.2%), obsessive-compulsive disorder (3.5%), generalized anxiety disorder (3%), enuresis (2.9%), oppositional defiant disorder (2.4%), depression, special phobias, attention deficit-hyperactivity disorder (1.6%), agoraphobia (1%), and social phobia (0.8%). Conclusions: Need-based age-appropriate mental health services are needed to promote mental health among children and adolescents.

This study identified recent changes in the prevalence of psychiatric disorders among Department of Veterans Affairs (VA) nursing home residents. Psychiatric diagnoses in administrative databases were summarized for nursing home residents in 1998, 2002, and 2006. Census prevalence rates were compared with findings from earlier VA nursing home surveys. Prevalence rates were compared for age groups and birth cohorts of VA nursing home admissions in 1998 (N=27,734) and 2006 (N=32,543). Among residents in the census samples, prevalence rates for dementia and schizophrenia fluctuated moderately from 1990 to 2006, depression prevalence increased sharply, alcohol use disorder prevalence declined, and drug use disorder prevalence increased. Among 1998 and 2006 admissions, dementia prevalence increased for most birth cohorts but declined for most age groups (35% to 32% overall). Depression prevalence increased for all age groups and birth cohorts (27% to 37% overall), as did posttraumatic stress disorder prevalence (5% to 12% overall). Serious mental illness prevalence increased among the oldest residents and birth cohorts (19% to 22% overall). Alcohol use disorder prevalence declined for all birth cohorts and most age groups (18% to 16% overall), but drug use disorder prevalence increased substantially for younger age groups (6% to 9% overall). Examining differences in prevalence between birth cohorts and age groups can clarify trends in nursing home resident characteristics and improve projections of their future needs.

The present paper examined the lifetime rates of mental health service use in a representative sample of youths identified as receiving services in at least one sector of care in a publicly funded service system of a large, metropolitan area. Service use was examined in relation to age, gender, mental health diagnostic status, and service sector involvement. Participants were 1706 youths ages 6-17 years who were active in at least one of the following service sectors: alcohol and drug services, child welfare, juvenile justice, mental health, and special education services for serious emotional disturbance. Structured service use and diagnostic interviews were administered to youths and their caregivers. High lifetime rates of mental health service use were found. Eighty-seven percent of the sample used at least one outpatient service, 45% used at least one inpatient service, and 71% reported use of a school-based service. Youths involved with the mental health and special education sectors had the highest rates of service use. In contrast, youths enumerated from the juvenile justice system tended to have the lowest rates of use. Additional research is needed to refine our understanding of the factors associated with the observed patterns of service use.

Previous studies have found that one-half to three-quarters of youths detained in juvenile justice facilities have 1 or more psychiatric disorders. Little is known about the course of their disorders as they age. To examine the prevalence, comorbidity, and continuity of 13 psychiatric disorders among youths detained in a juvenile justice facility during the 15 years after detention up to a median age of 31 years, with a focus on sex and racial/ethnic differences. The Northwestern Juvenile Project is a longitudinal cohort study of health needs and outcomes of 1829 randomly selected youths in a temporary juvenile detention center in Cook County, Illinois. Youths aged 10 to 18 years were interviewed in detention from November 20, 1995, through June 14, 1998. Participants were reinterviewed up to 12 times during the 15-year study period through February 2015, for a total of 16 372 interviews. The sample was stratified by sex, race/ethnicity (Black, Hispanic, and non-Hispanic White), age (10-13 years or 14-18 years), and legal status (processed in juvenile or adult court). Data analysis was conducted from February 2014, when data preparation began, to March 2020. Detention in a juvenile justice facility. Psychiatric disorders, assessed by the Diagnostic Interview Schedule for Children, version 2.3 at the baseline interviews. Follow-up interviews were conducted using the Diagnostic Interview Schedule for Children, version IV; the Diagnostic Interview Schedule, version IV; and the World Mental Health Composite International Diagnostic Interview (beginning at the 6-year follow-up interview). The study included 1829 youths sampled at baseline (1172 males and 657 females; mean [SD] age, 14.9 [1.4] years). Although prevalence and comorbidity of psychiatric disorders decreased as the 1829 participants aged, 52.3% of males and 30.9% of females had at least 1 or more psychiatric disorders 15 years postdetention. Among participants with a disorder at baseline, 64.3% of males and 34.8% of females had a disorder 15 years later. Compared with females, males had 3.37 times the odds of persisting with a psychiatric disorder 15 years after baseline (95% CI, 1.79-6.35). Compared with Black participants and Hispanic participants, non-Hispanic White participants had 1.6 times the odds of behavioral disorders (odds ratio, 1.56; 95% CI, 1.27-1.91 and odds ratio, 1.59; 95% CI, 1.23-2.05, respectively) and greater than 1.3 times the odds of substance use disorders (odds ratio, 1.90; 95% CI, 1.55-2.33 and odds ratio, 1.39; 95% CI, 1.11-1.73, respectively) throughout the follow-up period. Behavioral disorders and substance use disorders were the most prevalent 15 years after detention. This study's findings suggest that persistent psychiatric disorders may complicate the transition from adolescence to adulthood, which is already challenging for youths involved in the juvenile justice system, many of whom are from racial/ethnic minority groups and low-income backgrounds. The pediatric health community should advocate for early identification and treatment of disorders among youths in the justice system.

