Adolescent Mental Health Survey Research Articles

The role of callous and unemotional traits in the diagnosis of conduct disorder.

Callous and unemotional (CU) traits might usefully subtype DSM-IV conduct disorder (CD). We investigate this hypothesis in a large, nationally representative sample of 5-16-year-olds. We also examine the characteristics of children with high CU traits but without CD. Data come from the 2004 British Child and Adolescent Mental Health Survey including 7,977 children, 5,326 of whom were followed up after 3 years. DSM-IV diagnoses of psychiatric disorder were based on parent, teacher and child report. CU traits were assessed by parent report. Of the 2% of the sample who were diagnosed with DSM-IV CD, 46.1% were high on CU traits. In addition, 2.9% of the sample were high on CU traits without CD. Children with CD and CU traits showed more severe behavioural disturbance and were at substantially higher risk of CD diagnosis 3 years later. Children high on CU traits without CD showed evidence of disturbed functioning. Subtyping CD using CU traits identifies children with more severe and persistent psychopathology. Children with high CU traits but no CD diagnosis require further investigation.

Mental Health Care Reforms in Latin America: Child and Adolescent Mental Health Services in Mexico

Mental Health Care Reforms in Latin America: Child and Adolescent Mental Health Services in Mexico

Body mass index and its relationship to mental disorders in the Mexican Adolescent Mental Health Survey.

To assess the association between body mass index (BMI) and the prevalence of psychiatric disorders among Mexico City adolescents. Household survey of 3005 adolescents aged 12 to 17 residing in Mexico City in 2005 (response rate = 71%). Face to face interviews were carried out in the homes of participants with informed consent from a parent and/or legal guardian and the assent of the adolescent was obtained. Logistic regression analyses were performed. We only found an association between extremely low BMI and impulse control disorders. Elevated BMI was associated with impulse control disorders only among females. Specific impulse control disorders associated with low BMI included intermittent explosive disorder and conduct disorder. Only intermittent explosive disorder was associated with elevated BMI. Among Mexican adolescents, those with extremely high or extremely low BMI were more likely to have impulse control disorders than were adolescents with normal BMI.

Explaining the mental health advantage of British Indian children

To investigate the causes of the lower rate of mental disorders diagnosed in British Indian children compared to White children. Secondary analysis of two population-based, cross-sectional surveys of child mental...

How far are associations between child, family and community factors and child psychopathology informant‐specific and informant‐general?

Assessments of child psychopathology commonly rely on multiple informants, e.g., parents, teachers and children. Informants often disagree about the presence or absence of symptoms, reflecting reporter bias, situation-specific behaviour, or random variation in measurement. However, few studies have systematically tested how far correlates of child psychopathology differ between informants. Parents, teachers and children in the 1999 British Child and Adolescent Mental Health Survey (n = 4,525, ages 11-15 years) completed the Strengths and Difficulties Questionnaire. Multiple source regression models tested the extent to which child, family, school and neighbourhood characteristics were differentially associated with the three informants' reports. The 2004 British Child and Adolescent Mental Health Survey (n = 3,438, ages 11-15 years) was used for replication. Almost all significant correlates of child mental health were differentially related to parent, teacher and child ratings of adjustment. Parental distress, parent-rated family functioning, and child physical health problems were most strongly associated with parent ratings. Child ability and attainment, socio-economic factors, and school and neighbourhood disadvantage were more strongly associated with teacher and parent rated mental health than with children's own ratings. Gender differences in externalising problems were most pronounced for teacher ratings, and least so for child ratings; the opposite held true for emotional problems. Effect sizes for combined latent scores fell near the upper end of the range of effect sizes estimated for the three individual informants. Results showed good replication across the two samples. The study highlights that there is substantial variation across informants in the links between associated factors and child psychopathology.

