Adolescent Supplement Research Articles

The Strengths and Difficulties Questionnaire (SDQ): the Factor Structure and Scale Validation in U.S. Adolescents

The Strengths and Difficulties Questionnaire (SDQ) is one of the most commonly used instruments for screening psychopathology in children and adolescents. This study evaluated the hypothesized five-factor structure of the SDQ and examined its convergent validity against comprehensive clinical diagnostic assessments. Data were derived from the National Comorbidity Survey - Adolescent Supplement (NCS-A), a nationally representative sample of U.S. adolescents aged 13 to 18 years. Parents/parent surrogates (n=6,483) was asked to complete a self-administered questionnaire including the SDQ and DSM-IV comprehensive diagnostic information on the participating adolescents. Confirmatory factor analysis (CFA) was conducted to assess the factor structure of the SDQ. The five-factor solution of the SDQ (including emotional, conduct, hyperactivity-inattention, peer relationship, and prosocial) provided a satisfactory fit to the data, and was invariant across sex, age, race/ethnicity and income subgroups. SDQ scores predicted a significantly increased probability of meeting criteria for a DSM-IV disorder, with better prediction for behavior disorders than for mood disorders. Decreasing the SDQ cutoffs to the 80th percentile significantly increased the sensitivity from 39% to 63% for the SDQ Total Difficulties Score, with an expected decrease in specificity from 93% to 87%. This work confirms the five-factor structure of the SDQ in an ethnically and sociodemogrpahically diverse community sample of adolescents. Our findings strengthen empirical evidence for the use of the parent-reported SDQ as a screening tool for DSM-IV behavioral and emotional disorders in adolescents identified in the general population.

Diagnostic validity across racial and ethnic groups in the assessment of adolescent DSM‐IV disorders

We examine differential validity of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnoses assessed by the fully-structured Composite International Diagnostic Interview Version 3.0 (CIDI) among Latino, non-Latino Black, and non-Latino White adolescents in comparison to gold standard diagnoses derived from the Schedule for Affective Disorders and Schizophrenia for School-age Children (K-SADS). Results are based on the National Comorbidity Survey Replication Adolescent Supplement, a national US survey of adolescent mental health. Clinicians re-interviewed 347 adolescent/parent dyads with the K-SADS. Sensitivity and/or specificity of CIDI diagnoses varied significantly by ethnicity/race for four of ten disorders. Modifications to algorithms sometimes reduced bias in prevalence estimates, but at the cost of reducing individual-level concordance. These findings document the importance of assessing fully-structured diagnostic instruments for differential accuracy in ethnic/racial subgroups.

Food Insecurity and Mental Disorders in a National Sample of U.S. Adolescents

To examine whether food insecurity is associated with past-year DSM-IV mental disorders after controlling for standard indicators of family socioeconomic status (SES) in a U.S. national sample of adolescents. Data were drawn from 6,483 adolescent-parent pairs who participated in the National Comorbidity Survey Replication Adolescent Supplement, a national survey of adolescents 13 to 17 years old. Frequency and severity of food insecurity were assessed with questions based on the U.S. Department of Agriculture's Food Security Scale (standardized to a mean of 0, variance of 1). DSM-IV mental disorders were assessed with the World Health Organization Composite International Diagnostic Interview. Associations of food insecurity with DSM-IV/Composite International Diagnostic Interview diagnoses were estimated with logistic regression models controlling for family SES (parental education, household income, relative deprivation, community-level inequality, and subjective social status). Food insecurity was highest in adolescents with the lowest SES. Controlling simultaneously for other aspects of SES, standardized food insecurity was associated with an increased odds of past-year mood, anxiety, behavior, and substance disorders. A 1 standard deviation increase in food insecurity was associated with a 14% increase in the odds of past-year mental disorder, even after controlling for extreme poverty. The association between food insecurity and mood disorders was strongest in adolescents living in families with a low household income and high relative deprivation. Food insecurity is associated with a wide range of adolescent mental disorders independently of other aspects of SES. Expansion of social programs aimed at decreasing family economic strain might be one useful policy approach for improving youth mental health.