This study examined the prevalence of childhood maltreatment and its relationship with current psychiatric disorders among detained youths. Clinical research interviewers assessed history of childhood maltreatment with the Child Maltreatment Assessment Profile and psychiatric diagnosis with the Diagnostic Interview Schedule for Children, version 2.3, in a stratified, random sample of 1,829 youths detained at the Cook Country Juvenile Temporary Detention Center (final sample, N=1,735). History of maltreatment was also ascertained from Cook County Court Child Protection Division records. More than three-quarters of females and more than two-thirds of males had a history of physical abuse (moderate or severe). More than 40% of females and 10% of males had a history of sexual abuse. Females and non-Hispanic whites had the highest prevalence rates of childhood maltreatment. Among females, sexual abuse was associated with every type of psychiatric disorder. Females who experienced various types of abuse were 2.6 to 10.7 times as likely as females with no maltreatment to have any disorder. Among males, maltreatment was associated with every disorder except anxiety disorders (range of odds ratios, 1.9-7.9). Among youths who were sexually abused, abuse with force was associated with anxiety and affective disorders among females and attention-deficit hyperactivity or disruptive behavior disorders and substance use disorders among males. Childhood maltreatment is common among detained youths and is also highly associated with psychiatric disorders. The mental health, child welfare, and juvenile justice systems must collaborate to ensure that youths receive protection and care when they return to their communities.

Mental health services for children and youth in the child welfare system: A focus on caregivers as gatekeepers

Youths with conduct disorder extract an inordinate amount of time and money from the U.S. judicial system and taxpayers, yet studies pertaining to this population have been few. This study was undertaken to examine the co-occurrence of personality disorders and conduct disorder in a group of incarcerated children and adolescents and to raise the issue of the possibility of antisocial personality disorder in persons under the age of 18 years. One hundred incarcerated juvenile offenders aged 11-17 years were randomly selected and then interviewed with the Diagnostic Interview for Children and Adolescents--Revised and the Structured Clinical Interview for DSM-III-R Personality Disorders to establish their psychiatric diagnoses. Eighty-seven percent of the group met the criteria for conduct disorder. Among those diagnosed as having conduct disorder, the only comorbid personality disorder that was present with significant frequency was antisocial personality disorder. The other comorbid personality disorder diagnoses that appeared most frequently were the borderline, narcissistic, paranoid, passive-aggressive, and dependent types. Borderline personality disorder was observed more frequently in the females than in the males with conduct disorder. The findings suggest that by using DSM-III-R criteria for adult personality disorders, one finds a considerable number of personality disorders in a young population with conduct disorder. The findings also show that youths manifest signs of antisocial personality disorder before they are 18 years of age, raising the question of how age should be incorporated into the diagnosis of personality disorder as DSM-IV is being prepared.

This study examined rates of youth-reported maltreatment history and the association between youth-reported maltreatment and foster care history across four racial/ethnic groups in a public system of care. Interviews were conducted with 1,045 youth (European Americans, African Americans, Hispanic Americans, and Asian Pacific Islanders) and their primary caregivers, sampled from one of five service sectors (alcohol/drug services, child welfare, juvenilejustice, mental health, and special education) in San Diego. Overall, racial/ethnic differences in youth-reported maltreatment were minimal. However, in the child welfare sector, African American youth self-reported maltreatment less frequently than other youth. There were significant racial/ethnic differences in foster care history, with African Americans far more likely to have been placed, even after controlling for youth-reported maltreatment, income, age, and gender. Furthermore, maltreatment history was associated with placement for all youth except African Americans. These results suggest that the overrepresentation of minority children in child welfare does not stem from greater rates of maltreatment.