Youth mental health in a populous city of the developing world: results from the Mexican Adolescent Mental Health Survey

Because the epidemiologic data available for adolescents from the developing world is scarce, the objective is to estimate the prevalence and severity of psychiatric disorders among Mexico City adolescents, the socio-demographic correlates associated with these disorders and service utilization patterns. This is a multistage probability survey of adolescents aged 12 to 17 residing in Mexico City. Participants were administered the computer-assisted adolescent version of the World Mental Health Composite International Diagnostic Interview by trained lay interviewers in their homes. The response rate was 71% (n = 3005). Descriptive and logistic regression analyses were performed considering the multistage and weighted sample design of the survey. One in every eleven adolescents has suffered a serious mental disorder, one in five a disorder of moderate severity and one in ten a mild disorder. The majority did not receive treatment. The anxiety disorders were the most prevalent but least severe disorders. The most severe disorders were more likely to receive treatment. The most consistent socio-demographic correlates of mental illness were sex, dropping out of school, and burden unusual at the adolescent stage, such as having had a child, being married or being employed. Parental education was associated with treatment utilization. These high prevalence estimates coupled with low service utilization rates suggest that a greater priority should be given to adolescent mental health in Mexico and to public health policy that both expands the availability of mental health services directed at the adolescent population and reduces barriers to the utilization of existing services.

Do parental reports of child hyperkinetic disorder symptoms at school predict teacher ratings?

Clinical practice guidelines for the evaluation of children with suspected hyperkinetic disorder or ADHD recommend that information is collected from teachers. Using the development and well-being assessment, parents of 5-16 year olds participating in the 1999 and 2004 British Child and Adolescent Mental Health Surveys were asked about symptoms relating to hyperkinetic disorder and reports of teacher complaints about these symptoms. We examined whether parental reports about symptoms at school reflect teacher ratings and can be relied upon by clinicians. Parent reports about symptoms at school were moderately correlated with teacher ratings. If children potentially met criteria for hyperkinetic disorder based on parental ratings only, the positive predictive value (PPV) for a research diagnosis of hyperkinetic disorder was 47%. When parents reported high levels of symptoms at school in addition to sufficient parent-rated symptoms and impairment, the PPV for a diagnosis of hyperkinetic disorder increased to 59%. In a community sample, we found that parental reports about symptoms at school have limited utility in predicting teacher ratings. Our findings highlight that it is desirable and worthwhile for clinicians to obtain direct information from the teacher. If this is unavailable, clinicians and researchers should be aware that "second-hand" information about symptoms at school is second best.

Validation of the Ford Score as a Measure for Predicting the Level of Emotional and Behavioural Problems in Mainstream Schools

Emotional and behavioural difficulties (EBD) are common in children, and forecasting their prevalence in schools is of interest to both academic researchers and local authorities. Percentage of pupils eligible for free school meals is one measure often used for this purpose. The article presents the first independent validation of a simple numerical score, the Ford score, which predicts the level of EBD within schools using routinely collected school variables on eligibility for free school meals, special educational needs, unauthorised absences and permanent exclusions. The research tested the predictive utility of the Ford score in the English sub-sample of the British Child and Adolescent Mental Health Survey, 2004. This gave a sample of 6,379 children aged 5-16 in 3,117 schools, with mental health being assessed through clinician-assigned psychiatric diagnoses and through brief questionnaires filled in by parents, teachers and young people. The Ford score was found to be highly predictive of the level of EBD by all four of these measures, with a linear effect across the whole range. The estimated prevalence of mental disorder rose from about 5 per cent in schools with low Ford scores to around 14 per cent in high-scoring schools. The Ford score was more highly correlated with all measures of EBD than percent-age of free school meals alone. The Ford score's predictive utility did not seem to be further enhanced, however, by adding in an additional measure of local area deprivation. It was concluded that the Ford score represents a simple and up-to-date school EBD predictor which is more accurate than percentage free school meals alone and which is not notably improved by taking account of a schools' area deprivation.

