Abstract
Knowledge is scarce on the course of psychiatric disorders in adolescence. We aimed to assess changes in the frequency of psychiatric disorders, somatic disorders, pain, and substance use in a clinical psychiatric cohort from adolescence to young adulthood. This study is part of the Health Survey in Department of Children and Youth, St. Olavs Hospital, Norway. At age 13–18 years, 717 (43.5% of eligible) participated in the first study visit (T1) in 2009–2011, 549 were reassessed 3 years later with telephone interview (T2), and 464 had diagnostic evaluation at both time points. Data included: ICD-10 diagnoses (T1), DSM-IV diagnoses (T2), self-reported pain and substance use (T1 and T2). The overall rate of psychiatric disorders decreased (T1 vs. T2: 94.8% vs. 72.2%, p < 0.001); while, an increased rate of anxiety disorders was marked among girls (37.5% vs. 55.9%, p < 0.001), with accompanying raised frequencies of psychiatric comorbidity (14.1% vs. 42.6%, p < 0.001), somatic comorbidity (9.4% vs. 19.5%, p = 0.001), chronic pain (31.6% vs. 49.4%, p < 0.001), smoking, alcohol use and trying illicit drugs. Chronic pain, smoking and trying illicit drugs were associated with persisting psychiatric disorders, with highest risk differences for girls (RD = 25.4%, p = 0.002, RD = 15.6%, p = 0.008, RD = 18.0%, p = 0.001, respectively). Three out of four adolescents still had a psychiatric disorder after 3 years. Unlike boys, girls had an increasing rate of anxiety disorders and comorbidities. Chronic pain, smoking and trying illicit drugs were associated with persisting psychiatric disorders. Despite methodological limitations, these findings emphasize the importance of early targeted intervention for adolescents with psychiatric disorders.
Highlights
An increasing focus on mental disorders in children and adolescents has revealed large variations in prevalence between nations [1]
Psychiatric morbidity decreased over 3 years in this adolescent clinical sample, including mood disorders, but almost three out of four still had a psychiatric disorder
The high frequency of psychiatric and somatic comorbidity, and chronic pain, indicates generally a high burden of disease, and chronic pain may be seen as part of the complexity of psychiatric disorders, especially anxiety disorders
Summary
An increasing focus on mental disorders in children and adolescents has revealed large variations in prevalence between nations [1]. More boys than girls are diagnosed, and conduct disorder and attention deficit/hyperactivity disorder (ADHD) dominates; while after puberty, the diagnoses and gender predominance shift to anxiety, depression and eating disorders among girls [6, 7]. For both genders, emerging adulthood represents a vulnerable time for the initiation of mental health problems, including substance use [6, 8], and adolescence is the time at which a high burden of disease emerges from mental disorders [9]
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