Twelve-Month Suicidal Symptoms and Use of Services Among Adolescents: Results From the National Comorbidity Survey

The study assessed the prevalence of suicidal ideation, suicide plans, and suicide attempts as well as patterns of mental health service use among adolescents. Data came from the National Comorbidity Survey–Adolescent Supplement, a nationally representative sample of 10,123 adolescents aged 13 to 18 years who participated in computer-assisted, face-to-face interviews between February 2001 and January 2004. Prevalences of suicidal thoughts and behaviors in the past year were determined. Past-year use of any mental health treatment and receipt of four or more visits from one provider among youths with suicidal ideation, plans, or attempts were also assessed. Associations were evaluated by using logistic regression. During the course of 12 months, 3.6% of adolescents reported suicidal ideation without a plan or attempt, .6% reported a suicide plan without an attempt, and 1.9% made a suicide attempt. Overall, two-thirds of adolescents with suicidal ideation (67.3%) and half of those with a plan (54.4%) or attempt (56.9%) did not have any contact with a mental health specialist in the past year. Different predictors of use of care were identified for each group. Adolescent suicidality often is untreated in the United States. Increased outreach efforts to improve treatment access for youths with suicidal ideation and attempts are needed.

IED Quite Common, but Treatments Elusive

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessIED Quite Common, but Treatments ElusiveJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:17 Aug 2012https://doi.org/10.1176/pn.47.16.psychnews_47_16_12-aAbstractRonald Kessler, Ph.D., a professor of health care policy at Harvard Medical School, isn’t easily astonished by mental illness. He headed up the National Comorbidity Survey Replication (Psychiatric News, July 15, 2005). But the outcome of his most recent national mental disorder prevalence study—of intermittent explosive disorder (IED) among adolescents—came, he told Psychiatric News, “as a complete surprise.”Ronald Kessler, Ph.D.“I was surprised by the large proportion of adolescents in the United States who meet criteria for IED,” he admitted. “It is one of the most common of all DSM-IV disorders among adolescents. …”In essence, Kessler and his team found in their national sample of some 6,500 adolescents in which they used a modified version of the Composite International Diagnostic Interview, that 8 percent met DSM-IV criteria for lifetime IED. The disorder is characterized by recurrent episodes of aggression involving violence or destruction of property out of proportion to a provocation or precipitating stressors and is not explained by another mental disorder or by substance abuse.Still other provocative findings emerged from the study, which was published online in the July Archives of General Psychiatry.IED had an early age of onset, on average at age 12, and was highly persistent, as indicated by 80 percent of lifetime cases meeting 12-month criteria for IED.Moreover, every other time a youngster with lifetime IED experienced an outburst of anger, he or she injured someone enough that that person needed medical attention.While more than one-third of adolescents with current IED received treatment for emotional problems in the year before the diagnostic interview, only 7 percent were treated specifically for anger.And whereas boys were more likely than girls to engage in anger outbursts, the prevalence of IED did not differ between boys and girls. Kessler said he cannot explain this apparent contradiction. But “speculatively,” he said, “it’s likely that there are a lot of reasons why people have anger attacks. Some of them involve other mental disorders, like conduct disorder, bipolar disorder, and substance use disorder. Others occur for reasons unrelated to mental disorders. And then there are the minority of anger attacks that are due to IED.”The study results have clinical implications, Kessler believes. “I would like clinicians to know that an awful lot of adolescents have anger attacks who are not being treated,” he said. “And if effective treatments exist, there should be efforts to get a higher proportion of these youth into treatment.”Yet when Psychiatric News asked Emil Coccaro, M.D., chair of psychiatry at the University of Chicago and an expert on IED treatments, whether there are any evidence-based treatments for IED in adolescents, he replied: “Yes, but there’s not that much data in this regard, partly because child and adolescent psychiatrists don’t use IED as a diagnosis that often, given that there are other disruptive behavior disorders that they can give as a diagnosis.”David Fassler, M.D., a child and adolescent psychiatrist who is a clinical professor of psychiatry at the University of Vermont and APA’s treasurer, noted that “There is no specific or ‘approved’ treatment for IED. In general, treatment would be individualized to the person.… Psychotherapy will generally be the key, often augmented by medication.”For example, Fassler said, cognitive-behavioral therapy can help youth with the disorder identify situations or behaviors that may trigger an aggressive response and teach them how to manage their anger and control inappropriate responses with relaxation exercises. Medications that may help include antidepressants, anticonvulsants, antianxiety agents, and mood regulators, he said.The study was funded by the National Institutes of Health, the Substance Abuse and Mental Health Services Administration, the Robert Wood Johnson Foundation, and the John W. Alden Trust. “Intermittent Explosive Disorder in the National Comorbidity Survey Replication Adolescent Supplement” is posted at http://archpsyc.jamanetwork.com/article.aspx?articleid=1206777. ISSUES NewArchived