Treatment of mental disorders for adolescents in Mexico City.

This study describes the prevalence, adequacy and correlates of 12-month mental health service use among participants in the Mexican Adolescent Mental Health Survey. The authors conducted face-to-face household surveys of a probability sample of 3005 adolescents aged 12-17 years residing in the Mexico City metropolitan area during 2005. The prevalence of mental health disorders and the use of services were assessed with the computer-assisted adolescent version of the World Mental Health Composite International Diagnostic Interview. Correlates of service use and adequate treatment were identified in logistic regression analyses that took into account the complex sample design and weighting process. Less than one in seven respondents with psychiatric disorders used any mental health services during the previous year. Respondents with substance-use disorders reported the highest prevalence of service use and those with anxiety disorders the lowest. Approximately one in every two respondents receiving any services obtained treatment that could be considered minimally adequate. We found large unmet needs for mental health services among adolescents with psychiatric disorders in Mexico City. Improvements in the mental health care of Mexican youth are urgently needed.

Who are we missing? Area deprivation and survey participation

This study investigates selective participation by area deprivation in two population-based, nationally-representative surveys of children aged 5-16 years in England. We analysed the English participants (N = 22,903) in the British Child and Adolescent Mental Health Surveys, conducted in 1999 and 2004. The surveys recruited parents, teachers and children, allowing us to calculate participation rates for all three types of informant, with particularly detailed analyses possible for parents. Area-deprivation was assigned using Indices of Multiple Deprivation, 2004. We found that parents, teachers and children from more deprived areas were all substantially less likely to participate, with participation 8-9% lower in the most deprived areas than in the least deprived areas. There was substantial heterogeneity in the effect of deprivation on different types of parental non-participation, with a strong association for overall non-contact but none for overall non-cooperation. Refusal to participate in response to opt-out letters showed the opposite gradient to all other forms of non-participation, with individuals from less deprived areas being more likely to opt out. These findings indicate that the deprivation level of area of residence predicts non-response in multiple types of informants, which may exacerbate bias when estimating the prevalence of health outcomes. Furthermore, the magnitude and the direction of this may depend on the recruitment method used. Differential response by area deprivation may therefore be worth measuring in any survey.

Suicide Ideation, Plan, and Attempt in the Mexican Adolescent Mental Health Survey

No representative data among adolescents in Mexico exist on the prevalence and risk factors for suicide ideation, plan, and attempt despite a recent increase in suicide deaths. Data are presented from the Mexican Adolescent Mental Health Survey, a representative household survey of 3,005 adolescents ages 12 to 17 in metropolitan Mexico City who were gathered in 2005, regarding lifetime prevalence and age-of-onset distributions of suicide ideation, plan, and attempt and demographic and psychiatric disorders risk factors. Lifetime ideation was reported by 11.5% of respondents, whereas 3.9% reported a lifetime plan and 3.1% a lifetime suicide attempt. Onset of suicidality started around age 10 and at age 15 showed the highest hazards. Suicide ideators were more likely to report a plan and attempt within the first year of onset of ideation. Suicidality was more likely to occur among females. The presence of one or more mental disorders was strongly related to suicide ideation, plan, and attempt. Among ideators only dysthymia was consistently related to a plan and attempt. Intervention efforts should focus on assessment and target adolescents with mental disorders, particularly mood disorders, to be effective in prevention.