Role of Referrals in Mental Health Service Disparities for Racial and Ethnic Minority Youth

To investigate racial/ethnic differences in teachers' and other adults' identification and/or encouragement of parents to seek treatment for psychiatric problems in their children and to evaluate if and whether identification/encouragement is associated with service use. Data on identification/encouragement to seek treatment for externalizing disorders (i.e., attention-deficit/hyperactivity disorder, oppositional-defiant disorder, and/or conduct disorder) and internalizing disorders (i.e., major depressive episode/dysthymia and/or separation anxiety disorder) and services used were obtained for 6,112 adolescents (13-17 years of age) in the National Comorbidity Survey Adolescent Supplement. Racial/ethnic differences were examined for Latinos, non-Latino blacks, and non-Latino whites. There were few racial/ethnic differences in rates of youth identification/encouragement and how identification/encouragement related to service use. Only non-Latino black youth with low severity internalizing disorders were less likely to be identified/encouraged to seek services compared with non-Latino white youth with the same characteristics (odds ratio [OR] = 0.4, 95% confidence interval [CI] = [0.2-0.7]). Identification/encouragement increased the likelihood of seeking services for externalizing and internalizing disorders for all youth. However, compared with their non-Latino white counterparts, non-Latino black youth who met criteria for internalizing disorders appeared less likely to have used any services (OR = 0.4, 95%, CI = 0.2-0.7), after adjusting for identification/encouragement, clinical, and sociodemographic characteristics. Non-Latino black youth with internalizing disorders and without identification/encouragement were less likely to use the specialty care sector than their non-Latino white counterparts. In this study of a nationally representative sample of adolescents, almost no ethnic/racial differences in identification/encouragement were found. However, identification/encouragement may increase service use for all youth.

Severity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication Adolescent Supplement.

Estimates of DSM-IV disorder prevalence are high; stringent criteria to define need for services are desired. To present US national data on the prevalence and sociodemographic correlates of 12-month serious emotional disturbance (SED), defined by the US Substance Abuse and Mental Health Services Administration, from the National Comorbidity Survey Replication Adolescent Supplement. The National Comorbidity Survey Replication Adolescent Supplement is a national survey of DSM-IV anxiety, mood, behavior, and substance disorders among US adolescents. Dual-frame household and school samples of US adolescents. Total of 6483 pairs of adolescents aged 13 to 17 (interviews) and parents (questionnaires). The DSM-IV disorders were assessed with the World Health Organization Composite International Diagnostic Interview and validated with blinded clinical interviews based on the Schedule for Affective Disorders and Schizophrenia for School-Age Children. Serious emotional disturbance was operationalized as a DSM-IV/Composite International Diagnostic Interview disorder with a score of 50 or less on the Children's Global Assessment Scale (ie, moderate impairment in most areas of functioning or severe impairment in at least 1 area). Concordance of Composite International Diagnostic Interview SED diagnoses with blinded Schedule for Affective Disorders and Schizophrenia for School-Age Children diagnoses was good. The estimated prevalence of SED was 8.0%. Most SEDs were due to behavior (54.5%) or mood (31.4%) disorders. Although respondents with 3 or more disorders made up only 29.0% of those with 12-month DSM-IV/Composite International Diagnostic Interview disorders, they constituted 63.5% of SEDs. Predictive effects of high comorbidity were significantly greater than the product of their disorder-specific odds ratios and consistent across disorder types. Associations of sociodemographic variables with SED were generally nonsignificant after controlling for disorder type and number. The high estimated 12-month prevalence of DSM-IV disorders among US adolescents is largely due to mild cases. The significant between-disorder differences in risk of SED and the significant effect of high comorbidity have important public health implications for targeting interventions.

Lifetime co-morbidity of DSM-IV disorders in the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A)

Research on the structure of co-morbidity among common mental disorders has largely focused on current prevalence rather than on the development of co-morbidity. This report presents preliminary results of the latter type of analysis based on the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A). A national survey was carried out of adolescent mental disorders. DSM-IV diagnoses were based on the Composite International Diagnostic Interview (CIDI) administered to adolescents and questionnaires self-administered to parents. Factor analysis examined co-morbidity among 15 lifetime DSM-IV disorders. Discrete-time survival analysis was used to predict first onset of each disorder from information about prior history of the other 14 disorders. Factor analysis found four factors representing fear, distress, behavior and substance disorders. Associations of temporally primary disorders with the subsequent onset of other disorders, dated using retrospective age-of-onset (AOO) reports, were almost entirely positive. Within-class associations (e.g. distress disorders predicting subsequent onset of other distress disorders) were more consistently significant (63.2%) than between-class associations (33.0%). Strength of associations decreased as co-morbidity among disorders increased. The percentage of lifetime disorders explained (in a predictive rather than a causal sense) by temporally prior disorders was in the range 3.7-6.9% for earliest-onset disorders [specific phobia and attention deficit hyperactivity disorder (ADHD)] and much higher (23.1-64.3%) for later-onset disorders. Fear disorders were the strongest predictors of most other subsequent disorders. Adolescent mental disorders are highly co-morbid. The strong associations of temporally primary fear disorders with many other later-onset disorders suggest that fear disorders might be promising targets for early interventions.

Lifetime Prevalence of Mental Disorders in U.S. Adolescents: Results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A)

Lifetime Prevalence of Mental Disorders in U.S. Adolescents: Results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A)

Prevalence, Persistence, and Sociodemographic Correlates of DSM-IV Disorders in the National Comorbidity Survey Replication Adolescent Supplement

Community epidemiological data on the prevalence and correlates of adolescent mental disorders are needed for policy planning purposes. Only limited data of this sort are available. To present estimates of 12-month and 30-day prevalence, persistence (12-month prevalence among lifetime cases and 30-day prevalence among 12-month cases), and sociodemographic correlates of commonly occurring DSM-IV disorders among adolescents in the National Comorbidity Survey Replication Adolescent Supplement. The National Comorbidity Survey Replication Adolescent Supplement is a US national survey of DSM-IV anxiety, mood, behavior, and substance disorders among US adolescents based on face-to-face interviews in the homes of respondents with supplemental parent questionnaires. Dual-frame household and school samples of US adolescents. A total of 10,148 adolescents aged 13 to 17 years (interviews) and 1 parent of each adolescent (questionnaires). The DSM-IV disorders assessed with the World Health Organization Composite International Diagnostic Interview and validated with blinded clinical interviews based on the Schedule for Affective Disorders and Schizophrenia for School-Age Children. Good concordance (area under the receiver operating characteristic curve ≥0.80) was found between Composite International Diagnostic Interview and Schedule for Affective Disorders and Schizophrenia for School-Age Children diagnoses. The prevalence estimates of any DSM-IV disorder are 40.3% at 12 months (79.5% of lifetime cases) and 23.4% at 30 days (57.9% of 12-month cases). Anxiety disorders are the most common class of disorders, followed by behavior, mood, and substance disorders. Although relative disorder prevalence is quite stable over time, 30-day to 12-month prevalence ratios are higher for anxiety and behavior disorders than mood or substance disorders, suggesting that the former are more chronic than the latter. The 30-day to 12-month prevalence ratios are generally lower than the 12-month to lifetime ratios, suggesting that disorder persistence is due more to episode recurrence than to chronicity. Sociodemographic correlates are largely consistent with previous studies. Among US adolescents, DSM-IV disorders are highly prevalent and persistent. Persistence is higher for adolescents than among adults and appears to be due more to recurrence than chronicity of child-adolescent onset disorders.

Validation of diagnoses of distress disorders in the US National Comorbidity Survey Replication Adolescent Supplement (NCS‐A)

Research diagnostic interviews need to discriminate between closely related disorders in order to allow comorbidity among mental disorders to be studied reliably. Yet conventional studies of diagnostic validity generally focus on single disorders and do not examine discriminant validity. The current study examines the validity of fully-structured diagnoses of closely-related distress disorders (generalized anxiety disorder, post-traumatic stress disorder, major depressive episode, and dysthymic disorder) in the lay-administered Composite International Diagnostic Interview Version 3.0 (CIDI) with independent clinical diagnoses based on the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS) in the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A). The NCS-A is a national survey of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) among 10,148 adolescents. A probability sub-sample of 347 of these adolescents and their parents were administered blinded follow-up K-SADS interviews. Good concordance [area under the receiver operating characteristic curve (AUC)] was found between diagnoses based on the CIDI and the K-SADS for generalized anxiety disorder (AUC = 0.78), post-traumatic stress disorder (AUC = 0.79), and major depressive episode/dysthymic disorder (AUC = 0.86). Further, the CIDI was able to effectively discriminate among different types of distress disorders in the sub-sample of respondents with any distress disorder.