A prospective study of childhood psychopathology: independent predictors of change over three years

Whilst the correlates of child mental health problems are well understood, less is known about factors that operate to maintain healthy or unhealthy functioning, or that contribute to change in functioning. A range of factors may be of interest here, including relatively stable characteristics of children or their environment, that may have long-lasting and enduring consequences for their mental health, along with events that prompt changes in a child's mental state. Children were followed up 3 years after the original survey for a sub-sample of the 1999 British Child and Adolescent Mental Health Survey (N = 2,587 children). Latent mental health ratings drew on data provided by parent, teacher, and youth versions of the Strengths and Difficulties Questionnaire at baseline, and at follow-up. A residual scores method was used to assess change in functioning over time. Latent mental health scores showed strong stability over time (r = 0.71) indicating the need for effective intervention with children who have impairing psychopathology, since they are unlikely to get better spontaneously. A poorer outcome was associated with: externalizing as opposed to emotional symptoms, reading difficulties; living in a single-parent or reconstituted family at baseline; and after exposure between Time 1 and Time 2 to parental separation, parental mental illness, child illness, and loss of a close friendship. All these factors could be targeted in public health or clinical interventions, particularly as predictors of change in child mental health were closely comparable across the range of initial SDQ scores, suggesting that they operated in a similar manner regardless of the initial level of (mal)adjustment.

Modelling the contribution of changes in family life to time trends in adolescent conduct problems

The past half-century has seen significant changes in family life, including an increase in parental divorce, increases in the numbers of lone parent and stepfamilies, changes in socioeconomic well being, and a decrease in family size. Evidence also shows substantial time trends in adolescent mental health, including a marked increase in conduct problems over the last 25 years of the 20th Century in the UK. The aim of this study was to examine how these two sets of trends may be related. To illustrate the complexity of the issues involved, we focused on three well-established family risks for conduct problems: family type, income and family size. Three community samples of adolescents from England, Scotland and Wales were compared: 10,348 16-year olds assessed in 1974 as part of the National Child Development Study, 7234 16-year olds assessed in 1986 as part of the British Cohort Study, and 860 15-year olds assessed in the 1999 British Child and Adolescent Mental Health Survey. Parents completed comparable ratings of conduct problems in each survey and provided information on family type, income and size. Findings highlight important variations in both the prevalence of these family variables and their associations with conduct problems over time, underscoring the complex conceptual issues involved in testing causes of trends in mental health.

Prevalence and socio‐demographic correlates of drug use among adolescents: results from the Mexican Adolescent Mental Health Survey

To estimate the life-time and 12-month prevalence of illicit drug use among Mexican adolescents, the age of onset of first drug use and the socio-demographic correlates. A multi-stage probability survey of adolescents aged 12-17 years residing in the Mexico City Metropolitan Area was carried out in 2005. Adolescents were administered the computer-assisted adolescent version of the World Mental Health Composite International Diagnostic Interview by trained lay interviewers in their homes. The response rate was 71% (n = 3005). Descriptive and logistic regression analyses were performed considering the multi-stage and weighted sample design of the survey. Of the adolescents, 5.2% have ever tried illicit drugs, 2.9% in the last 12 months. The most frequently used drugs are marijuana, followed by tranquilizers/stimulants. The median age of first use is 14 years. Correlates of life-time drug use are older age, having dropped out of school, parental drug problems, low religiosity and low parental monitoring. While drug use among Mexican adolescents is lower than among adolescents from other developed countries, its increasing prevalence with age and the narrowing male/female ratio calls for firm public health actions, particularly prevention strategies.

Predictors of Service Use for Mental Health Problems Among British Schoolchildren.

Most previous studies of service use in relation to mental health have examined services in the USA. We wanted to provide up-to-date findings from a general population sample of British schoolchildren. A total of 2461 children aged 5-15 from the 1999 British Child and Adolescent Mental Health Survey were followed up for 3 years. We examine the relationship between a wide variety of potential predictors gathered in 1999 and the use of services over the following 3 years. Contact with most services was predicted by three factors: the impact of psychopathology; contact with teachers or primary health care; and parents' and teachers' perceptions that the child had significant difficulties. Other predictors were specific to each service. Education of parents, teachers and other important adults might increase the proportion of children with impairing psychiatric disorders reaching services.

Child Mental Health is Everybody's Business: The Prevalence of Contact with Public Sector Services by Type of Disorder Among British School Children in a Three-Year Period.