Identifying depressive subtypes in adolescents: results from the National Comorbidity Survey–Adolescent Supplement

Identifying depressive subtypes in adolescents: results from the National Comorbidity Survey–Adolescent Supplement

Social Phobia and Subtypes in the National Comorbidity Survey–Adolescent Supplement: Prevalence, Correlates, and Comorbidity

Social phobia typically develops during the adolescent years, yet no nationally representative studies in the United States have examined the rates and features of this condition among youth in this age range. The objectives of this investigation were to: (1) present the lifetime prevalence, sociodemographic and clinical correlates, and comorbidity of social phobia in a large, nationally representative sample of U.S. adolescents; and (2) examine differences in the rates and features of social phobia across the proposed DSM-5 social phobia subtypes. The National Comorbidity Survey Replication-Adolescent Supplement is a nationally representative face-to-face survey of 10,123 adolescents 13 to 18 years of age in the continental United States. Approximately 9% of adolescents met criteria for any social phobia in their lifetime. Of these adolescents, 55.8% were affected with the generalized subtype and 44.2% exhibited nongeneralized social phobia. Only 0.7% met criteria for the proposed DSM-5 performance-only subtype. Generalized social phobia was more common among female adolescents and risk for this subtype increased with age. Adolescents with generalized social phobia also had a younger age of onset, higher levels of disability and clinical severity, and a greater degree of comorbidity relative to adolescents with nongeneralized forms of the disorder. This study indicates that social phobia is a highly prevalent, persistent, and impairing psychiatric disorder among adolescent youth. Results of this study also provide evidence for the clinical utility of the generalized subtype and highlight the importance of considering the heterogeneity of social phobia in this age group.

Validation of the diagnoses of panic disorder and phobic disorders in the US National Comorbidity Survey Replication Adolescent (NCS-A) supplement

Validity of the adolescent version of the World Health Organization Composite International Diagnostic Interview (CIDI) Version 3.0, a fully-structured research diagnostic interview designed to be used by trained lay interviewers, is assessed in comparison to independent clinical diagnoses based on the Schedule for Affective Disorders and Schizophrenia for School-age Children (K-SADS). This assessment is carried out in the clinical reappraisal sub-sample (n = 347) of the US National Comorbidity Survey Adolescent (NCS-A) supplement, a large (n = 10,148) community epidemiological survey of the prevalence and correlates of adolescent mental disorders in the United States. The diagnoses considered are panic disorder and phobic disorders (social phobia, specific phobia, agoraphobia). CIDI diagnoses are found to have good concordance with K-SADS diagnoses [area under the receiver operating characteristic curve (AUC) = 0.81-0.94], although the CIDI diagnoses are consistency somewhat higher than the K-SADS diagnoses. Data are also presented on criterion-level concordance in an effort to pinpoint CIDI question series that might be improved in future modifications of the instrument. Finally, data are presented on the factor structure of the fears associated with social phobia, the only disorder in this series where substantial controversy exists about disorder subtypes.

Associations among Dietary Supplement Use and Dietary and Activity Behaviors by Sex and Race/Ethnicity in a Representative Multiethnic Sample of 11th-Grade Students in Texas

Background and objective The purpose of this study was to examine associations among dietary supplement use and dietary/activity patterns in a representative sample of adolescents by sex and race/ethnicity, a research area where extant data is limited. Design/participants Cross-sectional, multistage, probability-based sample of 11th graders in Texas during 2004-2005 (n=6,422; 48.8% white/other, 37% Hispanic, and 14.2% African American; 50.6% boys; mean age 16.7 years). Setting Classrooms. Main variables assessed Dietary supplement use, dietary/activity patterns, and anthropometrics. Statistical analyses performed Multiple logistic regression models (odds ratios [ORs] and 95% confidence intervals [CIs]). Results Dietary supplement users reported healthy dietary and physical activity behaviors overall, yet sex- and race/ethnicity-specific differences were seen in associations among specific diet/activity behaviors and supplement use. In whites/others and Hispanics, but not African Americans, supplement use was associated with higher diet quality scores (OR 2.93, 95% CI 1.74 to 4.95 for whites/others; OR 3.93, 95% CI 2.26 to 6.83 for Hispanics), and regular consumption of breakfast (OR 2.27, 95% CI 1.40 to 3.66 for whites/others; OR 1.96, 95% CI 1.11 to 3.46 for Hispanics) and low-fat foods (OR 3.02, 95% CI 1.53 to 5.98 for whites/others; OR 3.59, 95% CI 1.11 to 11.6 for Hispanics). Supplement use was not associated with body mass index or with sedentary behaviors overall, but was associated with less television viewing only in whites/others (OR 0.53, 95% CI 0.33 to 0.84). For physical activity, boys and whites/others showed positive associations between supplement use and all indicators examined, but girls, Hispanics and African Americans showed mixed patterns of associations. Supplement use was associated with higher weight preference only in boys (OR 2.47, 95% CI 1.24 to 4.90), and vegetarian diets only in girls (OR 2.96, 95% CI 1.35 to 6.47). Conclusions Dietary and activity patterns associated with dietary supplement use may vary by sex- and racial/ethnic subpopulation, especially amongst African American youth. These findings together with further research on psychosocial and attitudinal characteristics associated with adolescent supplement use can enhance the development of targeted and tailored health communications about supplement use in adolescent subpopulations.

Social Phobia Is Distinct from Shyness

To determine if social phobia (a type of anxiety disorder) is a distinct entity or merely the “medicalization” of common human shyness, NIH investigators analyzed data from 10,123 adolescents (age range, 13–18 years) who participated in the nationally representative National Comorbidity Survey Replication Adolescent Supplement. Adolescents completed a structured diagnostic interview that assessed a broad range of mental health disorders. Those who met all eight lifetime DSM-IV criteria for social phobia, including one or more social fears, were …

Service Utilization for Lifetime Mental Disorders in U.S. Adolescents: Results of the National Comorbidity Survey–Adolescent Supplement (NCS-A)

Mental health policy for youth has been constrained by a paucity of nationally representative data concerning patterns and correlates of mental health service utilization in this segment of the population. The objectives of this investigation were to examine the rates and sociodemographic correlates of lifetime mental health service use by severity, type, and number of DSM-IV disorders in the National Comorbidity Survey-Adolescent Supplement. Face-to-face survey of mental disorders from 2002 to 2004 using a modified version of the fully structured World Health Organization Composite International Diagnostic Interview in a nationally representative sample of 6,483 adolescents 13 to 18 years old for whom information on service use was available from an adolescent and a parent report. Total and sector-specific mental health service use was also assessed. Approximately one third of adolescents with mental disorders received services for their illness (36.2%). Although disorder severity was significantly associated with an increased likelihood of receiving treatment, half of adolescents with severely impairing mental disorders had never received mental health treatment for their symptoms. Service rates were highest in those with attention-deficit/hyperactivity disorder (59.8%) and behavior disorders (45.4%), but fewer than one in five affected adolescents received services for anxiety, eating, or substance use disorders. Comorbidity and severe impairment were strongly associated with service utilization, particularly in youth with behavior disorders. Hispanic and non-Hispanic Black adolescents were less likely than their White counterparts to receive services for mood and anxiety disorders, even when such disorders were associated with severe impairment. Despite advances in public awareness of mental disorders in youth, a substantial proportion of young people with severe mental disorders have never received specialty mental health care. Marked racial disparities in lifetime rates of mental health treatment highlight the urgent need to identify and combat barriers to the recognition and treatment of these conditions.

Prevalence, correlates, and comorbidity of eating disorders in the National Comorbidity Survey Replication Adolescent Supplement (NCS-A)

Prevalence, correlates, and comorbidity of eating disorders in the National Comorbidity Survey Replication Adolescent Supplement (NCS-A)

Comorbidity and treatment of mental disorders and sleep problems in the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A)

Comorbidity and treatment of mental disorders and sleep problems in the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A)

Prevalence, overlap, and correlates of anxiety disorders in the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A)

Prevalence, overlap, and correlates of anxiety disorders in the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A)