A third of the children from the 1999 British Child and Adolescent Mental Health Survey were followed-up over 3 years. Parents provided summary information on service contacts in relation to mental health; selected subgroups provided more detailed information by telephone interview. Common overlaps in service use were between health services, between teachers and educational specialists, and between the latter and CAMHS or social services. Services other than primary health care saw more children with externalising disorders, while children with anxiety disorders were less likely than children with other psychiatric disorders to be in contact with any service. Child mental health is everybody's business, and professionals need to be alert(ed) to the types of disorders that children using their service may have.

Preadolescent Conduct Problems in Girls and Boys

To examine sex differences in correlates of disruptive behavior disorders (DBDs) in preadolescent children using indicators of a wide range of well-established risk factors for DBDs and outcomes 3 years after initial assessment. Analyses were based on data for 5- to 10-year-olds (n = 5,913) from the British Child and Adolescent Mental Health Survey 1999, and a 3-year follow-up of selected subsamples (n = 1,440) at ages 8 through 13 years. DSM-IV diagnoses were assigned using the Developmental and Well-Being Assessment at both contacts. Boys and girls were equally exposed to most social and family risks for DBDs, with little evidence of differential sensitivity to these risks. Boys were exposed more to neurodevelopmental difficulties, attention-deficit/hyperactivity disorder, and peer problems and had lower rates of prosocial behaviors; together, these factors and physical punishment could account for 54% of the observed sex differences in DBDs. At follow-up, outcomes for girls and boys with DBDs were very similar. For children with subthreshold conduct problems at initial assessment, boys were more likely to go on to exhibit DBDs than were girls (25% versus 7%). Sex differences in the levels of a variety of child characteristics and interpersonal factors are likely to be important in understanding sex differences in risk for DBDs in preadolescent samples.

The Ford score

We combined data from the Office for Standards in Education with those from a large national survey of child and adolescent mental health and developed a simple score that schools or LEAs could use to predict the level of emotional and behavioural difficulties that they are likely to encounter. The final Ford score is based on the rates of free school meals, exclusions, unauthorized absence and children with special educational needs. These data are collected routinely, so the Ford score could easily be calculated to provide estimates of the level of emotional and behavioural problems in mainstream schools without the use of additional resources. It needs further reliability and validity testing but could provide a means of allocating resources.

Parental concerns about their child's emotions and behaviour and referral to specialist services: general population survey

Childhood psychiatric disorders are common and are associated with heavy use of health services.1 Up to a third of children and adolescents attending primary care and paediatric outpatient departments have...

Barriers to the identification of children with attention deficit/hyperactivity disorder

In most countries, the majority of children with attention deficit/hyperactivity disorder (ADHD) are undiagnosed. In the United Kingdom, a major barrier to accessing specialist services is the limited recognition of disorders by general practitioners. However, it is unclear whether there are also barriers at other stages of the help-seeking process. For children with ADHD, this study aims to examine the correlates of the different stages of help-seeking. Children with ADHD (n = 232) were identified from the 1999 British Child and Adolescent Mental Health Survey. Rates and correlates of parental recognition of child mental health problems and contact with services for these problems were examined. Children who had used particular types of services were compared with those who had not. Most (80%) parents of children with ADHD recognise that their child has a problem although few (35%) construe this in terms of hyperactivity. The impact of the symptoms on key adults, rather than child factors, best predicted parental recognition of problems. Most parents had been in contact with education-based professionals but few had consulted primary care for these problems or had sought help from relevant specialist health services. Parental recognition of problems and perceived burden, rather than child factors, were the main correlates of contact with services. Parental views that their child has hyperactivity were associated with greater severity of symptoms. The main barrier to care for ADHD is the limited presentation of these problems to primary care. The majority of parents discuss their concerns with professionals based in education services. There is a need for parental education about ADHD and for health service input to support education professionals in their contact with concerned parents.